In
the three weeks since the Sept. 11 attacks, Americans have become increasingly
concerned that the next one might be even worse. Among terrorism experts,
however, the focus has shifted from a single large-scale assault — which
would be difficult to pull off — to a series of smaller attacks that could
be just as damaging to the U.S. economy and public morale. How serious
are these threats? What form might they take?
Here's a look at what form a possible future attack could take...
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Anthrax
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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.
Bacillus anthracis, the organism that causes anthrax, derives its name
from the Greek word for coal, anthracis, because of its ability to cause
black, coal-like cutaneous eschars. Anthrax is normally found in sheep,
cattle and horses but can be transmitted to humans who contact infected
animals or their products. Usually humans acquire the disease by skin
contact with the bacteria or by inhaling the bacterial spores found in
sheep wool.
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.
Disinfection
of contaminated articles may be accomplished using a 0.05% hypochlorite
solution (1 tbps. bleach per gallon of water). Spore destruction requires
steam sterilization.
In the second half of this century, anthrax was developed as part of a
larger biological weapons program by several countries, including the
Soviet Union and the U.S. The number of nations believed to have biological
weapons programs has steadily risen from 10 in 1989 to 17 in 1995, but
how many are working with anthrax is uncertain. Based on primate data,
it has been estimated that for humans the LD 50 (lethal dose sufficient
to kill 50% of persons exposed to it) is 2500 to 55,000 inhaled anthrax
spores. The average for contamination is 8,000 to 10,000 spores. Direct
person-to-person spread of anthrax is extremely unlikely, if it occurs
at all. Therefore, there is no need to treat contacts of persons ill with
anthrax, such as household contacts, friends, or coworkers, unless they
also were also exposed to the same source of infection.
Symptoms
Inhalation
One of the major problems with anthrax spores is the potentially long
incubation period of subsequent infections. Exposure to an aerosol of
anthrax spores could cause symptoms as soon as 2 days after exposure.
However, illness could also develop as late as 6-8 weeks after exposure
-- in Sverdlovsk, one case developed 46 days after exposure. Patients
first develop a spectrum of nonspecific symptoms, including fever, dyspnea,
cough, headache, vomiting, chills, weakness, abdominal pain, and chest
pain. Signs of illness and laboratory studies were nonspecific. This stage
of illness lasted from hours to a few days. In some patients, a brief
period of apparent recovery followed.. After several days there would
be a slight improvement as the immune system tries but fails to rid the
body of the bacteria, more severe signs appear, including sudden onset
of difficulty in breathing, profuse sweating, cyanosis (blue colored skin),
high fever, shock and death in 24-72 hours for most people. Up to half
of patients developed hemorrhagic meningitis. If appropriate antibiotics
are not started before development of symptoms, the mortality rate is
estimated to be 90%, but that rate was determined before the use of current
technology. Deaths occur because once inside the body, anthrax bacteria
emerge from their dormant spore phase and begin to reproduce and spew
out toxins, which poison tissues and cause organs to fail. Inhaling spores
is most likely to result in death because the germs burrow into lung tissue,
where they come in close contact with lymph vessels. These serve as the
body's liquid highway, transporting nutrients, debris and bacterial toxins
throughout the body.
Cutaneous
Cutaneous anthrax is the most common naturally occurring form, with an
estimated 2000 cases reported annually. Disease typically follows exposure
to anthrax-infected animals. In the United States, 224 cases of cutaneous
anthrax were reported between 1944 and 1994. The largest reported epidemic
occurred in Zimbabwe between 1979 and 1985, when more than 10,000 human
cases of anthrax were reported, nearly all of them cutaneous. Shortly
after exposure through a cut or other break in the skin, a small, itchy
bump appears. In some cases, a rash may develop. In another few days,
the lesion fills up with fluid and develops into a painless ulcer 1 to
3 cm in diameter. Not long afterward, the lesion turns black, a hallmark
of skin anthrax, as tissue begins to die. Sweeling and pain may follow.
Fatality is estimated at around 20 %.
Gastrointestinal
Gastrointestinal anthrax is uncommonly reported. However, gastrointestinal
outbreaks have been reported in Africa and Asia. Gastrointestinal anthrax
follows ingestion of insufficiently cooked contaminated meat. The disease
affecting the distal gastrointestinal tract results in nausea, anorexia,
and fever followed by abdominal pain and bloody stool. The case fatality
rate among reported cases ranges from 25% to 60%. In 1982, there were
24 cases of oral-pharyngeal anthrax in a rural northern Thailand outbreak
following the consumption of contaminated buffalo meat. In 1987, there
were 14 cases of gastrointestinal anthrax reported in northern Thailand
with both oral-pharyngeal and abdominal disease occurring. Gastrointestinal
anthrax never has been documented in the United States because livestock
are vaccinated for anthrax in areas where the disease is endemic; animals
routinely are inspected by federal and state meat inspectors before, during,
and after slaughter; and raw meat is eaten infrequently.
Treatments
Cipro (ciprofloxacin hydrochloride) is an antibiotic used to treat bacterial
infections in many different parts of the body. It does not work for viral
infections (for example, the common cold) but it is approved for use in
patients who have been exposed to the inhaled form of anthrax. There are
a number of antibiotics that are currently indicated to treat anthrax
infections including doxycycline and penicillin. These older antibiotics
are readily available. FDA is stressing that any antibiotic should only
be used by those who really need it because unnecessary antibiotic use
exposes patients to the risks of a drug without any potential benefit.
Random prescribing and extensive use of Cipro could speed up the development
of drug-resistant organisms, and the usefulness of Cipro as an antibiotic
may be lost.
Some possible side effects of Cipro include:
- central nervous system (CNS) side effects including: dizziness, confusion,
tremors, hallucinations, depression, increased risk of seizures
- an allergic reaction (difficulty breathing; closing of the throat; swelling
of the lips, tongue, or face; or hives)
- pain, inflammation, or rupture of a tendon o a severe tissue inflammation
of the colon
- increased sensitivity of the skin to sunlight
Children
It has been recommended that ciprofloxacin ( Cipro ) and other fluoroquinolones
should not be used in children younger than 16 to 18 years because of
a link to permanent arthropathy in adolescent animals and transient arthropathy
and growth retardation in a small number of children. However, balancing
these risks against the risks of anthrax caused by an engineered antibiotic-resistant
strain, the working group recommends that ciprofloxacin be used in the
pediatric population for initial therapy or postexposure prophylaxis following
an anthrax attack (If antibiotic susceptibility testing allows, penicillin
should be substituted for the fluoroquinolone. As a third alternative,
doxycycline could be used. The American Academy of Pediatrics has recommended
that doxycycline not be used in children younger than 9 years because
the drug has resulted in retarded skeletal growth in infants and discolored
teeth in infants and children. However, the serious risk of infection
following an anthrax attack supports the consensus recommendation that
doxycycline be used in children if antibiotic susceptibility testing,
exhaustion of drug supplies, or allergic reaction preclude use of penicillin
and ciprofloxacin.
Other antibiotics effective against B anthracis in vitro include chloramphenicol,
erythromycin, clindamycin, extended-spectrum penicillins, macrolides,
aminoglycosides, vancomycin hydrochloride, cefazolin, and other first-generation
cephalosporins. The efficacy of these antibiotics has not been tested
in humans or animal studies. The working group recommends the use of these
antibiotics only if the previously cited antibiotics are unavailable or
if the strain is otherwise antibiotic resistant. Natural resistance of
B anthracis strains exists against sulfamethoxazole, trimethoprim, cefuroxime,
cefotaxime sodium, aztreonam, and ceftazidime. Therefore, these antibiotics
should not be used in the treatment or prophylaxis of anthrax infection.
The Vaccine
Anthrax vaccine is available for people in high-risk occupations, mostly
in military positions.
The anthrax vaccine is a cell-free filtrate vaccine, which means it uses
dead bacteria as opposed to live bacteria. BioPort Corporation is the
sole manufacturer of the anthrax vaccine.
The immunization consists of three subcutaneous injections given two weeks
apart followed by three additional subcutaneous injections given at 6,
12, and 18 months. Annual booster injections of the vaccine are required
to maintain immunity.
Anthrax vaccine may cause soreness, redness, itching, swelling, and lumps
at the injection site. About 30% of men and 60% of women report these
local reactions, but they usually last only a short while. Lumps can persist
a few weeks, but eventually disappear. Injection-site problems occur about
twice as often among women.
Beyond the injection site, from 5% up to 35% will notice muscle aches,
joint aches, headaches, rash, chills, fever, nausea, loss of appetite,
malaise, or related symptoms. Again, these symptoms usually go away after
a few days. Serious events, such as those requiring hospitalization, are
rare. They happen about once per 50,000 doses.
Smallpox
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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.
Sarin
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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
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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 water-treatment facility.
With this threat in mind, municipal water authorities have stepped up
security.
Dams
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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 (
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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
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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
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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
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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
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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 (
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Exotic weapons get a lot of attention, but conventional explosives and
suicide bombers in pizza parlors, discothèques 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 (
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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.
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References:
The Center for Civilian Biodefense Studies (Drs Inglesby, Henderson, Bartlett,
O'Toole, Perl, and Russell), and the Schools of Medicine (Drs Inglesby,
Bartlett, and Perl) and Public Health (Drs Henderson, O'Toole, and Russell),
Johns Hopkins University, Baltimore, Md; Viral and Rickettsial Diseases,
California Department of Health, Berkeley (Dr Ascher); US Army Medical
Research Institute of Infectious Diseases, Frederick, Md (Drs Eitzen,
Friedlander, and Parker); Office of Emergency Management, New York, NY
(Mr Hauer); Centers for Disease Control and Prevention, Atlanta, Ga (Dr
McDade); Acute Disease Epidemiology, Minnesota Department of Health, Minneapolis
(Dr Osterholm); and the Office of Emergency Preparedness, Department of
Health and Human Services, Rockville, Md (Dr Tonat).
Excerpt from TIME Magazine, October 8, 2001 By David Bjerklie, Christine
Gorman and Alice Park
For complete article go to: http://www.time.com
Picture by BARRY DOWSETT — PHOTORESEARCHER
