Panic -- The Real Enemy

Medically Reviewed by Gary D. Vogin, MD
From the WebMD Archives

Oct. 18, 2001 -- An alert nation nervously watches for news of the latest anthrax attacks. How safe are we? Pretty darn safe -- so far, says the Centers for Disease Control and Prevention.

"We are not experiencing a national outbreak of anthrax," the CDC's acting deputy director, Julie Gerberding, MD, tells WebMD. "The cases are limited to specific exposures. Most people have nothing to be concerned about."

There's no denying that the U.S. remains a target of terrorists. Also beyond doubt is that one of the most feared terror scenarios has come to pass -- the intentional unleashing of a deadly disease. Lost in the media furor over recent anthrax attacks is the fact that relatively few people actually have been exposed to the germ. And very few people have been infected. As of this writing, just one person -- whose case went unsuspected for weeks -- has died.

This doesn't mean there's no cause for concern. Far more deadly bioterror attacks remain possible, if unlikely. By taking sensible precautions and by acting responsibly, there's a lot you can do.

"Now it has become important for all Americans to learn a little more about anthrax -- both the [skin] and inhalation forms," Gerberding says. "The very first specific thing people should do is to pay a little more attention to things received in the mail. They should be alert for packages seeming suspicious."

To date, all recent anthrax attacks have come via contaminated letters or packages. Here's what to do if you receive a letter or package that you suspect contains anthrax or any other dangerous germs:

  • Do not shake or empty the envelope or package. Do not try to clean up any spilled powder or fluid.
  • Put the envelope or package into a plastic bag or other container to prevent the contents from leaking out. If you can't find a container, cover the envelope or package with clothing, paper, or a trash can -- and DON'T remove this cover.
  • Leave the room and close the door. Keep other people from entering the room.
  • Wash your hands with soap and water.
  • Call the local police and report the incident. If you are at work, call your building security officer and/or your supervisor.
  • Make a list of all the people who were in the room when you opened the letter or package. Give this list to the police -- and to local public health authorities.
  • Remove contaminated clothing and put it into a plastic bag that can be sealed. Give the bag of contaminated clothing to the police.
  • Shower with soap and water as soon as you can. Do not use bleach or disinfectant on your skin.
  • Do not start taking antibiotics until told to do so by your doctor or by health authorities.

Gas masks or respirators won't do much good once an exposure has taken place -- and it's much more likely that you or your children would be injured by improper use of gas masks than by a terrorist attack.

The only reason to begin taking antibiotics for anthrax is if authorities say you might have been exposed to the germ. Nose-swab tests, like those given to workers in the NBC building and in Congress, are only a way to track a potential epidemic. They cannot rule out anthrax exposure. A person who tests negative might still have been exposed. "There is no lab test for anthrax exposure," Gerberding says.

Only preventive treatment with antibiotics can keep an exposed person from developing anthrax. To prevent disease, these drugs must be taken after an exposure. In the absence of a suspected exposure, these medicines are more likely to do harm than good. Anthrax vaccine -- a series of six shots over the course of a year, with yearly booster shots -- is not recommended for, or available to, the public. New treatments and vaccines are in development.

Many bioterror diseases begin with the same symptoms as the flu. To reduce your worry -- and the very real chance of getting ill this winter -- the CDC recommends that people get their flu vaccine this year.

"People should get their flu shots," Gerberding says. "Now is the time to be especially compulsive about that."

Another good idea is for people to wash their hands regularly -- and properly. Use soap and warm water to scrub the hands for as long as it takes to say the ABCs. And remember to use a paper towel to turn off the faucet, and to open the door as you leave a public restroom.

Gerberding says there is no sign that any bioterror germs other than anthrax are currently being released in the U.S. However, the CDC has released a list of possible agents -- and the early symptoms of disease.


  • The most deadly form of this disease comes from anthrax spores inhaled into the lungs. Early symptoms are very much like those of the flu: fever, headache, shortness of breath, a cough, and chest discomfort. These symptoms may seem to get better -- but 2 to 4 days later, the symptoms get much worse. Breathing becomes very difficult, the cough is very bad, and chills accompany the fever.
  • The most common form of this disease comes from anthrax spores that grow on the skin -- most often on the hands, arms, and/or face. There is swelling followed by an itchy, fluid-filled bump. After a day or two, this gets bigger and becomes a painless, open ulcer. Tissue in the middle of the ulcer dies and dries into a sunken black area surrounded by swollen skin and purplish bumps.



  • Early symptoms of this deadly food poison are drooping eyelids, weakened jaw clench, difficulty swallowing or speaking, blurred vision, and trouble breathing. Nausea and vomiting accompany botulism poisoning when the germ is eaten, but these symptoms may not occur if the germ or its poisonous byproducts are inhaled.


Smallpox begins with the flu-like symptoms of muscle aches and fever. After a few days, a rash develops. This rash looks different than the rash of chicken pox. Chicken pox rash is usually most prominent on the body, and spreads in groups of bumpy lesions over the next few days, so there are bumps at different stages of development. Smallpox rash is most prominent on the face, arms, and legs, and its bumpy lesions all develop at the same time.


  • The inhaled form of tularemia begins with a sudden, flu-like disease. This gets more serious over the next few days as breathing becomes painful.

Hemorrhagic fever (can be caused by the Ebola or Marburg virus, among others):