Posted on: Sunday, November 25, 2001
Prescriptions
Beyond anthrax: Assessing the threat
By Dr. Landis Lum
Anthrax has monopolized the news recently. However, what about other chemical or biological weapons that many people have been worrying terrorists might use?
Some of that worry is founded in the fact that nerve agents are highly toxic; as little as 1 milligram can be lethal.
But at the same time, they are not as easily manufactured as some people fear. Producing high-grade nerve gas takes considerable expertise. Aum Shinrikyo, the Japanese cult that managed to kill 12 people in a 1995 Sarin nerve-gas attack in a Tokyo subway, employed 30 people and invested $30 million into producing Sarin; yet the gas they released was less than 20 percent pure.
That attack provided valuable lessons for our own emergency preparations. Ten percent of prehospital personnel, including police and paramedics, got sick from nerve-gas poisoning from exposure to victims and the contaminated environment. About 46 percent of hospital workers got sick through improper handling of victims. Less than 10 percent of the 5,000 victims came to hospitals via ambulance; more than 90 percent arrived unexpectedly via taxi and automobile, or by foot.
In the rare chance that an attack occurs, nerve agents are well absorbed through the skin, so careful decontamination using soap and water or dilute bleach is necessary. Protection of health care workers is key. Surgical masks and latex gloves are not good enough — health care workers must wear full protective gear and self-contained breathing apparatus.
Mustard gas, ammonia and chlorine are corrosive chemicals that may be used in a chemical attack, and can cause serious lung problems if inhaled. With such agents, skin decontamination by showering is required.
Now, what about germ warfare? Ken Alibek, who used to be the deputy head of the Soviet Union's germ warfare program (and defected to the United States in 1992) says that if a terrorist could pick one germ warfare agent to use against the United States, it would probably be smallpox or the plague, both of which are highly contagious. Since smallpox was eradicated 20 years ago, most people have no immunity. Even the protection many people had from their childhood smallpox vaccine has likely worn off.
But put these things into perspective.
Russia and the United States have the only official stores of this virus. While experts suspect that other countries, including North Korea and Iraq, may have covert stores, these countries may be unlikely to release these for fear of an epidemic among their own population.
Smallpox begins with two to four days of fever, headache and backache before pox lesions appear, mostly on the face and extremities (compared with the trunk for chickenpox). Most patients recover, but fatalities occur in 30 percent of people. The United States has ordered more smallpox vaccine for possible future use.
As for bubonic plague, the first case was discovered in Honolulu at the Wing Wo Tai grocery on Nu'uanu Avenue in 1900. The Health Department tried to stop the spread of the disease by setting controlled fires, but a gust of wind spread the blaze, starting the Great Chinatown Fire of Jan. 20, 1900. The lung form, pneumonic plague, causes high fever, chills, muscle aches, cough productive of often-bloody phlegm, and chest pain. There is a high fatality rate, but unlike smallpox, the germ is susceptible to antibiotics.
The anthrax scare also must be put into perspective.
Even assuming that terrorists manage to kill 20 people a year from anthrax, you are still 1,000 times more likely to die from the flu and 2,000 times more likely to die in a car accident — there are 20,000 flu deaths and 40,000 car crash deaths each year.
Therefore, with all the holiday traveling going on, be sure to buckle up. And with flu season fast approaching (December to March), go get your flu shot right away, especially if you're over age 50 or have diabetes, asthma, or any other health condition requiring regular clinic visits. I already got mine.
Dr. Landis Lum is a family practice physician with Kaiser Permanente, and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Write: Prescriptions, 'Ohana Section, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; e-mail ohana@honoluluadvertiser.com; fax 535-8170. This column is not intended to provide medical advice; you should consult your doctor.
