- The Washington Times - Tuesday, October 23, 2001

Doctors and hospitals in the metropolitan Washington area say they have been flooded with requests for prescriptions of Cipro since the first anthrax case was reported in the District last week, and caution against indiscriminate use of the antibiotic.
Insurance analysts say the increased traffic at doctor's offices will cause health care costs to rise in the short term. Insurers are covering anthrax tests, which are done by bloodwork or a nasal swab.
"It depends on whether they've got a lot of exposure in places like New York City or the Washington, D.C., area," said Douglas Sherlock, a senior analyst at Sherlock Co., a health care research firm. He said the cost of health care nationwide is expected to climb 15.6 percent next year, with costs locally rising 18.6 percent.
Medical insurers in general will not be hurt long term by the anthrax scare, analysts said.
"Our bottom line belief is that while there is a potential for some geographically specific acceleration in antibiotic prescriptions and office visits, we do not view it as a meaningful threat to profit margins," said a Lehman Brothers report on Friday. "The expectation is that this situation, if realized, still will not equate to the costs of a severe flu season."
Aetna Inc., which holds a large percentage of both markets, likely will be the most heavily hit, Mr. Sherlock said. Oxford Health Plans, a Connecticut managed care company, is also a major New York insurer and likely to suffer.
Right now there's no significant financial impact on us from this," said Stacey Bates, spokeswoman for Trigon HealthCare, a Richmond company that is the biggest insurer in Virginia, with nearly 2 million members.
Trigon, which is sending out information pamphlets to its physicians about using Cipro and medicine stockpiling, has seen a slight rise in requests for antibiotic prescriptions.
Before Sept. 11, the average number of weekly prescriptions for Cipro was 1,898. For the two weeks after the terrorist attacks, that average grew to 1,973. The company does not have more current statistics.
Aetna and Cigna, two of the largest insurers in the country, said they are creating pamphlets for their physicians instructing them about use of medications like Cipro. Both are urging doctors to calm office visitors and refer them to federal public health organizations for specific information about anthrax.
People who have been exposed to any kind of white powder or with symptoms of illness have been calling up their doctors or hospitals for fear they may have contracted the disease.
Doctors say the unnecessary use of Cipro can do more harm than good. Abuse of the antibiotic "can result in much worse problems," said Cheryl Winchell, who practices in Montgomery Village had one request for Cipro from a patient this morning.
The warning may fall on deaf ears since the announcement yesterday by D.C. health officials that two postal workers from the Brentwood facility in Northeast had died of suspected anthrax.
Dr. Michael Sauri, an infectious diseases specialist at Suburban Hospital in Shady Grove, said people often refuse to be reassured. "Some people believe the threat is directed at them they cannot be reassured and have to be sent to the ER," he said.
"People want Cipro just because they saw some white powder. Others have been requesting a vaccine. Some others insist on getting an evaluation," said Dr. Sauri of Rockville, who has received close to 100 anthrax-related calls every day since news of the first infection in the area.
In Montgomery County, hospitals had seen an increased volume of calls after news of the anthrax infections in the area, said Dr. Mark Seigel, president of the Montgomery County Medical Society. The county responded last week by setting up a bioterrorism hot line 240-777-4200 and a triage center.
The District also has set up hot lines for people who suspect they may have been exposed to anthrax. Private practices have not been given any facilities yet to screen for anthrax, said Dr. Robert Carr, who practices in Colmar Manor in Prince George's County.
Dr. Carr said he saw a couple of patients yesterday morning who had been customers at the Brentwood facility in the District and were concerned they were exposed to the disease, and another patient on Friday who works for Mayor Anthony A. Williams and had a skin rash.
The city is now checking postal workers for exposure, but not customers. "There is not a lot we can do right now other than refer them to public health services," he said.
Major medical societies in the area and nationwide already have put out alerts for affiliated physicians with guidelines in case of an outbreak and asking them to warn patients about the indiscriminate use of Cipro.
In an Oct. 18 letter, Dr. E. Anne Peterson, Virginia's health commissioner, urged doctors to refrain from prescribing antibiotics to ward off anthrax.
In Northern Virginia, pharmacists at Giant Food Co., Rite-Aid and CVS say they've seen an increase in Cipro prescriptions.
Along Virginia's East Coast, Giant Food pharmacists filled out 500 Cipro prescriptions last Wednesday, double the number the same time last year, company spokesman Jamie Miller said.
Web sites selling Cipro also have popped up on the Internet where people can easily order the antibiotic. Doctors cautioned against such abuse. "The health department is stockpiling Cipro for exactly such an emergency," said Dr. Winchell.
The antibiotic does not prevent anthrax but can only be used to treat it. "If you use it when you do not need, it you may build a resistance to it, or develop an allergy to it," Dr. Seigel said.
Anthrax is caused by a bacterium, Bacillus anthracis. According to the federal Centers for Disease Control and Prevention, there are three types of anthrax infections: pulmonary, cutaneous and gastro-intestinal.
The initial symptoms of pulmonary anthrax infection may resemble a common cold and after several days the symptoms may progress to severe breathing problems and shock. Inhalation anthrax often is fatal.
The intestinal disease form of anthrax may follow the consumption of contaminated food and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting and fever are followed by abdominal pain, vomiting of blood and severe diarrhea.
The cutaneous form of the disease looks like a swelling on the skin that could be anywhere but often is on the arms or hands. The swelling then develops a central area of ulceration of a depression, and a very dark, blackish-brown scab forms over that central area. It can be painless and sometimes can be accompanied by a fever.
Direct person-to-person spread of anthrax is extremely unlikely, the CDC says.
This article is based in part on wire service reports.

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