America At War:
How Hospitals Cope
With Dr. Christopher Ackermanr
Chief Medical Director,
Greater Southeast Community Hospital
Friday, Oct. 26, 2001; 11 a.m. EDT
As the federal response to the anthrax threat intensifies, D.C. health officials are recommending antibiotics for hundreds of Washington area workers who have handled mail that may have been contaminated. On Sunday, Oct. 21, a postal worker was admitted to Greater Southeast Community Hospital and later died of what was determined to be anthrax.
Dr. Christopher Ackerman, chief medical director at Greater Southeast Community Hospital, was online Friday, Oct. 26, at 11 a.m. EDT, to discuss the anthrax threat, medical preparedness and treatment protocols.
Ackerman is a graduate of the George Washington University medical school and has been practicing medicine in medically underserved communities for more than 13 years.
A transcript follows.
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Dr. Ackerman will be with us shortly.
Dr. Christopher Ackerman: Good Morning. Sorry I'm late.
Thanks for offering your thoughts and questions.
I've been reading a lot about the usage of antitoxins to reduce the effects of the lethal toxins produced by an inhalation anthrax infection. Please comment on the availability of this kind of treatment today, as well as any other types of treatment outside the antibiotic realm. Thanks.
Dr. Christopher Ackerman: CDC has no specific recommendation at this time. Some ID physicians have suggested the use of clindamycin for its anti-toxin effects in treatment of the severely ill, hospitalized patient with inhalational anthrax.
Mexico City, Mexico:
Do serum antibodies against anthrax reduce disease? And if so, can specific immunoglobulin from vaccinated/immune individuals be used to protect from inhalation anthrax?
Dr. Christopher Ackerman: There is a vaccine that the U.S. military has used. It is not presently approved for civilian use, to my knowledge.
Are doctors and area hospitals being overtaxed due to the anthrax scare? How are they handling the numbers? Is there enough care to go around?
Dr. Christopher Ackerman: The emergency departments are seeing substantial increases in numbers of visits. Many of these patients are area postal workers, on prophylaxis, who have developed symptoms of upper respiratory illness. A forum of all area hospitals, the departments of health of all local jurisdictions, and the CDC, is convened daily to address the needs of this increased demand.
Falls Church, Va:
I was initially angry the postal employees seemed to be getting the short end of the stick with late testing and treatment. I have revised my thinking though. I recognize that the info on anthrax is being written as we experience this event. I remember when AIDS was first being identified and "defined" by the CDC. Initial case definitions were, and continue to be, revised to reflect our growing knowledge base and testing technology. Some people were affected by being "excluded" by reason of case definition evolution, they were ahead of the curve. I think the case definition for anthrax risks has been changed quickly and hopefully the authorities will be more aggressive in deciding who is "at risk". Any comments?
Dr. Christopher Ackerman: Personally, I would prefer to avoid taking an antibiotic for sixty days unless specifically told to do so by a public health authority. Your point is well taken. We will see a whole new case definition for anthrax emerge. Specifically, case reports from our institution and from Inova Fairfax will be appearing in the medical literature next week.
I'm concerned with so many people without anthrax being given Cipro. Will Cipro be less effective for these people if they do get anthrax in the future?
Dr. Christopher Ackerman: Good question.
Anyone given Cipro should take it as directed. If it is taken strictly as prescribed, the possibility for emergence of resistance is reduced. Going to Mexico for one's own supply, or pressuring one's personal physician to prescribe it outside presently recommended guidelines will increase the possibility of resistance developing.
Dr. Ackerman, is there any way to detect early signs of infection besides swab tests? I know that you get flu-like symptoms but is there any other indication before it gets to that point? Thanks.
Dr. Christopher Ackerman: Actually, nasal swabbing is not recommended for diagnosis. Persons with a credible risk for exposure are receiving antibiotic prophylaxis as directed by public health authorities. Patients with symptoms of illness that may or may not represent anthrax are evaluated on a case by case basis by physicians and area emergency departments. Hospitals and providers have shared recommended protocols for these patient evaluations.
Although the chance of anyone contracting anthrax through their own personal mail is minute, do you think there is anything wrong with someone who gets "flu-like" symptoms to at least go to the doctor to be checked? Let's be realistic, if you don't start taking antibiotics early, you die. Is it fair for the "general public" to be ignored just because the threat is minimal? How do I know that the credit card bill I received from my bank in Maine, or some other state didn't go through machines that are contaminated? I have instructed my teenage daughters NOT to bring the mail in the house. I fear for their safety.
Dr. Christopher Ackerman: Your personal doctor is there to care for you on an individual basis in the event of an illness. I would always hope that one-to-one link remains for us all.
Is there a chance that small amounts of anthrax have been in all these places before 9-11 innocently (Walter Reed, CIA, House, Senate) but are just now being found? I'd bet if you tested the mail room at the Dept. of Agriculture you'd find anthrax ... but wouldn't you wonder if it was innocently sent from a farmer in Iowa??
Dr. Christopher Ackerman: Good question. I don't know. Certainly, anthrax spores occur naturally, but I believe the Attorney General has stated that this anthrax is processed and "highly pure."
Is your hospital beefing up its security at all?
Dr. Christopher Ackerman: Yes.
If I work at a local Foggy Bottom business, and handle mail, should I be worried at all?
Dr. Christopher Ackerman: Good question.
You could call the D.C. Dept. of Health office of communications; Jack Pannell. 202-442-5949
Washington , D.C.:
If I have flu like symptoms and I would like to get test for anthrax where I should go?
Dr. Christopher Ackerman: If you have not been advised by your public health officials that you were at risk of exposure, you should contact your doctor, as you ordinarily would, for any illness.
Thanks for providing additional information. Are treatment protocols changing as the CDC and the public health system learn more about the nature of the anthrax threat?
Dr. Christopher Ackerman: These have remained pretty much the same. Learning who needs prophylaxis is the part that changes quickly.
I am a health care professional and have received questions from others in my area concerning what types of masks will be effective against the anthrax that we are seeing today. Do you have any suggestions?
Dr. Christopher Ackerman: I don't know of any specific recommendation in this regard.
How likely would it be for anthrax spores to attach themselves to other pieces of mail flowing through contaminated areas? If it did, would exposure or contraction be as strong or potent?
Dr. Christopher Ackerman: Good question. I don't really know this yet.
East Lansing, Mich.:
If you visit the JAMA, FDA, CDC or any other credible Web site it's easy to find adverse event information on the Anthrax vaccine. Everything I've read points to minimal, if any, side effects. In fact the www.vaers.com which tracks all vaccine side effects rates the anthrax vaccine as one of the lowest in causing harmful side effects.
This being said, however, the news and many doctors are very critical of the vaccine. Which should the public believe? Organizations like the FDA, CDC, and JAMA or the recent press? Is this just a handful of extremists trying to make a stink over a good thing?
Dr. Christopher Ackerman: try CDC.ORG
I am trying to get pregnant and am concerned about the potential need to take antibiotics for this should I be exposed. What is being done for the women who were exposed (on Capitol Hill and in the postal service) who are or may be pregnant? I'm sure there is at least one in those groups!
Dr. Christopher Ackerman: There are protocols for children and for pregnant women. But again, you would only receive prophylaxis if you were at risk for a credible potential exposure and your public health authority (or the attending physician of the Capitol) would have recommended this for you and provided the antibiotics.
Dr. Christopher Ackerman: I'm sorry to sign-off but must run.
Thank you for these really good questions.
We're going to try to schedule another time within the next week to do this again. I'll try to leave more time.
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