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Last Updated

02 May 2003

Source: Wall Street Journal, May 2,  2003


Chicago, Seattle Plan Drills To Test Terror Preparedness


On Mother's Day weekend, terrorists will spray unseen germs over Chicago airports, infecting thousands with a lethal pneumonia, while their counterparts in Seattle prepare to detonate a dirty bomb.

The Seattle bomb, exploding between Tully's Coffee shop and the Rainier Brewery on Interstate 5, will lead to overturned cars, buses and container vans in the five-acre blast zone.

But the principal role of the bomb, set to explode a day or so after the germs are released, will be to divert the nation's attention and resources from the deadlier act of the game: effects of Chicago's airborne bacterial cloud that will start to bring patients into the hospital.

Fortunately, it will all be an exercise, part of a national bioterror drill sponsored by the Department of Homeland Security. The goal of the drill, called TopOff2, is to give health workers and agencies practice responding to a terror attack, and to assess readiness, uncover planning gaps and remedy them.

Tens of thousands of Chicagoans are expected to participate in TopOff2, says Patrick Finnegan, director of clinical, administrative, professional and emergency services of the Metropolitan Chicago Healthcare Council, a group of more than 140 area hospitals. More than 1,200 volunteers from high schools and senior centers have signed up to act as victims pouring into emergency rooms. Another 2,600 paper victims will be faxed into hospitals for virtual treatment. Every Illinois hospital is expected to participate, either in the physical drill or tabletop exercise.

The drill is the sequel to TopOff1, in which a simulated aerosol plague attack in a Denver concert hall in May 2000 led to an estimated 4,000 sick and 2,000 dead in four days. Organizers say the point of such drills isn't to forecast casualties but to improve preparedness for a bioterror attack.


The simulated terror attacks on Chicago and Seattle are expected to unfold as follows:

Mother's Day Weekend: Terrorists spray plague germs at O'Hare and Midway airports.

Monday, May 12: A second terrorist cell diverts attention with a dirty bomb in Seattle, as Chicago patients become ill and head for the hospital.

Tuesday, May 13: As more patients flock in hospitals, deaths occur and hospitals start to fill up.

Wednesday, May 14: National Strategic Stockpile of drugs is flown in.

Thursday, May 15: FBI agents take down a germ lab culturing plague germs.

Friday, May 16: Casualties mount into thousands, and deaths into hundreds.

Sources: James Hagen, Deputy Executive Director, DuPage County; Patrick Finnegan, Metropolitan Chicago Healthcare Council

Margaret Hamburg, a former Clinton administration official who is now a bioterror expert with the Washington-based Nuclear Threat Initiative, says such drills force leaders to sharpen their decision-making and untangle lines of authority. "Somebody has to be in charge," she says.

As an added bonus, such drills might further hone the country's readiness for natural disease outbreaks such as severe acute respiratory syndrome, or SARS, now challenging a number of countries from China to Canada.

In TopOff2, the mist of plague bacteria will be released at five Chicago sites, including O'Hare and Midway airports. Pneumonic plague -- which results when the germ causing bubonic plague is inhaled -- is highly contagious. But because the symptoms can initially resemble other diseases, the infection can spread rapidly before health officials realize the problem on their hands.

After inhaling the germs over the weekend, the pretend victims will develop fever and chills, head and body aches, in one to three days. Breathing becomes labored. Death ensues quickly if the antibiotic treatment -- preferably streptomycin -- isn't begun within 18 to 24 hours of exposure.

"The first patients will develop respiratory symptoms and victims will start arriving in the hospitals," says James C. Hagen, deputy executive director of the DuPage County Health Department in suburban Wheaton, Ill., one site of the drill.

The true diagnosis may take a day to confirm. By the time tests are complete, the first wave of mock victims could be dead. Sparing the second wave a similar fate will depend upon several real-time computer systems being tested by participating hospitals and the Centers for Disease Control and Prevention in Atlanta.

Once the news is out, mock television crews under the logo VNN, for Virtual News Network, will cover the attack as if it were real. Law-enforcement officers will close in on the scene of the crime. "There will be a possible 'takedown' of the site of suspected terrorists growing the [germs] on either Thursday, May 15, or Friday, May 16," says Dr. Hagen.

It isn't known where the mock terror lab is located, and authorities wouldn't say whether actors would be enlisted as "terrorists." However, Canadian authorities are slated for a role in TopOff2, giving the drill international scope.

TopOff2 won't be a perfect simulation, because the players know the ultimate diagnosis ahead of time. People acting as victims must sign a consent and release form stating: "I understand that as a participant in the mock disaster drill, I may have makeup applied so as to look like a disaster victim; may have my clothing soiled or torn; and may be transported by stretcher [or] wheelchair."

The participants are coached on what symptoms to display -- all according to a script by Mr. Finnegan's group and Illinois poison-control experts, who jointly wrote the scenario.

Likewise, doctors and other health workers at hospitals know roughly when the game will begin and what germ their tests will disclose. But they must play according to the script, and await test results before beginning treatment, rather than leap into premature diagnoses or actions.

"The way scenarios are written, they may not find out [the plague diagnosis] for 12 hours," Mr. Finnegan says. During that time, by following normal procedures, hospitals will make errors that spread the disease, as the first wave of patients is sent through normal channels to such venues as the emergency room, and on to the laboratory for tests and X-rays -- exposing other patients and staff on their way.

Once the diagnosis is made, the real test begins. Says Mr. Finnegan: "Now, what do they do with the other patients who have been exposed?"

Saturation ensues swiftly, if past simulations are any guide -- and seeing how hospitals handle that saturation is one of the key ways that the drill will test and evaluate the public-health infrastructure. "A number of hospitals are going to be overloaded very quickly," Mr. Finnegan predicts, triggering hospital closure, ambulance diversions and patient transfers. The goal is to see how hospitals perform under maximum stress.

No special drugs or protective suits have been purchased for the Chicago drill. Hospitals will use protective clothing they have on hand. But the government will activate the National Strategic Stockpile, flying in a crate of supplies, "to see how long it takes to break it down and dispense it," says Mr. Finnegan.

TopOff2 is the only drill planned for 2003, Mr. Finnegan says, adding that "there's not enough Prozac" to sustain staff for more such games.

Actors will be identified by their Top Off T-shirts, and hospitals will post signs and make announcements to reassure real patients. Vows Mr. Finnegan: "Normal patient care is not going to be affected." In Seattle, students at an elementary school near the site where the mock bomb will explode have been briefed and shown the protective suits workers will use.

Drill organizers also say they won't be dropping their guard in terms of defending against real terrorist attacks during the drill. For security reasons, Chicago is only using actor-patients specifically recruited from certain high schools and senior centers, rather than using any volunteers or walk-ons from elsewhere. Officials won't disclose what other security measures they are taking.

The total budget for the TopOff2 exercise is $16 million, coming from the Department of Homeland Security's Office of Domestic Preparedness, and the Department of State's coordinator for counterterrorism. Of that, $5 million will be given directly to the states of Illinois and Washington.

Simply going through the drill will help health workers train for a real event. But Dr. Hamburg, a veteran of the Dark Winter smallpox drill and other simulations, warns against too slick or transparent a scenario.

"I've participated in some exercises that were too easy," she says, citing one scenario in which a terrorist unleashed infected plague rats in a football arena, a janitor found the box by half-time, and the tests were done by game's end. Too easy, says Dr. Hamburg.

"Probably in the real world there would have been no clue until people started to get sick," she says. "Such games give you a false sense of omnipotence."

Dr. Hagen of DuPage County says that despite such drills, it is hard to know what would happen in a real terrorist attack. "Will people storm the medical facilities?" he wonders. "Or will they stay quietly at home? No one really knows."