- The Washington Times - Wednesday, August 28, 2002

Washington and three other cities will get a Pentagon-backed experimental "medical surveillance system" this fall and winter to track diseases in the hope of identifying a biological attack before it causes an epidemic.
The system will cobble together environmental monitors that will sample the air for biological agents, and software to collect data from pharmacies, hospitals and doctors' offices and send it to a central system that will search for "spikes" of unusual symptoms.
For instance, a jump in sales of cold and flu medicine during the summer could suggest a man-made outbreak of a respiratory disease.
The $300 million, two-year pilot program is sponsored by the Defense Department and is being designed to determine what kind of monitoring and reporting systems can quickly identify outbreaks.
"Our goal is not to protect the cities. Our goal is to find out how to do it," Ron Yoho with the Defense Threat Reduction Agency, said in an interview.
No such system was in place in Washington last year when anthrax-laced mail killed two District postal workers. Three other persons nationwide died in the anthrax attacks.
"We all recognize this is something we need to do," said Anna Johnson-Winegar, deputy assistant to the defense secretary for chemical and biological defense. "It has been less than robustly supported. It's a matter of competing priorities. A lot of people had put a biological terrorist attack in the hypothetical category until last fall. Shame on us."
Besides Washington, Albuquerque, N.M., has volunteered itself to test the system.
The Defense Department will hold a "competition" in December during which other cities can nominate themselves to test the system. The other two testing sites will be announced in early 2003 and environmental samplers and software will be distributed by midyear.
The cities with the best chances of being selected would have mass transit, including a subway system, a major airport, and be on the coast, the officials suggested.
It is not clear whether the biodefense system contemplated now would make any difference in the event of a small-scale attack, the officials said. However, it might have improved the chances that hospitals would have recognized the symptoms of anthrax earlier.
"It certainly would have been more probable," Mrs. Johnson-Winegar said. "We are trying to synthesize [the information] so that it would have been like all those people were seen by the same doctor."
Presumably, had the victims gone to the same doctor, a pattern would have been noticed and investigated. Two of them did, in fact, and both survived.
At least one of the postal workers who died last fall from anthrax in the Washington area was treated for flu and released from a hospital without the anthrax infection being detected.
"In this game, 12 hours, 24 hours or 48 hours can make a big difference in treating people," said Paul Bergeron, an analyst on the Pentagon's chemical and biological defense program.
Medical surveillance is not a new concept: The Centers for Disease Control and Prevention regularly tracks outbreaks of diseases, including an ongoing monitoring of the progress of the West Nile virus. The system relies on doctors and hospitals to report infectious diseases to a central database where anomalies and suspicious clusters are identified.
Most of the biological-detection projects tend to be "point detection," that is, machines that suck in air samples to check for the presence of certain agents. Those systems are limited, however, by their range, how often they are checked, and by the organisms and chemicals they are programmed to recognize.
Federal, state and local organizations already have more than 100 information systems designed for health surveillance, the National Association of County and City Health Officials says.
The Pentagon's software, based on the existing Army program known as "Essence," requires no additional inputs from health care professionals. It merely mines data off records already kept by hospitals and pharmacies.
That information also will have been scrubbed for privacy concerns by the health care provider, and the government will get no names or personal data.
"No data will ever come to us that haven't already passed through filters," Mr. Yoho said.
Acting on the data will also be the responsibility of health officials, Mr. Yoho said. If a biological event is detected, the most likely scenario for response is that hospitals will be notified and they will contact patients and other potential victims.
Biological attacks are often slow to be noticed. The early symptoms of many diseases resemble common viruses until it is too late to treat them and they have been spread to others.
Anthrax is not communicable from person to person, but a host of other agents believed to be in the arsenals of several countries are, including smallpox and Ebola hemorrhagic fever.
Many infectious diseases incubate for a week or more, during which time the patient feels healthy but is capable of infecting others. That is why medical surveillance matters to pool the individual cases into a central sample and determine quickly whether a terrorist has released a biological agent.
"Only a short window of opportunity will exist between the time the first cases are identified and a second wave of the population becomes ill," the CDC warned in an April 2000 report. "During that brief period, public health officials will need to determine that an attack has occurred, identify the organism, and prevent more casualties through prevention strategies (e.g., mass vaccination or prophylactic treatment).
"As person-to-person contact continues, successive waves of transmission could carry infection to other worldwide localities."
The Pentagon will also spend $120 million to set up a "virtual" biological terrorism research facility, tying together the multitude of researchers working on various aspects of biological defense.

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