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August 5, 2002

The 'halcyon days' of bioterror

Mary Loftus is associate editor of Emory Magazine

The 2000 National Republican Convention was in full swing, and Philadelphia was crowded with delegates from every state in the union. Gift shops were selling out of Beanie Baby elephants. Press tents surrounded the convention hall like bustling, brightly lit cities, complete with mess halls and Internet access and temporary studios for stations from CNN to MTV.

The New York Times had set up an entire newsroom, with reporters typing madly into laptops to meet deadline. Columnist Maureen Dowd wandered in, looking casually elegant and in her element.

I, on the other hand, was completely outside mine. For once, I wasn’t a journalist hanging out in the pressroom and scribbling down quotes and descriptions.

No, I was at the convention as a member of the Centers for Disease Control and Prevention’s antibioterrorism team, monitoring area hospitals for early signs that anthrax or smallpox or botulism had been quietly seeded into these unsuspecting crowds.

As one of six Knight public health journalism fellows at the CDC that summer, I had just completed a month of training with the agency’s new Epidemic Intelligence Service (EIS) officers—the elite “disease detectives” sent to investigate outbreaks around the world. We could now accompany public health officers into the field, although we were prohibited from reporting or writing about the agency’s investigations for the duration of the fellowship.

I was eager to go out as part of an investigative team and volunteered as soon as I heard about the Philadelphia assignment. I had just attended a workshop on the increasing threat of bioterrorism—strictly defined as the deliberate use by an individual, group or government of a virus, bacteria, fungi, toxin or chemical to produce death or disease for ideological, political or financial gain—and was curious to see what could be done to reduce the risk.

The convention was a prime potential target since most of the delegates would have returned to their home states by the first onset of symptoms, creating a devastatingly effective mode of dissemination. Delegates—like mosquitoes, birds or fleas—made perfect vectors for infectious diseases; the spread would be rapid and exponential.

As I walked into the small room at the back of the Philadelphia Department of Public Health (where the CDC team was set up), I wasn’t sure what to expect. A biohazard lab with petri dishes and centrifuge? A decon unit with portable showers and bleach? A team of doctors and nurses ready to head to hot spots?

Here’s what I found: a bank of computers, a stack of forms to distribute to area emergency rooms, and a statistician on Rollerblades. “I can make it to all the inner-city hospitals in 20 minutes,” he explained.

The computers were running data-analysis programs that would automatically sound an alarm if the information fed to them from Philadelphia ERs matched illnesses that could have been caused by bioterrorism agents. The problem is that early symptoms of bioterrorism are identical to early symptoms for just about any illness: lethargy, low-grade fever, cough, body aches, diarrhea.

Perhaps this was why, in the center of all the high-tech hardware, sat a bright red Santeria candle purchased from a nearby shop, labeled: “Protection from plague and pestilence.”
I asked one of the epidemiologists about the candle, and he grinned and shrugged. “We believe in incorporating local culture into our investigations,” he said. 

After entering some numbers into the computers, we walked to lunch at one of the shrines of epidemiology—the hotel where Legionnaire’s disease had been discovered. It was now (and I am not making this up) a mall food court.

Over fries and cheesesteaks, I got to know the members of the team, which was led by a young but widely respected doctor with experience in combating everything from meningococcal disease on airlines to malaria in Third World countries. He could also make very cool whale sonar sounds by holding a pair of government-issue walkie-talkie cell phones upside down next to each other, a skill for which he held a certain notoriety among the first-year EIS officers.

After lunch, we made hospital rounds. As public health workers, you always end up asking really busy people to do one more extra task, and all you can offer in return is that they will be contributing to the greater good of society.

Having once been an ER physician, our team leader knew we were doomed to low compliance on the forms we were asking the staff to fill out on every patient admitted. If we didn’t win them over, they’d see our green checklist as just one more piece of troublesome paperwork, and Patient Zero could slip right through the hospital corridor unrecorded.

So, at one of the busiest hospitals, our team leader had taken along a platter of canolis when he gave the stack of forms to the nurses. So far, compliance from that ER had been the highest yet. “Never underestimate bribing with food,’’ he said.

This was the same hospital to which 87-year-old Gerald Ford had been rushed when he had taken ill the night before at the convention. Later, we would see the green form that had been filled out on Ford, with “former president’’ listed for profession. The press was calling the hospital, waiting for word on his condition, which ended up to have been a mild stroke.

As part of the CDC team, I walked right in. But I wasn’t there for a news scoop. We were touring the decontamination unit, where several police officers had been stripped and showered earlier in the day after being sprayed with a colorful, strong-smelling solution by protestors outside the convention hall. It turned out to be paint and paint-thinner, but we were able to see how the decon system had worked in an emergency. The showers were set up for privacy, and baby shampoo was used instead of bleach.

“We were scrubbing people raw with bleach, when baby shampoo is just as effective for most contaminants,” one expert said.

Over the four-day rally, where George W. Bush was projecting his platform of “prosperity with a purpose’’ and vowing to “leave no American behind’’ to 45,000 party faithful, the CDC team never got near the convention hall.

That’s the irony of bioterrorism: it starts out silent and slow, so there’s little hope of blocking it at the source other than taking the same security precautions already in place at any large, VIP-filled gathering. But by the time it’s apparent that there has been an attack, hundreds of thousands of people may have been exposed.

Catching the subtle signs, the earliest cases, is vital, especially when the agent is infectious and spreads person to person like smallpox or the plague, instead of through direct contact, like anthrax or sarin gas.

I visited the convention for an hour one evening and was dazzled by the stadium seating, bright lights and cheering crowds. Although I sat in a press seat with a badge secured from a former colleague, I felt distant from the throng of reporters. They were looking for sound bites and anecdotal color; I was looking for viral hemorrhagic fever.

Long a CDC groupie, I relished my foray into this fascinating world where a ballpoint pen fitted with a vial of deadly germs could be a virulent weapon. But I was pretty sure we wouldn’t find anything.

After all, these were the halcyon days, before the difference between pulmonary anthrax and cutaneous anthrax was common knowledge in most American households. On this humid evening, just two Augusts ago, the threat of bioterrorism seemed as remote and unlikely as a tie in a presidential election.