Bioterrorism attacks in the United States

¶ … commencement of the Attack

On the 1st of December 2003, from the shores of Nigeria, 3 people boarded a plane for Hawaii. Ismaile, Tariq and Hussein had been knowingly carrying the deadly disease of the Ebola virus, which the Nigerian authorities had failed to detect at the airport. Ismaile, Tariq and Hussein, soon became friendly and made quick acquaintances with everyone on the plane.

After the 7-hour flight, the three Nigerians, like all other passengers went through the same health procedure, this time the U.S. Public Health Service (USPHS) Quarantine Station in Honolulu warned the passengers about a possible Ebola affected passenger on the plane, however, due to the negligence of the authorities, none of the passengers had been apprehended for a formal checkup at the airport..

The following day, the Health Dept of Hawaii wanted to offer the passengers a formal and thorough check up for the virus. They were able to contact the majority of the passengers with the help of the airline information within the initial 48 hours of contact with the virus. Of the total 300 passengers on board the plane, 215 were successfully reached and treated to prevent the spread of the virus, even if the implications of the diagnosis showed no signs of them being affected.

The remaining 85 passengers were a lot more difficult to track down, as they were not guests at a hotel, who are easier to find. This scenario turned out to be a dangerous one, because of Ebola being an air-borne virus, it spread quickly and stealthily amongst those that got in contact with even one passenger who had been affected by either Ismaile, Tariq or Hussein. This draws attention to the fact that newer and effective methods had not been created to get in contact at a faster pace with the passengers that might be potentially infected with a disease (O'Toole T, Mair M. 2002; Subcommittee on National Security 2002).

The Quarantine Station in Honolulu had been unable to detect the virus positively because it's not only hard to detect it but also because the patient didn't show any signs of having the disease during the duration of the flight. They could not detain the passengers on merely the suspicion of a possible virus (Kenyon TA, Valway SE, Ihle WW, Onorato IM, Castro KG 1996; DeHart RL 2003).

Bioterrorism has been adopted by terrorists on a regular basis because it is convenient and can go undetected in many public places. They use the transportation structures to spread the virus due to the regular and expected visits of public figures and large crowds (Secretary of Health and Human Services 2001).

The 85 that could not be contacted paved the way for a destructible venue. They went, unaware, to the mountains, villages, party venues and spread the disease further till it became a noticeable force and had to be controlled on the large scale (Daws G. 1974).

Chapter 2 - The screening process

While the terrorists have become very proactive in fulfilling their objectives and also very vigilant about the loopholes that exist in the security systems all over the world, it is alarming to note that very little has been done, either legally or institutionally, to protect the American people from deadly bioterrorism attacks. Furthermore, the tendency of the terrorists to attack the most vulnerable places and the most visited locations is also well-known; however, nothing has been done to enhance the security of the high-profile places. The process of screening in Airports today is the same, more or less, as it had been before the 9/11 attacks, as far as the detection of bioterrorist activity is concerned (Traveler Safety and Security Tips: (http://www.flyavp.com/2003/safety.htm;Robert W. Poole, Jr. And George Passantino 2003).

The passengers are asked to arrive at the airport one hour prior to the departure of their flights. Their luggage is thoroughly screened and checked before it is taken on the flight. Furthermore, the luggage then is passed through an X-ray machine, where the luggage is double checked to ensure that nothing illegal is being smuggled, which may jeopardize the safety of the passengers (Traveler Safety and Security Tips: (http://www.flyavp.com/2003/safety.htm;Robert W. Poole, Jr. And George Passantino 2003).

In an effort to stop the terrorists from deploying bioterrorism attacks in America, the airport authorities have started the process of thermal screening to all outbound, as well as inbound passengers. Almost all international airports have more than one automatic thermal scanner, which are considered to be the fastest ones around and are also not invasive for the travelers. Any passenger found to be suffering from fever will be scanned again by a nurse at the airport medical station. Subsequently, those suffering from fever will not be allowed to board the plane, unless they get a clearance from the doctor in the form of a medical certification (Traveler Safety and Security Tips: (http://www.flyavp.com/2003/safety.htm;Robert W. Poole, Jr. And George Passantino 2003).

Many state officials consider this measure to be effective enough to detect the terrorists planning to attempt a bioterrorist attack. However, it is clear that the danger of a deadly disease spreading like forest fire in the urban and sub-urban landscape of America is still a reality and a lot more needs to be done to effectively control bio-terrorist activities. The state officials cannot relax and think they have made this country secure just by introducing a reforms package in the senate and have it passed through the congress (Robert W. Poole, Jr. And George Passantino 2003).

Chapter 3 - What agencies should be involved

The "Department of Health and Human Services" (DHHS) works round the clock in order to ensure that even the remote possibility of a bioterrorist attack is detected at the earliest and effective measures can be henceforth taken. As the Department of Defense notes in their review: "Medical surveillance operate continuously to improve the chances of detecting unusual medical events sooner rather than later. This initial, non-specific detection of activity above an established baseline would trigger other response actions and therefore is important to timely response (Department of Defense. 2000)."

It is heartening to note that since the September 11 attacks, several local communities have been collaborating with "Department of Health and Human Services" (DHHS) in order to ensure that effective measures can be taken to tackle a bio-terrorist attack, should it take place on American soil. The benefits of this collaboration can be timely distribution of information and medicine, which can tremendously assist in decreasing the number of people infected. The department of Defense summarizes the benefits of the cooperation of the local communities and medical surveillance: "Several local communities now are monitoring hospital admissions, 911 calls and unexplained deaths as indicators of an unusual medical event. When baselines are exceeded, city health and emergency management officials will decide if an unusual event has occurred. Medical surveillance can be expanded to actively poll emergency departments, pediatricians, infectious disease doctors, veterinarians and other infection-control practitioners to ascertain the context and possible cause of the non-specific indicator(s). The decision to initiate active investigation should have a low threshold, as these activities have modest cost and impact on the community. Moreover, such timely decisions would avoid delays in active and accurate investigation during actual events that reduce the effectiveness of emergency response in saving lives and reducing suffering (Department of Defense. 2000)."

Lastly, it is important to note that if the medical community notes a probable bioterrorist activity, they then immediately notify the local law enforcement agencies, as well as, the public healthcare professionals along with the relevant information so that effective measures can be taken in an appropriate time.

Health check

Once the medical surveillance indicates a potential bio-terrorist activity on the horizon, the "Department of Health and Human Services" (DHHS) officials immediately follow the conventional procedures to diagnose the disease and its variables. The preliminary samples are not only diagnosed locally, but also, sent to qualified state laboratories for further verification. Once the Centers for Disease Control and Prevention (CDC) and the U.S. Army Medical Institute of Infectious Diseases (USAMRIID) verifies the disease: "the medical and health community should notify the senior local elected official, emergency manager and local law enforcement. Likewise, any selected infectious disease laboratory results that are reported to the public health department also should be reported to the senior local elected official, emergency manager and law enforcement (Department of Defense. 2000)."

Epidemiological analysis

Conducting an epidemiological analysis is critical as it will assist in assessing the data collected and also greatly help in the development of the pertinent procedures necessary for the prevention, control and treatment of the disease. The law enforcement agencies are also given a copy of the collected data so that they too can initiate a criminal investigation. The Department of Defense explains the necessary procedure for a successful epidemiological investigation: "The key to successful epidemiological and criminal investigations of potential BW events is a good working relationship among law enforcement, epidemiologists and the public health department. Developing procedures to facilitate sharing of information among these agencies is highly recommended. Consideration should be given to the development of a common form to be used by both law enforcement and epidemiology personnel. This form should allow the sharing of necessary information while protecting the confidentiality of victims (Department of Defense. 2000)."

Criminal Investigation

The criminal investigation is a critical step as it allows the law enforcement agencies and the health community to determine the cause of the attacks and the gravity of the situation. The "Federal Bureau of Investigation" plays a frontline role in conducting a comprehensive investigation; however, many other agencies are involved as well, as the Department of Defense notes: "The criminal investigation would be a joint effort involving many agencies and could complement the epidemiological investigation. It likely would entail conducting interviews with the sick in hospitals, fellow sick officers and others in the affected population groups. To facilitate these interviews, a checklist of basic questions to ask should be developed. The interviews can help determine the cause, perpetrators and other details of the attack (Department of Defense. 2000)."

Mass prophylaxis

After careful and methodical analysis of the results from the medical diagnosis along with epidemiological and criminal investigations, "Federal Emergency Management Agency" (FEMA) works in collaboration with the local health agencies to limit the influence of the disease. The Department of Defense notes: "Mass prophylaxis, the first emergency response component of the template, involves the distribution and medical application of appropriate antibiotics, vaccines, or other medications in order to prevent disease and death in exposed victims (Department of Defense 2000)."

Residual hazard evaluation and alleviation

The job of the "Environmental Protection Agency" (EPA) is to ensure that they work in collaboration with the Public health professionals, medical examiners, as well as, criminal investigators in order to not only protect the unaffected population but also limit the damage to the affected population. The task includes: "Assessment and mitigation may include environmental sampling of air, water and soil, as well as surface swipes and insect and animal screening for the BW agent (Department of Defense. 2000)."

Control of affected area and population

The control of affected area has been divided into two main categories, which are (1) Physical control (2) Public information control. As far as the physical control is concerned, it comprises: "crowd control and security at hospitals, emergency medical facilities, fatality handling sites and other vital installations such as airports, utility sites, bridges and tunnels. In addition, activities that control the affected area also provide excellent opportunities for isolation and preservation of the crime scene, if one is identified. Managing the affected area also involves management of potential evidence, such as contaminated materials and victims (Department of Defense. 2000)."

Similarly, limiting public information is also very critical as false rumors start to circulate, which cause unnecessary panic amongst not only the affected but also the unaffected. The typical activities comprise: "Establishing and operating a city hotline, providing information to the media and distributing self-help fact sheets. Strict management of information as well as ensuring that all information disseminated is timely and accurate are crucial activities of the command structure in order to prevent panic and maintain public cooperation (Department of Defense. 2000)."

Modular Emergency Medical System (MEMS)-care of existing fatalities and worried well

While many people may be affected from the spread of deadly virus, many people may not be affected from the virus at all. Unfortunately, these unaffected individuals ask for diagnosis and treatment at a very critical time, particularly, when the sick and the affected are being treated. Therefore, an appropriate plan has also been drawn to attend these "worried well:" "In order to manage this huge casualty load, the BW IRP team developed the Modular Emergency Medical System (MEMS) to address shortfalls in hospital space, equipment and medical personnel. The MEMS concept was developed to address the need of a BW response plan to expand and contract in size, based on casualty counts and acuity. Municipalities need a plan to receive large numbers of victims. The MEMS is an example of one way a municipality could begin to address this issue. Under the MEMS, public and private area hospitals would admit BW casualties until they approach full capacity while operating under their internal emergency operations plans. As the hospitals become full, local officials would determine that the medical emergency is overwhelming the community's medical care system and could decide on appropriate activation of a system similar to the MEMS (Department of Defense. 2000)."

Managing the Dead

While effective measures have always been taken to counter bio-terrorist attacks, one cannot guarantee the safety of the lives of all the people. It is highly probable that a huge number of people actually loose their lives. Therefore appropriate measures have been taken to ensure effective fatality management: "The template includes the use of morgues to provide rapid central processing of remains and the establishment of long-term storage facilities using refrigerated trucks, rail cars or other containers to hold remains until final disposition. Additionally, Disaster Mortuary Teams can be provided by the federal government through the Federal Response Plan. Local officials would need to make a decision on the final disposition of remains. Options for the final disposition of remains could include (1) mass cremation, (2) mass burial and (3) release of remains to families for normal disposition. Temporary interment is an option that might be used while awaiting final disposition (Department of Defense. 2000)."

Emergency Management Procedures

Emergency operations center (EOC) is activated when the health professionals determine a critical health crisis is about to emerge. On some occasions, when the threat is extremely severe, the health professionals establish a unified medical branch where all the local, state and federal health officials work round the clock to limit the threat of the disease. The Department of Defense highlights: "The key is early coordination among all departments and forging early relationships among police, medical practitioners, and emergency management and public health officials. Planning and conducting joint training exercises are effective in preparing strong unified command structures (Department of Defense 2000)."

Logistic and Supply Support

While the health professionals along with the law enforcement agencies work round the clock to manage the epidemic, they do need continuous logistic and resource support. This can be done by establishing distribution points for incoming personal and supplies for timely and hassle free delivery. "Supplies would be delivered to the response sites from the staging areas and distribution points. A central reception center would receive incoming mutual aid as well as state and federal support personnel and provide instructions, accreditation and assignments (Department of Defense. 2000)."

Stability of Critical Infrastructure

If there is interruption in the working of the fundamental infrastructure, such as electricity, drainage and telecommunication it will not only cause more panic amongst the people present in the affected area, but also negatively influence the treatment procedures of the sick. Therefore, the strategy has always been to ensure that there is no interruption in the working of the critical infrastructure: "Telecommunications would activate their emergency communication plan to establish priorities, call blocking and cellular augmentation. Electrical power generation, water and transportation would activate their emergency staffing plans as required based on absenteeism. Sanitation would augment disposal of biohazard material and provide sanitary facilities and pest control at Acute Care Centers and other emergency facilities (Department of Defense. 2000)."

Chapter 4 - Responsibility for an event of this nature

The steady presence of bioterrorism has been due to the lack of communication, cooperation and interrogation between the security services, intelligence agencies and the airport authorities. And the only way this form of terrorism can be detained or controlled is in the scrutinized collaboration of these forces. Furthermore, responsibility for the success of terrorists in staging a bioterrorist attack on American soil should be labeled on these institutions.

It is worth noting here that bioterrorism is not a new phenomenon, instead bioterrorism almost wiped out a large portion of European population after it found its origin in 1346, in a war between the Tatar and the Genoese armies and has existed through a conventional pattern since then. The Tatar armies had been suffering from a deadly plague that was dissipating a large number of the armed force, so in order to inflict the same misery on the antagonists, they hurled plagued dead corpses across the city borders. The Genoese army soon suffered from the same plague and retreated into Europe thereby causing the spread of the disease there. Due to its rapid and effective death rate, the disease soon became the Black Death in the Middle Ages for nearly depopulating the European States. (Derbes, V.J. 1966)

It was of course not until the present century that bioterrorism took a stronger turn out of the battlefield. There have been numerous cases which have led the governments to determine that the countries that are recognized as terrorist countries might be able to use them as a counter attack or an offensive attack against their adversaries. There are many non-terrorists countries that have ongoing bioterrorism research and weaponry. The five out of seven terrorist countries are suspected to have these bioterrorism techniques and weapons which they are fully utilizing. One of these countries is Iraq. Iraq owned up to the fact that they had the technology and weapons of bioterrorism such as weaponized anthrax, botulinum toxin, and aflatoxin in 1955. (Siegrist, D.W. 1999, Zilinskas, R.A. 1997). Therefore, many external forces exist, which may be considered as a threat as far as bioterrorist attacks, on American Soil, is concerned.

Many Soviet rebels also revealed the gigantic plans and programs for enhancing biological agents of the Former Soviet Union. This includes the production of tons of anthrax and smallpox, every year (Alibek, K. And S. Handelman 1999). It is believed by many experts that since the breakdown of the Soviet empire, the economies of this region had been deteriorating and all the jobless scientists may either migrate to those countries or join those groups, which may have plans to develop biological weapons (Office of the Secretary of Defense 1997).

Prior to this event, a number of countries had suffered from bio terrorist attacks. In 1995, sarin nerve agent attack in the Japanese subway structures shook a lot of people. This attack had been carried out by the terrorist organization by the name of Aum Shinrikyo and it demonstrated the ability of these terrorist organizations at that point in time (Olson, K.B. 1999). It has been more than a decade since those attacks, an surely the resources of the terrorist organizations has grown manifold throughout this time, making them more dangerous than before and making the public more vulnerable then before. While, the physical responsibility of these bio-terrorist attacks lies solely in the failure of the intelligence and security services, one cannot but blame the political institutions, both domestic and international, for their self-serving actions, which has triggered an uprising on a massive scale.

Chapter 5 - How can we better the process for the future?

At present, many loopholes exist in the methodologies adopted by the civil and intelligence bureaucracy. These loopholes must not be overlooked in the realm of the fight against the external forces, such as Al Qaeda, Hezbollah and other terrorist organizations. Collaboration, cooperation and coordination between the security and intelligence services should be task pursued with vigor and force. Concrete steps in this direction will definitely yield positive results and decrease the vulnerability of the American people with regards to a bio terrorist attack.

However, should an attack of this sort take place, then it is critical that the bioterrorism awareness, readiness, and reaction preparation amongst the medicinal, environmental, as well as, emergency response specialists is widespread and sufficient. Preparation programs should be introduced that allow the medicinal, environmental, as well as, emergency response specialists to prepare themselves in situations where a deadly epidemic has broken out (Rich Richardson. 2002).