Few places prepared for bioterrorism

WASHINGTON -- Spotting bioterrorism early can be crucial to preventing its spread, but few cities have even crude systems in place to identify the first patients.

Three weeks into the anthrax scare, doctors are on alert for signs of it. But a future biological attack using a different germ could go undetected until it's too late.

Most state and local governments lack early warning systems, leaving a big hole in preparedness for a biological or chemical attack. Legislation pending in Congress would spend hundreds of millions of dollars to beef up readiness.

"There are huge gaps in the system today," said Sen. Bill Frist, R-Tenn. "There are gaps in every community in America."

"It's extremely important to be able to identify that you have a potential problem," said Philadelphia Mayor John Street, one of many city leaders who has begun serious thinking about bioterrorism over the last month and a half. "In the world we're dealing with, 24 hours is all the difference in the world."

Public health experts say surveillance systems are key to helping doctors figure out whether they have a patient with anthrax, smallpox, the plague -- or simply the flu.

Check the obvious

Doctors are trained to look for the obvious diagnoses first, said Rex Archer, director of the Kansas City, Mo., health department and a longtime bioterrorism expert.

"It would be nice to be able to tell doctors, we have a surge of illness," he said. The best systems, he said, monitor trends in hospital symptoms, prescriptions for medication and ambulance calls.

Once the first patient has been identified, doctors and hospitals are warned to look for similar cases. If the biological agent involved is contagious, finding the first infections could save thousands of lives.

In Washington, where two people have died with inhalation anthrax, local health officials credit a surveillance system with helping them get a handle on the crisis early.

Immediately after the Sept. 11 terrorist attacks, the District of Columbia health department put all hospitals on active surveillance, asking them to call if they saw patients with any unusual symptoms.

A week ago, a District postal worker checked into a suburban Virginia hospital with flu-like symptoms, and doctors immediately suspected inhalation anthrax. District and Virginia health authorities began testing and prepared themselves should the tests come back positive.

When they did, authorities were ready to spread the word. They immediately shut down Washington's central mail processing center and began preventive treatment for more than 2,000 employees.

"Especially when people are trying to send stuff out that you can't see -- anthrax, smallpox and what have you -- that kind of system can really save lives," said Dr. Ivan Walks, Washington's chief health official.

The system could be even more valuable with a contagious agent like smallpox. If just a few people were infected, and they went to different hospitals, a surveillance system could help doctors spot the pattern early and prevent the first patients from infecting others.

System errors

But Washington's system is only as good as the hospital workers who must spot suspicious patients. Case in point: Two days after the first postal worker checked into the hospital, one of his co-workers went to a suburban Maryland hospital with similar symptoms. They sent him home when a chest X-ray turned up nothing unusual. A day later, he was back, but it was too late. He died of inhalation anthrax, a disease not seen in the United States in a quarter-century.

"Every indication was that it was stomach flu," said David Clark, a spokesman for Southern Maryland Medical Center.

Unusual patterns

The gold standard for surveillance involves electronic monitoring of symptoms. Computers monitor the symptoms of patients at a sampling of hospitals and look for unusual patterns.

"If something happened you would start to see a blip on the screen if you had that active surveillance underway," said Bruce Clements, a bioterrorism expert at St. Louis University.

Others are more circumspect.

"That's years and years and years away," said Dr. Tara O'Toole, deputy director of the Civilian Biodefense Studies Department at Johns Hopkins University. The key, she says, is simply giving doctors the information they need to ask the right questions.

"Then they can call and say, 'I have a case here. It may be nothing, but it's a little weird. Let me tell you about it,"' she said. "We need to get doctors in the loop."