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 juice up ratings.
Do your own research. Fortunately, there is a great deal of solid, useful medical information available, both in print and on the Web, so use it. Aside from The Merck Manual, which is available at major bookstores, the Internet site at www.nih.gov medlineplus is voluminous and trustworthy, as are the Web sites of your local medical schools or medical societies. (Be wary, however, of sites offering miracle cures for anthrax or smallpox—or anything else, for that matter.) You can also call your county or state health departments or visit them online (the Texas Department of Health’s Web site is www.tdh.state.tx.us). You may think that all these guys know how to do is remind you to get your flu shot each winter, but in fact they know a lot about many diseases, and since they aren’t trying to pump up circulation or ratings, they tend not to be hysterical.
Don’t forget the odds. The question isn’t whether anthrax is worthy of our concern. Of course it is. The real question is whether racing down to the border to stock up on Cipro because the bug turned up in some senator’s mail in Washington, or in some elderly widow’s mail in Connecticut, is an appropriate risk response.
Indeed, if everybody had just relaxed for a moment and applied a little prudent risk assessment to the situation, most of us would have quickly seen that there wasn’t that much to fret about. It’s quite simple. With heart disease, for example, doctors decide whether you need to take cholesterol-lowering medication based on a total of your positive and negative risk factors: Add a point if you smoke, subtract one if your HDL (good cholesterol) is above a certain level, and so on. With anthrax, you might add a point because it travels by one of the most pervasive disease vectors possible—the mail—but subtract one point because the attacks seemed to be directed at VIPs only, another point because they were limited to New York and Washington, and a third point because the disease isn’t contagious. Then go ahead and add a point for the continuing threat of more cross-contamination cases or another mailing altogether. That would give you a risk assessment of negative 1, which is much lower than a relatively healthy person’s risk of cancer or heart disease. (That was why I didn’t call the doctor about my case of the sniffles.) Indeed, if you want to worry about catching something, you would be better advised to worry about the flu, which will kill about 20,000 Americans this year.
Do support your local health department. State and county health departments have long played second fiddle to police and fire departments when it comes to public safety. That needs to change. When the anthrax scare hit, we all needed—but couldn’t quite locate—the confidence that the army we were fielding against this enemy was even remotely as well financed and trained as the one we sent to Afghanistan.
Beefing up the infrastructure won’t be cheap. Experts have projected that our country’s public-health system will need about twice the $1.5 billion that the White House has pledged to improve it. And here in Texas, my sources at the state’s department of health tell me that their agency needs to double its epidemic-response capability, most of which could be accomplished if it receives the additional $12 million it has requested from the Legislature.
I say cut them the checks and don’t look back. Ever since we conquered polio, we have not had a clear idea of how much to spend on public health. Now we do. While we’re at it, we might remember to support our local microbiologists as well. As I watched news reports of people stockpiling antibiotics, I had to wonder if that money—however modest the amount—would have been better invested in a donation to the nearest biomedical research facility, like, say, the University of Texas Southwestern Medical Center at Dallas, where researchers are developing technologies that can quickly formulate new vaccines or even “megavaccines” to inoculate the public against multiple infections.
Do resist the urge to stockpile antibiotics or buy a gas mask. Don’t buy or take antibiotics unless your doctor prescribes them. You may only be wasting your money and contributing to the spread of antibiotic-resistant bacteria. As for gas masks, they work only if you wear them all the time, and they look silly. Besides, I doubt that your HMO will cover the cost.