By Carolyn Taschner
Capital News Service
Sunday, Sept. 30, 2001

WASHINGTON - Maryland health officials have heightened surveillance for potential bioterrorism attacks in the wake of the Sept. 11 terrorist bombings, and say that doctors and nurses around the state are being more scrupulous about reporting potential problems. 

But even with a plan in place, experts said there is not much that can be done to prevent biological attacks. Unlike the fiery explosions of the Sept. 11 attacks, the first signs of biological terrorism could look like a cough and a sneeze. 

"To kill as many people as we saw fall victim to the horrible attacks ... you could do that with a few grams of anthrax, with what you could hold in one hand," said Bruce Clements, associate director of the Center for the Study of Bioterrorism and Emerging Infection at St. Louis University. 

"People have the misconception that, boom, we have terrorism from explosives," he said. "That's not what bioterrorism looks like. At first it looks like a bad flu season." 

But that does not mean the state is not ready to respond, said Julie Casani, the Maryland Department of Health and Mental Hygiene's medical coordinator for emergency preparedness and response. "People shouldn't stop breathing," said Casani. "They should be proactive in finding out if plans exist and finding out if they can get involved." 

The main thrust of the state plan relies on early detection of biological agents like anthrax and smallpox while they are still in the "bad flu season" stage and can be treated with common antibiotics. Maryland sends health investigators to emergency rooms throughout the state to monitor patients and check up on the possibility of symptoms that might indicate a biological attack. 

Prior to the Sept. 11 attacks, Casani said surveillance was event-driven, coming during presidential inaugurations or protests. Now, she said, the surveillance goes on every day. 

Another part of the plan is educating health officials around the state. Casani said that since Sept. 11, doctors, nurses and emergency medical workers have been more willing to call the state health department and report cases, to make sure they are not the result of bioterrorism. None have been discovered. 

Because the biological agents that could be used as weapons are odorless and tasteless, recognizing an attack depends on the ability of medical personnel to identify symptoms and connect them to the agent. 

Smallpox has the potential to become an epidemic, because it can be passed from person to person. 

Anthrax and other possible weapons cannot be transmitted, and their impact would be limited to those people who actually breathed in the spores. 

C.J. Peters, a professor of pathology and microbiology at the University of Texas Medical Branch at Galveston, said terrorists would most likely spread biological agents by some type of aerosol, which must be sprayed upwind. 

"This will go anywhere air goes," Peters said. "It can go into your house, into your office. If you are near the point of release, it will get everyone." 

The incubation period for bioterrorism agents can be anywhere from a few days to a few weeks. Many can be treated with antibiotics, but only if they are detected almost immediately. 

"With the majority of these pathogens, you have a window of opportunity before this becomes a full-blown disease," Clements said. "It's so important that we train healthcare workers in not only how to diagnose but how to respond to these agents." 

There are vaccines for both smallpox and anthrax, but in very limited quantities, said Defense Department and federal health officials. Those vaccines are largely reserved for military use. 

Health officials agree that early diagnosis is the key. 

"We can't monitor all the air -- it's too expensive and too difficult. We can't do it by vaccination -- we don't have enough and not without risk," Clements said.

Casani and some county health officials in Maryland have reported calls from people asking about vaccines for smallpox and anthrax. But Casani said people should not think about vaccinations yet. 

"We're here to protect public health, we're not going to let things slide," she said. "If we see a need for prophylactics, we'll start working on that." 

Maryland is also collecting information about medical resources and emergency manpower throughout the state and maintaining a list of people willing to help in the case of an emergency. 

For now, Casani said, people should just maintain their personal safety and be cautious, but not paranoid. 

She concedes that the state plan is not foolproof. But she said state officials continue to hope for the best even as they prepare for the worst. 

Clements said awareness is the best way to prepare for biological attacks, and he hoped that it would not take an attack to spark interest in the threat. But, he too, said panic is not the answer. 

"You can do no more as an individual to prepare for an act of bioterrorism than you could do to prepare for a plane flying into your building," he said. "But do we want to live our lives in fear? Because if we do, the terrorists have won."

Copyright © 2001 University of Maryland College of Journalism