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Bioterrorism: be alert, but not anxious, says city expert

By Brian Fitzgerald

Anthrax -- not the flu -- is the health threat that currently seems to be on everyone's mind. And Anita Barry, the director of communicable disease control at the Boston Public Health Commission, has been vigilantly preparing hospitals and public safety agencies to respond should a bioterrorism attack occur in the city.

Anita Barry says that the public should be more concerned with influenza than with anthrax. Photo by Kalman Zabarsky

Barry's department is spearheading Boston's Bioterrorism Surveillance Project, which every 24 hours downloads computer records from the emergency rooms of 11 hospitals. Its purpose is to monitor and notify city health officials of surges in the number of patients -- especially the ones with similar symptoms.

But the Boston Public Health Commission won't be just looking for evidence of biological warfare. Barry (SPH'88), who addressed present and future public health officials at a School of Public Health alumni breakfast at The Castle on October 16, is preparing for an outbreak of a far more mundane and well-known killer. "It's widely expected that over the next several years a new strain of influenza will arrive," she said.

Barry pointed out that her talk at BU on the city's preparedness was planned months before the September 11 terrorist attacks, but the subject has taken on a new sense of urgency because of the recent spate of anthrax infections. Still, three known fatalities (at press time) from anthrax in the United States do not qualify as an epidemic. Influenza, on the other hand, causes or plays a role in 20,000 deaths a year in this country.

New flu strains strike every 30 to 40 years, and the last one was in 1968, when the Hong Kong flu killed 34,000 Americans. When the next severe influenza epidemic hits, "we will have large numbers of people becoming ill," Barry said. "It will not be a bioterrorism event, but it will clearly cause a demand on public health professionals."

Barry said that she understands the public's fears about anthrax, but feels the media has contributed to the recent hysteria over a disease that is still not a widespread public health threat. Leaders in public health should spread the message to "be alert but not anxious."

Should a bioterrorist attack hit Boston, the city is prepared, thanks to funding from the federal Centers for Disease Control and Prevention (CDC) for several "tabletop" drills over the past two years, simulating outbreaks of pneumonic plague. These exercises have involved representatives from Boston area community health departments, hospitals, and schools, as well as officials from the Federal Emergency Management Agency and the Massachusetts Emergency Management Agency.

Boston Emergency Medical Services (EMS), a department of the Boston Public Health Commission that handles ambulance and prehospital care, is also prepared for an attack involving biological or chemical agents, as is the Boston Fire Department's Hazardous Materials Response Team (HazMat). "At this year's Boston Marathon, Boston EMS treated 1,400 people in two hours," Barry said. "It's really good at handling disasters." The city has ordered 40,000 doses of antibiotics for anthrax; the antibiotics are expected to arrive in several weeks.

What can complicate matters is the fact that anthrax has flulike symptoms, although the Boston Health Commission is on the lookout for "any unusual clusters" and suspicious cases. Healthy young patients with severe fevers and breathing problems "will raise red flags," she said.

During the question-and-answer period, an audience member inquired about the ability of Boston hospitals to handle a bioterrorist attack considering a recent report from the General Accounting Office concluding that already-crowded emergency rooms in metropolitan areas may not get the necessary medical reinforcements for up to 72 hours. This is a concern, Barry responded, mentioning a training video for nurses showing victims of the 1995 release of sarin gas in the Tokyo subway system by the Japanese cult Aum Shinrikyo. "It showed people descending on the hospitals," she recalled. During a similar scenario in Boston, she said, elective surgeries would be canceled and armories would be converted into temporary hospitals.

Barry pointed out that public health officials will play a crucial role if such an event occurs in Boston. "Everyone is going to turn to the health department and ask, 'How many people have been infected? How many people have died? Does it look like it's getting better? Does it look like it's getting worse?' " she said. "As wonderful as the medical institutions are in Boston, none of them are going to get the citywide picture."

Nonetheless, Barry feels that the anthrax scare is still pretty much a media-driven crisis. At present, the odds of being infected with anthrax are extremely low. At a City Hall press conference on bioterrorism in early October, she said, "One reporter -- God bless him -- stood up and asked, 'As a public health professional, what's more of a concern right now for the public, influenza or bioterrorism?'"

Barry's answer, of course, was influenza. "Public health professionals have got to spread the message to put the fear of bioterrorism in the proper perspective," she said.

26 October 2001
Boston University
Office of University Relations