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ALUMNI SYMPOSIUM Treating BioterrorismLast fall Frederick Bieber, HMS associate professor of pathology at Brigham and Women's Hospital, set guidelines with other forensic geneticists to identify the more than 30,000 people killed in war or murdered in the former Yugoslavia. Bieber, who spoke at the Alumni Symposium on June 7, reflected on the human tragedy in the Balkans--seemingly so far removed from concerns in the U.S.--as his plane left Dubrovnik. It was 8:30 a.m. Eastern Standard Time. The date was Sept. 11.
David Bell, HMS '77, who now is at the National Center for Infectious Diseases, told the audience at the Alumni Symposium about the need to develop bidirectional surveillance and communication systems between health workers and government agencies for times of crisis. (Photo by Steve Gilbert) Like Bieber, the speakers at "Terrorism: A Range of Responses," framed the events of 9/11 and the ensuing anthrax outbreak in a modern historical context. Nine months after the fact, HMS is taking a lead role in adapting public health priorities to new threats, said the speakers, even as we struggle to define them. Mustering Care ProvidersGary Fleisher, HMS professor of pediatrics at Children's Hospital, likened present efforts to the mobilization of Medical School personnel after the attack on Pearl Harbor, when "the faculty emerged as leaders both on the Quadrangle and in the field hospitals behind the front lines." He offered a glimpse of the School's ongoing work against bioterrorism, from basic research on anthrax to the leadership Harvard medics brought to ground zero. Fleisher said computer modeling shows the urgency of rapid intervention in the case of a bioterrorist attack. "In metropolitan areas, expedition of diagnosis of a first case by 48 hours might save a million lives," he said.Indeed, alert physicians made a difference in the recent anthrax outbreak, according to Morton Swartz, HMS '47, HMS professor of medicine at Massachusetts General Hospital. Ninety-eight percent of the spontaneous cases of anthrax in the U.S. between 1938 and 1970 were fatal, he said, compared to 45 percent in the outbreak last year, a difference "probably due to early diagnosis." Stressing the fact that "the detection of infectious diseases never seen in practice involves initial clinical pattern recognition," Swartz provided a primer of anthrax symptomatology for four forms of anthrax--cutaneous, inhalation, gastrointestinal, and pharyngeal--and outlined how each is distinguished from other illnesses. Monitoring the ThreatBut the trick will be to deliver such essentials to clinicians working on the front lines. "Providing timely and credible information was a significant problem last fall during the anthrax incidents," said David Bell, HMS '77, who is from the National Center for Infectious Diseases at the Centers for Disease Control (and who also spoke at the Class Symposium). The future challenge, he said, is to develop bidirectional surveillance and communication systems between health workers and government agencies, rather than to "just beam out messages from Atlanta."Bell placed acts of bioterrorism in the broader public health context. "They are the most recent example of how the world of infectious diseases has changed since most of us went to medical school," he said. "In the 1970s it seemed to me that virtually all of the important infectious agents and their modes of transmission had been described. And antimicrobial drugs and public health interventions such as immunization had brought infectious scourges of mankind under control, at least in countries that could afford them." But the emergence of AIDS in the 1980s, followed in the 1990s by the appearance of fatal human infectious agents such as the Hanta virus in New Mexico, West Nile virus in New York, and mad cow disease in Europe, coupled with the worldwide reemergence of drug resistance, Bell said, "seriously compromised the treatment of many previously easily treatable infections." He concluded that "although the terrorist attacks have caused tragedy and destruction, the challenges they pose offer an opportunity to improve linkages between clinicians, health care delivery systems, and public health agencies that will be useful not only in dealing with bioterrorism but other emerging public health problems, as well." --Anne Mahon |
