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Anthrax Threat Needs Aggressive Action PlanMay, 2003 Despite the fatal delivery of anthrax through the U.S. mail in 2001, no government plan exists for responding to an airborne attack with the pathogen. To study possible effects of an attack, a research team headed by the Business School's Lawrence Wein predicts that two pounds of anthrax spores dropped over a city the size of New York could be expected to kill more than 120,000 people. The death toll can be reduced to about 1,000 by planning a far more aggressive response than anything currently being discussed, the researchers say in an article published in March in the Proceedings of the National Academy of Sciences. Wein's coauthors in the anthrax study are David L. Craft, a doctoral student at the MIT Operations Research Center, and Edward H. Kaplan, professor of management sciences at Yale School of Management. The three earlier created another mathematical model of an attack with smallpox that led the federal government last year to revise its response plan for smallpox. In their work on anthrax, the researchers proposed a scenario in which two pounds of weapons-grade anthrax are dropped from a height of 300 feet just upwind of a large U.S. metropolitan area containing 11.5 million people. About 1.5 million people become infected, with some of those infected showing symptoms within two days. Assuming that the first patients to exhibit symptoms are correctly diagnosed, intervention begins 48 hours after the attack, which means that as soon as one person in any 10,000-person neighborhood exhibits symptoms of inhalation anthrax, the other 9,999 are placed into a waiting line to get prophylactic antibiotics. Under current response planning, the researchers estimate that antibiotics can be delivered to the entire population within four days, a timeframe that the model estimates would result in 123,000 deaths. The reason: not enough people receive antibiotics quickly enough to prevent symptoms from developing, and those who develop symptoms overwhelm the medical facilities. "My colleagues and I then asked ourselves: What would it take to reduce the death toll from 123,000 to 1,000?" Wein explained. He listed four key elements to a successful response: "The person in charge needs to put the intervention process in motion as soon as the first case is diagnosed; prophylactic antibiotics need to be distributed as rapidly as possible to everyone in the affected region; the affected population requires aggressive education about the importance of adhering to the full course of treatment; and we need to quickly create a surge in our capacity to aggressively treat the symptomatic patients." The appropriate antibiotics could be distributed before the attack or within six to eight hours after the first diagnosis, the researchers say. "The best option may vary from city to city, depending upon the risk of an attack and the city's ability to distribute antibiotics quickly," Wein said. "Pre-distribution of antibiotics can save 10,000 lives for every day that it takes to hand them out post-attack, and may also significantly reduce the panic that could ensue." The third element of a successful response is education about drug adherence. In the 2001 postal attack, only 40 percent of postal workers who were told to take a 60-day course of the antibiotic Cipro actually adhered to the full regimen. "Our model optimistically assumes that 90 percent of people will adhere," Wein said, which means the government needs to educate people before an attack and afterward. The team suggested three steps to creating surge capacity for aggressive medical care. First, local doctors and nurses who are not specialists in pulmonary care or emergency care should be trained in the basics of inhalation anthrax treatment. "We can offer basic training for respiratory therapists and emergency medical technicians with advanced life support training," Wein said. Second, national organizations should be tapped. "We need to take full advantage of the National Guard, the Red Cross, the VA hospitals, and to scale up the Disaster Management Assistance Teams program that has been developed by the government," he said. "However, our calculations suggest that even if we get antibiotics out rapidly, to reduce the death toll from 123,000 to 1,000 would require one anthrax medical care provider for every 700 people in the affected region. This is a very difficult ratio to achieve." To reach that level, the team proposes that the government start a national volunteer system of pulmonary specialists that would behave in much the same way as volunteer fire departments in rural areas. "If there was an anthrax attack in New York, doctors from LA, Chicago, Miami, and San Francisco would jump on the next airplane, take some Cipro and bring some ventilators along, and would arrive six hours later ready to save some lives," Wein said. "I believe that there are many brave and selfless medical workers in this country who would volunteer. This is the only way I can see that we could avoid a catastrophic number of fatalities." KATHLEEN O'TOOLE |
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Related InformationTranscript of Prof. Lawrence M. Wein's Remarks at March 17, 2003 Press Conference Policy Implications of an Anthrax Attack Anthrax Threat Needs Aggressive Government Action Plan Additional ReadingScholars Call for a Change in Government Response to Bioterrorism Attack Scenario, September 2002 Emergency Response to a Smallpox Attack: The Case for Mass Vaccination, Edward H. Kaplan, David L. Craft, and Lawrence M. Wein, Proceedings of the National Academy of Science (Vol. 99, No. 16), 2002
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Anthrax
Threat Needs Aggressive Action Plan
