They had a native Thai speaker but not enough signs. At the behest of the Bush administration, Arlington County officials staged a mock mass vaccination clinic yesterday, aimed at testing the federal government's blueprint for responding to a bioterrorist incident such as a smallpox attack.
The lessons learned -- including the need for more directional signs -- are intended to help federal health officials refine their emergency response plans for a medical disaster.
Over the course of four hours, nearly 400 volunteers streamed through the Washington-Lee High School cafeteria pretending they had come for an emergency inoculation. From the 11-minute informational video at the start to the take-home daily symptom diary, organizers re-created what would happen in a clinic that tried to meet the stated goal of vaccinating 1,000 people in a day.
"This is as realistic as we could make it short of doing real vaccinations," said Arlington County Health Director Susan Allan. Police officers directed traffic, Red Cross workers handed out snacks and doctors screened out people posing as patients whose health circumstances would preclude them from getting the smallpox vaccine. Instead of pricking arms, public health nurses poked two-pronged needles into oranges to simulate the time and stamina needed to administer hundreds of inoculations.
The drill was one more step in the Bush administration's year-long effort to prepare the country for a possible biological assault, particularly an attack using the deadly smallpox virus.
Although smallpox has not been diagnosed anywhere in the world since 1977, security experts say they fear terrorists or a nation hostile to the United States, such as Iraq, might have a cache of the virus ready to be used as a stealthy, potent weapon.
Because the vaccine can cause serious or even fatal reactions, the administration is not recommending nationwide vaccination. Instead, President Bush has adopted a policy that calls for immunizing as many as 10.5 million medical workers and emergency responders who would serve as the nation's front line against a smallpox attack. Mandatory immunization of 500,000 military personnel is underway.
At the end of this month, Virginia will begin immunizing as many as 12,500 medical personnel, including two dozen Arlington County health department workers.
If an outbreak were to occur, federal health officials say they would move rapidly to vaccinate all 290 million Americans. Detailed guidelines developed by the Centers for Disease Control and Prevention estimate that it would take 1.3 million volunteers working 16 hours a day about one week to immunize the entire U.S. population. That breaks down to about 20 clinics for every 1 million residents.
The Arlington County drill tested that model, Allan said, with the specific intention of straining the system to "see where there are bottlenecks."
And they found them. About 100 volunteer patients, many of them government employees from Virginia and nearby, stood for 45 to 60 minutes at the third of five stations waiting for a medical assessment that included a discussion of allergies, weakened immunity and the health of close relatives who could be exposed inadvertently to live virus from the vaccine. At that juncture, some volunteers were rejected for the vaccine, and others were directed to a doctor or nurse to further discuss the situation.
One military officer who was inoculated for typhoid within the past month worked his way through a team of experts until they decided he qualified for the smallpox vaccine.
"Once the backlog was undeniable and well-documented," organizers added screeners and rerouted traffic, Allan said.
Throughout the day, Allan's health staff and consultants hired by the federal Department of Health and Human Services tweaked the setup and recorded the volunteers' movements with time stamps. Most participants said a process designed to take about 40 minutes took from 60 to 120 minutes.
"There's a lot of confusion working your way through," said Bernard Kripkee, whose run-through took almost two hours. He said the informational packets were not well designed, and the snaking layout in the cafeteria befuddled more than a few participants. He urged health officials to consult with commercial experts, such as companies that manage large football games or design airplane emergency evacuation cards, to assist with the logistics.
A Health and Human Services spokesman said the department gave Arlington County $70,000 to run the exercise, but he refused to say how much the Center for Naval Analyses would receive for conducting an assessment. Even before that report is written, officials said they saw the need to revamp the educational materials and order more bandages.
Peter Stauffer, a public health service officer who observed the drill for Health and Human Services, said he would run tape along the floor to direct clinic traffic. One public health nurse chuckled at the CDC estimate that each inoculation would require just 90 seconds. Some people, she said, take that long to remove a sweater or roll up a sleeve.
Bob Mauskapf, Virginia's statewide planner for emergency preparedness and response, acknowledged that there are limitations to any exercise. "You cannot introduce genuine panic into a drill," he said.
In addition, the session did not include children, disabled individuals or ornery patients who might disrupt a clinic, nor were there any medical problems, such as fainting or allergic reactions. Nevertheless, he said the experience would help prepare not only for smallpox but other possible crises, such as a flu pandemic.
Mauskapf and several colleagues drove from Richmond early in the morning to participate in the drill. A retired military man who has lived overseas and speaks Thai, Mauskapf posed as the "tall Thai guy" who could not speak English. They quickly found him an interpreter.