A Report Card on our Public Health System
How Well Prepared Are We for More Bioterrorism?
By Joseph Waeckerle
The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
WebMD asked Joseph Waeckerle, MD, about the state of our public health system in the wake of the current anthrax threat. Waeckerle is a medical disaster specialist who has served on a task force for the Defense Science Board, led a task force for the Office of Emergency Preparedness, and currently serves as a consultant on emergency preparedness to the FBI and CDC.
Q: Dr. Donald Henderson, the director of the Center for Civilian Biodefense Studies who was recently appointed to advise HHS Secretary Tommy Thompson on bioterrorism, says, "I think it is difficult for me to exaggerate the deficiencies of our present public health capabilities." What's your opinion?
Waeckerle: Yes, Dr. Henderson and I have worked together in this area for a long time, and I'm very privileged as he is probably the foremost expert on bioterrorism in the western world. He is absolutely correct that we need to do a much better job in preparing the three critical components of our health and medical response to any bioterrorism incidents:
Each of these three critical components needs to be integrated into the national strategy and domestic preparedness and response plans educated regarding the current threats and funded to properly train and sustain their involvement.
Q: Physicians have told us that they received a brief stint of bioterrorism training in medical school, but since it's not been utilized, they have often forgotten it. How prepared are individual physicians around the country to identify these diseases, especially since so many begin with flu-like symptoms?
Waeckerle: I'm going to take a step back from this question so that I can develop the rationale for my answer.
Currently, our healthcare system has very minimal ability to detect and identify a bioterrorism agent. In fact, there are no environmental detectors currently workable and there are not very many rapid and reliable diagnostic tests for the pathogens that we are most concerned about.
Add to that the lack of a detection and management surveillance system, which should be an essential component of the public health system, and we must then rely on human intelligence. By that I mean we need to educate the new first responders of the 21st century for biologic warfare -- the emergency doctors, emergency nurses, and the EMTs -- to have a working knowledge of these rare diseases and maintain a high index of suspicion so that we can sound the alarm early on in a biologic incident in order to save lives and contain the agent.
Specifically, this requires a more in-depth education for the potential pathogens and their presentations during the emergency medicine residency programs and emergency nurse certification programs and the EMT educational programs. We can only hope that by educating these people we protect ourselves until technology provides us with rapid and reliable diagnostic tests and adequate detection and management surveillance systems. This should be a major focus of the Department of Health and Human Services strategy for the near future.
Q: From the sounds of that, you must believe that we are not very prepared to deal with bioterrorism at this time.
Waeckerle: I believe we are very prepared to deal with the threat from agents currently of concern, but we need to do a significantly better job because future incidents may present dramatically different than these anthrax cases we have all witnessed.
For example, right now there is a known source of infection in a known area of the country with exposed individuals mostly recognized by the epidemiologists currently managing this terrorist activity. What if we had a different dispersion technique affecting a much larger audience in different parts of the country? It would be hard to quickly identify the cases so that we could intervene in a timely fashion. The longer it takes to rapidly identify some of these agents, the more victims suffer and die and the harder it is to contain if it is a contagious agent. So while I feel we can respond appropriately to the incidents we face now, we have a much longer way to go to respond to large-scale attacks in the future.
Another problem will be the potentially very large number of patients that will overwhelm the capacity of local healthcare systems in this country. The hospitals operate in very difficult financial times today, and as a result they have no excess or surge capacity to properly care for an additional influx of patients with infectious diseases. Add to that that these infectious diseases are potentially contagious, and in some cases require a tremendous amount of critical supportive treatment resources, personnel, and specific drug treatments -- none of which may be readily available. Obviously, such challenges could easily overwhelm any community in America and must be addressed very quickly.
Q: Could you please expand on the concept of a "detection and management surveillance system?" By this, do you mean some sort of central oversight body that could manage and coordinate responses to several incidences simultaneously?
Waeckerle: Detection and surveillance systems are the focal point of future strategies. Technology is advancing so rapidly that better detection and surveillance systems will be available. In the meantime we continue to rely on our healthcare professionals and our public health system as discussed earlier. I am pleased the authorities have appointed Gov. Ridge because we needed a centralized oversight and management authority at the federal level. We have had in the past too many different programs that have been somewhat uncoordinated, fragmented, and redundant and therefore have not delivered the best product for the invested dollar. This is an often-asked question and should be of concern to our country.