Preparing for patient zero: the government must prepare for the possibility of a terrorist-unleashed smallpox epidemic that could kill millions and overwhelm the U.S. health-care system

0 Comments | Insight on the News, Dec 10, 2001 | by Timothy W. Maier

Concern is growing privately within the government and among health officials that Osama bin Laden or the terrorist states that support him may have obtained a weaponized version of the smallpox virus. Bin Laden has made no secret of his intention to acquire such a biological weapon for use in his jihad against Christians, Jews and others he regards as infidels. If he has obtained it, the nightmare of terrorism may just be beginning.

Consider this: According to public-health professionals, an outbreak of smallpox in the United States would kill about 1 million people in three months. How big an outbreak? One case of smallpox. And if even one case turns up, make no mistake, it will be no accident and immediately regarded as an act of terrorism. Writing for the Wall Street Journal, Elizabeth Whalen, president of the American Council on Science and Health, says one case would mean "epidemic and worldwide catastrophe." The patient would be isolated and all contacts vaccinated. Instead of ground zero, it would be "patient zero."

Fifty years ago the United States was prepared to handle such an outbreak. While most people then received a smallpox vaccination in childhood, the experience of that time provides hope for the future. The outbreak occurred in New York City in 1947 when a man arrived from Mexico very ill with smallpox. Doctors missed the diagnosis until two other cases were detected. Everyone was isolated and a decision was made by public-health authorities to inoculate 6 million Americans. The result? The epidemic was controlled, with only 12 cases being reported.

Some doctors say better technology and medical knowledge will provide even quicker responses should such an incident recur. But others are not so sure because smallpox easily can be missed or misdiagnosed by doctors who never have seen the disease.

Often confused with chicken pox, smallpox is a contagious viral infection that causes high fever, a blistering and painful rash and disfigurement. It has a 30 percent mortality rate. The disease is spread by breathing into someone's face, by infected saliva or by respiratory droplets. It also can be transmitted on linens or clothes. After being infected with smallpox the patient is not contagious for about 12 days until a high fever sets in and a rash, or pox, becomes apparent. Death then can come within 48 hours.

Although it was not indigenous to the New World, smallpox is no stranger in the United States. Because they had no immunity to the disease, whole tribes of American Indians died of it. Smallpox was even used in germ warfare against the Ottawa under Chief Pontiac in the summer of 1763 by Lord Jeffrey Amherst, commander of British forces in North America during the French and Indian War (1754-1763). Historical records show that Amherst approved the sending of smallpox-infected blankets and handkerchiefs to the tribe as it besieged Fort Pitt, now Pittsburgh, in the wilds of Pennsylvania. In his own hand he authorized use of any means "to extirpate this execrable race"; within two weeks a smallpox epidemic began wiping out Chief Pontiac's tribe.

Worldwide use of vaccination eventually brought the disease under control. The last documented case of smallpox was in 1977 in Somalia; two years later the World Health Organization declared it eradicated. The United States stopped its vaccination program in 1972 because there was almost no risk of contracting the disease here and many people had experienced severe side effects from the shots.

In recent years there have been just 15 million doses of the vaccine, and those were stockpiled for U.S. troops. But last year the military restored its vaccine development for smallpox after U.S. intelligence learned that Iraq and North Korea had produced smallpox virus for germ warfare. The U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, and a Russian virology installation in Siberia called "Vector" reportedly are holding smallpox virus in freezer repositories.

Acambis PLC, which manufacturers a new smallpox vaccine, has contracted to deliver 40 million doses to the federal government by next year. Meanwhile, the Food and Drug Administration (FDA) is studying ways to dilute the stockpiled 15 million doses to allow more people to receive the vaccine should an emergency arise.

Most Americans younger than age 40 have not been vaccinated for smallpox, and many of those who have been are no longer protected 10 years after receiving the shot. But some doctors suggest those with outdated vaccinations who come in contact with smallpox infection are not likely to get as sick as others and may have a better chance of surviving.

Health and Human Services Secretary Tommy Thompson says he is against implementing a plan to inoculate all Americans against smallpox, noting the number of severe side effects associated with the shot. The Wall Street Journal recently suggested that inoculating about 280 million Americans might result in 600,000 vaccination-related deaths. However, many doctors insist the new vaccine likely will be less dangerous, reducing mortality rates.