Creative Way to Detect Germ Attacks
— -- Using Creative Tactic to Detect Germ Attacks
N E W Y O R K, Nov. 4 — Public health officials have developed an oddinterest lately in the mundane and arcane.
Epidemiologists are tracking orange juice sales at the localSafeway and poring over school attendance data. They're mappingevery case of the sniffles they can find and watching surveillancevideos to count how many times people sneeze.
The idea is that a sudden spike in everyday aches, pains,sniffles and coughs could signal the earliest stages of a healthcommissioner's worst nightmare — a massive biological attack. So inthe last few years, an increasing number of health departments havestarted collecting electronic data from hospital emergency rooms,pharmacies and other sources in an effort to gauge the overalllevel of illness in the population.
Epidemiologists call their new strategy syndromic surveillance,because it looks for increases in clusters of symptoms "syndromes" in medical jargon — rather than particular diseasediagnoses. In September, public health officials from around thecountry met at the New York Academy of Medicine to explore thepotential of using syndromic surveillance as part of a bioterroralarm system. The conference was organized by the New York Cityhealth department with help from the Centers for Disease Controland funding from the Sloan Foundation.
The new disease-tracking approach is also on the agenda at theAmerican Public Health Association annual meeting in PhiladelphiaNov. 9-13.
Last year's anthrax letter campaign was just "a tragicdry-run," Minnesota state epidemiologist Michael Osterholm toldhis colleagues on the first morning of the conference.
"Do not under any circumstances be surprised when the next shoedrops," Osterholm admonished. "It will drop."
And more than a year after the Sept. 11 attacks, the nationremains woefully vulnerable to terrorist attacks of all kinds, apanel on homeland security reported recently.
If it were to provide early warning of a bioterror attack,syndromic surveillance might avert massive casualties. Even some ofthe deadliest bioterror agents — including anthrax, plague andsmallpox — can be treated successfully if they are diagnosed earlyenough. But they also progress quickly from mild symptoms toserious illness to death, so hours count.
"There is the potential of a huge benefit if we really do getearly detection of a large bioterror event out of this," saidFarzad Mostashari, an assistant commissioner at the New York Cityhealth department.
Traditionally, health departments have relied on astute doctorsto identify bioterror attacks by diagnosis. That's how last fall'sattacks came to light — Dr. Larry M. Bush, a physician at JFKMedical Center in Atlantis, Fla., identified anthrax in asupermarket tabloid photo editor named Bob Stevens.
"We don't pretend that the technology can replace man or thatthis is the answer to everything," said Mostashari.
But doctors may not recognize such rare diseases as tularemia, Qfever or bubonic plague — all potential bioterror agents. And onediagnosis would not tell public health officials very much aboutthe scope, geographic location or timing of an attack. So tosupplement the eyes and ears of individual physicians, some publichealth departments now monitor everything from emergency roomvisits, 911 calls and doctor visits to school absenteeism and salesof cough syrup.
Public health has enjoyed a badly needed cash infusion in theyear since the World Trade Center and anthrax attacks. The Centersfor Disease Control and Prevention got $1.1 billion from Congressthis year to beef up bioterrorism defense. It is hard to sayexactly how much of that money is going to surveillance, but manyexperts believe spending a sizable chunk of it on warning systemswould be a good idea.
"For a long time it was very hard to get people to listen whenyou talked about public health surveillance," said MargaretHamburg, vice president for biological programs at the NuclearThreat Initiative, a Washington, D.C., think tank. "Surveillancesimply was not sexy and it was very poorly understood."
Until recently, some researchers were skeptical that anything soapparently trivial as cough syrup sales could indicate asignificant jump in illness. But researchers have shown that atleast with the annual flu season, there are a wealth of indicatorsthat people are getting sick.
Elaine Newton, a graduate student at Carnegie Mellon University,has done studies showing that orange juice and paper tissue salesincrease at the onset of flu season. She has also found thatInternet consumer health Web sites dealing with the flu get morehits a few days before a flu outbreak is officially announced.
Now Newton is exploring the seemingly far-fetched idea of usingsurveillance camera footage of public places to gauge the health ofthe population, perhaps even by counting coughs and sneezes.
Such notions naturally raise the issue of privacy. The currentsystems do not collect names or other identifying information, butCarnegie Mellon computer scientist Latanya Sweeney said anybody whoreally wanted to identify a person would probably be able to do soby combining data from the bioterror system with facts culled fromvoter rolls or some other public database.
New York has had a system since 1999. It analyzes informationfrom hospital emergency rooms, the 911 system and ambulancedispatches for sudden increases. The system also collects salesdata from city drugstores and absentee statistics from employersand schools as supplementary information.
Since June 2001, Seattle's public health department has analyzedreports from three emergency rooms and 11 primary care clinics. TheSeattle system also monitors 911 dispatches, which are availablevia the Internet by the city's fire department.
Baltimore even collects information on dog and cat deaths fromthe city's animal control department, and keeps track of schoolabsenteeism and over-the-counter cold medicine sales.
A system in western Pennsylvania collects information on everypatient who passes through the doors of 21 hospital emergencydepartments. It records the age, gender, home ZIP code, time ofadmission and chief complaint of each patient, and looks for suddenincreases in respiratory illness and other symptoms that mightindicate a bioterror attack. A version of the Pennsylvania systemwas also set up in Utah for the 2002 Winter Olympics, and has beenoperating there ever since.
Monitoring major public events for bioterrorism has become achallenging subspecialty for designers of these early warningsystems. In addition to the 2002 Winter Olympics, systems have beenset up for the 1999 World Trade Organization meeting in Seattle,both the Democratic and Republican party conventions in 2000 andthe 2001 World Series.
In October the Centers for Disease Control and Preventionawarded a $1.2 million grant to Harvard University researchers tobegin developing a national warning system that automaticallycollects information on the number of patients with flu-likesymptoms, strange rashes and other possible symptoms ofbioterrorism.
The New York health department knows its surveillance systemworks because it goes off all the time. A sudden increase in rashesat a particularly busy emergency room is much more likely to be arandom uptick than a smallpox attack. A rise in fevers and coughsduring November almost certainly means "flu," not "anthrax."
For example, New York's system issued an alert the day AmericanAirlines Flight 587 crashed on takeoff from JFK airport, two monthsafter the World Trade Center attacks. The two hospitals nearest tothe crash site were reporting an unusually high number of patientswith respiratory problems, a possible indicator of an attack withanthrax or several other bioterror agents.
When investigators checked with the hospitals, they discoveredthat the increase was due to a handful of factors, some related tothe plane crash and some incidental. There was one firefighter whohad smoke inhalation from responding to the crash, two cases offlu, three asthma attacks, two people complaining of chest pain andone person who appeared upon examination to be having an anxietyattack.
"We didn't really think there was a bioterrorism attack," saidMostashari, who is credited with setting up the New Yorksurveillance system.
Even so, he added, every suspicious pattern has to beinvestigated or the system won't work.
"We do need something to give us a sense of the pulse of thecity," said Marcelle Layton, an assistant commissioner at the NewYork Department of Health and Mental Hygiene.
For all its sensitivity, New York's system did not detect theanthrax attacks last fall. Layton and her colleagues do notconsider that a problem, however, because the system is designed todetect major airborne bioterror attacks. Last year's mail attackswere so limited that only one of the seven New Yorkers whocontracted skin anthrax from contaminated letters even visited anemergency room.
— The Associated Press
Suspicious Bag Prompts Airport Evacuation, Flight Delays
S A N J O S E, Calif., Nov. 4 — Three planes were evacuated, at least 56flights were delayed and hundreds of people were cleared out ofMineta San Jose International Airport after a suspicious bagslipped past screeners.
The airport's most serious security problem since the Sept. 11terrorist attack began when a piece of luggage tested positiveduring a routine swabbing for explosives. A second test of theluggage was negative and the passenger left the checkpoint with thebag.
When a supervisor was told what had happened, the alert beganSunday afternoon.
When screeners checked the explosives detection machine, theydetermined that almost 30 minutes had passed since the alarm hadbeen activated. At least one flight had departed before aTransportation Security Administration supervisor was alerted tothe security breach, police spokesman Joseph Deras said.
Once that plane landed in San Diego, all passengers wererescreened, officials said.
Security screeners randomly swab passengers' carry-on bags anduse the machine to test those swabs for explosives residue. Thesuspicious bag passed through the machine at 3:11 p.m. PST.Officials said things were back to normal by about 10 p.m.
The incident forced hundreds of people to be rescreened. "People are cutting in lines. It's very confused," said StevenBurright, who was waiting to board an American Airlines flight toLos Angeles. "They got caught with their pants down."
— The Associated Press
Medical Volunteers Train for Public Health Disaster
E U G E N E, Ore., Nov. 4 — Federal officials selected Lane CountyMedical Society as one of 42 groups in the country for ademonstration project using medical volunteers in a public healthdisaster.
The society received a $50,000 federal grant to establish alocal Medical Reserve Corps, a cadre of volunteers able to respondto catastrophic medical emergency including a bioterrorism attack.
About 200 applicants vied for the $2 million in initial yearfunding from the U.S. Department of Health and Human Services.
The Medical Reserve Corps units are made up of local volunteerstrained to respond to bioterrorism and other catastrophic events.Their responsibilities include emergency response, logisticalplanning, records keeping, assisting in public health and awarenesscampaigns and public communications.
The idea is to have a team to work in concert with existingdisaster response and public health officials during health crises,said Candice Barr, executive director of the Lane County MedicalSociety.
Volunteers also may help with local health campaigns such asimmunizations and health education and awareness throughout theyear. While the medical corps would be able to assist with naturaldisasters such as floods and earthquakes, its main purpose would beto respond quickly to a bioterrorism event, Barr said.
"Hopefully we'll never have a need for anything like that, butwe want to be in a position to respond," she said.
The medical corps would respond if, for instance, one of thelocal hospitals was overcome by infectious disease and had to beshut down, she said.
Barr said she hopes to recruit about 150 volunteers for theMedical Reserve Corps. She's looking for an interdisciplinary mixof doctors, nurses, pharmacists, medical office assistants andother health professionals.
The local team will be an outgrowth of a task force establisheda year ago in the wake of the Sept. 11 terrorist attacks and theanthrax attacks. The task force included local, state and federallaw enforcement officials, state and local public health officials,emergency responders, doctors and nurses.
— The Associated Press
Engineers Evaluate Designs to Seal Elevators in Disaster
F A R M I N G T O N, Conn., Nov. 4 — It's standard emergency procedure — incase of fire, use the stairs.
But officials at Otis Elevator Co. are hoping to change that.
In the wake of the Sept. 11 terrorist attacks on the World TradeCenter, engineers at Otis, a subsidiary of United TechnologiesInc., have been analyzing how well the building's elevators held upduring the attacks. And they're starting to grapple with complexquestions about how the destruction might influence the design anduse of elevators in all buildings.
They are evaluating designs that could seal elevator shafts tokeep smoke, fuel and water from spreading through a damagedbuilding.
They're also looking at technology that would let passengersdirectly control the movement of their car, rather than relying onoutside electronics that could be damaged by water or fire.
And they're analyzing the feasibility of using elevators forevacuations — something that's now discouraged because people couldbe trapped if power went out.
"Today's technology says stay put or use the stairs," ThomasW. Saxe, an Otis vice president, told The Hartford Courant. Butbecause of the World Trade Center, the Federal Emergency ManagementAgency is recommending that the "rules" be reconsidered forcertain types of emergencies.
"You can imagine lots of things," said Ray Moncini, head ofOtis' North American operations. "We don't want people to feellike they're going down 80 floors into a coal mine."
Richard K. Pulling Jr., senior manager for high-rise products atOtis, predicts that the first improvement will be a communicationsystem that helps tenants, building managers and firefighters getinformation during an emergency.
Ideally, firefighters will be able to use a computer to pinpointthe location of a fire or other problem, determine where survivorsare located and identify which banks of elevators are safe to usefor evacuations.
The system would also tell firefighters which sprinklers areactivated and where smoke alarms have gone off, said Edith L. DiFrancesco, Otis' vice president for product development.
"It's a question of getting information out quickly," shesaid.
Elevator companies will have to work with engineers in fieldsfrom electronics to ventilation to incorporate improvements intothe design of their equipment.
But changes could take years.
U.S. and global authorities need to reach a consensus onimprovements. It isn't clear yet whether those would be mandated bybuilding codes, something construction industry officials generallydon't favor. Authorities must also decide which changes — if any — will be required in existing buildings to help them withstandterror attacks.
— The Associated Press