Wednesday, September 17, 2014
EBOLA, EMERGING THREATS AND “JET SET” PATHOGENS
BIOLOGICS SOUGHT BY TERRORISTS
New York City Office of Emergency Management: a multi-agency overseer coordinating
the efforts of the FDNY, NYPD and many other federal, regional and local agencies during
a major catastrophe.
TAGS: NYC OFFICE OF EMERGENCY MANAGEMENT, MEDICAL SURVEILLENCE SYSTEM,
NYPD INTEL & COUNTER TERRORISM, FDNY, FDNY HAZ MAT, HAZ TECH,
EBOLA, EMERGING DISEASES, WEAPONIZING VIRUS AND BACTERIA,
BIOLOGICAL WARFARE, THREATS, RISKS,
NATIONAL SECURITY, NYC METRO SECURITY
(Wednesday September 17, 2014) In post September 11, 2001 America, virtually every aspect of society and its institutions ability to function properly has an enhanced importance. Under the rubric of national security, there is not much that the government federally, by state and locally does not have some influence in or financial support invested. One might be surprised to learn the breadth and scope of the national security umbrella and, in many respects it is difficult to find fault with this metrics.
Public education is important because in the past two years 24% of the young men and women seeking to enlist in the Armed Services could not even pass the Military Basic Aptitude Test. So, essentially, 25% of the pool of those who want to serve haven’t the basic skill levels required. Public health is very important for many reasons not the least of which relates to the circumstances above. 32% of military applicants were deemed unfit on medical/health grounds to serve with juvenile diabetes and obesity as impediments for that segment of the willing. These facts seriously affect the fighting forces we are able to utilize and, if necessary, deploy.
There is another component in the public health arena that is of grave importance to the government, military planners and public health officials and that is the threat of a biological or chemical agent being effectively weaponized and unleashed among us here on our subways and buses, shopping malls and other locations with high population density. The nature of potential biological weapons is the most concerning. A sophisticated biologic could be introduced somewhere among us in America and it might take days, weeks or even months until the public health community realized what they were seeing in their patients was something of an offensive weapon. It is for this reason that every city in America has a medical surveillance system in place. Hospitals, clinics and doctors are required to supply weekly statistics in some locations such as here in New York City and the Metropolitan area reporting what ailments they are seeing, in what concentration of patients and other clinical markers that may indicate a biologic has been unleashed on the unsuspecting public. In computer modelling game scenarios and from advanced tracking algorithms, it has become obvious that a highly contagious bacterial or viral agent could remain latent for an elongated period of time before people began showing symptoms and would seek medical attention. This provides a bacteria or virus with more than adequate lead time to spread.
New York City and our immediate Metro Area have one of the most robust medical tracking and surveillance capabilities in the world. Given the significance of NYC to those seeking to attack us here, the density of our population, large far reaching commuter networks including Amtrak trains, long distance bus depots and, of course, three of the busiest airports in the country, NYC cannot afford to have anything less than the sophisticated tracking system that has been incrementally developed since 2001 and now, as an “up and running sentinel” stands as the premier system of its kind in America, perhaps, the world.
AMTRAK AND ANTHRAX
The “Acela Corridor” is the segment of the Amtrak network that travels in a mere 3 hours from New York City’s Penn Station to Union Station in Washington, DC. Its non-stop express service runs several times daily with local trains interspersed in the schedule. A “local” train makes several station stops in New Jersey, then on to Philadelphia, Baltimore and ultimately the District of Columbia. In October 2001 just weeks after the 9-11 attacks, a highly sophisticated weaponized “aerosol powder” of anthrax was sent to several TV network personnel, members of the Senate and to a tabloid newspaper. Each of the letters containing the potentially fatal powder was mailed from the same mailbox near Princeton, NJ; a point not far from several Amtrak stops. Despite an enormous effort spanning years, the case of these mailings which claimed several lives has never been adequately explained or closed. It is mentioned here more as a forgotten side note but also as an example of what one dedicated individual possessed of certain, specific scientific talents and knowledge can do if so motivated. The nagging thought that still perplexes and causes sleepless nights among some of those deeply involved in the long, fruitless investigation has not dissipated. The next time could be the “real thing”; not just an “attention getter” by a lone actor trying to prove a point as many have since dismissed the case.
EBOLA AND OTHER JET SET VIRUSES
There is no shortage of horrors in the world today. Bloody, barbaric wars rage ceaselessly, humanitarian crisis of almost incalculable magnitude, and the ever present scourge of terrorism requires constant vigilance. As if all these “man-made” killing fields, death, and catastrophe were not enough to try to engage in some way for positive, or at least less brutal resolutions, one of the most primitive forms of life on the planet, a virus, namely – Ebola – has once again emerged from the dark, damp jungles of western Africa. Ebola is one of a viral family known as “hemorrhagic fevers” because the untreated course of the disease will always be some systemic shutdown due to the massive internal and external hemorrhaging that are likely its florid defining end stage. The mortality rate for Ebola patients is between 50 to 90% making it among the most lethal viral infections known to man.
American Doctor Kent Brantly, contracted Ebola while treating infected patients in Liberia this past July. His recovery was in some significant ways remarkable but he had the advantage of immediate treatment after he was brought back to the United States and administered an experimental treatment protocol. In his testimony before a senate sub-committee yesterday, he said of this on-going outbreak, “Many have used the analogy of a fire burning out of control to describe this unprecedented Ebola outbreak. Indeed it is a fire-a fire straight from the pit of hell. We cannot fool ourselves into thinking that the vast moat of the Atlantic Ocean will keep the flames away from our shores. Instead, we must mobilize the resources needed to keep entire nations from being reduced to ashes”. While it may indeed be among the most hellish of disease processes, it came not from Satan’s lair but from local host reservoirs in Liberia, Guinea, Sierra Leone primarily, and isolated pockets in Nigeria, and Senegal. It being a blood-borne illness to get the infection one must come in direct contact with the body fluids of an infected human or other primate. One species of bat is known to carry the virus without being infected. In the first wave of this outbreak, “Patient X”, the epidemiological designation of the “first patient” may have been a two year old boy who came into contact with bloody fluids from an infected animal.
THE NATURE OF A VIRUS
Viruses, as far as pathogens are concerned, are very different from bacteria, fungi, and parasites. They are small collections of amino acid produced proteins assembled not by cellular DNA material but rather by RNA, the pseudo-negative template of raw DNA. They cannot live by any definition of the word except in a host’s cell. They insinuate their way into cells, use that cells genetic machinery to replicate themselves until they are of sufficient quantity to fully crowd that cell to the breaking point when all those untold copies of that virus are released into the host blood stream. This method of subatomic machination makes viral borne illnesses among the most difficult for medical science to treat.
Viruses can be as difficult to identify due to the fact that they remain hidden as they replicate in the host cells. Each cell they infect becomes a virtual clandestine virus factory and will not be vacated until the virus, now exponentially multiplied, vacates the now useless host cell. But, as with other pathogens, there is a wide variety of viruses. They range in severity from the “common cold” causing rhinovirus, up through the spectrum of mortality to the hemorrhagic viruses including Lassa fever, Dengue fever and Ebola.
Viruses’ can also present a particular diagnostic challenge. While replicating in the host cells, the outer membrane of those infected cells serve as “good cover” for the virus factory just beyond that thin membrane. But, it is that membrane and its receptors and other immune system gadgetry that is more than adequate to protect the immune system from any suspicious intracellular activity. As in Ebola, this “latency” period, the time between acquiring the infection until the onset of the initial symptoms can be as long as three weeks. With a three week head start, once symptoms are obvious the disease process is already well established and replicating at an exponential rate. The virus has the upper hand in this scenario and typically always does.
Ebola was first identified in 1976. At that time in the years shortly thereafter, several other never before seen pathogens were responsible for outbreaks primarily in west sub-Saharan Africa. Some of these pathogens were found to be zoonotic; they had originated in an animal population – usually a member of the ape family – and tended to be clustered along the lines where new towns and villages were suddenly encroaching on the local ecosystem in a negative manner. These pathogens have probably been present in their natural hosts for millennia; it was only as human industry such as lumber and mining companies began altering dramatically these ecosystems; fragile, complex ecosystems that had not changed for centuries. Settlements and towns were constructed to house the lumbermen and miners, new routes of overland travel, an unprecedented spike in prostitution along these new trade routes, and the recipe for disaster was in place for whatever “opportunistic” disease happened to emerge first.
One of the most frightening developments in virology is that some emerging viruses, through the biological process of natural selection and subsequent mutation, now contain human and mammalian genetic characteristics. These mutations are of particular concern because they further the means of the virus towards its ultimate ends; death to as many healthy host cells as possible while leaving at least some of the host cells available for further replication of the virus. With a disease as lethal as Ebola, a supply of rip for the infecting hosts is a necessity. If it kills all available hosts in too rapid a time it will literally burn itself out. Such “burning out” of the virus population in a community or settlement is one of the fundamentals of modern epidemiology.
Ebola as it is in nature is not a likely choice for bio-terrorism; it is too fragile outside its host and native environs and requires “blood to blood” contact for transmissibility. But it does represent the potential of what a similarly lethal pathogen could do to a wide population if deployed. There is also the specter of what epidemiologists have called the “Jet Set” biologics such as a genetically altered strain of an existing scourge or of an old predator such as Small Pox. The theory is that a person or persons infects themselves with a fatal pathogen, hops on a plane from where ever they are with a ticket for the United States. If properly timed that terrorist could wander the subway system here for days if not weeks before eventually taking ill and succumbing to the disease but he could have infected millions in that short time.
USAMRIID: U.S. ARMY MEDICAL RESEARCH INSTITUTE of INFECTIOUS DISEASES
The bucolic campus setting here in Frederick, Maryland belies the history of this institute as well as what was once its core mission. The United States officially got out of the “bio-weapons” age decades ago after some very dark episodes. Today, with a new mission and purpose its easy to forget that this entire enterprise was once in the business of creating death on a horrific scale. Now days, it enjoys a loftier pursuit. We spoke with a physician here to gain a perspective on the potential of a biological attack. A conversation with him rapidly becomes an interesting game of “fill in the blanks”. He is easy and open in tone but will only go so far when asked direct questions about his work. For the sake of this discussion we will refer to him as Dr. Jones, a native of table-top flat Kansas holding both MD and PhD degrees. Dr. Jones admits that USAMRIID has divisions devoted solely to combating any among the jet set viruses. He explains the term jet set as, “In our interconnected world today, with many largely open international borders, it is literally possible that a man living in Senegal today could be working in your local McDonald's next month. He brings with him from his homeland pathogens native to that part of the world which may cause sickness to others who are here. Imagine a person who undertook such a mission purposely, with the intent of coming to the United States already infected with some exotic bug. That one person, that “Patient X” would be the terrorist version of Typhoid Mary. It is a very sobering thought.”
TERRORISTS SEEKING BIOLOGICAL WEAPONS
It is no secret in or out of government, the intelligence community and law enforcement agencies that terrorist groups from al Qaeda to ISIS have long expressed interest in the development and ultimate deployment of biological weapons. Terrorist groups that were active as far back as the 1960’s sought all manner of biological and chemicals for weaponization. It has largely been only through luck and the difficulty terrorist cells have had in weaponizing certain agents that we have not seen a full-scale biological attack since World War II. It certainly has not been from a failure towards that goal on their part. It is well known and documented that al Qaeda sought to develop biological weapons and had even progressed to the testing phase by using dogs as the test subjects. For a myriad of technological problems, they were never able to develop a delivery system for any non-conventional agent.
Certainly, on September 11, 2001, one of the primary questions on many minds after the two planes had struck the Twin Towers was if there were biological or chemical weapons that had been secreted on board those massive jet airliners. Even on that eye opening morning the issue of “unconventional warfare” including biologics and chemicals was not an absurd assumption. So seriously was it taken that many government agencies including the EPA began monitoring the air in and around the World Trade Center site. (Unfortunately for many who suffer and die today the EPA did not perform sufficient testing on the quality of the air being inhaled by rescue and recovery workers and residents in the adjacent and immediate neighborhoods. That’s a discussion for another day.)
As daunting as the challenges are pertaining to the Ebola outbreak that seems to be spreading at a rate initially thought not possible, President Obama announced that he will deploy 3000 US troops in an effort to “contain and control” the lethal spread as well as provide treatment beds, facilities, personnel protective equipment for care givers and forces for security management, that are necessary for our national security. The spread of this hemorrhagic death threatens to destabilize some of the most already unstable countries on the African continent. It is also a humanitarian effort aimed at preventing mass migrations by the families of the sick, dying and dead. As is always the case when chaos reigns some modicum of control must be enforced.
IN HARM’S WAY
One of the most degrading, depersonalizing and over used terms in Washington today is “boots on the ground”. The term itself makes light of our various military commitments and the fact that we are actually deploying troops – young men and women – into various battle theaters or areas of highest risk. What each deployment means essentially, even after all the political rhetoric and haggling is that we, our Commander in Chief, with or without a do nothing Congress is placing the lives of American servicemen and women in harm’s way. Sometimes the old “boots on the ground” metaphor is meant to soften the blow; at other times it is meant to lend an air of “safety”, or “low threat” to our troops and their actual mission.
President Obama will send his 3000 troops, primarily medical personnel, into the African nations most afflicted by this latest outbreak of a deadly virus. However, despite the humanitarian gloss to the mission lurk unforeseen risks, the inevitable “laws of unintended consequences” and how they have the distinct tendency to upset even the best laid plans. Our personnel will not be entering a welcoming environment no matter how well intended their mission is designed. It would be beyond naive to believe that our medical, logistical and security presence in those unfriendly, unstable nation/states will be perceived by all on the ground as a purely “gesture of goodwill”. This mission is as wrought with the potential for unforeseen negative blow-back as has been every mission we’ve undertaken in the past decade. The absence of some formation of at least a “semi-united African face” on our endeavor may backfire to a degree not yet recognized nor calculated. We need the African allied nations with resources to participate in this mission or it is, sadly, doomed to fail. We have experienced interventional failures far too many times since 9-11-01 and we do not need a new front of hostility to be opened in West Africa.
The watchwords of our post 9-11 America cannot be repeated often enough. Constant vigilance must be our stance regardless of the circumstances on the ground where ever we have troops deployed. The world is a small place; we learned that the hard way back in 2001 when not many of us could pin point Afghanistan on a map. We have learned a great deal over the course of the intervening years. Some lessons were learned harder than others; some are still sinking in but, on balance, we are more secure today in very many ways than we were 13 years ago last Thursday.
But, we can never underestimate the motivation, mindless dedication and absolute commitment of our adversaries. We fight people who will go to any lengths, who will gladly sacrifice their own lives for the cause to which they are inextricably bound. Indeed our world is as small a place as it has ever been and our proximity to the zealots and extremists bent on inflicting death and destruction here is as close as the next apartment, mosque or café. This reality needs to be what drives us, our foreign policy and our policies and practices at home.
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