Bioterrorism expert Michael T. Osterholm, peppered discussion participants with questions about how to respond to an anthrax attack.
Thinking the unthinkable: Imagining bioterrorism at the U
Imagining bioterrorism at the U
By Robert Roos
Published on August 5, 2004
"How would you dispose of the carcasses?" asked bioterrorism expert Michael T. Osterholm, referring to dead cows and addressing his question to Jeff Bender of the University of Minnesota College of Veterinary Medicine.
Bender looked him in the eye and responded, "Could you ask an easier question?"
"That was the easy one," Osterholm replied with a smile.
On this particular day, Osterholm, director of the University's Center for Infectious Disease Research and Policy (CIDRAP), was asking the tough questions. Fielding the queries was a diverse group of about 20 officials and specialists from the University and local, state, and federal agencies. Their task during the exercise was to think hard about how they would deal with a hypothetical release of deadly anthrax spores at the University.
Four or five years ago, many might have scoffed at the exercise as a waste of time. But the landscape changed in October 2001, when a still unidentified person or group mailed letters containing anthrax spores to several media and government offices on the East Coast. The attacks killed five people and made another 17 seriously ill.
Their task during the exercise was to think hard about how they would deal with a hypothetical release of deadly anthrax spores at the University.In the exercise, the imagined anthrax attack unfolded in a series of six scripts that went into considerable detail about the cascading events and the reactions to them. Here is a summary:
The setupOn a June morning, University President Robert Bruininks receives a threatening letter from a group called Living Natural Lives. The group threatens "dramatic action" if the University doesn't stop all genetic and stem-cell research and all use of lab animals.
Thirteen days later, on a Tuesday, dairy cattle in a facility on the University campus in St. Paul start getting very ill. By midnight, three cows are dead. Early Wednesday morning, a pathologist studying samples from the cattle finds bacteria that look like Bacillus anthracis, or anthrax. Despite the efforts of veterinarians working through the night, 60 percent of the cows are sick or dead by 8 a.m.
By midday, the Minnesota Department of Health (MDH) reports that anthrax is the probable cause of the outbreak, and investigators are checking the feed and the ventilation system in the cattle barn. Workers and students who might have had contact with the barn are started on preventive antibiotics. Acting on a tip, a WCCO-TV reporter calls the University and the Health Department to ask about the situation.
Early Thursday morning, the MDH confirms that feed from the dairy barn has been laced with anthrax. That afternoon, a University researcher is admitted to a local hospital with a severe respiratory illness that looks like inhalational anthrax. All Twin Cities hospitals are alerted to be on the lookout for anthrax cases. By 11:30 p.m., nine patients with suspected anthrax have been reported, and one has died.
Questioning of the patients points to a research building on the University campus in St. Paul as the source of contamination. Late Thursday evening, University and FBI officials start planning to scour the building for anthrax spores. The next morning, lab tests confirm the diagnosis of anthrax for the sick people. Meanwhile, University police start receiving numerous reports of suspicious white powders and mysterious packages.
By three weeks later, 26 people have contracted anthrax, and four have died. Most of the cows in the dairy herd are dead of anthrax after eating contaminated feed; disposing of their carcasses has turned out to be a major challenge. Investigators have found the research building in St. Paul to be heavily contaminated from an apparent release of spores into the ventilation system. The barn and the research facility are closed for cleanup and will probably stay that way for months.
What next?The stated purposes of the exercise were to clarify the roles of the many players who would have to respond to a bioterrorist attack and to find areas where more planning is needed. Osterholm served as moderator and chief inquisitor for the drill, peppering the participants with questions after each script was read aloud. On the issue of disposing of the dead cows, Bender said they would pose a problem because it's illegal to haul anthrax-contaminated carcasses on an interstate highway, and the University does not yet have a "tissue digester" that would take care of the remains.
At the point in the scenario when people started showing up at hospitals with signs of inhalational anthrax, considerable discussion focused on how to decide who would get preventive antibiotic treatment.Kristine Petrini, assistant director of the Minnesota Board of Animal health, said the law would require that the cows be cremated. "We would have to partner with the PCA [Minnesota Pollution Control Agency] and others on that," she said.
Buddy Ferguson, risk communication specialist with the MDH, took exception to the third chapter of the scenario, in which nothing was publicly revealed about the anthrax outbreak until WCCO called the University at mid-afternoon Wednesday, the day after the cows started getting sick. "Ideally, I'd like to see us having gone public with something before it reaches this point," he said. Amy Phenix, director of the University News Service, agreed.
Osterholm was quick to ask who the leading spokesperson for the incident would be. Ferguson replied that the public information duties would probably be shared, with the University describing the outbreak and response and the MDH addressing the risk to public health.
At the point in the scenario when people started showing up at hospitals with signs of inhalational anthrax, considerable discussion focused on how to decide who would get preventive antibiotic treatment.
"This is a conversation we'd want to have with the University, with the CDC, and a number of other players. I'd set up a conference call," said Ruth Lynfield, MDH medical director for infectious disease control. She said participants would need to review the cases while looking at a map of the campus, so they could judge whether contamination was limited to the one research building or was more widespread.
"I would recommend setting up a mass vaccination clinic," Lynfield said, adding that the MDH has local caches of antibiotics used to treat anthrax.
A little later in the scenario, after investigators had determined that a research building was contaminated with anthrax, the problem of mapping the contamination in the building took center stage. Participants had to figure out who would go into the building to take samples for analysis and how they would go about it.
At the end of the exercise, participants reflected on what was learned. Frank Cerra, senior vice president for health sciences and chair of the Academic Health Center Emergency Response team, had a sober assessment: "I'd say we know we're vulnerable. I think we've come a long way in understanding where our risks are and in our emergency response planning But I think we're at best pre-novices, and I think we need to do two or three of these [exercises] a year."
Phenix said the scenario demonstrated to her the importance of personal relationships with other "agency communicators," given the multiple audiences at the University. She also reflected that, since the anthrax attack would be international news, the University's ability to handle the situation skillfully "would have long, long reputational tails."
Lynfield said the simulation showed "that the University has put some thought into how they'd set up an emergency operations center and that they have a person responsible each day to deal with the emergencies as they come up."
And Bender said the exercise already has stimulated fruitful discussions at the vet school. In fact, he said, if something like the scenario happened now, officials would know what to do with the cattle carcasses.