A Common Sense Guide to Being Prepared

The shock of the September 11 airplane attacks has made the improbable and the catastrophic suddenly seem possible. Crop dusters have been grounded for fears of a biological attack. Guards are posted at many city reservoirs. Trucks are being inspected on their way into New York. But some scenarios are more likely than others. That's why we've assembled this guide to help you sort out the threats for yourself and see what precautions people are taking. The possibility of any of these things happening is extremely remote. Even assembling the needed biological or chemical agents would require far more organization, money and expertise than was evident on September 11. But, in the interest of being prepared for the unlikely and also calming down any unnecessary fears, here's what's being done, and what you can do. Smallpox It doesn't take an exotic virus like Ebola to transform the U.S. into a hot zone. A single case of smallpox could put the entire nation at risk. The smallpox virus is highly contagious and would spread quickly because Americans are not vaccinated. Routine inoculations were halted in 1972. People vaccinated before 1972 lost most of their immunity within 10 years. A terrorist who wanted to launch a smallpox attack, however, would probably have a very hard time getting hold of the virus. Smallpox was eradicated in 1980. Officially, only two stores of the virus exist, for research purposes, in secure locations in the U.S. and Russia. There may be covert stashes in Iraq, North Korea and Russia, but these countries would be reluctant to release them, fearing a smallpox epidemic among their own unvaccinated people. Even if a terrorist were successful in obtaining the virus, his plans could backfire: smallpox is so contagious that the first victims are likely to be the members of his own terrorist cell. Anthrax Many bacterial agents can be used as bioweapons, including Clostridium botulinum (botulism) and Yersinia pestis (plague). But anthrax stands out because its spores are particularly hardy; they are resistant to sunlight, heat and disinfectant, and can remain active in soil and water for years. Anthrax occurs naturally in both wild and domestic animalsincluding cattle, sheep and camels. Infection from direct contact with affected animals is fatal in 20% of cases. If inhaled, however, anthrax spores cause death in almost 90% of the time. Yet manufacturing sufficient quantities of any bacteria in a stable form is a technical and scientific challenge; plague bugs, for example, degrade within hours when exposed to the sun, and anthrax spores tend to clump together in humid conditions. The Japanese cult Aum Shinrikyo sprayed anthrax and botulism eight times over parts of Tokyo without effect. Despite all the attention being given crop dusters, using one to spread germs is not as easy as it sounds. The planes are designed to spray pesticides in heavy, concentrated streams, whereas bioweapons are ideally scattered in a fine mist over as large an area as possible. The nozzles in

crop dusters are best suited to discharging relatively large particles 100 microns in diameter not tiny one-micron specks of bacteria. Sarin Unlike biological agents, which are living organisms that require proper conditions to survive, chemical weapons such as the nerve gases sarin and VX are relatively easy to acquire and stockpile. Chemicals are difficult to manufacture in sufficient quantities for a large-scale attack, however; more likely are isolated assaults such as the 1995 sarin attack on a Tokyo subway that injured thousands and killed 12. Reservoirs Poisoning your enemy's well is an ancient tradition, but would-be terrorists would find it extremely hard to inflict widespread casualties through our water supply. Chlorine in treated water kills most microbes, and huge quantities of chemical toxins would have to be dumped into a reservoir to make many people sick, let alone kill them. (A U.N. study estimated that it would take 10 tons of potassium cyanide.) Drinking water might be threatened locally, however, if someone managed to tap the pipe going into a building or neighborhood or infiltrate a watertreatment facility. With this threat in mind, municipal water authorities have stepped up security. Dams If poisoning the water supply doesn't work, terrorists might try to cut it off or disrupt it. On an even grander scale, they might blow up a dam, causing widespread flooding damage downstream. Compounding the impact would be the loss of hydroelectric-power generation. With security beefed up at major dams across the country, however, especially at landmark behemoths such as Hoover and Grand Coulee dams, it would take a very determined effort to carry out such an attack. Chemical plants some 850,000 facilities in the U.S. handle hazardous chemicals. Many substances that have benign industrial uses, such as metal cleaning or photo developing, can in theory be turned into dangerous weapons. But gaining access to plants, either for sabotage or to get raw materials, is difficult. Employees handling hazardous materials undergo security background checks, and chemical manufacturers across the country last week were double-checking their employee rolls. Since Sept. 11, most facilities have barred outside visitors and allowed only authorized personnel to enter. Trucking companies dangerous chemicals are most vulnerable to interception while they are being transported. Today 2.5 million Americans have commercial driver's licenses to carry fuels and other hazardous materials. Truckers must pass two tests: the federally mandated 30-question multiple-choice test (states can add more questions) to obtain a commercial vehicle license and a separate test on the

procedures for safely handling hazardous substances. After the arrest of about 20 people suspected of fraudulently obtaining haz-mat licenses, chemical companies tightened their transport policies, assigning two drivers to every vehicle and using satellite tracking systems to monitor haulers from pickup to drop-off. Salmonella as oregon's rajneeshee cult demonstrated in 1984, it is not difficult to set off a wave of food poisonings. Indeed, gastroenteritis caused by natural contamination and careless food handling afflicts millions and results in 5,000 deaths each year. The Rajneeshees considered a number of different viruses and bacteria, including those that cause hepatitis and typhus, but decided for their purposes (disrupting the outcome of a local election) on a strain of salmonella that would be debilitating but not fatal. Salmonella poisonings tend to be localized. With proper hygiene, the bacterium is not particularly contagious. E. coli an even easier bug to obtain is the familiar intestinal parasite E. coli. Naturally occurring outbreaks of E. coli, typically the result of fecal contamination in everything from hamburgers to swimming pools, sicken hundreds of thousands of Americans each year. In New York City this spring, a man was arrested after he was spotted spraying what turned out to be feces-laden water over the contents of a midtown salad bar (fortunately, no one got sick). A far more virulent strain of the bacterium called O157:H7 is sometimes fatal, but identifying and isolating the right strain is beyond the technical capabilities of most terrorists. Foot-and-mouth disease A terrorist attack aimed at crops and livestock would be less dramatic but might cause more disruption in the long run. Such attempts are not unheard of. In World War II, Britain accused Germany of dropping small, cardboard bombs filled with beetle pests on English potato fields, and in the 1980s Tamil militants threatened to target Sri Lankan tea and rubber plantations with plant pathogens. Perhaps the most worrisome threat to U.S. agriculture is foot-and-mouth disease, which can spread with astonishing speed in sheep, cattle and swine. Not seen in this country since 1929, the disease is harmless to humans but renders farm animals economically worthless. The U.S. could be forced to destroy much of its own livestock, as Great Britain had to do earlier this year. Car, truck and backpack bombs Exotic weapons get a lot of attention, but conventional explosives and suicide bombers in pizza parlors, discothques and shopping malls can spread terror with stunning effectiveness. Fertilizer bombs like the one that destroyed the Alfred P. Murrah Federal Building in Oklahoma City, Okla., in 1995 could wreak havoc with bridges, tunnels and buildings. Nuclear-power and chemical-manufacturing plants make even more horrifying targets. The 1984 leak at the Union Carbide plant in Bhopal, India, may have killed 3,000. Estimates of the final death toll from the 1986 explosion in the Chernobyl nuclear plant run as high as 30,000.

Nuclear weapons The ultimate nightmare would be terrorists in the U.S. wielding nuclear weapons. For this reason, the ability to create or worse, steal or buy weapons-grade plutonium has long been an issue of great concern and international intrigue. Fortunately, the practical difficulties in acquiring precisely the right materials, not to mention the engineering know-how to jerry-build a nuclear device successfully, makes this type of threat highly unlikely. Germ warfare has been around since at least the Middle Ages, when armies besieging a city would catapult corpses infected with the black plague over the walls. Today the bugs authorities most fear are anthrax (a bacterium) and smallpox (a virus). Both are highly lethal: the former kills nearly 90% of its victims, the latter some 30%. Anthrax is not communicable; smallpox, on the other hand, can be transmitted with horrifying ease from one person to another. "The feelings of uncertainty, of who is infected, of who will get infected, are the main advantages of biowarfare," says Stephen Morse of the Columbia University School of Public Health. During the cold war, both the U.S. and the Soviet Union began developing anthrax as a biological weapon. Today 17 nations are believed to have biological weapons programs, many of which involve anthrax. Officially, the only sources of smallpox are small quantities in the labs of the Centers for Disease Control in Atlanta and at Vector in Koltsovo, Russia. But experts believe that Russia, Iraq and North Korea have all experimented with the virus and that significant secret stashes remain. Even more worrisome are reports that Russia used genetic engineering to try to make anthrax and smallpox more lethal and resistant to antibiotics and vaccines. (The U.S. put a similar program on hold.) Why not just vaccinate every American against every possible germ-warfare agent? That would be impractical, if not impossible, and the side effects of the inoculations would pose a significant health risk. Instead, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, we should strengthen the country's public health system. After Sept. 11, hospitals in New York City were asked to report any outbreaks of unusual symptoms. Health experts know that in the event of biological attack, the earlier an epidemic is detected, the easier it is to contain. Experts in antiterrorism share their concern. At the turn of the past century, says Brian Jenkins of the Rand Corp., epidemics of diseases like yellow fever and cholera kept health workers on their toes. Now, after a decade of cutbacks, "our ability to treat large numbers of casualties has been reduced," he says. "The notion of reinvesting to create a muscular public health system is not a bad idea, even if there is no terrorism." General Safeguards

All cropdusters have been temporarily grounded. The CDC maintains and can expand a national pharmaceutical stockpile with antibiotics, vaccines and antidotes for many biological attacks. You can stock up on a few emergency items, including bottled water, storable food, batteries, flashlight, antibiotics, a portable radio and face mask.

Nightmare Scenario: Untrue Anthrax is a deadly but non-contagious soil bacteria. The nightmare scenario found in a chain email currently making its way around the Internet states: 100 grams of anthrax properly dispersed downwind over Washington, D.C., for example, could kill between 150,000 and three million people in the surrounding areas. The reality is more benign; the Johns Hopkins Center for Civilian Biodefense Studies says this scenario would actually require 100 kilograms and only those directly exposed would be infected. Hospitals would initially notice an epidemic of cold and flu-like symptoms, deteriorating into severe breathing problems and then death in those not treated with common antibiotics. Safeguards

Anthrax is not contagious. It requires direct exposure, which is difficult to effect on a mass scale. Anthrax is hard to produce safely. Japan's Aum Shinrikyo cult built high-tech labs but failed repeatedly to grow significant quantities of active spores. The Soviet Union, which is reported to have stockpiled thousands of gallons during the Cold War, had its own production problems, resulting in one 1979 accident that killed 68 people. Iraq armed missiles with anthrax in the Gulf War, but experts have noted that Iraq's biological arsenal probably would have been militarily ineffective because it was small and inefficiently organized. There's a vaccine. Special units of the U.S. military are inoculated. It's not currently available to civilians. BioPort, the company that produces the vaccine, tells callers "Every dose is being used or reserved for the American armed forces." According to reports, the U.S. government is now looking at creating a national stockpile. Dr. Luciana Borio of the Johns Hopkins Center for Civilian Biodefense Studies says that doctor education is key, so that emergency rooms can detect anthrax outbreaks and begin antibiotic treatment. Even if individuals store Israeli-style anthrax kits or antibiotics, they should still get treated at a hospital. Gas masks are only useful if there is advance warning.

More Information

CDC Anthrax FAQ General information and frequently asked questions about Anthrax DoD website for Anthrax Vaccine Immunization Program Official Anthrax Immunization site (Flash required) Center for Civilian Biodefense Study Anthrax Report Helpful fact sheet from the Johns Hopkins Center with links to other information about biological threats

Hypothetical Exercise In June 2001 anti-terrorism authorities held war games, called Dark Winter, to simulate a

deliberate aerosol release of smallpox in three U.S. states. Such high level players as former U.S. Senator Sam Nunn and James R. Woolsey, former director of the CIA participated, and did not fare well: In the scenario, highly-contagious disease spread to 25 states and 15 other countries within two weeks as the players failed to establish effective quarantines and current vaccine stockpiles proved inadequate. The Dark Winter exercise has alerted public health officials of the need to promote early detection and the importance of isolating infected individuals, monitoring contacts, and instituting a selective vaccination program. Safeguards

In 1980 the World Health Assembly declared that smallpox has been eradicated. Only two labs in the world officially store smallpox samples, in Atlanta and Koltsovo, Russia. It is possible that these are the only remaining samples. The smallpox vaccine is effective, even up to four days after exposure. Fifteen million doses of smallpox vaccine exist in the U.S. The CDC recently ordered 40 million doses of a new vaccine that will be available in 2004.

More Information

CDC Smallpox Page General information and frequently asked questions about smallpox New Yorker: The Demon in the Freezer Article on smallpox as terrorist threat from July 12, 1999 Center for Civilian Biodefense Study Smallpox Report Helpful fact sheet from the Johns Hopkins Center with links to other information about biological threats

Likelihood: Very Unlikely In March 2001 the Journal of the American Medical Association published a report speculating about the effects of an aerial spraying of anthrax. The same article named intentional contamination of the U.S. food supply as another bio-terrorism concern. The report also pointed out that Aum Shinrikyo, the terrorist group responsible for the release of sarin in a Tokyo, Japan, subway station in 1995, dispersed aerosols of anthrax and botulism throughout Tokyo on at least 8 occasions. For unclear reasons, the attacks failed to produce illness. Safeguards

Botulism is not contagious. It requires direct exposure, which is difficult to effect on a mass scale.

Botulism is treatable. In the past 50 years the proportion of patients with botulism who die has fallen from about 50% to 8% because of improved medical care in intensive care units. The CDC maintains the national botulism anti-toxin supply, and offers clinical consultation around the clock to physicians. A network exists to identify all incidences of botulism. New technology may be useful in quickly expanding the supply. A botulism vaccine is available. Widespread vaccination, however, would end medical uses of the toxin for treating migraine headaches, back pain and cerebral palsy.

More Information

CDC Botulism FAQ General information and frequently asked questions about Botulism WebMD: Botulism Facts about botulism and the botulinum toxin. Center for Civilian Biodefense Study Botulism Report Helpful fact sheet from the Johns Hopkins Center with links to other information about biological threats

Likelihood: Not Very Likely During the Cold War both the U.S. and the Soviet Union worked to develop methods of aerosolreleasing (spraying) plague bacteria into the atmosphere. A terrorist could do this with a crop duster airplane, a spray bottle or a variety of other methods. A 1970 World Health Organization report estimated that a city of 5 million sprayed with 50 kilograms of plague bacteria would suffer 36,000 dead. Safeguards

Plague is almost 100% fatal if not treated within a day of the onset of symptoms but if it's caught early enough, modern antibiotics are quite effective. There's a vaccine available for bubonic plague (the "Black Death"), and a vaccine for pneumonic plague is currently under development. Plague is extremely contagious (it's spread through sneezes of victims as well as bites from infected fleas), so isolating victims is an essential step in stopping the spread of the disease.

More Information

CDC Plague Homepage General information and frequently asked questions about pneumonic plague. Discovery: The Black Plague Follow the rat and learn about the history of bubonic plague Center for Civilian Biodefense Study Plague Report Helpful fact sheet from the Johns Hopkins Center with links to other information about plague threats

Likelihood: Extremely Unlikely A terrorist could deliberately infect himself with the Ebola virus and travel to a major city, seeking to spread the disease to its citizens (via sexual contact, sharing needles). Most people infected with Ebola die within a week, and suffer obvious, debilitating symptoms (including profuse bleeding from major body openings); thus any terrorist's "window of opportunity" to infect others would be brief. Given its gruesome symptoms and the relative difficulty of transmission, Ebola is perhaps more valuable to bioterrorists as a threat than as an actual weapon.

Safeguards

Ebola can spread from person to person, but only via the blood or other body fluids of an infected individual. Most victims to date have caught the virus while caring for other Ebola victims in unsanitary hospital settings. There is currently no known cure for Ebola; scientists combating the disease focus on educational prevention, such as raising the standards of hygiene in developing-world hospitals.

More Information

CDC Ebola Factsheet General information and frequently asked questions about the ebola virus. World Health Organization Fact Sheet: Ebola

VACCINES Preventing a disease is always better than having to cure it, but most of these vaccines were developed before bioterrorism emerged as a threat, and few are widely available BIOLOGICAL WEAPONS: AVAILABILITY OF VACCINES VACCINE'S DISEASE SYMPTOMS EFFECTIVENESS AVAILABILITY First signs of An early version Only to military inhaled of the U.S. vaccine personnel and anthrax may was 93% others whose resemble successful in jobs put them at Anthrax those of a protecting against high risk; common the disease. Full approved only cold; then treatment involves for healthy adults breathing six shots followed between the ages

problems, by an annual of 18 and 65 hemorrhage, booster edema and shock. Untreated, about 90% of cases are fatal Fever, chills, May prevent weakness, bubonic plague, Recommended shortness of but that is not the only for people breath, cough form of the disease who work with with bloody Pneumonic that would likely the plague sputum. If Plague result from a pathogen, not treated bioweapon attack. Yersinia pestis, early, rapid Pneumonic plague or in plagueonset of should be treated infested areas septic shock with antibiotics and death High fever, fatigue, Extremely severe Given prior to limited. Not headache and exposure, provides recommended backache, almost 100% since 1980, when followed by a protection against disease was Smallpox characteristic the disease. Still eradicated. The rash and effective up to four U.S. has a few deep, round days after million doses; 40 lesions. exposure million more on Highly order infectious Blurred vision, slurred Only on an speech, experimental difficulty basis for those swallowing, Believed effective believed at high progressive against five of the risk of exposure. Botulism muscle seven types of The standard weakness botulism toxin but treatment is to that spreads still being tested administer from head to antitoxin after toe, exposure paralysis, respiratory failure

Abrupt onset of high fever, followed by pneumonia, pleuritis and systemic Tularemia infection. Can lead to respiratory failure, shock or death. Highly infectious

Only given to Provides partial people who work protection against routinely with infection by tularemia inhalation or direct bacteria. Not yet contact. approved by the Antibiotics are the Food and Drug treatment of choice Administration

Face Masks In New York a lot of people bought face masks from their local hardware stores to deal with particles in the air. The more expensive ones filter out more particles: A N100 or P100 mask will do more than an N95 or P95, although they still filter out a good deal. They won't do much about a biological attack in your neighborhood but can help if you're 30 miles away from one. QCSupply has a good assortment of masks. Gas Masks The September 11 attacks led to a run on gas masks, most of which sold out in the first week. Don't feel too bad. Unlike obvious provisions such as food and medicine, gas masks are only useful in very specific instances. And even then there is unlikely to be enough advance warning to put one on. Nevertheless, the most important factors are a snug, airtight fit and a properly installed filter. There are half-masks that just cover the mouth, but it's a good idea to protect your eyes. Some filters are specialized, filtering out something specific like chemical gasses or nuclear dust. If you want to protect yourself from the most possibilities you'll need an NBC mask, which filters Nuclear dust, Biological entities and Chemical gasses and aerosols. At the newsgroup misc.survivalism there are big arguments over which gas mask is the best, but in the end it seems to be a matter of which one feels the best when you put it on. There are also other considerations; one guy didn't like the US Army M17 mask because he said it made firing a rifle more difficult. You can buy a gas mask designed for civilians for $25 to $35, like the popular Israeli Gas Mask (currently selling on Ebay for $75 and up) although there are $200 military masks which have features like straw adapters so you dont have to take them off to sip water. You can read the gas mask reviews of a guy named Grunt here. When buying a gas mask the most important thing is to check the expiration dates of the filters and the age of the masks itself. You'll need to check for leaks. One way is to get someone to dip a Q-tip in some banana oil, then have them wave it around your head while you're wearing the mask. If you smell banana then you don't want the mask. According to Maine Military, an Army surplus store, a gas mask won't do you the slightest bit of

good. Without knowing what chemicals are in the air and how often your filter needs to be changed, the mask is useless. Until September 11, Main Military mainly sold masks to kids who would use them as Halloween costumes or adapt them for use in smoking marijuana. Supplied Air Respirators Gas Masks won't work if there's not enough oxygen in the air, so the next step up is the Supplied Air Respirator. This is a hood that completely covers the head and a tube that runs to an oxygen tank. You can find one for $500 or so. The EPA has more on these respirators. Vapor Proof Suits One problem with gas masks is they don't protect the rest of your body, and chemicals can be absorbed through the skin. To protect against that you can get a supplied air respirator with a full body suit. You would need a vapor proof suit, which would run you around $1300. This is the kind of setup used by people who have to go into leaking nuclear power plants. In an emergency you'd probably be dead before you got the suit on, but if you want to feel you're as prepared as humanly possible this is definitely the way to go.