IN LATE NOVEMBER TWO things happened that revived my flagging interest in bioterrorism. The first was news that at least two more people had died of random anthrax infection—apparently contracted via cross-contamination of mail—and that tens of thousands of other pieces of mail might bear traces of the bug. The second was that I came down with a mild case of influenza. Sitting in front of the tube, loopy and listless from Tylenol and Actifed, I tried and failed to ward off the darkest of speculations. The news was full of reminders that anthrax starts with flulike symptoms. If the lethal spores had shown up in Connecticut, why not Dallas? I wondered. Could it possibly be . . . ?
Fortunately, my fever broke before I found myself rushing off to the Parkland Memorial Hospital emergency room in my robe and slippers. My illness had been nothing more than an ordinary flu bug—albeit one that had gotten past whatever the Centers for Disease Control and Prevention had put in the flu vaccine last year. But I realized that, even after absorbing the saturation coverage about bioterrorism, I did not know very much about the real risks involved and I would have absolutely no idea what to do if I truly believed I had anthrax. So I did a little poking around and tried to do what the networks chose not to do: offer some plain-sense advice about the disease.
Don't call your HMO. Or, I should say, don't call mine. When I did, to inquire about whether they'd cover anthrax screening for me if I had flulike symptoms, one woman said, "You know, you're the first person to ask me that . . ." A second added helpfully, "That's something you'd need to call your doctor about. If there's like an outbreak or anything, we would go in and have some screening tests set up."
I guess that meant that if a lot of us were already sick, or dead, then they'd start taking care of us. I should have known. If you have a serious question about health care, never call an HMO.
Do call your doctor. That may seem like an odd suggestion, considering that a lot of us don't know from physical to physical if we'll have the same doc, or if our managed-care company is still in business, or if when we call, no matter how urgent the need, we'll be told: "He can see you after the first of the year." Under the circumstances, wouldn't we all be better off taking our flulike symptoms to the nearest emergency room?
No, says Dr. Paul Pepe, the head of the nationally renowned emergency room at Parkland in Dallas and a member of the Texas Medical Association's task force on bioterrorism. Our ERs are usually crowded and chaotic, and you may have to wait a long time. Experts say that if some mysterious powder wafted up from a piece of junk mail you opened and you know you inhaled a pretty good dose of it, you should first call 911 so that emergency personnel can get the mail quarantined. Then go to your own doctor, who can prescribe remedies if the substance is confirmed to be anthrax. If you just have a suspicion that you were exposed and have come down with flulike symptoms or an inexplicable blister that turns black, also call your doctor first. He might be able to clear things up quickly with a nasal swab that checks for the presence of the influenza virus (thus identifying the most likely culprit) or with a blood culture that can determine within 24 hours if you have anthrax. He can also tell by looking at the blister if it is something to worry about.
Still, if your symptoms have moved from flulike to anthraxlike—sustained fever over 100.5 degrees, difficulty breathing, or blackened sores that continue to fester—and you can't see your own doctor immediately, head for an emergency room. Remember that county hospitals, though they are well equipped to treat the effects of bioterrorism, are also likely to be jammed. A better bet is to find a private hospital with an ER near where you live, like my personal choice, Presbyterian Hospital of Dallas. In any event, be specific and assertive, as doctors don't pay much attention to you unless you seem really sick.
Don't watch the news. I don't advise this flippantly but only after realizing that I learned more about anthrax from my copy of the standard medical reference The Merck Manual than from the aggregate of newsprint blather and talk-show hot air I ingested on the subject. This was because, perversely, CNN et al. seemed to be telling me everything except what I truly needed to know about the disease. While they buried me in details of the hunt for the source of the bugs and bombarded me with insinuations that the public-health system had failed us (five deaths isn't great, but I'll gladly put public health's performance up against, say, airport security's any day), they only occasionally touched on what I needed to know: What are my true chances of getting it? And then, what are the odds that it's going to kill me?
The media always have trouble with this phase of a public-health story—the need to get beyond simply scaring or titillating people and tell them something useful and true. Remember the mad cow and bioengineered-corn panics over the past couple of years? It wasn't that those stories didn't deserve coverage, but at some point all you wanted to know was whether it was likely that these things could pose a plausible threat to your life (it wasn't). The constant repetition of phrases like "no one in the U.S. has come down with mad cow disease yet . . ." made me wonder if the media weren't using the infection's presence anywhere as an excuse to say those three words, " mad cow disease ," every hour on the hour to