Courtesy of www.usflag.org
MARK B. LEVIN, M.D.
JOHN M. COTTON, M.D.
TIMOTHY J. PATRICK-MILLER, M.D.
LOUIS J. TESORO, M.D.
HELEN M. ROSE, M.D.
THE PEDIATRIC GROUP, P.A.
66 Mt. Lucas
Road, Princeton, N.J. 08540-2733 tel: (609) 924-4892, fax: (609) 921-9380
website: www.pedgroup.com
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BIOTERRORISM and CHEMICAL TERRORISM I
October 10, 2001
We have received many inquiries regarding the risks of bio- and chemical terrorism and the recommendations for immunization and medical prevention. We agree with the Centers for Disease Control: the risk to anyone of us to be exposed and harmed by smallpox or anthrax wielding terrorists is very small. We are not convinced that terrorist organizations today have the capability of delivering these agents in any efficient manner whereby large numbers of people would be affected. We are convinced that the emergency response by the government would successfully prevent any epidemic of smallpox or anthrax.
Anthrax is an animal disease that can be transmitted to humans through inhalation of the dormant phase (spores) of the germs or through the handling or ingestion of contaminated animal or animal products. Because of animal immunization practices, the disease is uncommon in the U.S. Terrorists wishing to distribute live anthrax organisms would require sophisticated laboratory facilities with negative pressure rooms, vacuum hoods and airtight personal protection gear; it is more likely that terrorists handling the organisms would become infected and succomb before they could complete a distribution system. Person to person transmission does not occur. Anthrax spores are normally found in soil; the spores can cause disease only if inhaled. Airborne distribution of the spores would require control of wind currents (so as to assure deposit of the spores in the target location), a dispersion spray unit with sufficiently small apertures for distribution of microscopic spores (these currently do not exist to our knowledge) and some mechanism to assure inhalation of the spores by the target population before they settle on the ground where they are harmless. The CDC does NOT recommend the vaccine for anyone other than the military, nor is the vaccine available to the public or any community physician. The CDC does not recommend that physicians prescribe antibiotics for anthrax at this time. The CDC has enough antibiotics to prevent the disease in 2 million people exposed to anthrax, and the capability to rush it to a risk area within 12 hours. The regimen for antibiotic treatment for prevention of anthrax after exposure is twice daily medication (Ciprofloxacin or teracycline) for 60 days. Having a few doses available in the home would offer no benefit.
We are equally comfortable with the nearly non-existent risk of a smallpox outbreak. While smallpox is very contagious and it is frequently fatal, the disease has not occurred on the planet since the late 1970s. Unlike many other viruses, smallpox virus can not survive in animals or soil; it can only live in humans. The only known existing smallpox viruses are in deep freeze-dried storage in the U.S. and Russia. Notwithstanding the New York Times Science Times article of October 9, 2001, the virus is not easily available to terrorists. In the event that smallpox did re-emerge, the CDC has made arrangements to expedite production of a new vaccine supply. Currently, the CDC has stockpiled 20 million doses of the old vaccine. While this vaccine is not available to the public (this includes physicians), our government will be able to ship it urgently to an exposed area if necessary.
Fearful population here and abroad have been purchasing gas masks for their families. The chemical agents that could possibly be used for a terrorist attack are absorbed through the skin as well as through the respiratory tract. Even if the gas masks were effective (which many of them are not), protection would require airtight total-body suits. Other than affecting a small local group by hand held distribution, a terrorist would have the same difficulty with air currents that anthrax distribution would entail. Gas mask purchase does not seem to us to be a logical approach.
We are all concerned about the precariousness of the world's politics; we all would prefer pro-active settlement of grievances and peaceful coexistence with our neighbors. While apprehensive of terrorists and their violent unethical disregard for life, we must calmly and rationally consider all of our options. We should proceed in the most logical way to maximize our chances of sustained well-being. We encourage you to heed to science, knowledge and reason, and follow our experts' advise. Resist the temptation to succumb to panic. Stay informed, and take only effective and reasonable preventative measures to protect yourselves and your children from terrorist threats.
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