The deaths of two postal workers whose anthrax symptoms were too long mistaken for flu is a troubling omen for the days ahead. As flu season approaches, the responses of a national health system forced into a steep bioterrorism learning curve will be tested as never before, and public confidence in that response will play a critical role in limiting the impact of this terrorism - or in making it worse.
By failing to test postal employees quickly in areas where workers could have handled anthrax-contaminated letters, health officials - particularly at the Centers for Disease Control and Prevention, which is charged with meeting such national health emergencies - have shaken that confidence. But efforts to meet this sudden and complex challenge have steadily gained momentum, and criticism of the CDC is premature.
The threat of bioterrorism has drawn attention in America, but resources to prepare responses have been limited. In 1999, the Journal of the American Medical Association published a study of the issue by the Working Group on Civilian Biodefense, and this June a bioterrorism exercise at Andrews Air Force Base simulated a smallpox attack on the United States. Among the lessons was the realization that mechanisms for the rapid flow of information don't exist in the medical and public health systems, noted the Center for Civilian Biodefense Studies at Johns Hopkins University.
The failure to test and intervene in time to save postal workers in the Washington area, though, simply may stem from inexperience in actually facing such unprecedented attacks. Health and postal officials mistakenly assumed that if a smaller mail processing center closer to the Capitol Hill target tested negative, sufficient spores to produce deadly inhalational anthrax weren't likely at the main center one step farther back - especially since no previous inhalation case had involved unopened letters.
Those assumptions proved tragically wrong, but that's hindsight. And even historical records provide mixed guidance: The accidental release of anthrax spores from a Soviet military germ warfare facility in 1979 caused 68 civilian deaths downwind, but the Japanese terror group Aum Shinrikyo released aerosol clouds of anthrax and botulism throughout Tokyo on at least eight occasions without triggering any disease.
The CDC might be faulted more properly for its slowness in taking center stage in what is clearly a national health emergency. Instead of its initial behind-the-scenes investigation in Florida and later in New York, New Jersey and Washington, the agency should have seized a more public role in keeping the nation briefed and easing the fears that have proven more contagious than the disease itself.
That role must be played now, and it won't be easy. "They have to deal not only with the response to the health emergency, but also with leadership and guidance at the national level," noted Dr. Anthony J. Billittier IV, Erie County health commissioner.
The $1.5 billion emergency package sought by the Department of Health and Human Services would ease some of the problems, although it's targeted mostly at stockpiling vaccines and other supplies, and offers only a start at bolstering the "front line" preparedness of local health agencies.
In the meantime, it's not surprising that hospitals, and even the victims themselves, mistook anthrax symptoms for the flu, especially since doctors in at least one case didn't even know their patient was a postal worker who might have been exposed. The diagnosis is difficult, but must be made quickly. And that triggers another concern - the number of actual anthrax exposures remains small, but the onset of flu season could trigger panic and demands for antibiotics like Cipro, many of which carry their own health risks.
Health officials - and patients - are in a new world. And while those health officials should be held accountable for their actions, we need to remember that it's difficult to immediately steer the correct path in uncharted waters.