biological warfare: are we prepared?
by Jenny Bryan
Doctors in the UK now have access to extensive information about recognising and dealing with biological or chemical weapons attacks. A core group of around 350 health care staff have been identified for immunisation against smallpox and recently updated guidelines explain what to do in the event of deliberate release of smallpox, plague or anthrax organisms, botulinum toxin, or chemicals including nerve agents, hydrogen cyanide and ricin.
© Getty
As Professor Simon Wessely, from the Institute of Psychiatry, London, explains, the greatest impact of biological warfare is likely to be psychological rather than physical. Fear, anxiety and a loss of public confidence in government is what terrorists will be hoping for.
'The best way to overcome public fear is to provide accurate information,' he said.
During the ricin drama a few years ago, the Department of Health activated a pre-set system of e-mail alerts to hospital and GP groups which in turn alerted GPs, nurses and pharmacists. Full guidance on dealing with ricin and other agents can now be found on the Public Health Laboratory Service (PHLS) website. So there is no shortage of information.
ricin risk
Although there is no cure for ricin poisoning, experts agree that the chemical, made relatively easily from the seeds of the castor bean plant, isn't well suited for a mass attack. Putting it into an aerosol to attack a large number of people, for example, on the London Underground, would require large amounts of ricin and, unlike microbial agents, ricin can only be spread from person to person on contaminated clothing. It would be much more effective for targeting prominent politicians or other individuals and creating panic.
Fever, gastric upset and coughing are usually the first symptoms of ricin poisoning. If swallowed or injected, ricin almost immediately causes vomiting, diarrhoea and internal bleeding, followed by seizures and nerve damage. If inhaled, it causes severe breathing problems. Initial symptoms are followed by fatal kidney, liver and heart failure.
Treatment is focused on relieving symptoms and making people as comfortable as possible.
anthrax attack
Although the dozens of anthrax reports in the UK in 2001 proved to be false alarms, the bacterial infection remains a serious potential threat (see the abc of body under anthrax). It can be treated with antibiotics but, if there is a delay in diagnosis, lethal levels of the toxin produced by the bacteria can build up.
'Long after the organism has been killed off, the toxin is still doing damage, which is why it is so important to use antibiotics early and reduce the bacterial load,' explains Dr Alastair Miller, from Worcestershire Acute Hospitals NHS Trust.
Like the Liverpool postal workers caught up in one of the first false alarms in the UK, anyone suspected of being in contact with anthrax will be isolated and disinfected and then given prophylactic antibiotics while samples are tested. They should not expect to be sent to a hospital A&E department unless they are ill as, despite the fact that anthrax is not contagious, this could only spread alarm and add to queues.
what about botulism?
Although botulinum toxin is widely advertised as the most poisonous thing on earth, it is very difficult to concentrate and stabilise, explains Dr Miller. Products based on botulinum toxin, which are used in medicine to treat muscle spasms and in cosmetic surgery to reduce signs of skin ageing, are extremely dilute. And, even if some way could be found of getting the toxin into water supplies, the chemicals which are used in water treatment systems would inactivate the toxin (see the abc of body under botulism).
could plague be a killer?
Plague is caused by a bacterium transmitted by rat fleas. The last notified case in the UK was in 1930 but, worldwide, the infection is not as rare as might be assumed, with 5,000 cases reported in 1997. It can spread through the body from a flea bite on the skin (bubonic plague) or infect the lungs (pneumonic plague).
Fortunately, the plague bacterium can be destroyed by the same antibiotics as the anthrax microbe and, as with anthrax, should not be a significant threat as long as it is detected early (see the abc of body under plague).
the return of smallpox?
An outbreak of smallpox would have devastating effects as there is no effective treatment. Officially declared eradicated as a human infection in 1980, immunisation in the UK ended in 1974 when it was felt that the side effects, which include a small risk of a serious brain inflammation and a larger risk of skin rashes, outweighed the benefits (see the abc of body under smallpox).
The only known samples of the virus which causes the disease are carefully locked up in two laboratories, one in the USA and the other in the former USSR. But the possibility that terrorist organisations could have got hold of the organism cannot be overlooked.
The purpose of immunising key health workers against smallpox now is so that they can "ring vaccinate" people living in an area around any future smallpox outbreak to stop the infection spreading.
'We have no evidence of a specific threat of a smallpox attack on the UK. However, it is sensible and prudent to ensure that the NHS can deal effectively with any potential threat,' said health minister John Hutton in a written Parliamentary statement in December 2002. 'The Department of Health's primary strategy would be to contain and "ring vaccinate" around any outbreak. The teams of vaccinated health care staff are central to delivering this strategy,' he added.
unanswered questions
Despite the reassuring news that standard strains of anthrax and plague bacteria can be treated with antibiotics and that botulinum toxin can be neutralised by water purification procedures, there are still many unanswered questions about the type of biological weapons that terrorists around the world could have at their disposal.
The biggest question is whether anyone has managed to genetically modify anthrax, plague, botulinum or other microbes to make them harder to diagnose and treat or easier to spread. During the US anthrax scare in 2001, it was suggested that some of the anthrax samples sent in the post were treated to make them float in the air rather than sink to the ground, thus improving their ability to spread. Far more serious would be the successful production of a strain of bacterium or virus which is resistant to current antibiotics and anti-viral agents.
help and info
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organisations
Anti-Terrorist Branch
Hotline: 0800 789 321
Website: www.met.police.uk/terrorism/index.htm
Call the free and confidential hotline if you have any information about people or activities that could be linked to terrorism.
NHS Direct
Helpline: 0845 4647 (24 hours)
Website: www.nhsdirect.nhs.uk
The NHS is able to provide advice to the public regarding toxic material and public safety.
websites
Centers for Disease Control (CDC) and Prevention
www.cdc.gov
Serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion designed to improve the health of the people of the US. The site carries extensive information about anthrax and other diseases which could be used in biological warfare.
Preparing for Emergencies Website
www.pfe.gov.uk
The UK Government's official guidance on what to do in the event of a terrorist attack.
Public Health Laboratory Service
www.phls.co.uk
The 'Deliberate Releases' section features a range of information, pictures and guidelines on anthrax, botulism, plague, smallpox, and harmful chemicals including ricin.
Terrorism
www.homeoffice.gov.uk/terrorism
UK Home Office information on terrorism.
reading
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Chemical and Biological Warfare: A comprehensive survey for the concerned citizen by Eric Croddy (Springer-Verlag New York Inc, 2001) |
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Germs: The ultimate weapon by Judith Miller, Stephen Engelberg, William Broad (Simon & Schuster, 2001) |
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Super Terrorism by Yonah Alexander and Milton Hoenig (eds) (Transnational Publishers, 2001) |
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(March 2003, resources updated January 2005)
