Biological terrorism is a hot media topic these days, but by confusing fact and fiction, coverage could cause more harm than good. While national security and public health experts become increasingly concerned about bioterrorism, misleading stories are appearing -- including the recent anthrax scenario on ABC's "Nightline."
In a five-part series that aired between Oct. 1 and Oct. 8, "Nightline" presented "Biowar," a fictitious scenario of a bioterrorist attack in which an epidemic was unleashed when unknown terrorists broke glass bottles containing anthrax spores in a city subway. Panelists on the show, who in real life hold elected office or serve as governmental or public health authorities, represented the beleaguered professionals trying to cope with the fictional attack.
The "Nightline" series endeavored to call attention to a serious national security problem. It did succeed in illustrating how poorly informed and unprepared the country is at this time. In so doing, it also presented several inaccuracies.
First, "Nightline" incorrectly portrayed medical and public health intervention as ineffectual. In fact, an epidemic caused by bioterrorism would benefit from the application of expertise similar to that required in responding to a naturally occurring disease outbreak. These efforts include clinical recognition of cases, confirmation by laboratory testing, epidemiological investigation by public health staff, and the initiation of treatment and control measures. Medical and public health professionals would bear the primary responsibility for designing and executing such a response. Thus far, however, health professionals have been little involved in bioterrorism response planning sponsored by the federal government and were not much in evidence on "Nightline" either.
In "Nightline's" scenario, inhalation anthrax was depicted as having a three- to seven-day incubation period. What this means is essentially that all those infected in the scenario became ill within a week after exposure. By the close of the scenario, 65,000 had fallen sick, and 80 percent were expected to die. In the "Nightline" story, antibiotics were erroneously depicted as being of little value, and vaccines, arriving by airlift by Day Six, were too late to be beneficial.
The truth is, the incubation period for anthrax would extend far longer than the seven days portrayed. So too would the window of opportunity for carrying out life-saving medical interventions extend beyond a week. The only known epidemic of inhalation anthrax occurred in Sverdlovsk, Russia, in 1979 when anthrax spores were accidentally released from a bioweapons factory. About 80 cases followed, some occurring as early as two days after exposure and some as late as 47 days later.
Why does this matter? "Nightline's" story ended at Day Seven, implying -- incorrectly -- that no further interventions would be useful. In the real world, an anthrax epidemic is unlikely to be recognized any sooner than three or four days after the attack. It would take another 24 to 48 hours to obtain and distribute large quantities of antibiotics and vaccines. By Day Seven in the real-life epidemic at Sverdlovsk, 75 percent of cases had yet to show the first signs of illness; antibiotics and vaccines given at this point still could have saved many lives.
Other misleading scenes showed emergency health personnel wearing space suits and helmets; it was suggested that persons bringing in food or essential supplies might have to be similarly garbed. This is curious because, as the scenario correctly notes, anthrax does not spread from person to person, and workers run no risk of becoming infected after the event.
It is hoped that a terrorist attack using biological weapons will remain in the realm of fictional scenarios. But should such an event occur, professionals and the public need to be accurately informed and appropriate measures need to be taken to mitigate the effects. The Centers for Disease Control and Prevention and others have begun to raise awareness of the need for coherent medical and public health responses to potential bioterrorism. These efforts should be improved by increasing public understanding of the true threat of bioterrorism -- a result that can only come from careful media coverage of this easily sensationalized topic.
The writer, a public health physician, is director of the Johns Hopkins Center for Civilian Biodefense Studies.