Maine officials urge planning for bioterrorism

loading...

AUGUSTA – It was a fictitious bioterrorism scenario Maine Bureau of Health Director Dr. Dora Anne Mills described Tuesday at the Augusta Civic Center, but it caught the attention of more than 250 hospital and medical professionals.

An outbreak of the highly contagious smallpox virus had spread across the United States’ Eastern Seaboard. Its first appearance in Maine came when a patient went to a Bangor hospital.

Over a period of days, the crisis deepened: cases were diagnosed elsewhere in the state, quarantined hospital wings with separate ventilation were set up, hospital parking lots were transformed into makeshift triage centers, front line medical workers demanded inoculations before reporting for work and stores began to close.

The governor took to the airwaves. Executive orders diverted some anti-viral medications and other supplies from pharmacies and hospitals to locations where needed. Another executive order required the bodies of smallpox victims be cremated within 24 hours of death.

Gatherings were banned and people were encouraged to stay home. A ban on nonessential travel across state lines was contemplated.

“You may say the scenario described is unlikely and the harsh public health strategies implemented unnecessary,” Mills said. “I hope you’re right.”

But in the wake of Sept. 11, Mills and other health officials in Maine are keenly focused on better preparing the state for such an emergency, and they are describing scary scenarios designed to get emergency workers thinking about the complexities of contagious disease outbreaks. Next week, the Maine Medical Association will sponsor another conference on the topic in Concord, N.H.

Mills said doctors, emergency medical technicians, civil authorities and individuals need to come together to create better plans for handling possible terrorist actions.

“I believe our current system for handling bioterrorism or any other weapon of mass destruction incident at federal, state, and local levels needs improved capacity in order to be able to successfully face new challenges we are preparing for,” she said.

Smallpox is a contender for use by bioterrorists because it is highly contagious, kills about 30 percent of those infected and disfigures survivors.

Ironically, the World Health Assembly declared smallpox to be eradicated from the world in 1980. The defeat of the virus was considered a triumph of public health and vaccination efforts. But even as victory was declared, the U.S. and the Soviet Union maintained the virus. The Soviets grew large amounts of the virus for use in possible biological warfare.

Other biological agents that could be used by terrorists include various types of plagues, anthrax, tularemia and botulism, experts said Tuesday.

Mills said that even if a terrorist attack never comes, improving the state’s medical preparedness and communication plans would benefit Mainers by improved responses to problems like flu epidemics or ice storms.

She said the conference was organized “to help energize our healthcare delivery systems and the state against bioterrorism.”

Dr. Norman Dinerman, head of Eastern Maine Medical Center’s emergency department, said in an interview during a break at the conference that his mind was racing as the scenario, which he described as entirely possible, was depicted.

Even though Bangor’s hospitals have worked together to develop disaster plans, hearing the stark descriptions of potential problems and anxieties that would be created by a bioterrorism attack had him thinking about additional measures that could be taken in Bangor.

“By bringing these scenarios up it sparks you to find more creative solutions,” Dinerman said.

With an international airport, Bangor is vulnerable to people arriving with infectious diseases from overseas, Dinerman said.

As he listened Tuesday, he said he was contemplating the possible use of the hospital facilities at the old Loring Air Force Base as a place to take a plane to quarantine those aboard who might have been exposed to bioterrorism. Such a facility is a resource that could be put to use in such a situation, he said.

Before Sept. 11, there was little attention to medical warnings and papers about the United States’ preparedness for bioterrorism. Mills pointed up that a group of papers published in the Journal of the American Medical Association in 1999 was largely ignored.

Now, those same papers are being widely distributed. At the same time, the national news of anthrax and other threats has heightened anxieties.

“Clearly we’ve had an outbreak of anthrax phobia in Maine,” Dr. Kathleen Gensheimer, state epidemiologist, declared Tuesday. In the last two months the state has had 400 suspicious packages tested for anthrax. All the tests have been negative. But actual cases from Connecticut to Florida underscore the importance of expanding the scope of public health activities.

“These are not times when you can sit back and hope these instances just go away,” Gensheimer said.

Gensheimer and other speakers urged physicians to report suspicious illnesses or other unexpected situations to health officials quickly. The experts described what specific symptoms should trigger concern and how and where doctors should contact public health and emergency management organizations.

Gordon Smith, executive vice president of the Maine Medical Association, said in an interview at the Civic Center Tuesday that bioterrorism is one of his top priorities for the next year. He said even primary care doctors must make themselves more familiar with infectious diseases that they haven’t had much experience with.

“They need to know more than their patients,” he said. “We’re in new territory and the doctors are on the front lines.”

“Nobody before September 11 was interested in this and now it has catapulted into a huge issue,” Smith said.

He explained that the federal government wasn’t adequately prepared either. For instance, when the first anthrax cases came to light the suggestion was made that they might have been contracted from nature, he said.

Smith said the doctor who identified the first case has been called a hero by some. He said doctors may be busy but they need to be ready to understand the mental-health impacts of bioterrorism and be ready to diagnose viruses that they’ve never seen before.