Research Outline
An intentional release of the Francisella tularensis virus is thought to have occurred in the City of Dallas, Texas and adequate measures need to be taken to prevent the spread of the virus that is likely to cause Tularemia disease in the city resulting to massive illness and deaths. In real life, there is no vaccine for the Tularemia disease, but the condition is curable at its early stages. The disease has an incubation of between 3-6 days after which it causes severe incapacitation of the victim and may lead to death if the condition is not treated. Tularemia disease is common in small animals such as squirrels, beavers and rabbits but not human beings. Some scholars of the world have often referred to the illness as ‘rabbit fever’. The condition is less contagious hence not communicable. Individuals can only acquire the disease by breathing in the dust that is contaminated with the Francisella tularensis virus, by drinking water or by consuming virus-contaminated food, by biting an insect that is infected with the disease and by touching wounds, fur, skin of both infected animals and humans.
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The Department of Health and Human Services ( HHS), the Office of Emergency Preparedness (OEP), the Centers of Disease Control and Prevention ( CDC), the National Institute of Health (NIH) and the Federal Bureau of Investigation must respond appropriately to the situation surrounding the outbreak of Francisella tularensis virus because it is a bioterrorist case.. The local law enforcing agencies as well as the Texas Health Department would also play a significant role in containing the incidence. At this juncture, the different health agencies will work towards minimizing the number of casualties by all means possible. The Texas emergency management program will be completely staffed, with fully dedicated personnel. The Department of Texas Health (THD), health care physicians, and other medical practitioners would work long hours to try to contain that situation. In this way, resources within the Texas hospitals will be stretched and ultimately exhausted.
Chen is a medical chief at Harborview Medical Center and also an associate professor at the University of Washington. Hickner is a professor of Family Clinical medicine and a Head of Department in the University Of Illinois College Of Medicine. Dr Fink is a physician practising family medicine. Callagher is one of the best research consultants in America, while Dr Helen is the vice president of the National Quality Forum (NQF). The main aim of this article was to establish the nature of preparedness of the Americans as far as the bioterrorism attack is concerned. Through national surveys across America, the above scholars found that a very few numbers of the physicians felt prepared to face a bioterrorism event before training. Still, upon exercise, the same physicians felt more confident to face the terrorist attacks. The findings of this article, therefore, established that the American government has to work hard towards training the primary care physicians to enhance their abilities to respond to the bioterrorism events.
Dr Gallet is a lecturer in the University of Southampton teaching Human Geography. Magruder is a prominent researcher in America and Molgard is a professor and a chair in the School of Public and Community Health Sciences at the University of Montana. The research study was intended for the general public. The study focused on the growing concerns in the public health community docket where these researchers argued that there were potential threats of terrorism of chemical and biological nature. They went on to show how such acts of terror would impact the general society and more specifically, the local community. In their view, the chemical and biological actions of terrorism were beyond the limits of the city, country or even the geographical borders. This research study further established several precautions that they felt that would help the government in fighting bioterrorism and making the country a safe place for everyone.
Dr Gourlay is a specialist in pediatric and surgery in the Children’s Hospital of Wisconsin. On the other hand, Dr Siwek is a family health physician in Maryland and often associated MedStar Georgetown University and Providence Hospital. The article was intended for the different health agencies, the government, as well as the various hospitals. The study sought to establish some of the resources that are adequate to counter the bioterrorism acts and how such funds can be applied in different contexts to reduce the number of casualties in a bioterrorism attack. The research study further provided the specific guidelines and procedures that should be implemented by the law enforcing agencies to reduce the number of casualties in a bioterrorism act. This research article is essential since it establishes some of the resources needed in a country to counter the bioterrorism events.
Rachael is an Assistant Professor in the School of Public Health at the University of Illinois, Chicago. Mar is a Professor if Industrial Hygiene in the University of California, Berkley. Hubbard is an Associate Professor in the School of Public Health at the University of California, Berkley. Sylvester is currently a PhD student in Bioengineering Track in Stamford University. The research study was intended for the general public and mainly focused on the issue of the spread of bioterrorism pathogens- Francisella tularensis. In the study that was aimed at estimating the individual’s risk of getting infected from an air-borne pathogen, they found that the air-borne pathogen adequately varied from one person to another. They further concluded that the spread of tularemia person-to-person is in this regard possible. This article was vital in the sense that it established the nature of the Francisella tularensis, which is a major biological pathogen used in bioterrorism attacks.
Khan is a professor in Surgery-Breast Surgery at Northwestern University Feinberg School of Medicine. Morse, on the other hand, is a professor in the School of Veterinary Medicine at the University of California. This research study was mainly intended for the government, the different health agencies as well as the various health practitioners across the American nation. The study generally addressed the varied ways of facing the biological weapon threat and how to reduce the threat of the biological weapons adequately. The findings of this study are significant in the sense that it provided adequate knowledge on how to counter and mitigate the risks of bioterrorism pathogens.
Francisella Tularensis Virus in Dallas Texas
Abstract
The level of preparedness to respond to the bioterrorism is not solely the effort of the government but more of communal activity. The government, the surrounding community and the different health agencies in America are supposed to join hands and face the crisis together. This means that the government, the local communities and the health agencies are to remain conversant with the emergency response procedures to respond to an emergency in the best way possible adequately. Also, the local community is to be educated on how to handle events about bioterrorism to be able to care of their selves and know how to take adequate measures and precautions to contain a bioterrorism event even before help arrives. However, this has not always been the case; most communities in America still lack clarity on how to respond to emergencies. They are not even sure of whom to notify of the conditions or even the precautions to take in such a situation. Bioterrorism and other related acts of terror are perpetrated by the terrorist groups to hurt the community in general. Therefore, the local communities are supposed to be in a situation where they can adequately take care of themselves without the help of the government agencies. So far, there has not been any actual bioterrorism attacks on the US. Still, there is a need to take precaution by determining how well prepared the American health sector is to issues of bioterrorist attacks.
Introduction
Despite the excellent contribution to the way of life throughout the 20th century, the American health sector remained adequately the same throughout the century. But this situation would later change following major terrorist attacks on the American soil on September 11, 2001, that was followed by a bioterrorism attack on a significant America postal institution that led to spread of anthrax (Chen, 2002). America as a nation did very well towards responding to these particular attacks and adequately elevated the level of bioterrorism preparedness in the different health practitioners and the level of international awareness. This also resulted in the creation of emergency response teams and sectors to respond to the occurrence of similar incidents. The federal government further went on to release a budget that saw a massive sum of money set aside to cater for the emergency response activities as well as elevating the level of preparedness in the country. Similar funding followed the following year and even years after.
Bioterrorism has been defined by the Centers for Disease Control and Prevention (CDC) as a deliberate release of toxins, bacteria, viruses and other dangerous elements to kill or cause illness to the general population, animals and even the plants (Gourlay and Siwek, 2006). However, the biological pathogens do exist naturally in various parts of the world and that they can adequately be adjusted or mutated to power their abilities to cause harm to the human race (Jones et al., 2005). Mutating such agents does not only make them dangerous but also resistant to medicines and further enhance their speed of spreading in the environment. The pathogens in bioterrorism are said to be mainly spread through water, touch, food and air. It is often believed that the bioterrorism agents are very hard to detect once released to the surrounding environment (Khan et al., 2000).
Background
The history of weapons of Mass destruction can be traced back to the early 1990s. Particular incidents led to the evolution of international policies regarding weapons of mass destruction. In the year 1995, Aum Shinrikyo in Japan released a bioterrorism agent-sarin nerve gas in a subway in Tokyo (Garrett et al., 2000). This was a clear demonstration that the biological and chemical weapons were already on the wrong hand and that the nations of the world were to start getting prepared on how to counter these threats and get ready to suffer the consequences. In the same year, the Murrah Federal Building in Oklahoma City was bombed by terrorists. This resulted in a loss of lives and massive destruction of property. It finally dawned on the American government that an imminent threat was knocking on the door. In response to these threats, the American government introduced adequate policies about the weapons of mass destruction (Khan Et.al, 2000). Such systems made America a safer place free from terrorist activities and further enhance the awareness and the abilities of the federal, local and state governments in fighting the terrorist activities.
In the recent past, America has created a lot of enemies in the world, mainly following its remarkable efforts on the war on terror. International terrorist groups such as the ISIS and Al-Shabbab in this regard feel pinned down. Further, America has been involved in global operations in the fight for the appreciation of human rights. An example is the case of Libya in Africa. As much as this is good for the people of the world and the nations of the world, it is perceived as an intrusion by certain individual groups of the world. This is what has made America a real terror target today. Therefore the American forces have to continue being extra-vigilant to matters pertaining security now that weapons of mass destruction that can be used to inflict a lot of pain on the American nation are already on the wrong hands.
The problem affecting the US regarding WMD
The public health sector must respond to particular health emergencies in America and prevent the spread of diseases, prevent the occurrence of epidemics, prevent injuries, protect the general public against the environmental hazards and provide quality and accessible health services to the general public (Khan et al.,2000). This is what is expected of them by the American government and the general public. To adequately respond to a health emergency, health practitioners have to be adequately prepared.
The different public hospitals must remain prepared on events triggered by weapons of mass destruction which result in an outbreak of diseases through humanmade ways or even natural means. In this regard, the physicians, administrative personnel, nurses and even the technicians should adequately be trained in different forms of responding to situations involving weapons of mass destruction (Chen, 2002). The main problem is the different locations call for various measures, and the public health sector has always to be ready for such a crisis. The federal government, on the other hand, has to annually budget for the expenses involved in training the different health practitioners on these issues. Therefore, the government must regularly assess the plans in place and the level of preparedness of the involved stakeholders.
Currently, the US government faces a challenge of preparedness to the different types of bioterrorism. According to Garrett et al. (2000), the biological agents are easily picked from the environment as compared to the chemical agents. This makes them an easy target for the terrorist groups. Currently, America does not have the advanced detection warning system that would adequately send early signals to the disaster management agencies in case of an impending bioterrorist attack, establish the contaminated locations of the country and the people at risk or even predict the methods that would be used to release the biological agent by the terrorist in the major cities. The American government dwells on CDC for forensic analysis of such situations.
Francisella Tularensis Agent
The F. tularensis agent has been categorized by the Centers for Disease Control and Prevention as a significant biological welfare agent (Jones et al., 2005). In the past years, this agent has been included under the natural welfare programs in different countries of the world, including the Soviet Union, Japan and the United States. Various scholars and researchers have the Tularemia disease outbreak experienced by the German soldiers during the First World War was as a result of the Francisella Tularensis virus released by the Soviet forces. Ever since then, America has always been on the verge of extending research on this particular biological agent. According to Jones et al. (2005), Francisella Tularensis is less persistent and easier to decontaminate, unlike the anthrax virus. However, it has severe consequences and eventually results in death after damaging the victims. The illness has also been perceived to be aerosolized and highly infective but less lethal.
Jones et al. (2005), further indicated that once F. tularensis agent has been ‘weaponized’, it becomes a low infectious dose and that with only 50 kilograms of the pathogen released in a metropolitan area with approximately five million city dwellers, 250, 000 would be damaged by the virus and 19,000 would eventually die. Even though the virus is less infective or also does not infect when released in low volumes, the respiratory infections have been perceived to be the worst with this particular virus.
Literature Review
In the early years of the 21st century, the first cases of Tularemia disease hit America. The outbreak was experienced in Martha Vineyard, but it is believed that the explosion was not a bioterrorist act. The CDC conducted more investigation into the matter and established that the Francisella Tularensis virus emanated from the law of lawn mowing in the area. Adequate measures were taken to prevent further spread of the virus.
Over the 20th century, several other incidents about the Francisella Tularensis virus were witnessed in America. In the year 2005, in an area around a shopping mall in Washington DC, small traces of the Francisella Tularensis virus were detected in the air. This was a morning after the antiwar demonstrations held about the end of the war on foreign nations. In this regard, thousands of people around the mall were exposed to the virus, but no severe infections were reported. Researchers have established the fact that the Francisella Tularensis virus infects some individuals upon exposure, but others are not.
Nevertheless, the American government was quick to defend the fact the action that led to the exposure of thousands of Americans around the mall was not an act of terror but a natural act. Recently, in the year 2011, a bunch of researchers set on a mission in Texas discovered evidence of the presence of Tularemia infection in the area. Concerns were raised, and the residents of this area were cautioned about the incidence and the necessary measure to avoid the spread of the disease to the humans. However, in the year 2014, two residents tested positive for the virus and were put in isolation to prevent further spread of the disease. CDC officials toured the area of Northern Colorado and established several rabbits had died for no reason, but upon testing for Tularemia disease, the carcasses tested positive for the virus.
Training/Education
Different researchers and researchers tend to believe that inadequacy in training and education on bioterrorism is an apparent factor to the spread of significant viruses in the different parts of the world since the individuals lack the knowledge and technical know-how on how to address a particular matter and even contributes to further spread of the virus when one fails to address issues in the right way. According to Gourlay and Siwek (2001), it is often hard to for the medical practitioners and the local community to establish an epidemic occurring or an outbreak of a particular disease not until the results are scientifically screened by government health agencies such as CDC. It is unfortunate the local population in the different parts of America continue to lag on matters relating to the bioterrorism events. In this regard, adequate public information on how to prevent the spread of Tularemia disease in human beings is significantly vital to the local populations.
Preparedness
Preparedness has often been perceived as the act of having taken the needed precautions and adequately prepared well to face a threatening situation (Jones et al., 2005). The preparation involves placing the resources required in their rightful place and effectively coordinating and controlling them to significantly counter an epidemic, act of terrorism, a natural occurrence or even other significant disasters. Hospitals across America are adequately prepared regarding emergency response to situations since adequate policies, plans and strategies have been implemented in most hospitals in America (Khan Et.al, 2000). Governmental and other independent organizations have been equipped with the right resources to enhance their level of preparedness. Nurses, physicians and medical officers are regularly trained on the issues of emergency and disaster management. Not so much to say about the level of readiness about bioterrorism events in America through the American government has developed and still on the verge of developing adequate measures to avoid the occurrence of such incidences on the American soil.
In case of a bioterrorism event in Dallas, Texas; therefore, knowledge of the attack would be learnt upon a continuous influx of individuals with similar symptoms in major hospitals in Texas. The symptoms of the disease would never be first linked directly to a bioterrorism event since it might not be considered as an outbreak until the numbers are high. Nevertheless, following the report of the incident to the federal government, agencies obligated to counter the bioterrorism threats will adequately respond to the situation. The Department of Health and Human Services (HHS), Office of Emergency Preparedness (OEP), Centers of Disease Control and Prevention (CDC), National Institute of Health (NIH) as well as the Federal Bureau of Investigation would respond to the situation. It would be observed that the response would be run by the FBI in collaboration with the local law agencies and upon establishing evidence of a credible threat, the information would then be passed to the local health departments, in this case, the Texas Health Department. The Texas Health Department would then move to define the population at risk, locate the persons under threat of exposure, monitor the treated persons as well as have surveillance on the infected area and its neighbouring environments. All other, agencies will be involved partly in trying to establish ways of containing the epidemic.
Problem with the response
It is of importance to clearly understand that different bioterrorist attacks call for a different set of agencies to respond to the situation. Therefore, a bioterrorist attack on humans will require a different set of response group from a bioterrorist attack on animals and plants. Also, it is of significance to note that the use of chemical weapons creates a significantly different situation from that of the biological evidence. In this case, the effects of the chemical weapons are immediately felt after the agent is released to the environment. On the other hand, the impact of the biological evidence is slower and equally lethal. However, it is not possible to learn of a release of the biological agents not until the effects of the pathogens are physically observed on the targeted population.
About the response of a bioterrorist attack in Texas, several problems would be imminent in the response system. First, there would be no adequate methods of notifying the health agencies of the event until there are mass cases of similar illness reported in major hospitals in Texas. Secondly, an increase in the number of ill persons in the infected region would arise from the continued spread of the virus by residents who have no idea of how to conduct themselves. Francisella Tularensis virus is not contagious and spread in human through touch. This would further mean that the local population is not aware of how to deal with events of a bioterrorism attack. Also, the response would be run by the FBI and the local law enforcement agencies of which in most cases are not even aware of what they are dealing with hence pausing even higher risk to the public.
Consequences of the attack
Usually, the Tularemia disease does not have a high mortality rate and is ordinarily controllable at its early stages through the use of antibiotics (Jones et al., 2007). Once not controlled, it eventually results in deaths. Regarding a bioterrorist attack in Texas, the consequences would not be that lethal for the different health agencies will work together in containing the situation and establishing a way to stop further spread of the virus. However, it would be likely that several deaths would be experienced. These are usually the first cases a few cases of the disease.
Future implications
The response system is supposed to act within the most minimal time in establishing and containing a threat. By following the Texas procedure of response where an epidemic can only be found when the local hospitals only record-high number of similar illness; a lot of lives are put at risk. Further, it implies that it would be almost impossible for America to control bioterrorist events if more lethal viruses are used.
Suggestions
Let the fight against the bioterrorist attack be a fight for everyone. Let the local communities participate in putting an end to such endemic situations. These communities would only participate in this process if they are fully aware of the nature of the attack or are aware of how they should conduct themselves in such situations. Better systems of alert need to be implemented at the community level to help establish threats before they even occur. This would make the health response system of the country proactive rather than reactive. Further, there need for better coordination of the groups involved in containing a bioterrorist event. In this case, I would suggest relocation of the CDC officers to most local regions of America such that concerns of bioterrorism attacks would be evaluated early enough to reduce risk of spread thus boosting the chances of containing such events.
References,
- Chen, Fredrick, M., John Hickner, Fink, Kenneth S., Calliher, James, M. and Burstin, Helen.
- (2002). On the front lines: Family physicians’ preparedness for bioterrorism. The Journal of Family Practice, Vol. 51, No. 9.
- Garrett L., C, Magruder, C., Molgard, C., A. (2000). Taking the terror out of bioterrorism: planning for a bioterrorist event from a local perspective. Journal of Public Health Management Practice; 6(4):1–7.
- Gourlay M, Siwek J. (2001). Resources in the war against bioterrorism. Am Fam Physician; 64(10):1676–8.
- Jones, Rachael M., Nicas, Mark, Hubbard, Alan, Sylvester, Matthew D., and Reingold, Arthur. (2005). The Infectious Dose of Francisella tularensis(Tularemia), Applied Biosafety, 10 (4) pp. 227-239.
- Khan A., S, Morse, S, Lilli-bridge, S. (2000). Public-health preparedness for biological terrorism in the USA. Lancet, 356(9236):1179–82.
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