Public health's main fear over bioterrorism: surge capacity

Health departments are concerned they may not have the facilities, tools and personnel to carry out smallpox plans.

By Victoria Stagg Elliott, AMNews staff. Feb. 24, 2003.

Are we ready for a bioterrorist attack? The answer is an unsettling maybe -- or even no.

In recent months, significant resources have been focused on bioterrorism planning, steps that have improved dramatically the nation's ability to confront an attack involving smallpox or some other insidious agent. But holes in the long-neglected public health sector still exist, triggering uncomfortable doubts about the health care system's so-called surge capacity if such a worst-case scenario were to occur.

Take the Kansas City (Mo.) Health Dept. as an example. It developed a plan to respond to smallpox or other possible pathogens that would likely sicken thousands and require mass vaccinations. But Rex Archer, MD, MPH, the health department director, is not sure he could pull it off.

"We don't have the capacity to do either ring vaccination if there are very many cases or mass immunizations," Dr. Archer said. "It doesn't do any good to put plans in place if you actually don't have the capacity to do what the plan says."

In Kansas City, he said, a mass smallpox vaccination effort would take 10 days and require 4,000 volunteers, most of them rapidly trained lay people, scattered at eight locations.

"No way, no how," he said. "I don't have enough nurses to supervise at each of those sites for the 24 hours a day for those 10 days, and I don't have enough epidemiologists to do contact tracing if a case shows up."

His concerns are very real, echoed across the country -- from cities with varying populations and levels of awareness. According to a survey by the National Assn. of Counties and the National Assn. of County and City Health Officials, most local health departments are better prepared for a bioterrorist attack than a year ago, but only 3% would be ready if it happened tomorrow. Another 18% said they were nearly ready. The largest group -- 47% -- said they were about halfway there. Thirty-two percent said they were in the very early stages of planning or were not ready at all.