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Six months later: Anthrax lessons learned

Three medical specialists review the trials and errors

Six months later: Anthrax lessons learned

From Rea Blakey
CNN Medical Correspondent

(CNN) -- Six months after anthrax-by-mail attacks rocked the nation, the public health community is left with a series of lessons learned.

They range from tracking the trail of exposure, to identifying inhalational-anthrax treatment options and effective crisis communication when bioterrorism strikes.

Take the case of Washington postal worker Leroy Richmond. The odds were against the 57-year-old living to tell his story.

Lesson 1: Track the vulnerable

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"What we learned from the mail-service anthrax attack of 2001 is that you really have to look at the vulnerable people along the chain of exposure," says Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, a division of the National Institutes of Health.

Richmond was the first of four Washington-area postal workers to become ill and subsequently be diagnosed with inhalational anthrax. "Its an amazement to me how two of my closest friends that I knew quite well, got the anthrax bacteria and died," marveled Richmond, "and myself and another person got the same effect from the bacteria and lived."

The medical treatment Richmond received also serves as a very important lesson.

Lesson 2: Treat aggressively

"Aggressive treatment of sick individuals takes us away from what was previously thought to be 100-percent mortality in people with inhalational anthrax," says Fauci.

Postal-service job-assignment logs show that Richmond was infected with anthrax spores after a mail-sorting machine was cleaned with a high-pressure air hose. Richmond recalls what he thinks of as the moment he was infected: "Particles go up in the air, and dust, and whatever comes out of the machine. It just so happened I remember looking up" and commenting about "all this dust."

"I probably inhaled it at that point," says the 34-year postal service employee. Management immediately suspended the use of high-pressure air hoses to clean the machines. It was yet another lesson learned -- this time the hard way.

Lesson 3: Share sensitive info

Access to sensitive information also posed problems during the anthrax attacks.

Washington's health director, Dr. Ivan Walks, says the city immediately put its bioterrorism disaster plan into effect. But it was days after the October 15 anthrax-laden Daschle letter arrived before federal officials consulted with local District of Columbia health officials.

As a result, Dr. Walks says, the key is "Who gets to know what? How do you find out the secret stuff you need to know to plan?"

He strongly recommends that the federal government establish advance security clearance for the appropriate local health officials who will deal firsthand with any bioterrorism threats.

Lesson 4: Don't assume a case is isolated

Another public health official -- who also happens to be the infectious disease expert who diagnosed the first case of inhalational anthrax last fall -- has another communication recommendation for the feds.

Dr. Larry Bush diagnosed the Florida man, Robert Stevens, who died October 4. "The initial approach," says Dr. Bush, "was 'This is an isolated case of inhalation anthrax, which we don't think has anything to do with anything.' I think that was a mistake."

Dr. Bush says he believes the federal government's reluctance to recommend other anthrax-fighting antibiotics in addition to Cipro during the earliest days of the outbreak created a bigger problem. "It created sort of this scare and this scarcity and this black market for Ciprofloxacin that didn't have to occur," he says.

Key lesson: Improve communication

So how should government communicate with the public during a bioterrorism crisis?

Here are comments from each of these key physicians on the question of what may be the biggest lesson of all: effective crisis communication.

  • Dr. Anthony Fauci on the government's initial reaction: "If there's a problem and we don't know the answers to the problem, we've got to say, 'We don't know'. We've got to give the information we have and make -- or not -- any recommendations based on the information we have."
  • Dr. Ivan Walks on the antibiotic treatment plan for the masses: "One message, targeted to diverse populations -- at the end of the day, you get everybody doing one behavior."
  • Dr. Larry Bush on awareness among the medical community: "The CDC (Centers for Disease Control and Prevention) has sent out a lot of guidelines over the years on how they predicted they would detect a bioterroristic attack. One of them would be what they called 'syndrome surveillance' -- in other words, all of a sudden seeing a lot of cases of unusual respiratory or cutaneous infections.
  • "But those surveillance systems didn't seem to work here," Bush says. "Once the medical community was aware that there was a bioterroristic attack, it was the practicing physicians and other health caregivers who knew what to look for."


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