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Coping with bioterrorism

The terror attacks on the World Trade Center in Manhattan in 1993 and the Federal Building in Oklahoma City in 1995, together with the Sarin attack on the Tokyo subway in 1995, have forced upon America an unwanted awareness of its vulnerability to terror attack. So far there have been no biological attacks within the United States, but many feel that this may only be a matter of time. Recently the Institute of Medicine and the National Academy of Sciences have made recommendations for research that would help in managing chemical and biological terror attacks against the civilian community.1

There are specific problems that are unique to biological attacks. Firstly, whatever the agent, and however it is delivered, there will be time lags between exposure and onset of the first symptoms and the development of the full blown disease. Thus the disease will be dispersed before we become aware that an attack has occurred (assuming no public announcement by the terrorists). Since the population exposed in a large community will approach the health system in many different ways there may be no clumping of cases to trigger awareness of an attack.

Secondly, the early manifestations caused by virtually any of the biological agents will look identical clinically. It is currently impossible to distinguish viral from bacterial disease until a specific organ pathophysiology declares itself, and this will probably be true also for a biological weapon. Moreover, …