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Bioterror scheme: Infected terrorists in waiting room
A one-two punch using smallpox and plague
A counterterrorism researcher has conjured up a dark thought problem for other planners in emergency response and medical care to ponder. What if intentionally infected terrorists — some with smallpox, others with pneumonic (e.g., airborne) plague — coordinated an attack that used medical settings as one of its prime sites of initial exposures?
"The suicide 'martyr' scenario posed in this report is logically feasible . . ." concludes a counterterrorism expert at the Terrorism Intelligence Centre in Canberra, Australia.1 "Improvements can, however, be made; they will ultimately include research into rapid confirmation tests for the plague and smallpox, the development of antiviral drugs, biochemical awareness training for all physicians and hospital staff, and anti- terrorist initiatives aimed at preventing 'conversions' to militant organizations."
Here is summary of the key points in the scenario:
• Smallpox component: Smallpox — which most of the U.S. population is susceptible to — spreads directly from person to person, primarily by droplet nuclei expelled from the oropharynx (the space beneath the mouth cavity) of the infected person or can be disseminated by aerosol spray. Natural infection occurs following implantation of the virus on the oropharyngeal or respiratory mucosa. Exposure to smallpox could, therefore, occur through inhalation of an aerosol or exposure to droplets through a "suicide carrier." Intelligence agencies and international relations scholars are concerned that Russian researchers of the former Biopreparat, many whom have been unemployed since the 1990s and feel disenfranchised, could be tempted to smuggle and sell smallpox to those terrorist groups with the financial resources and microbiological expertise to use it, or further weaponize it.
• Pneumonic plague component: A suicide terrorist infected with the pneumonic plague would not look out of place in a hospital ward or a physician's [office], while he or she spread the plague. The suicide pneumonic plague carrier would not be seeking to be diagnosed with the plague but would be relying on the "flu-like symptoms" to remain undiagnosed. The terrorist may also stay long enough to spread the plague, but leave before the physician examines him or her. It is often assumed that the "visible sickness" of the plague-infected terrorist would make plague-based bioterrorism easily detected, but spreading the pneumonic plague at hospitals makes its symptoms less suspicious than coughing heavily on trains, in the workplace or in foyers of Congress or Parliament. Not only is plague highly fatal and contagious, it also is stored in microbe banks around the world. In the 1950s and 1960s, there were many institutions and thousands of scientists studying variants of the plague. It thus remains probable that this expertise could be purchased at any time.
• Suicide Martyr Scenario: In this scenario, two "suicide pneumonic plague-infected terrorists" strategically target doctors' offices (in winter) to obtain a medical certificate to explain their absence from work. (They could even leave before seeing the physician.) They blend in with people suffering flu symptoms in the waiting room, but they are already effectively spreading the pneumonic plague amongst staff and patients. A terrorist organization claims responsibility for the plague outbreak. Citizens are too terrified to seek medical attention, as they now are aware that medical facilities have been targeted. This is when the second stage of the bioterror attack occurs. Smallpox is delivered to the target city through either aerosolized delivery, or through an infected set of suicide terrorists passing on smallpox through exhaled droplets.
Mass terror is created by the paradox that smallpox needs to be contained and treated, yet the mass plague (and smallpox) infection of patients and staff at hospitals causes citizens to stay away from medical facilities. A radio talk-back host ponders on-air whether by attending the doctor to get checked for the flu, or vaccinated for smallpox, you may acquire both the pneumonic plague and smallpox before the vaccination takes effect. Large segments of the community avoid medical treatment. The strain placed on the infrastructure of the city brings it to a halt: Planes do not arrive or leave, police at roadblocks turn back fleeing residents, and the "terror" caused by the bioterror attack is unmatched by any previously experienced health catastrophe. The economy is brought to a standstill and the bioterrorists now have political influence as they have demonstrated their capacity to inflict terror. Worse still, a rumor circulates that the smallpox is a weaponized variant from the former USSR, for which there is no vaccine. Thus, the containment of infected people proves to be impossible even though the World Health Organization vaccines arrive quickly. There are not enough respirator masks to go around.