Viruses are feared because of high case-fatality rates, no treatment, and communicability from person to person. Infectious doses are often very small.  While we have experience with outbreaks, it does not extend to instances in a densely populated, highly mobile, and unvaccinated population.

Readers may think I’m referring to the current outbreak of Ebola virus which started in West Africa, but I’m not. I took this information from the Dark Winter exercise documents. This exercise, which involved 14 national–level participants and spanned 14 days, was the result of an intentional release of a biologic agent.

Smallpox

Smallpox

Ebola

Ebola

In Dark Winter the virus of concern was Smallpox not Ebola.

While strikingly similar, there is one glaring difference between the two diseases.  In 1947, in response to a single case of smallpox in New York City, 6,350,000 people were immunized. 500,000 in one day, including President Harry Truman.  There is no vaccine for Ebola, so that disease management option is currently off the table.  Our best tools are identification of infected persons, contact tracing, isolation, quarantine, and symptomatic treatment.

It may be instructive to look at the findings from this 2001 exercise and consider our current level of preparedness to meet the Ebola threat.

  • An attack on the United States with biological weapons (BW) could threaten vital national security interests. Massive civilian casualties, breakdown in essential institutions, violation of democratic processes, civil disorder, loss of confidence in government, and reduced U.S. strategic flexibility abroad are among the ways a biological attack might compromise U.S. security.
  • Current organizational structures and capabilities are not well suited for the management of a BW attack. Major “fault lines” exist between different levels of government (federal, state, and local), between government and the private sector, among different institutions and agencies, and within the public and private sector. These “disconnects” could impede situational awareness and compromise the ability to limit loss of life, suffering, and economic damage.
  • There is no surge capability in the U.S. healthcare and public health systems, or in the pharmaceutical and vaccine industries. This institutionally limited surge capacity could result in hospitals being overwhelmed and becoming inoperable, and it could impede public health agencies’ analysis of the scope, source and progress of the epidemic, their ability to educate and reassure the public, and their capacity to limit causalities and the spread of disease.
  • Dealing with the media will be a major immediate challenge for all levels of government. Information management and communication (e.g., dealing with the press effectively, communication with citizens, maintaining the information flows necessary for command and control at all institutional levels) will be a critical element in crisis/consequence management.
  • Should a contagious bioweapon pathogen be used, containing the spread of disease will present significant ethical, political, cultural, operational, and legal challenges.

Readers could argue there is little connection between the naturally occurring outbreak of Ebola and an intentional release of Smallpox. That, and a great deal of planning has taken place since 2001. But we see close to one hundred thousand hospital acquired infection deaths in the United States every year.  This tells me we have a problem following infection control procedures and Ebola capitalizes on these lapses to spread. I suggest we should bring together key community resources around hospitals, EMS, free-standing healthcare clinics, emergency management, law enforcement, public health and providers of mass transportation and talk. Now.   As a wise man told me, the only thing harder than planning for a disaster is explaining why you didn’t.