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The Wire
Digital City
Hospitals on alert for an attack by chemical weapons

Tuesday, November 9, 1999

By CAROL SMITH Mail Author

Local hospitals are stockpiling antidotes against biological and chemical weapons and putting their own decontamination units in place in preparation for the World Trade Organization meeting in Seattle later this month.

Harborview Medical Center, like other downtown hospitals, has warned its staff to be on the lookout for unusual clusters of symptoms that would alert them to biological or chemical exposure in time to intervene quickly and minimize potential damage. Most of the hospitals will be doing dry-runs of their response plans in the final week before the conference, which runs from Nov. 29 through Dec. 3.

"We want to emphasize the likelihood of a (weapon of mass destruction or bioterrorism) is really quite small, and we must keep this in perspective," said Dr. Ron Dobson, chief of emergency services at Swedish Medical Center in Seattle. "But it is not zero. The (attack on) the World Trade Center and the Oklahoma City bombing have shown us that we are at risk."

Public Health -- Seattle & King County, is asking physicians to be especially aware of symptoms that might indicate an attack involving anthrax, botulism or smallpox.

"We'll be more acutely aware of a cluster of flu-like symptoms," said Alonzo Plough, health department director. "There's a possibility it could be related to an exposure."

In addition, hospitals are increasing their staffing to handle everything from potential injuries from riots to chemical attacks, said Dr. Michael Copass, director of Harborview's emergency services.

"We have to realize we're in a time and age when people no longer keep their sadness at home," he said.

Hospitals are tracking supplies of medications and antidotes that would be useful to combat anthrax, smallpox, botulism or chemical agents, such as nerve gases, said Kim Baisch, manager of emergency services for Virginia Mason Medical Center. The amounts and locations of those medications will be reported to Harborview, which would coordinate a response to such an attack.

"Medications will be available to treat those things," she said. "The supplies will be here in the city."

One medication hospitals are keeping close track of, for example, is atropine, a drug used to combat damage from neurotoxins, such as Sarin, the gas used in the Tokyo subway attack.

"Atropine is a mainline defense for many chemicals of mass destruction," said Dobson. "What we're doing is making certain how much each hospital has and where it is if we need it."

In addition, clinicians will be looking for signs of biological warfare.

Anthrax, for example, is caused by a spore-forming bacterium that produces flu-like symptoms that worsen quickly.

An epidemic of anthrax in its early stages could be confused with a wide variety of viral, bacterial or fungal infections, so epidemiologists will be on alert to try to discern patterns that would discriminate such an epidemic from a more mundane outbreak of the flu, Plough said.

"One of the issues around planning is very rapidly trying to determine what's happening," he said.

The health department, which monitors 52 diseases on an ongoing basis anyway, is well equipped to do the epidemiological analysis to pick up an attack, he said.

"We do this everyday, seven days a week, anyway."

The incubation period for anthrax can be one to six days, followed by gradual, non-specific symptoms that may include fever, malaise, fatigue and coughing.

Two to three days after that, however, the symptoms develop into severe respiratory distress and shock and death may follow within 24 to 36 hours.

Anthrax is a particular concern because it's difficult to treat, Dobson said. "It's treatable, yes. How successful is a question."

Botulism, which is caused by neurotoxins produced by the bacterium Clostridium botulinum, is treatable, but often requires putting patients on ventilators to prevent them from dying.

The symptoms of botulism begin as early as 24 to 36 hours following exposure. Patients may initially show generalized weakness, dizziness, and drooping eyelids, followed by extreme dryness of the mouth and nose. Motor symptoms also begin early on and may include blurred vision, and difficulty swallowing.

The most frequent cause of death is respiratory failure caused by paralysis of respiratory muscles.

Smallpox is also a concern, Dobson said. Even though the disease has been eradicated in nature since 1978, there is a small but real possibility that secret stores of the virus exist.

"It's unlikely, and we're unaware of any, but we can't rule it out," he said. Because the disease has been eradicated, a percentage of the population has never been immunized against it.

"It can be fatal, but it is treatable," he said.

The problem with some of the biological agents are the lag times before symptoms appear, Plough said. Smallpox, for example, can take days or weeks to show up.

In addition to biological agents, hospitals are taking steps to prepare for chemical attacks.

The University of Washington Medical Center, for example, is increasing its nursing staff and number of doctors on-call by about 20 percent, said Shirley Tainter, nurse manager of the UW's emergency department.

Swedish is also increasing staff by about 20 percent for the week of the conference.

"There's been a fair amount of effort to design facilities and pre-establish some decon (decontamination) stuff in the area," said Copass. "We want to emphasize, we're always in a state of readiness for things that don't happen."

The city has taken steps to establish decontamination centers at various undisclosed locations, he said. "The equipment is in place.

Area hospitals are preparing and upgrading their decontamination facilities to make them independent of the fire department in the event of a massive event.

If such an event occurs, "the reality is, we won't be able to call 911 (for help with decontamination)," said Marianne Klaas, accreditation and safety manager for Swedish Medical Center.

So the hospital, like others in the area, is investing in its own decontamination equipment.

"We have to be able to shut down the hospital, filter people through a central intake where we can shower and wash them down," she said. The hospital has purchased $50,000 worth of tents, special respirators, protective suits, boots and gloves.

Despite the emphasis on biological and chemical attacks, however, the biggest concern remains physical injuries.

"Bioterrorism is a concern, but the greater likelihood of disaster has to do with riots or injury resulting from protests," Dobson said. "Our hope is it will be business as usual and there will be large and peaceful demonstrations and no one gets hurt."

P-I reporter Carol Smith can be reached at 206-448-8070 or carolsmith@seattle-pi.com

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