RUTHFULLY YOURS

The CDC, Anthrax, Illegal Immigration, And The Public Trust (Part 2 of 2)

“The single greatest threat to man’s continued existence on earth is the virus.” Joshua Lederberg, Nobel Laureate

Part 1 – Click Here

Bioterrorism Preparedness

What does national preparedness mean? It suggests the ability to respond to a wide array of threats and prevent unnecessary loss of life or injury. This requires translating national policy initiatives into local program implementation. It is a significant challenge to prepare for an unknown event, especially without a clear cut indicator of who and how many to protect, and from whom.

National activities to prevent or respond to a bioterrorism event have hinged largely on the development of biosurveillance programs and arms length detector technologies.  As I’ve written for FSM back in 2008, when the National Biosurveillance Center was about to be officially opened, the GAO reported that they weren’t sure what the NBC could actually accomplish given the interagency rivalries, growing bureaucracy, problems with interoperability, and the ubiquitous ‘mission creep’ that evolves in such important undertakings. If these were the problems afflicting the NBC under a president, and administration that actually cared about homeland security, imagine how the various government agencies designed to protect the US are faring under an administration that seems consumed with shifting national resources to entitlement programs, decreasing the stature of the US from one of international superpower to that of merely an ordinary country, just another member of the United Nations.

As an aside, and general terrorism preparedness comment, having NY City downgrade its capabilities in their intelligence division so as not to offend the very people who are likely to attack our country – again – seems ridiculous. Our adversaries must laugh themselves to sleep.

According to studies by the GAO and US Department of Agriculture IG reports at increased risk for incidents at laboratories doing research of deadly pathogens as part of bioweapons research, in no small measure due to the feds failure to develop national standards for lab design, construction and operation.

The growing weakness in bio preparedness in the USA from the top down is staggering. From the ADD-like foreign policy and domestic preparedness edicts of President Obama, to the growing disinterest in bioterrorism among all but a handful of health care professionals and health care facilities are just some critical infrastructure issues that this current president is contributing to.

Emerging Pathogens & Public Health

We live in a global world where most people outside of North America are likely to die from an infectious disease – something the average US citizen doesn’t worry about, and hasn’t had to since the mid 20^th century.  TB, dengue, HIV, influenza, malaria, food-borne illnesses, and environmental (mosquitoes, worms, other insect vectors) threats pose daily risks to most people worldwide, especially the poor, which suggests immigrants from South America, parts of Africa, the Middle East, and Asia can import their illnesses as they immigrate or travel within our borders.

By May of 2014 the Middle East Respiratory Syndrome Coronavirus (MERS, or MERS CoV) arrived in the United States. For many of you, this is a new virus, and another threat emanating out of the Middle East, in case terrorism and energy insecurity weren’t enough! The World Health Organization (WHO) alerted the international community about MERS after identifying the new pathogen from two men who became ill in Jordan in 2012. Early in the MERS lifespan, cases were sporadic. A few cases were in clusters around health care workers and close contacts. Lately the numbers are growing seemingly exponentially. By March 27, 2014 WHO reported 206 confirmed cases. By end of April 2014 the WHO case count increased by more than 50 additional cases. The total as of last month there has been reported at 536 laboratory confirmed cases, and 145 deaths. While the apparent case fatality rate has appeared to decline, from ~50% in the early days of MERS to approximately 25% depending upon the country, that is still a high percentage of deaths per cases infected. While there is still no readily available vaccine against MERS, and the use of current antiviral medications remains in question, an early index of suspicion by well informed health care professionals can reduce the risk of spread, and initiate aggressive intervention, which can also provide life saving support at the earliest possible critical junction in care.

While our vaunted laboratory network (LRN) that was strengthened during the Bush years may be able to detect MERS and other potentially deadly, emerging pathogens, it might have been nice if our own CDC had been more proactive than merely placing updates on MERS and other global infections on its website – most of the content being derived from the World Health Organization (WHO). Not to play “pile it on” given the CDC but there are some things in the preparedness arena that are under the heading of “low hanging fruit” and then there are some that are under the heading of “no brainer” – providing safe ventilation in areas housing or studying aggressive pathogens, and monitoring the successful treatment of biological weapons stockpiles definitely coming under the heading of “no brainer.” Lack of warning to American doctors and the public about a new strain of avian flu or a new respiratory virus MERS CoV (Middle East Respiratory Syndrome Coronavirus), who might have not heard about it since first appearing in 2012 w/out articles in New England Journal of Medicine, Disease a Month (article by yours truly) and a scant few other journals well before the first US cases – but do we really want to hope our physicians stay current with medical journals in the face of a new pathogen that has the capacity to kill a fairly high percentage of those diagnosed?

The CDC website is very nice. It is frequently parking World Health Organization information. With our powerful media and social media capacity, perhaps more proactive warnings can come to Americans, besides those few who know to check out the travelers information page (highly useful) or update section of the CDC website.  A website is not a surrogate for public awareness and preparedness.  Several years ago I reported on the World At Risk Report emphasized the importance of engaging the public. This is a bad time to lose ground.

It is just a matter of time before another outbreak risk occurs on our shores. Swine flu was not the last threat we faced as a country.

Discussion

The US faces an onslaught of threats and challenges, not the least are several which will impact the health of our nation.

First – natural pathogens. From MERS to the latest version of avian flu, to the changing geographic spread of dengue, malaria and TB. One approach requires greater surveillance, and greater research on antimicrobials, and vaccines. We need to continue vaccinations in spite of the anti-vaccine movement in the US. And our government agencies need to be more proactive in alerting the health care community of new threats such as MERS. Does anyone seriously think parking an article on the CDC website or some blurbs about this and other threats is sufficient?

Second -investment in critical infrastructure. From 2001 to 2005 – as homeland security dollars flowed into hospitals and health departments, not surprisingly there was both interest and educational programs addressing bioweapons, pandemic flu and emerging infections. As those dollars continues to shrink, so does the knowledge of our health care professionals, limiting the tools they need, and the preparedness we as a society rely upon.

Third – this issue remains the third rail of political discourse and something we’ll discuss in a future article is the growing threat of illegal immigrants – mostly from poor countries where many diseases occur that are still somewhat uncommon in the US. How healthy will our communities remain when tens of thousands of people – including the unaccompanied minors flooding the border – are sent across the country instead of returned to their countries of origins? Also where does the government think the doctors, nurses, PA’s, and equipment to treat the warehoused kids that are being sequestered in Arizona and Texas will come from and who will lose those services while they are transferred to care for illegal population? Moreover, many of these illegals bring with them serious, often contagious illnesses. At a time when our health care system is woefully overstretched, our hospital overcrowded, and the misuse of emergency departments growing from the swelling ranks of uninsured (Obama care not really making a difference), welfare recipients (legal and illegal), when many of these folks could be well treated by public health clinics, which are sadly closing or underfunded, well we need to address this problem before our health care facilities become irrevocably similar to third world countries. This is a resource, not race issue.

Lastly – whether Al Qaeda, or other terrorist groups, or rogue nations, biological weapons are highly sought out and valuable. There are too many labs, too many players and too many pathogens to ever think we are safe from the threat. For many, 2001 was a blip, an anomaly. I wonder if the people of Manchuria during WWII – tens of thousands of whom were killed or made sick by Japan’s Unit 731 – think bioweapons are an anomaly? Which is why USAMRIID and CDC are so vital to our security, and must be held to the highest standards. When they fail their mission, they fail our nation.

We as citizens need to be proactive about our health, vocal about the critical infrastructure investments vitally needed, and make it clear that border security is health security. Our elected need daily and frequent reminders. Our health care facilities need to receive heightened training about emerging threats, as does the public – the way it was in the Bush years, when preparedness was deemed a valuable investment. Further investment in antiviral medications and vaccines are essential – and the pharmaceutical industry provides shovel ready and high paying jobs.

Conclusion

June 2014 through another safety breach, the CDC allowed ~ 84 workers to be exposed to anthrax. Should we take some solace that the CDC is telling us the public is not at risk? Not a trick question. CDC has to earn the public trust before thinking we will sleep soundly with their comments that things are under control.  That the CDC remained in charge of investigating their own mistakes, is a flawed strategy and certain to delay necessary improvements. The CDC is too vital to US interests to allow internal politics, egos, bureaucratic problems and plain old fashioned institutional pride to get in the way of sound safety practices, objective investigations, and revamped security protocols. To do any less would be a disservice to the country, and the public trust.