Confronting the terror within
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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.
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.
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."
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."