If Bioterrorists Strike, Letter Carriers Might Deliver Antibiotics
Thursday, October 2, 2008; Page A02
"Neither snow, nor rain, nor heat, nor gloom of night, nor bioterrorism attack stays these couriers from the swift completion of their appointed rounds -- especially if they are delivering antibiotics to protect people from anthrax."
That may someday become the unofficial motto of the U.S. Postal Service.
Health and Human Services Secretary Mike Leavitt yesterday proposed a solution to one of the bigger challenges in responding to an anthrax bioterrorism attack -- how to deliver protective antibiotics to tens of thousands of people overnight.
The tentative answer: have the mailman (and -woman) do the job.
As an incentive to the letter carriers -- who would be volunteers -- the government would issue them in advance an antibiotic supply large enough to treat themselves and their families. They would also be accompanied by police officers on their rounds.
"We have found letter carriers to be the federal government's quickest and surest way of getting pills to whole communities," Leavitt said.
The strategy has the full support of the Postal Service and its unions, spokesmen said.
"Letter carriers are on the street six days a week. They are constantly helping out as just part of their job, and this is taking it one step further," said Drew Von Bergen of the National Association of Letter Carriers.
"Anytime this country has any kind of crisis, it is the Postal Service that is out there first," said Postal Service spokeswoman Sue Brennan.
Boston, Philadelphia and Seattle held experimental runs of the distribution strategy in 2006 and 2007, said William Raub, Leavitt's science adviser. In Philadelphia, 50 carriers, each accompanied by a city police officer, reached 55,000 households in less than eight hours.
Based on those tests, the strategy was deemed practical and will be put in effect on a trial basis next year in Minneapolis and St. Paul, he said.
The Postal Service there will solicit about 700 letter carriers, enough to cover 20 Zip codes or about one-quarter of all households. The workers will be medically screened (including questions about family members), fitted with N95 face masks, and issued a supply of the antibiotic doxycycline for their household.
If successful, it may be expanded to encompass the entire Twin Cities area, said Jude Plessas, a Postal Service official.
Before that pilot project can begin, however, the Food and Drug Administration must approve distribution of the drug for this purpose, which is not currently part of its label, or officially approved list of uses.
Leavitt yesterday requested that FDA review, which may take months.
Since 2004, the federal government has funded the Cities Readiness Initiative, which is helping 72 urban areas make plans to distribute drugs to a target population within 48 hours of a bioterrorism attack.
Any of those cities will now be able to employ the letter carrier distribution strategy. The federal government will not force them to adopt it, as disaster planning is principally a job for state and local governments.
The federal government has enough anthrax antibiotics in the Strategic National Stockpile to treat 40 million people for 60 days. The medicine is cached in 12 sites around the country.
Sixty days is the maximum amount of time a person exposed to airborne anthrax spores might have to take medicine to prevent the inhalational form of the bacterial infection, which is rapidly fatal if not treated.
Letter carriers who volunteer for this duty would not be paid bonuses or given any other incentives, Brennan said.
In a bioterrorist attack seven years ago this fall, finely powdered anthrax spores were sent in envelopes to several addresses on the East Coast. Four workers at a mail processing center in the District, where at least one of the letters was sorted, developed inhalational anthrax, and two died.
In all, 8,424 postal employees were offered prophylactic courses of antibiotics. Sixty-six percent started, but about 10 percent of them stopped taking the offered drugs for various reasons. Nearly all took ciprofloxacin, a medicine that is not being offered as part of the letter carriers' supply under the new plan, in part because of its possible side effects.
In another action yesterday, Leavitt issued a declaration that will provide protection against lawsuits for companies that make drugs for mass distribution during an anthrax attack, or who help distribute them.