Doctors Warned on Bioterrorism

Federal health officials have warned that primary care physicians, hospital emergency rooms and other local health providers must learn to recognize the signs and symptoms of bioterrorism--because they probably will be the first to see them.

The ability to quickly identify the infectious agents unleashed by bioterrorists will be critical to the nation’s ability to respond, according to a new, still-unpublished report drafted by a working group of the federal Centers for Disease Control and Prevention.

“This is the case where we’ve said doctors will have to go back to school,” CDC spokeswoman Barbara Reynolds said.

The report, part of the government’s continuing effort to prepare for a potential germ warfare threat, was posted over the weekend on the CDC’s Internet site. The recommendations have already been accepted by the Clinton administration, Reynolds said.

The plan marks the first time the CDC has joined with law enforcement, intelligence and defense agencies--in addition to traditional CDC partners such as state and local health agencies--to address a national security threat.

The report does not estimate the cost of the proposals. Congress funded bioterrorism planning activities for the CDC for the first time in fiscal 1999, awarding the agency about $120 million.

The CDC said it will work with state and local health authorities during the next five years to enhance their ability to identify dangerous agents, such as smallpox, anthrax, plague, botulism and hemorrhagic viruses such as Ebola--which has caused several deadly outbreaks in Africa in recent years.

The agency plans to create a network that will link clinical labs to public health agencies in all states and in selected cities and counties. Also, the CDC said it will make sure that state health laboratories and other agencies that would perform initial testing have the proper diagnostic technology.

In addition, the report said the agency will stockpile appropriate vaccines and drugs, establish effective communication and education programs and establish a surveillance system to detect drug-resistant infectious agents. The CDC listed as its top priority the training and education of local health care providers.

If they fail to recognize suspicious illnesses or injuries, the consequences could be “devastating,” with the movement of infected people--and transmission of disease--going unchecked, the report said.

“Only a short window of opportunity will exist between the time the first cases are identified and a second wave of the population becomes ill,” the report said.

During that brief period, public health officials would need to determine that an attack had occurred, identify the organism and prevent more casualties through strategies such as mass vaccination or preventive treatment, the report said.

In the event of an attack, signs of disease might not become apparent immediately, since many infectious agents require an incubation period before patients become ill.

Medical personnel must be alert to the possibility of rare, previously unseen diseases before dismissing early symptoms as routine, the report said.

For example, if bioterrorists release variola virus, which causes smallpox, “patients will appear in doctors’ offices, clinics and emergency rooms during the first or second week, complaining of fever, back pain, headache, nausea and other symptoms of what initially might appear to be an ordinary viral infection,” the report said.

By the time patients begin to die, “the terrorists would be far away and the disease disseminated through the population by person-to-person contact,” the report said.

Smallpox was declared eradicated worldwide in 1980, and no one younger than 20 has been vaccinated against it.

However, some “undeclared” stocks of the highly contagious and often fatal virus are believed to be in the possession of U.S. adversaries. For this reason, President Clinton decided a year ago to preserve remaining U.S. samples of the virus.

“Preparing the nation to address this [bioterrorist] threat is a formidable challenge, but the consequences of being unprepared could be devastating,” the report said.