Thursday, September 20, 2001

Remember 9-11-01

State alert for
biological attack

Hawaii's emergency plan
had the Health Department
on the lookout since day 1

Signs of a biological hit

By Diana Leone

The same day terrorist-piloted planes slammed into the World Trade Center, the Hawaii Health Department started watching for any signs of terrorist biological attacks here.

Not because there were any threats or suspicions. Not because they expected to find anything. But because that's part of the emergency preparedness plan.

Workers checked twice daily with 30 hospitals and major clinics to see if they detected any unusual diagnoses or volume of patients that could signal biological terrorism.

And that continued for a week, until monitoring was reduced slightly, said Dr. Joan Chang, bioterrorism medical coordinator for the epidemiology section. "So far, everything has been pretty much normal, with routine volumes and routine illnesses," she said.

"Hawaii is prepared as well as any other state in the nation" for a potential biological or chemical attack by terrorists, state Health Director Bruce Anderson said.

"There are both advantages and disadvantages of being a small island state," he said. "Being a smaller state, we have been able to coordinate an organized response plan with county, state and federal agencies relatively easily. But our isolation makes us vulnerable with limited health resources and limited hospital capacity. These are issues we continue to address.

Rebecca Sciulli, the state Department of Health's bioterrorism microbiologist
and coordinator, worked under a vented hood yesterday
at the state laboratory in Pearl City.

"We've put a lot of effort into planning," Anderson said. "And we do probably have some of the best-organized hospitals in the country."

Isolation is a concern, but planners said that through a cooperative effort with the pharmacy association, Hawaii has drugs needed to battle the first 24 to 72 hours of an attack. A national stockpile of medical supplies would be made available within 12 hours -- even if it had to be flown in on military planes, said Laurence Raine, preparedness planner for the Health Department.

The city also has a plan -- which is a guiding force in state plans as well -- approved by the U.S. Department of Health and Human Services and the Office of Emergency Preparedness, he said.

Salvatore Lanzilotti, Honolulu director of emergency services, noted that Honolulu was "one of the first 27 cities ... to develop a metropolitan medical response system, in terms of biological agents, and to prepare for up to 10 percent of our population being affected by an agent."

Like everyone else in government making plans for such contingencies, he hopes nothing near that scale ever comes to pass.

Lanzilotti painted this picture of how Hawaii response would look, if there were a bioterrorism event:

Once the attack was confirmed, paramedics would help at public health clinics and fire stations, giving out antibiotics to those who might have been exposed and directing those who are developing symptoms to the hospitals. Hospitals would enact their emergency plans, preparing for a large volume of emergency patients.

If there were overwhelming numbers, regular hospital patients might be flown to neighbor islands or the mainland, Lanzilotti said.

One of the front-line fighters against biological attack is Rebecca Sciulli, bioterrorism microbiologist and coordinator in the state epidemiology branch. She has been wearing a beeper the last 10 days because she has the expertise to test suspected biological agents and determine what they are.

In November, Sciulli will train about 15 people across the state to be able to make basic diagnoses, in effect becoming her assistants and spreading the safety net.

More than 200 health care workers attended a conference in April that outlined the basics of recognizing the symptoms of biological attack. But more need to be educated because time is of the essence.

Most biological weapons take several days to manifest symptoms, but then must be treated quickly. They are undetectable when released and have deadly results.

An advantage for Hawaii is its military presence. Military officials could not be reached for comment yesterday, but their civilian counterparts said the military will help civilians with disaster management as long as it does not interfere with their military mission.

Training to assist civilian efforts is the 93rd Weapons of Mass Destruction Civil Support Team, a group of 22 National Guard members that will be fully certified sometime next year, said Guard spokesman Maj. Charles Anthony.

"I think for many years there was a sense it could never happen," Anderson said. "I think today there's a sense it could happen, and we need to plan around that."

Signs of a biological hit

These are the symptoms that, if occurring in large numbers, could indicate a biological or chemical attack:

>> Respiratory illnesses.

>> Neurological illnesses, such as meningitis or encephalitis.

>> Botulism-like syndrome, accompanied by paralysis and respiratory problems.

>> Unusual rashes.

>> Sepsis/shock, a blood-borne infection resulting in shock.

>> Diarrhea or vomiting.

>> Fever.

Source: Joan Chang, medical coordinator for the state Health Department's epidemiology bioterrorism section

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