Anthrax: Myth & Reality
by Elizabeth Terry

Movies and other fictional presentations have conditioned us to expect bioterrorism to result in thousands or even millions of horrific deaths. The victims usually appear helpless, with no means whatever to fight back. But, fortunately, that is fiction, and we live in reality. We can't leave the theater and walk out into the sunlight of a safe and comfortable world where bioterrorism doesn't exist, but we are not helpless. The more we understand about anthrax, the better able we will be to deal with it.

Anthrax has been high on the list of possible biowarfare agents because of its hardiness. Unlike most bacteria, it forms spores which can survive for years under proper conditions. Anthrax is a naturally occurring soil bacterium which only infrequently infects people. The common forms of the disease are caused by contact with infected farm animals. Eating diseased meat can cause an intestinal infection. Handling of infected animals or animal products can result in a skin infection. This form of anthrax was known as wool-sorters disease when wool processing was done by hand.

The most serious form of anthrax infection is pulmonary -- an infection of the lungs. Pulmonary or inhalational anthrax is caused by inhaling the bacteria or its spores. As anthrax lives normally in the soil rather than the air, this form of the disease suggests a deliberate release of anthrax into the air. The same bacterium causes all three forms of anthrax disease. It is the mode of entry into the body which determines the form of the illness a patient experiences.

All forms of anthrax are treatable with antibiotics. Today this is the best line of defense. While anthrax vaccines do exist to protect in the same way that polio shots do, a number of injections are required to provide immunity, and a yearly booster is a necessity. For a disease that is treatable with antibiotics, where very few people have to date been affected, and where the disease is not transmissible from one person to another, treatment rather than prevention is the better choice today.

Gas masks and other protective gear are not particularly practical. Gas masks are heavy, must form a complete seal around the face, and have filter cartridges with limited life spans. Most importantly, one is only protected if wearing the gas mask, properly sealed, when anthrax is released.

To date there appear to have been several anthrax attacks in various parts of the country. More may surface in the next weeks. The mode of disseminating anthrax in these attacks was by envelopes sent through the U.S. mail. This is not an effective means of infecting a large number of people. There are steps one can take to minimize risk of this type of attack. Incoming mail to companies that might be on a terrorist's hit list might be considered suspect if the sender is unknown. Envelopes should be opened away from the face with a gentle motion to avoid distributing the contents should it be powder or particulate material. Envelopes containing such material should be reported to local law enforcement or HAZMAT immediately, and the room in which the envelope has been opened should be evacuated. The individual touching the envelope should touch nothing else, and should immediately wash his hands with the assistance of another so he does not have to touch faucets or other surfaces. That individual and others nearby should then await instructions from health officials.

The overriding question today is whether the anthrax attacks are related to the events of September 11th. Although absolute proof is not yet available, there are factors which suggest a relationship. The time proximity of anthrax outbreaks to the attacks on the Pentagon and Twin Towers suggests a relationship. A similar outbreak of anthrax infections has never occurred in our country, and the statistical probability of such an outbreak coinciding with but not related to the other major terrorist attacks is very low. The fact that anthrax contamination has occurred in various cities across the country implies that this was done by a widespread, well-traveled organization, rather than a local radical militia of American origin. Finally, the report of a pharmacist in South Florida that Mohammad Atta came to him seeking medication for inflamed hands may be an indication that Atta himself was handling the anthrax. While anthrax infection itself is a possibility, it is also possible that he used harsh chemicals to decontaminate his hands, or even used latex surgical gloves to which some people are allergic.

Preliminary information on the postmarks of envelopes suspected of carrying anthrax suggests one disturbing factor. Atta and the others who died in the airline attacks could not have mailed envelopes postmarked long after September 11th. That means other terrorists are still alive and in the United States, and possibly in possession of additional stores of anthrax.

One intriguing question that has not yet been answered is where the anthrax came from. The particular strain of anthrax found in all of the attacks originated in the United States. This does not mean that it was never carried out of the country. But the real question is where the material used in the attacks was prepared. The sprinkling of attack sites across the country does not allow triangulation to some particular laboratory site within the U.S. It is possible that no such site exists. The leaky Canadian border prior to September 11th could have provided an entry portal for pounds of anthrax powder. While longer term storage might result in a sticky mass rather than a powder, depending upon the care with which it was produced and packaged, anthrax is hardy enough to have survived weeks to months before the recent attacks.