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Last Updated

10 Jan 2003

Source: San Diego Union-Tribune, January 10, 2003

Physician who spotted anthrax will speak at local workshop


Dr. Larry Bush is among the first U.S. physicians after Sept. 11 to meet bioterrorism head-on.

The West Palm Beach infectious disease expert quickly recognized that the rod-shaped microbes in his patient's spinal fluid were anthrax.

"There was a short list of what could be making this man so ill so fast, and anthrax was at the top of it," he said in a recent interview.

That experience, he said, made him realize what many others have not.

"Any diagnosis made as a result of covert bioterrorism will be made during an individual clinician's encounter with a patient," he said. "Someone will see something that's unusual. It will not be made by a hospital or a federal government agency."

That's the message he will bring to about 300 San Diego-area doctors, nurses and clinic staff at a bioterrorism workshop tomorrow sponsored by the San Diego County Medical Society and the Council of Community Clinics.

Bush will discuss the lessons learned in the weeks after the terrorist attacks, when 23 patients in several states would be diagnosed with anthrax and five of them would die.

National news personalities would become targets, several federal buildings and the U.S. Postal Service offices would be shut down and the media would be mesmerized by the topic for months.

But fast recognition, Bush points out, enabled 20,000 people who lived or worked in the vicinity of the anthrax patients to get on antibiotics quickly. And many were saved because of it, he said.

"We know there were people in whom anthrax spores were found when their noses were swabbed and who took prophylactic medication. They didn't get sick," he said.

He has criticized the federal government's belief that emergency room staffs will rapidly recognize and report bioterrorist-related cases among the hundreds of patients in their crowded waiting rooms.

"The people who are working out in the field will be the first to see a case that fits with bioterrorism," he said. "Ill people go to doctors, not to government agencies. And if we're waiting for several emergency rooms to let us know they have a few unusual cases, we will be far too late."

Bush said part of his message will be to encourage doctors and other health-care workers in clinic settings to learn to distinguish chickenpox from smallpox, for example. Smallpox rash begins on the outer limbs and moves in, while chickenpox begins in the chest or torso area and moves out.

He hopes to convey the message that clinicians who see suspicious cases may think, "This is probably chickenpox, but at least let us think about smallpox," Bush said.

The society's session will be at the Mission Valley Hilton. It is open to health professionals, but not the general public.

The event is funded in part with $600,000 from tobacco litigation funds allocated by the county to the Council of Community Clinics. About $200,000 of that was subcontracted to the medical society for bioterrorism awareness, and a portion of that is paying for the bioterrorism session.

The remaining funds are being spent on mobilizing teams to train health-care workers how to recognize a chemical or biological agent of bioterrorism, who to call and what to do with the patient.

For example, said Dr. Nancy Bowen, county public health officer, it's important that people suspected of having smallpox not be sent to the emergency room, where they might infect others.

Instead, she said, health workers should isolate the patient and contact designated investigators.

Other topics include health-care worker concerns about smallpox immunizations, how to recognize vaccination side effects, and what impact the threat of bioterrorism will have on the mental health of the community.

Mickie Beyer, council chief executive officer, said the use of tobacco money to prepare the private sector for bioterrorism is important because 80 percent of the health care in the county is provided by private physicians and clinics.

Other speakers at tomorrow's event include Cmdr. Pietro "Pete" Marghella, Navy chief of medical plans and operations for the Joint Chiefs of Staff at the Pentagon, and numerous county health officials, including Emergency Medical Services chief Dr. Gary Vilke, UCSD epidemiology director Dr. Leland Rickman, and county immunization program manager Sandy Ross.