It starts with muscle aches and fever. Few sufferers would even visit their doctors. Those who did would probably be prescribed nothing more than a popular flu remedy.
A few days later, with poison coursing through their bloodstream and convulsions wracking their body, it would be obvious that this was no cold. By then, it would be too late.
This is the progress of an infection caused by inhaled anthrax bacteria, and it was no hypothetical situation for those who handled contaminated mail last fall.
Just a handful of letters caused several deaths, but nothing compared to what would happen if billions of tiny, odorless, colorless anthrax spores were sprayed from an airplane, distributed in a subway, or dropped into the ventilation shaft of an office building.
Biological weapons arent new. They even have a Pittsburgh connection that few residents would care to brag about. In the waning days of the French and Indian War, as Indian tribes laid siege to Fort Pitt,[*] British General Jeffrey Amherst ordered his troops to give the Indians blankets taken from smallpox patients. With no natural immunity to the disease, Indians died by the score.
Amherst knew instinctively what todays terrorists have figured out: biological weapons are cheap and deadly. No wonder that terrorist cells and so-called rogue nations are believed to be developing biological weapons or acquiring strains of germs that were cultured in the former Soviet Union during the Cold War.
They cant take us on tank for tank, battleship for battleship, says Samuel Watson, a defense and intelligence expert who advised President Ronald Reagan and the elder President George Bush. He now serves as director of public health and bioterrorism preparedness and response at Pitts Graduate School of Public Health.
They have to find some other way to leverage their combat power, says Watson, associate professor of public health practice. Biological agents are not hard to find. Theyre around us everywhere. Under the right conditions, they can be easily incubated in the same type of equipment used to ferment mash or yeast, he says.
Weaponized germsincluding bacteria like anthrax or viruses like smallpoxare sometimes called the poor mans nukes. They have an ability to inflict great numbers of casualties at a fraction of the cost of nuclear or conventional weapons, says pathologist A. William Pasculle, director of microbiology and associate professor of pathology at Pitts School of Medicine.
Before September 11, few Americans entertained such dark thoughts. Such issues were the province of military strategists and a handful of academics like Pitts Senior Vice Chancellor for Health Sciences Arthur S. Levine. He was better informed than most about the danger; he spent most of his career working for the federal government at the National Institutes of Health.
According to Levine, federal authorities had become increasingly alarmed about the potential for a bioterror attack on Americans after the collapse of the USSR. Although the United States and the USSR signed a treaty in 1972 in which they agreed to stop developing biological weapons, widely-published American intelligence reports cite that since the Soviets believed the Americans were cheating, they stepped up production of weaponized germs. With the fall of the USSR, many of the old germ warfare laboratories were left abandoned in former republics like Kazakhstan, where security was in disarray, bioweapons experts were out of work, and Russian military technology could be hadfor a price. There was worry among world leaders that bioweapons technology would be sold to nations that fund terrorist cells. Pennsylvania Senator Arlen Specter[*]the ranking member of the US Senates veterans affairs committee and a member of the defense appropriations subcommitteesaw the need for bioterrorism research.
With Specters support, Carnegie Mellon University[*] and the University of Pittsburgh formed the BioMedical Security Institute (BMSI) two years ago to coordinate research by the universities into ways to prevent, detect, and respond to both terrorist activity and natural outbreaks of disease. The directors are Pitts Michael Wagner, an associate professor of medicine and intelligent systems, and Andrew Moore,[*] an associate professor of robotics and computer science at CMU.
In the wake of last falls anthrax attacks, many universities scrambled to launch their own bioterrorism research programs. Some are working on projects much like those at BMSI. But as Levine points out, no other anti-bioterrorism center draws on the resources of two large research universities and a network of teaching hospitals. And no other university anti-bioterrorism center has received the attention of the White House, in the form of a visit from the President of the United States.
People close to George W. Bush say he has a propensity to give staff members and associates affectionate nicknames. According to the Dallas Morning News, the President has dubbed National Security Adviser Condoleezza Rice Guru, a reporter for a Washington newspaper Super Stretch, and Minnesota Senator Paul Wellstone Pablo. After Bush completed a tour of BMSI and several laboratories at Pitt and UPMC last February 5, he had a new nickname for Pittsburgh.
Pittsburgh used to be called Steel Town, he said. You need to call it Knowledge Town.
The compliment was gleefully broadcast again and again on the local news. Beneath the quip, say University officials, is evidence that the White House recognizes that researchers here are in a unique position to design tools that detect biological attacks. Both schools have programs that complement each others strengthsPitt, for example, in biomedical informatics and law; CMU in computer science and software engineering. Much of what we need to do with respect to the recognition of bioterrorism and the response will be computer-based, Levine says. This city and these two universities have tremendous computational power. [Pitt] has the only graduate school of public health in the Commonwealth of Pennsylvania. And were third nationally in respect to our support from the federal government for research.
Computers are the backbone of a BMSI-affiliated research project that Bush compared to the Cold War-era Distant Early Warning, or DEW,[*] Line. It has an equally catchy name: RODS, for Real-Time Outbreak Detection System. Just as DEW Line radar could spot enemy bombers approaching the United States, RODS spots invasions, too. Todays enemies are a lot smallertiny fractions of a millimeterbut in the event of a bioterror attack, could be just as deadly as a fleet of jet bombers.
Like Web-crawling search engines that comb Internet data to find documents, RODS filters hospital admissions records to locate where people become ill, how old they are, and what symptoms they have. RODS constantly runs the numbers through different equations and decides whether any of the information is unusual. Are there higher-than-average reports of gastrointestinal problems? Flu-like symptoms? Paralysis? Bleeding? Rashes? People having trouble breathing? If something unusual occurs, a message is sent to a public health physician by pager or e-mail.
RODS needs only a handful of variables. There are a finite number of ways the human body reacts, says Wagner, the director of the RODS Laboratory, within Pitts Center for Biomedical Informatics, where researchers study ways to collect and use medical data.
(The research is funded by the National Library of Medicine, the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and the Defense Advanced Research Projects Agency.)
Using data that indicate where patients are from and which hospitals theyre in, RODS pinpoints where people are ill. The information is plotted onto maps. A spike in hospital admissions from a neighborhood, or a message that something is strange by RODS standards, could merely indicate that theres a flu bug going around. Or it could mean that a chemical or biological weapon has been released.
After 40 years, Wagner says, computer systems have become good at spotting individual cases of infectious disease; programs exist in which a health-care worker can enter symptoms into a database that compares them to tables of likely ailments, and suggests a course of action. However, until RODS came along, little research was being done on ways to look for patternsspotting many people with the same symptoms and suggesting that their illnesses were related. Developing a system that sifted the raw data as it was collected by hospital admissions workers represented a huge research opportunity, Wagner says.
To the frustration of many elected officials, collection of public health data in the United States is a patchwork of procedures that varies from county to county and state to state. For the most part, it relies on doctors to voluntarily report unusual cases to the authorities, a time-consuming process thats spotty at best.
With RODS, no one reports information because in the event of an epidemic, natural or man-made, we dont believe theres time for people to report information, Wagner says.
The country has already invested hundreds of millions of dollars in data collection systems such as hospital information systems, pharmacy benefit systems, management systems, he says. What theyve really built is an early warning system for outbreaks of disease. They just didnt finish the job.
After receiving permission from hospitals and other health-care organizations to tap into their data collection systems, RODS goes to work. In order to protect patient confidentiality, it doesn't look for names. Rather, it scans the raw information to look for patterns of patients complaining of symptoms that could be the result of an infectious disease outbreakwhich could, in turn, be the result of a terror attack.
If you cant prevent bioterrorism, early detection is the next best thing, says Anne Solomon,[*] an analyst at the Center for Strategic and International Studies,[*] a nonpartisan think-tank in Washington, DC.
According to the FBI, the anthrax letters sent last year announced their intentions. We have this anthrax, reads a letter sent to Senate Majority Leader Tom Daschle. You die now. Another, sent to NBC News, warned the recipients to take penacilin (sic).
Its unlikely the next bioterror attack will be announced, Solomon says. Patients will go into their doctors complaining of a disease that looks like the flu or some other ailment, she says. It could be several days before (officials) decide its obviously a terrorist attack. The earlier you detect that, the better.
RODS is deployed in 13 counties near Pittsburgh and at two hospital systems near Philadelphia. It received its first real test at the Winter Olympics in Salt Lake City. Wagner and his colleagues arrived December 13, and had RODS collecting data by mid-January. Theres no reason why RODS couldnt be deployed in every metropolitan area, he says. If the regions and their health systems have the will, it can go very quickly.
While the decision to implement RODS must be made by public health officials in each city, Wagner says Bushs visit to Pitt will be enormously valuable in helping the RODS laboratory demonstrate the worth of the program.
Additionally, researchers at BMSI are studying how best to coordinate the local agencies that would respond to bioterrorism, including emergency rooms, ambulance services, and police and fire departments. They're examining the mental aftershocks to the public and doctors, health and safety personnel, that would result from a successful attack. And they continue to solicit proposals from researchers interested in tackling everything from planning hospital facilities to anticipating legal and political issues; BMSI was recently awarded a $755,000 grant from the Centers for Disease Control and Prevention so that teams can continue their work.
Indeed, bioterrorism experts note that research into improved vaccines, treatments, and monitoring will ultimately help the entire public-health infrastructure. The President seems to agree.
Research we do to fight bioterrorism is likely to deliver great new advances in the treatment of many other diseases, such as tuberculosis, pneumonia, malaria, and AIDS, Bush told an audience at Pitts Alumni Hall, formerly the Masonic Temple on Fifth Avenue. Among the educators and officials in the audience were Health and Human Services Secretary Tommy Thompson and Homeland Security Director Tom Ridge.
Bush called for increasing by 300 percent the amount of money available for research into bioterrorism. Its an investment that will pay off not only for better security, but for better health, he said.
Bill Pasculle, director of microbiology at Pitt, compares the commitment to bioterrorism research to the money and effort spent on the space program, which generated everything from improved metallurgy to smaller, faster computers. All of the technology that flowed from the research to put a man on the moon was of innumerable value to mankind, he says.
Levine is more blunt: When you put a lot of money into scientific research for any purpose, good things happen.
Spotting germs early can prevent epidemics. Bill Pasculle, director of microbiology and associate professor of pathology at Pitts School of Medicine, made that pointand a strong impressionwhen President Bush recently visited Pitt. He greeted the President with a petri dish of anthrax.
Pasculle knew it was a harmless strain of the bacteria. He says he wanted Bush to know what anthrax looks like to a lab technician because laboratory expertise and the human eye are the nations front line of defense against bioterrorism.
Pasculle first saw anthrax in a textbook picture while in graduate school. At that time, there had been few cases in the United States: I was up late one night studying, and thinking, why do I have to read about anthrax?
Now he knows. Last October, a 63-year-old man living in Florida, went to the hospital with a fever, shortness of breath, and nausea. Doctors suspected spinal meningitis. A doctor ordered a spinal tap, then looked at the fluid sample through the microscope. He told reporters later he saw large rods that looked like boxcars and ordered tests to determine if they were a deadly strain of anthrax.
Although it was too late to save the patients life, the identification provided an important warning to doctors elsewhere when patients complained of similar symptoms. Early treatment using antibiotics can kill anthrax before it produces lethal doses of toxin.
These days Pasculle reminds his studentsand the Presidentthat the war on terrorism must include medical lab training and education.