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

I just returned from a mandated course on Weapons of Mass Destruction that is required for my NYS EMT recertification. It was a steaming pile of crap.

The “All Hazards” approach is the one being taught now. So, for the first 45 minutes we talked about how little money the US has offered Burma for cyclone relief and how the “government” failed the people of New Orleans. You see, all those people who had been cared for by the government for four generations were abandoned and they didn’t know enough to evacuate on their own.

So, the talk began with liberal politics and continued in that manner.

Explosives has been added to the list of Weapons of Mass Destruction. Follow me on this, it’s interesting. The instructor points to Oklahoma City, then moves to “We’ve all been exposed to WMD” as slides appear showing firearms. Yes, the Public Health weenies that consider firearms crimes as an epidemic have infected WMD training.

Columbine was a WMD event, apparently, though I somehow missed that announcement. Now I know because I took the NYS class.

Oh, and BTW, the people that died at the WTC did so because they were following their emergency plan. I guess Rick Rescorla was an idiot.

Essentially, the class was an exercise in attempting to conflate civilian incidents, including but not limited to haz mat incidents, with WMD attacks. Eric Rudolph came up as an example. Crazed bombers like him and Ted Kuzinscki are WMD for our purposes.

Curiously, the instructor maintained that there had never been an insurgent terrorist attack on US soil. I recalled for her the FALN attack on Congress in the late 1940′s and the Black Muslim attack in Washington in the 1970′s. I could have gone on but she wanted to talk about other matters.

We got the usual crap about bird flu and pandemics, without a mention that most people have lived through at least one flu pandemic.

And… as a final criticism, she managed to discuss car bombs without mentioning that both Oklahoma City and WTC I were VIED’s.