Response Plan Is in Works for Biotoxin Threats

Recent anthrax threats in Southern California dramatically underscore the lack of a comprehensive national plan to guide health agencies responding to biological or chemical terrorism, federal officials said Tuesday.

Using $120 million in federal funds appropriated this fall, officials from the federal Centers for Disease Control and Prevention are scrambling to draw up the nation’s first blueprint for such an emergency public health response, said Dr. Stephen Ostroff, associate director for the agency’s National Center for Infectious Diseases.

Representatives from the Atlanta-based organization have been in Los Angeles reviewing the work of local health and law enforcement agencies that have handled more than a dozen anthrax threats over the past two weeks. All were hoaxes, including one Tuesday at the Van Nuys courthouse. But thousands of people have been evacuated from offices, courthouses, government buildings and a nightclub under the threat of exposure to the potentially deadly bacteria.

The recent scares in Los Angeles and elsewhere will serve as case studies, Ostroff said.

Center officials have warned for years that without a comprehensive plan, local, state and national public health officials are ill-prepared for terrorist threats or an actual attack. Public health officials say that Los Angeles authorities, for example, overreacted to the first threat earlier this month.

The money earmarked for the response plan is a fraction of what is needed, Ostroff said. Besides creating a national response plan, the government must organize the stockpiling of specialized medical supplies and set up communications and computer networks connecting local, state and federal health authorities.

“Once you start looking at the magnitude of the problem, you realize quickly that [$120 million] is not nearly sufficient to accomplish what needs to be done,” Ostroff said. “But we are very grateful to finally have resources to begin to address this problem. As the incidents in Los Angeles and elsewhere tell us, it is not a moment too soon.”

Public health authorities, among the first on the scene, need authoritative guidelines on assessing the danger and how best to proceed. Health officials responding to recent incidents around the country, Ostroff said, have on occasion spent precious time arguing with law enforcement authorities and others over what to do.

In the event of contamination, people would need to be quarantined and medically treated immediately, not only so authorities could try to save their lives but to prevent a spread of biotoxins that could spiral out of control, health authorities say.

Currently, such emergency response measures are hampered by confusion, miscommunication and misinformation, said Ostroff and other public health and law enforcement authorities.

A letter warning that it contained anthrax was sent to a Westwood office earlier this month, prompting authorities to corral 21 workers in a basement where they were undressed, scrubbed down and sent under guard to a hospital for more treatment. Later, authorities decided that such dramatic measures were unnecessary because anthrax cannot be transmitted easily from one person to another.

Los Angeles County has been working on its own emergency response plan, but as the recent anthrax scares have shown, “there is a lot of education that has to go on . . . in all of the organizations,” said Dr. Jonathan Fielding, the county’s public health director.

Dr. Laurene Mascola, the county’s acute communicable disease control chief, said her staff knew that the Westwood office workers did not need to be disrobed and scrubbed. But, she said, “We were not contacted in a timely manner.”

She said law enforcement authorities often have no idea how to assess a biological threat.

“Even I don’t know how many thousands of spores you’d need to actually get an anthrax contamination,” she said. “This is a new phenomenon.”

Health officials have found that medications to treat victims of chemical or biological attacks are unavailable on a large scale. In addition, many public health labs lack the capacity to quickly analyze letters, clothing and other items.

“There has been a belated realization that there is a need to enhance and involve the public health community to address these threats,” Ostroff said. “Unfortunately, all these episodes are happening now, [and], very clearly, some are not prepared.”

The Pentagon and the FBI have been gearing up for a potential biological or chemical attack since the 1991 Persian Gulf War. But the Atlanta center’s pleas for funding to develop a uniform public health response plan have gone unheeded. As a result, officials say, public health authorities have been left with a hodgepodge of uncoordinated response plans.

In hospital emergency rooms, Ostroff said, “We have had instances elsewhere where one group is making recommendations to give people antibiotics and the next group over will be saying, ‘Don’t give them antibiotics.’ ”

The new effort is aimed at helping local health authorities quickly determine which threats are hoaxes and which require full mobilization. They also are finding that many rural and suburban governments lack even the most basic equipment, such as computers and fax machines, that is critical for exchanging information with federal epidemiologists.

The center plans to spend about $30 million buying such equipment, and $60 million to set up government depots around the country to ensure an adequate supply of penicillin and other medications.

Much of the work will focus on coordinating local, state and federal authorities.

Sheriff’s Lt. Dennis Beene of the county Emergency Operations Bureau and Lt. Anthony Alba of the Los Angeles Police Department said the recent hoaxes reveal potential problems.

Alba said, for instance, that response teams need decontamination kits, as well as special suits to guard against toxic chemicals and deadly bacteria.

John Schiman, special agent in charge of the FBI’s Los Angeles office, said the hoaxes have shown that local health agencies need to have uniform guidelines, describing, for example, when to evacuate and when to quarantine.

Dr. Kevin Reilly of the state Department of Health Services said a better coordinated network of labs is needed, in addition to on-site testing equipment, to immediately determine when a threat is real.

Most authorities, Reilly said, “are used to dealing with chemical exposure. . . . We are just [now] developing protocols to deal with the possibility of mass [biological] exposure.”

Ostroff said a coordinated and comprehensive public health plan is one of the center’s highest priorities. Public health authorities, he said, are the primary defense against biological attacks, which can produce no immediate symptoms but can lead to fatal illnesses days or weeks later.

Ostroff said he could not comment yet on what center officials learned in Los Angeles, except that the responses were generally “very good.” The officials plan to meet next week to discuss their visit and to set a timeline for producing the national response plan.

Meanwhile, Ostroff said, “As has been the experience elsewhere in the country, there are gaps that need to be filled in terms of getting the local communities--health, emergency response and law enforcement--to talk to each other. It has been a recurrent theme across the country.”