In a crowded store during the Christmas shopping rush, a man sneezes and does not cover his face. Early one morning, a sniffling woman wipes her nose with her fingers and then wipes it off on the subway pole she’s holding onto for support. A sweating, glassy eyed toddler is fussed over by its mother and several other travelers just outside the security gates at a large airport.

America is under attack by bioterrorists.

All of these scenarios and dozens more are evaluated every day by the men and women of numerous police departments, Homeland Security offices and the Public Health services nationwide. They all realize one important truth. We will not know we have been attacked until it is well underway.

Illnesses have two time frames to consider. The first is the incubation period. That is the time that passes before the patient becomes sick. The second item is the period of time that the patient is infectious.

A bioterrorist seeking to use human hosts to initiate the attack must use a disease that incubates long enough that the terrorist host can reach the target. The disease selected must also be infectious long enough to allow the terrorist to spread the illness before succumbing to it. An ideal disease has a long incubation period and is infectious before the host becomes ill.

Many of today’s terrorists are inspired by some religion, and draw their ideal vision of an attack from the sacred writing of that religion. An attack must appear like it was a plague from God, Allah or whichever deity the terrorist follows.

Along with that, the disease must terrify. The common cold would not be the terrorist’s choice. Everyone has had it. Everyone is annoyed by it but no one fear it. A bioterrorist weapon must terrify.

The media’s imagination has been captured by smallpox and by Ebola. Smallpox is deadly to some of its victims, but its appearance is what terrifies. Oozing pustules all over the body mark smallpox and the survivors are often horribly scarred for life.

Ebola is also terrifying. In the poverty stricken areas of the world where it appears naturally, the vast majority of its victims die. And, they die horribly, bleeding from every orifice including the eyes. That is an image to terrify the most hardened soul.

Terrorists learned a great deal from the anthrax letters. It became clear that a small threat could result in a great deal of panic. Government officials, the media and the public reacted in just the manner that a terrorist wants, fear, some panic, the spending of vast sums of money, disruption of media and government offices and operations for weeks and months. The lesson was that a small attack can achieve great things.

Most terrorists are not content with the small attack. A bioterrorist attack will attempt to spread a terrifying disease throughout our population in enough cases that the results of the anthrax letters will be multiplied a hundred times.

The easiest way for a bioterrorist to spread an infectious disease is through using living hosts. Since many terrorist organizations are devoted to suicide, that is not much of a hurdle. The hosts must be infected and in the United States before their disease begins to show.

The disease selected ought to be easily spread, and the symptoms of the common cold or the flu are an ideal way. Snot kills. Smallpox spreads via contact with the virus which can exist on surfaces for days. Ebola is spread by contact with the bodily fluids and is very fragile outside the human body.

Terrorists would concentrate on targets that have meaning to them, or to the United States. The Pentagon has both buses and a train station where its employees arrive daily. Public transportation is an ideal means of bringing thousands of people into contact with a disease at the same time.

A disease could also be spread by using non-human hosts. Rats could spread plague in New York City, as they have throughout history. Mosquitoes carrying a disease could be released into a shopping mall.

Spreading a disease without using a host is a difficult task. A dispersal method must be developed that is effective and not obviously a threat. A means of carrying the infectious disease must also be found that does not threaten the person carrying it and does not kill the disease en route. The technology exists but it is a far more daunting task for the potential bioterrorist. The method of transportation might fail. The means of dispersal might fail. The mechanisms involved might be detected by American security forces before they can be used.

The most likely scenario for a bioterrorist attack on the United States involves one or more infected terrorists doing their level best to be disgustingly unsanitary in a public area of their target. They may appear ill or they may not. They will be coughing, vomiting, sneezing and wiping snot on anything and anyone they can.

Tomorrow we will look at bio toxins.

World At Risk, The Report of the Commission on the Prevention of WMD Proliferation and Terrorism was issued on December 2, 2008. One of its conclusions was that the threat from bioterrorism was greater than that posed by either nuclear or chemical weapons of mass destruction.

The Commission believes that unless the world community acts decisively and with great urgency, it is more likely than not that a weapon of mass destruction will be used in a terrorist attack somewhere in the world by the end of 2013.

The Commission further believes that terrorists are more likely to be able to obtain and use a biological weapon than a nuclear weapon. The Commission believes that the U.S. government needs to move more aggressively to limit the proliferation of biological weapons and reduce the prospect of a bioterror attack.

In a five part series this week, America’s North Shore Journal will be examining the threat of bioterrorism to the United States and the preparations which have been made against that threat.

Bioterrorism is the use of infectious diseases or biologic toxins in a terrorist attack. Terrorism is defined by US law:

Section 2656f(d) of Title 22 of the United States Code defines certain key terms used in Section 2656f(a) as follows:

1. the term “international terrorism” means terrorism involving citizens or the territory of more than one country;
2. the term “terrorism” means premeditated, politically motivated violence perpetrated against non-combatant targets by subnational groups or clandestine agents; and
3. the term “terrorist group” means any group practicing, or which has significant subgroups which practice, international terrorism.

The United States has experienced bioterrorism in the past. The example that most people will be familiar with is the anthrax letters of 2007. Less well-known are the tens of thousands of hoaxes based upon fears of anthrax or the thousands of false alarms created by people finding dust or powders of various sorts in unexpected places. It is very clear to the law enforcement community as well as terrorist groups that it is not necessary to actually conduct an attack to create the publicity, fear and economic disruption of a bioterrorism attack.

The United States has both vulnerabilities as well as strengths when it comes to bioterrorism. Our freedom of movement and the way our society operates its transportation systems mean that an infectious disease or toxin can rapidly move from one part of the nation to another with little impedance. The traditional “Protestant work ethic” also is a factor with Americans commonly coming to work sick. We go places even though we are ill, and that spreads disease.

Our main strength is the quality of our healthcare system, from emergency medical services all the way to the highest quality medical facilities in the world. We have the ability to fight a bioterrorist attack from the street corner on up the healthcare chain.

We also have a medical research and pharmaceutical industry that is unmatched on the planet. Our best and brightest minds are available to research and counter any biological attack.

Over the next few days, we will look at the threats from infectious diseases, biological toxins, the potential sources of biological agents and the measures that have been or need to be taken to counter bioterrorism. There will be a little history and a little speculation, as well.

Bioterrorism Research Resources:

• The Report of the Commission on the Prevention of WMD Proliferation and Terrorism
• Centers for Disease Control and Prevention
• U.S. Food and Drug Administration
• World Health Organization
• Interpol

The U.S. Army Chemical Materials Agency destroyed the last landmine in its stockpiles containing VX nerve-agent munitions, Dec. 24, at the Anniston Chemical Agent Disposal Facility in Anniston, Ala.

“We have reached a truly remarkable milestone following more than five years of deliberate, but careful, operations,” Timothy K. Garrett, ANCDF site project manager, said. “All nerve-agent munitions — those containing GB and those containing VX — have been safely processed.”

CMA personnel and contractors have destroyed the VX munitions at six disposal sites: Anniston, Ala.; Umatilla, Ore.; Newport, Ind.; Pine Bluff, Ark.; Tooele, Utah; and Johnston Island, about 800 miles southwest of Hawaii.

“I commend Anniston and all CMA destruction sites on this extraordinary achievement. By destroying the VX agent at each of CMA’s destruction sites, you have made the world a much safer place,” Conrad Whyne, CMA director, said.

CMA continues to safely and securely store the remaining VX in the U.S. chemical weapons stockpile at the Blue Grass Chemical Activity near Richmond, Ky., officials said. Construction is under way on a neutralization facility there, and the U.S. Army Element Assembled Chemical Weapons Alternatives is charged with the agent’s destruction.

Destruction of chemical weapons already is complete at Newport, Aberdeen and Johnston Island, officials said. Operations continue at Tooele, Umatilla, Anniston and Pine Bluff, CMA’s remaining destruction sites. These sites are destroying or preparing to destroy blister agent and the only remaining nerve agent for CMA’s destruction mission — GA at Tooele, officials said.

VX is the least volatile, but most potent, of all chemical warfare agents, officials said. The agent attacks the nervous system, causing muscles to convulse uncontrollably. Exposure can result in loss of consciousness, convulsions, paralysis and respiratory failure.

The nerve agent first was developed in the early 1950s. The nation’s original stockpile of about 4,400 tons was produced at Newport Chemical Depot between 1961 and 1969. Newport’s production facility was destroyed in 2006.

The nerve agent never was used in combat by the United States.

“The elimination of this deadly chemical agent from each site’s stockpile is a relief to the stockpile communities, and a sign of our commitment to other nations as we move one step closer to a safer world,” Whyne said.

DVIDS

This story is a prime example of the reason that EMS workers are told to use universal precautions for every patient. You cannot know what you may encounter.

Although plague is endemic west of the Mississippi — brought here in the 1800s by flea-infested rats on ships ferrying Chinese railroad workers to the USA — York had little reason to suspect it. Mountain lions usually stalk bigger game than rodents. But this lion had kittens that had to learn to hunt.

When York became ill, he visited the park’s clinic, Wong says. On Oct. 30, clinic staff diagnosed a flu-like illness and sent him home. It was there, three days later, that a roommate found him lying motionless on the couch.

Wong says York’s toughness and self-sufficiency may have cost him his life. “He was a tough guy. He gutted out more than you or I or almost anyone else would.”

USA Today
By Steve Sternberg

The National Incident Management System was developed so that:

responders from different jurisdictions and disciplines can work together better to respond to natural disasters and emergencies, including acts of terrorism. NIMS benefits include a unified approach to incident management; standard command and management structures; and emphasis on preparedness, mutual aid and resource management.

As localities created their emergency plans, it was evident that in the event of certain disasters resources beyond those available at the local level would be necessary. Emergency plans were expanded to include regional, state-wide and national resources.

Each succeeding level of resources would serve to fill in, supplement or provide those things that the lower levels could not. At the top of the chain of resource procurement would be the United States military.

The military’s resources are vast and would be useful in any emergency. It was recognized that the military was a unique source of resources for certain types of incidents, those involving chemical, biological, radiological, nuclear or high energy explosive [CBRNE] mechanisms. As the civilian sector created plans and organizations for emergency and disaster management, the military began to put together its structure for the part it would play in NIMS and CBRNE incidents.

During a recent Blogger’s Roundtable, I was able to interview two officers directly involved with the military’s part in responding to CBRNE incidents. Col. Lou Vogler is the U.S. Army North’s chief of future operations and LTC James Shores (U.S. Marine Corps) is chief of plans for Joint Task Force-Civil Support.

Recent moves by the Pentagon have placed the military’s response to disasters within the United States under the United States Northern Command and U.S. Army North. Joint Task Force-Civil Support has recently fallen under that command.

JTF-CS is the organization tasked with working with the civilian side in the event of a disaster. It also is in charge of training, maintaining and planning the military’s response to CBRNE incidents. JTF-CS involves all four services and the resources that each can command.

As the locality and the incident commander requests resources, the military and JTF-CS becomes the agency of last resort. When all of the civilian resources are exhausted or non-existent, the military can take action on a request from the incident commander. Col. Vogler stressed that the military response is additive to the already existing response.

JTF-CS would begin a response with an assessment and communications group, to determine the need and which of the resources at their disposal are needed. As military units were tasked, they would be self-sufficient upon arrival at the scene. LTC Shores stated that they would be there to help and not to be a burden on existing resources.

The various state National Guard units have CBRNE response capability. They would be involved at the direction of the state governor, and thus be on scene before the military. JTF-CS is prepared to support that mission.

The pieces all fall into place October 1.

A robust, joint response force designed to respond to chemical, biological, radiological, nuclear and high-yield explosive (CBRNE) incidents will be assigned Oct. 1 to U.S. Northern Command (USNORTHCOM) and placed under the operational control of U.S. Army North, USNORTHCOM’s standing joint force land component command. Designated “CCMRF 9.1,” the CBRNE Consequence Management Response Force is a federal initial entry force that is scalable and task-organized to mitigate loss of life and relieve suffering in response to a CBRNE disaster or terrorist attack. The response force is participating in a joint training exercise Sept. 8-19 at Fort Stewart, Ga., and is expected to achieve full operating capability Oct. 1.

The question of the law prohibiting the military’s involvement law enforcement was brought up. Col Vogler responded:

Now, with regards to posse comitatus, again, we are clearly in support of federal agencies, and we do not have a law enforcement role. We will integrate with law enforcement to understand the situation and make sure we’re aware of any threats, but CCMRF is not designed to enforce security on the local population. It’s designed to respond. It has forces for security, but that’s really — they call them security forces, but that’s really just to establish our own footprint and make sure that we can operate and run our own bases. So there’s — just so there’s no confusion there, we do not expect a law enforcement role.

We train our soldiers on posse comitatus. We train them on the restrictions that we have to operate domestically, and that’s really one of the major differences for a lot of these soldiers. You know, the truck drivers drive trucks just like they would always do, but they’re going to operate in a unique Defense support of civil authorities to meet the domestic environment, and that’s what we strive to teach them — that they will be operating inside the United States, and there are very different rules than they might have if they were deployed overseas.

The military is prepared to respond in the event of a CBRNE incident. Their command structure is in place. Their planning, training and logistics are active and being tested routinely. Should an incident commander need them, they will be there.