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Confronting the terror within
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Spring 2002
Confronting the terror within
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One of the problems facing the task force is the near impossibility of predicting the shape of a future bioterrorist attack. Before September 11, no one considered that commercial airliners might be used as missiles to blow up buildings — nor did anyone imagine that the U.S. Postal Service could serve as a workable and efficient vector for the spread of a lethal disease on a large scale.

"There's no way to predict exactly how it's going to happen," says David Pegues, an infectious-disease epidemiologist and chair of the task force. But the list of agents the Centers for Disease Control and Prevention and the World Health Organization consider to be particularly worrisome is not that long. At the top are anthrax and smallpox, along with plague, botulism, tularemia and a class of hemorrhagic fevers, including Ebola.

UCLA, in a land so prone to earthquakes and other natural disasters, didn't start its planning from scratch. On the other hand, much of this was uncharted territory. "We've long had very strong disaster-response planning in the medical center, but that has been related to an earthquake or some defined catastrophic event," says Frances Ridlehoover, chief operating officer of the UCLA Hospital System. "Bioterrorism could display itself that way, or in a way that unfolds over a period of days or weeks."

Rather than pondering how to respond to every possible contingency, the task force grouped its plans into categories: Is the event catastrophic or evolving? Does it involve trauma or illnesses? If it is illness, is it contagious? Planning for a noncommunicable outbreak such as anthrax is one thing; a communicable disease like smallpox or plague opens up issues of respiratory isolation, quarantines and immunization of those placed at risk. "It's a very different kind of response," says Ridlehoover. "Everyone's recent experience has been with traumatic events. This has forced us to put an enormous amount of thought and planning into how to protect our own staff so that we can confidently meet the public's needs in such a case."

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