As with dirty bombs, the main thing keeping us safe from bioattack is the nature of the weapon itself. The most dangerous and virulent pathogens, like the Ebola virus, kill their victims too quickly, so an infected person is able to spread the disease to only a relatively small number of people before succumbing. According to the Centers for Disease Control and Prevention, Ebola has an incubation period of 2 to 21 days and kills 50 to 90 percent of those infected within two weeks of the onset of symptoms. This produces terrifying but limited and short-lived outbreaks. The second problem terrorists face is how to infect victims with their disease of choice. Aerosolizing the pathogen—so that it can be released and inhaled by a large number of people—is an obvious approach, but this is difficult to do, not least because many infectious agents can’t survive long outside a host.
Anthrax is seen as a particular threat because it occurs in spore form, meaning that it can be transported easily and will remain potent for decades. In principle, inhaling just a couple of spores could spark a fatal infection. More realistically, being exposed to several thousand spores would be required for most people to develop symptoms, but that still amounts to a dose weighing far less than a millionth of an ounce.
It’s no surprise, then, that anthrax was used in the still-unsolved bioterror mailings that occurred in the weeks after 9/11. The attacks sparked frenzied countermeasures among the general public, with people ironing their mail to kill spores and reports of people attempting to obtain personal stockpiles of the antibiotic Cipro. The government set up more elaborate schemes to use electron beams to sterilize mail. Yet despite the mailings’ status as the most sophisticated and deadly series of bioterrorist attacks in the United States to date, just five people were killed and another 17 sickened. Compare this with the average annual death toll of 36,000 Americans from ordinary influenza.
Chemical weapons are a more clearly evident risk: The sarin nerve gas that cultists used to attack the Tokyo subway killed 12 and injured hundreds in 1995. As a consequence, stockpiles of the nerve gas antidote, called Chempacks, have been put in place in cities around America, and detection systems are being developed to warn of an attack and have already been deployed in a few places like Grand Central Terminal in New York City. First responders have also been provided with field supplies of nerve gas antidote, with each ambulance in New York City, for example, carrying 60 Mark I kits, says Neal Richmond, former deputy medical director of the New York Fire Department. Each Mark I kit has two autoinjectors, one containing atropine, which works to counteract the immediate effects of the nerve gas, and the other a drug called 2-PAM, which helps the body clear the nerve gas out of its system.
All that said, for those caught in a chemical attack, the available countermeasures are not exactly reassuring. A chemical weapons attack would be a “mass casualty event,” Richmond warns, meaning that emergency responders would expect to be overwhelmed by the number of sick and dying people. In such an event, the rules for treating victims that most people have come to expect from emergency responders are altered. “You want to use available resources to get the greatest benefit for the greatest number of people instead of focusing all your resources on the sickest people,” Richmond says. Rather than treating the sickest first, rescuers would treat the most likely to survive first, evacuating those who can walk or crawl to a decontamination area before sorting out the rest.
In a chemical attack, the task of first responders would be further complicated by their bulky protective suits. These make normal medical examinations impossible, forcing responders to rely on “noxious stimulus triage”—nicknamed kick triage—to sort out the living from the dead. “You don’t really kick them, but you do shake them, move them” to see if they react, says Richmond. “Anyone who doesn’t appear dead gets dragged out” and injected with three Mark I kits. If that stabilizes the victim long enough to reach hospital care, chances are he will survive, as more antidote can be administered as needed to keep counteracting the nerve gas. If the victim’s condition worsens before he can reach the hospital, however, he is unlikely to receive any additional antidote—especially if the antidote is in short supply—as the responders turn their attention to others.
Richmond worries that despite all the elaborate planning made by the Department of Homeland Security and others to deal with chemical and biological attacks, mundane but important things aren’t happening—like conducting enough drills to make sure that these plans actually get implemented properly. He also notes that a lot of money has been spent preparing for rare attacks, but emergency rooms around the country already have difficulties coping with routine patients: “We need to tackle building the everyday infrastructure in this country so that it’s working for every patient, every day. Then when the big things come down, we’ll be pretty prepared.”
