Anatomy of a Bioterrorist Attack

Few things elicit more fear than being attacked by something unseen or unknown. This is precisely why a Bioterrorist Attack is a scenario that requires some of the most advanced preparation. A bioterrorist event is not a fictional scenario; it is, rather, a reality that has been carried out in the recent past with the anthrax attacks in the United States shortly after the 9/11 terrorist attacks of 2001 and the Aum Shinrikyo-orchestrated attacks against the Japanese subway system; the group is known to have unsuccessfully attempted to use biological agents.

The probability of such an attack increased with the passage of time. U.S. intelligence agencies have issued warnings, in fact, of a pending bioterrorism attack against the U.S. homeland within the next few years. Not only can a bioterrorist attack cause mass casualties as infected carriers unknowingly transmit the pathogen throughout the population, but it can also cause a widespread public panic that would overwhelm public resources as people become anxious over the potential of being exposed or having recently been exposed.

Moreover, the economic impact can be considerable from, among other things, lost productivity from employees calling in sick, the probable loss of tourism, and numerous facility closures and decontamination. One has only to look at the economic impact on Mexico (and the rest of the world) from the 2009 naturally occurring H1N1 Swine Flu Epidemic that, according to some estimates, cut the world GDP by $2 trillion. Incidentally, the U.S. National Planning Scenario for an aerosolized anthrax attack estimates that such an attack on a U.S. metropolitan center would cost billions of dollars and could lead to a major economic downturn caused by the loss of consumer confidence.

Unlike a chemical, nuclear, or explosive event, there usually is no immediate and/or clear indication that a nation, or community, has been attacked by terrorists using a biological weapon. Even chemical weapons leave at least some traces – caused by obnoxious odors, burning sensations, or difficulty breathing. In contrast, a biological attack, termed a “silent” attack, can be carried out by tampering with food – as was the case in the notorious 1984 Rajneeshee attacks on salad bars in The Dalles region of Oregon. Moreover, a biological attack can be perpetuated significantly by distributing pathogens in water, aerosolizing spores, or even via the U.S. mail system – all of which can be carried out without being detected. In the absence of a visual indicator, such as a powder accompanied by a credible threat, the detection of a biological attack can take days, weeks, months, or even years, and it can be very difficult if not impossible to catch the perpetrators.

An Important Question – Followed by a Very Slow Answer

So the question arises: What would a “silent” biological attack look like? According to the National Planning Scenario for an aerosolized anthrax attack, it very probably would not be a dramatic event that could easily be pinpointed to a time of infection. What seems more likely is that sick people will begin presenting themselves to hospital emergency rooms (ERs) within about 36 hours post-release of the bioterrorism pathogen. Also most likely, the first victims will be misdiagnosed because the initial symptoms closely resemble flu symptoms. However, after a number of victims with advanced symptoms present themselves to ERs, epidemiologists will be able to declare a contagious disease emergency and activate the response network. In all likelihood, though, at least a week will have passed before detection.

Quicker detection is the key, therefore, to minimizing the impact of a bioterrorism attack and the saving of lives after such an attack occurs. Fortunately, there are a few quicker detection methods (less than two days) that can be employed. One method is to continually monitor air in strategic locations for the presence of biological particles. Once characterized biological particles have been detected, an automatic trigger initiates the collection of air samples for identification, and a determination then can be made on the burning question of whether a bioterrorism pathogen has been released.

Current air-surveillance technologies have the capability to identify an attack in 1-2 days. Other methods are utilized to identify powders. Visible powdery substances – the so-called “white powder” threats – now can be identified with a high degree of certainty within just a few hours through the use of new and highly sensitive field instruments carried by well-trained first responders such as hazmat technicians, firemen, or policemen.

Biosurveillance and field assessments are obviously among the most valuable tools available for the early detection of a biological attack, largely because first responders will almost always not only be first on the scene but also will be responsible for managing the initial stages of the event. For practical purposes, this means that, while field teams are waiting for the Laboratory Response Network (LRN – managed by CDC and the Association of Public Health Laboratories) – to complete confirmatory testing, the first responders will be, and are, responsible for quarantining and decontaminating probable victims and organizing the potential response reactions based on the initial credibility of the threat.

For that reason alone, it is imperative that these responders always have the best tools currently available to properly manage the incident and save lives. Fortunately, the U.S. government continues to fund such programs so that response agencies in communities – local, state, and federal – throughout the nation can reach an adequate preparedness level.