Biological terrorism threat commands attention

The nation's fragmented, underfunded public health system is coming under increased scrutiny in Congress as federal and state law enforcement officials continue an investigation into a second confirmed case of anthrax contamination in South Florida.

The Centers for Disease Control confirmed Monday that the bacterium that causes anthrax was identified in a sample taken from the nasal passages of a co-worker of a man who died of anthrax last week. Both men worked at the tabloid newspaper The Sun.

While there is no evidence of criminal activity at the building where the two men worked, officials are clearly worried about the highly unusual circumstances. Anthrax has long been considered a potential tool of terrorists seeking to use biological agents to kill or sicken large numbers of people. Because an attack would probably not be obvious until large numbers of people had been infected, thereby alerting public health officials, an attack with toxic agents, while difficult to achieve, could be particularly deadly.

The FBI sealed off the newspaper's Boca Raton offices Monday and public health officials began screening employees for the disease and prescribing antibiotics as a preventive measure. The newspaper offices are located a few miles from where some of the hijackers involved in the Sept. 11 attacks on the World Trade Center towers and the Pentagon lived and took flying lessons.

In a public health message, CDC officials emphasized that the risk of anthrax among employees and visitors to the building is "extremely low." The incubation period from exposure to anthrax to the onset of illness is usually one to seven days, but may be as long as 60 days, according to the message. Anthrax produces flu-like symptoms and is often fatal if left untreated. It is not contagious.

While state and federal officials urged people to remain calm and not jump to conclusions, the highly unusual incidence of anthrax is a clarion call to health care workers and public officials who have for years bemoaned the nation's weak public health infrastructure.

Donald Henderson, director of the Johns Hopkins Center for Civilian Biodefense Studies, said no hospital or group of hospitals in a single geographic area in the country could effectively manage even 500 patients in need of the sophisticated medical care that would be required in an outbreak of anthrax. Henderson testified before the Senate Health, Education, Labor and Pensions panel on public health on Tuesday.

"In the event of a contagious disease outbreak--such as smallpox--far fewer patients could be handled," Henderson said. "There isn't enough staff, enough supplies, enough drugs on hand to cope with such an emergency," he added.

More than 20 federal agencies play a role in preparing for or responding to the public health needs that would stem from a attack using biological agents. Janet Heinrich, director of public health issues at the General Accounting Office, told the Senate panel that despite recent attempts to better coordinate the activities of various agencies, much of the work remains fragmented.

Even agencies that could conceivably play a critical role in responding to a bioterrorist attack are sometimes in the dark about federal response plans, Heinrich said. The Department of Transportation, for instance, which is responsible for a large number of potential terrorist targets, "was not part of the founding group of agencies that worked on bioterrorism issues and has not been included in bioterrorism response plans," she said.

Sen. Edward Kennedy, D-Mass., chairman of the public health panel and Sen. Bill Frist, R-Tenn., are seeking an additional $1.4 billion in federal spending to improve the nation's capacity to deal with the consequences of a bioterrorism attack. Most of the money would be spent to improve medical facilities and educate health care providers, who will need to quickly identify an attack and provide the most appropriate treatment.

"There are no simple actions or one-time infusions of funding that will rebuild a deteriorated public health system and provide the needed surge capacity in our hospitals to be able to cope, on an emergency basis, with large numbers of casualties," said Henderson. "A longer-term strategy is critical."