Are you ready?
Duct and cover? Government advice on terror and safety triggers both panic and skepticism
Nearly 17 months ago, the nation was shocked to learn that a Florida newspaper editor had died of inhalation anthrax, the first casualty in a bioterrorist attack that through the fall infected 22 people and killed five.
Last week, the government put Americans on high alert, warning that another biological, chemical, or radiological attack may be near. And for the first time, officials at the newly formed Department of Homeland Security issued guidelines to citizens for making themselves, their families, and their homes more secure. This week, DHS is beginning a national ad campaign to publicize those guidelines.
Terrorism preparedness has been ongoing for a year and a half. More than $1 billion has gone to state and local health departments and hospitals to develop plans, conduct exercises, hire staff, vaccinate, and more. Some state and local public-health labs have improved their testing capability. A national system to track disease outbreaks and monitoring for airborne biological agents is being put into place.
But at the same time, only a small percentage of the nation's first responders in police and fire departments have received any of the $3.5 billion in funding for preparedness training and equipment promised after the anthrax attacks. Nearly 80 percent of local health departments are reporting that they'll have to use all their bioterror funding--and some budgeted for other important public-health problems--to pay for costly smallpox vaccinations mandated by the president in December.
Bioterrorism experts say Americans are better prepared today than before the anthrax attacks. But how much better, for which threats, and how much individual citizens can actually do to prepare remain open questions:
1 How much do we know about the actual risk of a biological, chemical, or radiological attack?
Fortunately, building and deploying effective weapons of mass destruction remain very difficult. If al Qaeda operatives do pull off another terrorist attack on American soil, they will most likely use conventional explosives. The latest U.S. terror warning, however, is based in part on intelligence about a specific plot to use a radiological dispersion device, or "dirty bomb." But intelligence agencies have no proof that al Qaeda has ever successfully tested such a device.
Chemical weapons are sparking new concern following recent arrests in Europe that exposed plots to use cyanide gas and the poison ricin. But ricin, while often fatal, cannot be widely dispersed, and it is not clear if the terrorists have any way to effectively deliver cyanide. A biological attack could be particularly devastating, but U.S. intelligence officials believe that such attacks are even less likely because they are so difficult to stage.
While al Qaeda prefers spectacular, mass-casualty attacks like 9/11, it may settle for acts that are less dramatic but nevertheless terrifying and disruptive--exploding bombs in shopping malls or subways, for example, or even something akin to last year's Washington sniper spree. "Terrorists have learned how effective an attack of mass disruption can be," says Matthew Levitt, a former FBI terrorism analyst now at the Washington Institute for Near East Policy. "It's been a while since al Qaeda hit us here. And they want to."
2 How useful are the government's new guidelines in helping families prepare for a possible attack?
Most of the government recommendations issued last week are common sense and applicable to any disaster, natural or not: Stock water, batteries, a first-aid kit. But the one that most puzzled preparedness experts was the one that sent people scurrying to their hardware stores for plastic and duct tape to make "safe rooms." Indeed, by last weekend the duct-and-cover method had been dismissed by many as at least unnecessary and maybe unsafe. "It just doesn't seem to make a lot of sense," says Peter Katona of the Infectious Diseases Society of America's bioterrorism work group. Even in the highly unlikely event that an attack is instantly apparent, "you can't tape up every crack." Even if you could, he adds, the chemicals could permeate the plastic. Furthermore, though much has been said about going upstairs in case of chemicals and downstairs for radiation, experts point out that it's unlikely that the average citizen will even know the nature of the attack soon enough to make that choice.
Others of the recommendations are faulted more for being vague or obvious. For example, it is unquestionably good to have a family communication plan in place, including a point person that everyone should call. But communications experts add that you shouldn't count on your cellphones to make those calls. On 9/11, the cellphone system was quickly overwhelmed. Using a wireless phone's text-messaging features or a two-way pager may be the faster way to keep in touch.
3 It's likely that our kids will be in school when an attack occurs. Are the schools prepared?
The school may or may not be a good place to be, depending on the nature of the crisis--and also the level of preparation by the school. Virtually all of the nation's schools have some kind of disaster plan in place, but the plans may have been conceived with a tornado rather than a dirty bomb in mind. Well-prepared schools have three basic components: a trained staff, plans for a couple of days of shelter, and a system for communicating with parents. The custodian should know where, and when, to turn off the water and ventilation system. The school nurse should have three days of medication for children with serious disorders. The cafeteria should have two days of food and water for the children. Parents should know where to call, or log on, or listen for information about whether or not they should pick up their children. And while the principal is ultimately in charge, "three deep" is the rule: That is, two other employees should be able to step in if the principal is absent or disabled.
Experts advise parents to query their school principals about the particulars of their plans. But in fact, few schools can point to such comprehensive plans. In a survey of school-based police officers, 95 percent said their schools were vulnerable to terrorist attack, and 79 percent said they were not prepared to respond. Why? Each school district must strike a balance between responsible vigilance and fanning hysteria. And there is no better way to fan hysteria, says Stewart Roberson, the president of the Virginia Association of School Superintendents, than "to send out ill-advised messages across a school community." Not all agree with this. Says Kenneth Trump, president of National School Safety and Security Services: "Fear is really created by not giving people adequate information."
4 How about the hospitals? Have they made improvements since the anthrax scare?
The good news is that most have added responses to a biological, chemical, or nuclear attack to their disaster plans. "We are substantially improved from where we were 18 months ago," says James Bentley, a senior vice president at the American Hospital Association. Many medical workers have received training now to recognize the symptoms of smallpox, anthrax, nerve agents, and poisons, and most hospitals have antibiotics, antidotes, and other medications available. Hospitals have coordinated with emergency response teams, participated in drills, and established backup communication plans.
The bad news is that there's still a long way to go. Preparing for a potential onslaught of victims is complex and expensive, and basic changes will take years. Hospitals need more protective suits and more decontamination equipment, but $30,000 "decon tents" are out of reach for many hospitals. Installing isolation facilities and modifying ventilation systems to prevent the spread of disease are even pricier. So even with improvements, no one knows if hospitals could deal with mass casualties. "We're reasonably prepared," says Stephen Cantrill, associate director of emergency medicine at Denver Health Medical Center. "But if I had to treat 700 people, how would I do that?"
Smaller hospitals face even greater challenges. Some are working together on regional plans, so if one emergency room is full, victims can be sent to another. What will it take to get everyone up to snuff? Money and time. The AHA is hopeful the federal government will come through with planned hospital funding of almost $500 million. And future hospitals will most likely be designed to specifically address the new threats.
One technological enhancement that could help is RSVP, for the Rapid Syndrome Validation Project. Physicians enter patient symptoms, such as fever or diarrhea, into a computer, and within seconds a screen pops up, plotting similar, recent cases on a regional map. Public-health workers currently use the inexpensive, Web-based system to review this data and detect outbreaks in 23 clinics in California, New Mexico, and Texas. A national healthcare company is poised to license the program, created at Sandia National Laboratories, which would extend its use to thousands of clinics, doctors' offices, and emergency rooms in every state.
With Josh Fischman, Dana Hawkins, Katherine Hobson, Katy Kelly, Nancy Shute, Marianne Szegedy-Maszak, Kenneth Terrell and Kevin Whitelaw
This story appears in the February 24, 2003 print edition of U.S. News & World Report.