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    Antidote to Terrorism: Preparedness

    Public Health Experts Plan for the Unthinkable

    Easier Said Than Done

    It is somewhat reassuring to know, say public health experts, that most biological agents are difficult to convert into weapons that can do large-scale damage, and they usually require special laboratory techniques and equipment to make them into a form that is easy to spread through the air.

    For example: The CDC notes that in the anthrax scare of autumn 2001, only 22 people were infected with either the inhaled or skin (cutaneous) form of anthrax, and there were only five deaths, despite the fact that 85 million pieces of mail passed through the processing centers in New Jersey and the District of Columbia through which the contaminated envelopes also traveled.

    As the HHS official told WebMD, it would take massive quantities of biological agents to even begin to contaminate a large municipal reservoir, because the toxin would otherwise be highly diluted and therefore very weak. Even then, the disease-causing agents would probably be killed by chlorination or filtered out of the water through the normal treatment process.

    Similarly, the HHS expert said, poisoning of the food supply would have to occur fairly high up in the chain of production, such as a processing plant, for an intended biological weapon to have a large-scale impact.

    And even such highly contagious and deadly agents as smallpox, while terrifying, can be contained if doctors remain vigilant for signs of infection and public health measures such as quarantine and vaccination are set into motion at the first sign of trouble, infectious disease experts say.

    Be Prepared

    The Department of Homeland Security recently issued terrorism-preparedness guidelines that mirror natural disaster-readiness guidelines. The agency recommends that citizens have adequate supplies of food and water, battery-operated flashlights and radios, but also duct tape and plastic sheeting for sealing off windows and doors and presumably sealing out infectious agents or chemical contaminants.

    Public health experts, the people who will be at the frontlines of any major public health alert, emphasize that anti-bioterrorism efforts involve far more than emergency response teams, ambulances, and vaccination programs.

    "While people are intrigued by the rocket-science nature of biological weapons and whether it's a virus or chemical, sometimes we are killed by the very basics -- this person didn't know the phone number for that person, and didn't call them," says Deborah Prothrow-Stith, MD, professor of public health practice at the Harvard School of Public Health.

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