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Last Updated

13 Jul 2003

Source: Washington Post, July 13, 2003

EDITORIAL

Are We Ready?

POST OFFICES HAVE been cleaned, and many mailrooms are better protected. But how much has the U.S. medical establishment really learned from the anthrax attacks of October 2001? If anthrax -- or smallpox, or a newly engineered disease -- were to break out tomorrow, would hospitals and public health departments be prepared?

Part of the answer is deeply unsatisfying: At least at some level it is impossible to say, because no federal agency has published the results of a full investigation into what went right and what went wrong. The Department of Health and Human Services says it has conducted its own investigations but will not publish the results, for security reasons. That leaves everyone else to rely on the work of private scientists.

Their conclusions, some recently published, indicate that the medical response to the anthrax attacks was flawed. After extensive discussions with those involved, three scientists from Johns Hopkins University and the ANSER Institute for Homeland Security found, for example, that the work of doctors dealing with anthrax patients was significantly hampered by the poor distribution of information. Hospitals in Florida, New York and the Washington area were compiling evidence about anthrax cases but weren't receiving timely medical advice in return. Whereas the Pentagon held daily news briefings after Sept. 11, 2001, health professionals got their information about the spread of anthrax from CNN. An electronic system designed to link public health departments with the Centers for Disease Control and Prevention (CDC) in Atlanta worked poorly, and a public CDC Web site crashed twice. In any case, neither was dispensing pertinent medical information directly to hospitals and doctors who needed it.

HHS says much has improved. The department, along with many communities across the country, has begun conducting mock disaster drills, furthering the integration of public health officials with hospitals. Money has been spent on computers and cell phones, as well as safety shoes and surgical masks. Scientists are trying to develop a new anthrax vaccine. HHS says it can get antibiotics to any part of the country within hours -- though it isn't clear, at the local level, how they would be distributed after that.

Is it enough? Some think not -- and they usually point to personnel problems. Another report, issued last week by the Partnership for Public Service, points out that federal biodefense agencies may actually lose qualified staff in the next few months. Despite claims by Tom Ridge, the secretary of homeland security, that "a new human resource management system" is one of his top priorities, and although HHS says it has hired "hundreds" of public health officials, starting salaries for public health workers are still far lower than those in the private sector, and academia still offers scientists more stable careers. Others, both inside and outside government, point to a shortage of medical personnel as well: The nation's hospitals are already overstretched, and they have very little "surge capacity." After creating a computer model of the effects of a major anthrax attack in New York City -- and concluding that 120,000 people might die -- Stanford University business professor Lawrence M. Wein concluded that the nation needs a medical SWAT team, specialists who could fly to an emergency from cities across the country, set up tents and start caring for patients.

Both the administration and its critics agree that coming to clear conclusions is difficult, if not impossible. They generally agree that the nation is better prepared than it was, but also that if an attack took place tomorrow, many people still might die. Worse, substantial resistance remains at many levels to the very idea of preparing for a bioterrorist attack -- as we will discuss in editorials tomorrow and Tuesday on the experience of smallpox vaccinations and on biothreats of the future.