BETHESDA – The aerosol of powdered anthrax released by the unmarked white van goes unnoticed by the 18,000 tourists crowding the Tidal Basin during the annual Cherry Blossom Festival, but within five days, reports of deaths by anthrax begin to surface.
The hypothetical anthrax scare was one of two possible catastrophic public health events discussed by about 95 emergency response officials and public health experts Tuesday, in an effort to determine the disaster readiness of the Maryland, Virginia and Washington, D.C., area.
“Should there be a bioterrorism event our region is very, very special,” said Dr. Myron Levine, director of the Middle-Atlantic Regional Center of Excellence, which hosted the event, in the opening speech of the day.
If such an event were to occur in Utah, for example, there’s only one set of jurisdictions, Levine said in an interview after the conference. But if the same event occurs in Washington, there are three states, multiple counties, two major cities and several smaller cities that all need to coordinate efforts.
The complexity of the region’s disaster response plan laced every question raised during the eight-hour, one-day conference held at the Uniformed Services University of Health Sciences in Bethesda.
The conference is the first of its kind to bring together scientists who concentrate on the research aspect of disaster events and first-response health officials who deal with the real world complexities of disaster response execution.
The purpose of the conference is to “bring the two worlds together,” said lead moderator Michael Greenberger, director of the Center for Health and Homeland Security at the University of Maryland.
Concerns focused specifically on the confusing chain of command among the local, state and federal responders that infamously broke down during 2005’s botched response to Hurricane Katrina.
That problem resulted in the resignation of the Federal Emergency Management Agency’s director, Michael Brown.
“I don’t think the lesson has really been learned,” said Greenberger.
Montgomery County Fire and Rescue Service Division Chief Michael Love used his team’s Katrina experience to illustrate the layers of bureaucracy needed to complete even seemingly simple tasks.
“Our team was deployed to Gulf Port, Miss., to hand out ice,” Love said in an interview outside the conference.
It took eight hours to fill out paperwork and an additional 10 hours of local/state/federal negotiations to transport the 100-person team south. And that’s after years of test runs, he said.
Then came the issues of who was going to deliver the ice, how was it to be distributed, and so on.
“It’s complex when you talk about all the layers,” Love said shaking his head.
Although authority issues dominated the morning conference, it was hardly even the tip of the iceberg in the grand scheme of disaster preparedness.
“Keep in mind the disabled,” said JoAnne Knapp, director of emergency preparedness policy at the Maryland Department of Disabilities during the open discussion.
Even if a vaccine is handed out, there are people “who can’t leave home to receive it,” Knapp said.
“You have to have a plan B for people who can’t leave…or don’t speak English as a primary language.”
Dr. Philip Russell spoke to the effectiveness of those vaccines during the conference dialogue.
“The fact is,” said the professor of international health at Johns Hopkins University, “antibiotics are only 80 percent of the solution. Is the entire population going to take 60 days worth of antibiotics? No. So what do we do where antibiotics are not the solution?”
The United States faced this question in 2001 when letters containing anthrax were mailed to media and political offices in several states resulting in five deaths, two of which were Washington postal workers.
Health officials distributed antibiotics to postal workers and Senate staffers at that time, but still, partly due to the confusion over jurisdictional authority, the assailant was never found.
In the years since the scare, experts worry that antibiotic-resistant strains of anthrax have been developed.
In that case, “I don’t know,” said Dr. Lisa Kaplowitz, deputy commissioner of Emergency Preparedness and Response at the Virginia Department of Health.
There is “no plan B of what to use.”
Despite the obstacles of communication and outreach, and the lack of concrete solutions, experts are positive their efforts are moving in the right direction.
Greenberger sees this conference as being the first of many of its kind and Levine plans to take what insights arose on Tuesday to the MARCE group meeting in April for review.
“A lot has been done,” he said, “but we still have a ways to go.”