If the Cincinnati region is targeted by terrorists in a biological or chemical attack, is local government ready to respond? To find out, The Cincinnati Enquirer submitted the following questions to a group of local professionals who have been working together to address local preparedness, response and recovery phases of emergency management. This team is tackling potential acts of domestic terrorism involving nuclear, chemical, biological, incendiary and explosive weapons. The group is part of a network of government and private agencies.

        Q. If Cincinnati had to deal with anthrax exposure such as the one in Florida, would there be enough resources to screen, test and provide antibiotics? What if thousands were “exposed” rather than the hundreds in Florida?

THE EXPERTS

• Malcolm P. Adcock, Ph.D., Health Commissioner, City of Cincinnati   • Tim Ingram, Health Commissioner, Hamilton County General Health District   • Jerome Lautz, District Chief, Office of EMS & Domestic Preparedness, City of Cincinnati Fire Division   • Donald A. Locasto, M.D., Assistant Professor of Emergency Medicine, University of Cincinnati Medical Center   • Don Maccarone, CEM, Director, Hamilton County Emergency Management Agency   • Colleen O'Toole, Ph.D., Vice President, Greater Cincinnati Health Council.

        A. Cincinnati has taken a regional approach to planning for terrorism under the federal Domestic Preparedness Program for Weapons of Mass Destruction involving Nuclear/Radiological, Biological, Chemical and Explosive/Incendiary Devices. A Metropolitan Medical Response System is being developed to provide treatment for large numbers of persons if needed. Local stockpiles of antibiotics and other supplies are being developed to provide initial response for more than a thousand persons and the National Pharmaceutical Stockpile can be delivered within 12 hours from one of six sites around the nation. This large cache of antibiotics, vaccines, other pharmaceuticals and supplies is sufficient to provide treatment for several thousand persons. Testing capability is available from the Ohio Department of Health, the Centers for Disease Control and Prevention and other federal laboratories across the country.

        If it is the size of Florida's, we can handle it. However, it is unlikely thousands of people could be exposed to anthrax due to the extreme difficulty of delivering an effective dose.

        Q. What is the worst threat if terrorists use biological or chemical weapons against us in Cincinnati? Which agents pose the greatest danger, i.e., are relatively easy to obtain and use, and are threatening to large numbers of people?

        A. Assuming the worst, smallpox would be the most dangerous, followed by pneumonic plague, since these are the agents that can be transmitted person to person. The plague bacteria would be treatable with antibiotics. The smallpox (a virus) would be more difficult to contain since we have no treatment for the disease. The hope would be that only 30 percent of the people coming in contact with a smallpox-infected person would actually contract the disease. And of that 30 percent, only 30 percent would have a fatal outcome. So one tenth of people exposed would die. We could treat with a vaccine and reduce the numbers infected. We could also rely on home quarantine to reduce the spread of disease. Look at how many people refused to fly after Sept. 11. So if you told people to stay home or risk smallpox — what would you do?

        None of the chemical or biological agents that top the lists of weapons of mass destruction are easily obtained or used. The chemicals of greatest concern are nerve agents, such as the sarin gas that was used in the 1995 Tokyo subway terrorist attack. This agent is not readily available, but the Aum Shenrikyo cult developed the ability to synthesize what they used in this incident. Anthrax and smallpox are considered of greatest concern. Smallpox is thought to be very difficult to obtain. However, the low immunity level across all populations, the ability of the virus to be transmitted from person to person and the high mortality rate warrant the high level of concern. Anthrax is also difficult to obtain and a terrorist would have to produce large quantities of specially processed spores and release the material as a specialized weapon in order to infect large numbers. Many believe that this would be difficult.

        The Aum Shenrikyo failed with anthrax even though they tried on two occasions.

        Q. Are local hospitals ready if our city is attacked?

        A. The Tristate's 27 hospitals with emergency departments all have disaster plans that include multi-casualty disasters. Almost all are connected by radio or phone to the Hamilton County Disaster Radio Network, to receive and report information to emergency responders in the field. Disaster plans and the radio system are regularly tested.

        In addition, hospital personnel participated in the Domestic Preparedness training course for hospital providers in May 1999 and have, through their professional societies such as the Association for Infection Control Practitioners, participated in ongoing training specific to terrorist incidents using various explosive, chemical, and biological agents.

        Most of these hospitals participate in the National Medical Disaster System, designed to assist an area whose medical system is overwhelmed. If we had more victims needing inpatient care than our hospitals could manage, the system would be activated and federal resources would be used to move victims to hospitals in other parts of the country. In fact, our hospitals began reporting their bed availability to FEMA immediately after the Sept. 11 attacks in case we would have been called upon to receive victims from New York or Washington.

        Finally, if needed, the National Pharmaceutical Stockpile of medications and antidotes would arrive here within 12 hours. Since it would take additional time to break down the stockpile and distribute it, we have begun negotiations with a regional pharmaceutical wholesaler to provide our area with a cache of medications that would be guaranteed within 2 hours.

        Although no organization or agency can prepare for any possible incident, the hospitals have been participating in Tristate terrorism readiness efforts.

        Q. Is our water safe? Is it tested for the agents terrorists are most likely to use?

        A. Most experts believe that large water supplies such as the Cincinnati Water Works are safe because of the large quantities of water processed that would require very large quantities of an agent that would be difficult to get into the system without being detected. Water suppliers are under the highest alert and have taken a number of security precautions to safeguard the drinking water supply, including lockdown of facilities and ongoing testing to rapidly identify contamination. If detected, the water supply could be shut down to quickly isolate and eliminate the problem.

        Yes, it is safe. Biological agents would not survive the water treatment and disinfection system. Treatment kills bacteria and other microorganisms every minute in order to make our water safe to drink. Besides that, the water would dilute any biological agent.

        Q. How do public health teams prepare when nothing is “unthinkable”?

        A. Public health authorities are planning for the worst case scenario involving biological agents. And while there are situations that could overwhelm resources, this is also the case when explosive and incendiary devices are used such as the attack on the World Trade Center. The collaborative network of local and state health departments is working with federal public health agencies to rapidly identify biological agents (we are currently able to test for Anthrax in a matter of hours). A broad network of electronic communication, and availability of large quantities of antibiotics and vaccines will provide our best defense.

        Each day the public health system in Hamilton County tracks 88 communicable diseases to determine any unusual disease incidence or outbreak. We systematically look for contagious diseases. We investigate the mode of disease transmission by confirming the diagnosis, verifying the disease, locating affected persons, providing those persons with information, looking for potential common modes of transmission among affected persons, confirming the original source of the disease, and providing the public with information about the disease along with prevention measures. While we may not have experience with all biological threats, we would follow the epidemiological methods used by public health for generations. These methods have been effective on a daily basis in controlling the spread of communicable diseases.

        Q. What can the public watch for and do?

        A. The public should be aware of unusual packages or other items, or activity that might represent a threat, and report those according to local guidelines. For example, many communities ask you to call 911. However, many calls have been received about materials found that may be unusual, but without any associated written or other indication of threat. We are asking people to use good judgment in asking for an investigation in order to not overwhelm the system and make it more difficult to respond to cases that may be a creditable threat.

        The public can prepare supplies, such as a radio with fresh batteries, flashlight and bottled water. We are not recommending individuals strockpile their own antibiotics or purchase gas masks. The antibiotic may not be the one you need and they outdate quickly; gas masks should be fitted to be effective, and may not be effective against all agents.

        The best thing for the public to do is realize how very unlikely it is for chemical or biological terrorism incidents of any magnitude to occur.

        In case there are problems with utilities, transportation or other services, people should always have on hand enough of the following for 72 hours: bottled water, food, regular medications, sanitary supplies, flashlight, a battery-operated radio to be able to listen for emergency instructions, a supply of batteries, etc.

        Q. If the federal government makes public health readiness a much higher priority in the war on terrorism, how would additional resources be used in our region?

        A. Increased funding for public health should be targeted at disease surveillance involving computer analysis of disease symptoms that may indicate an unusual illness and provide early warning of a terrorist event; epidemiological staff and training to provide more disease investigation capability to quickly track the source of an outbreak; clinical capability to assure staffing of emergency services for care to large numbers of persons; funding for equipment, pharmaceuticals and supplies that will have to be renewed over time; and ongoing training of personnel, including exercises of response plans.

        We also need support for ongoing training for police, fire, hospital, public health, and other emergency response personnel.

        Q. What can we do to prevent hysteria and an overload of health systems if people panic and flood emergency rooms with flu symptoms?

        A. Continue public education on flu and other communicable diseases in the community so people can determine for themselves how likely it is that they have a common disease instead of being exposed to a terrorist agent.

        Hysteria is a function of the press coverage. If the press relays the facts, as spelled out here, it should allay some of the fears the public may have.

        The media should not sensationalize an isolated incident. Accurate and timely information provided to the public will prevent overloading of the health system.

        Q. How fast can a possible "threat” be tested to prevent long quarantines?

        A. If the threat means exposure to anthrax, preliminary test results can be completed in 6-7 hours.

        Q. What else do we need to know?

        A. It is improbable that a terrorist event will occur in Cincinnati involving either a chemical or biological agent. However, the planning that is being done will prepare us to provide the best possible response to safeguard citizens. The same planning can also be used to more effectively deal with naturally occurring events, such as a more severe outbreak of influenza and natural disasters of all types.

        As a result of federal emphasis on domestic terrorism since 1996, the City of Cincinnati and Hamilton County have been receiving federal equipment grants, training programs and medical response programs offered to 150 major metropolitan areas.

        Would anyone be capable to successfully infect thousands of people? This is extremely doubtful. There are four steps to develop and deliver any biological agent: 1. Acquire the agent. 2. Reproduce the agent. 3. Make the agent weaponizable. 4. Actual delivery.

        Each of these steps is extremely difficult.

        We need to keep the extremely low probability of a chemical or biological terrorist incident in perspective relative to other risks we encounter every day and not let this very unlikely event incapacitate us.

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