MCBC: Day One of Bio

Today was the first day of Medical Management of Biological Casualties, or the "B" part of MCBC, at USAMRIID (which is a much nicer drive from my place than Aberdeen Proving Grounds). They starting things off with a running start, and then it kept on going until they set us free around 5.

Just a bit of a brief overview, the first documented case of biological warfare in history was back in 1346, when plague corpses were launched over the city walls of Kaffa. Whether or not this contributed to the fall of Kaffa is unknown; chances are, the rats (which don't really respect city walls) were going to cause an outbreak of plague around that time anyway.

The US did have an offensive biowarfare program, from 1943-1969 (which was three years before the Bioweapons Convention ban). Most of the agents we produced were aimed at disrupting the food supply instead of killing people, such as diseases against cattle and crops (we did produce anthrax, botulinum toxin, tularemia, and others, though). In 1969, President Nixon ended the program and ordered all stockpiles removed. Three years later, as I said, was the Bioweapons Convention, which was ratified by over 100 countries (including the USSR, which blatantly ignored the fact that they said they weren't going to produce or stock offensive biological weapons, and stockpiled a few hundred tons of smallpox, anthrax, and other scary stuff).

The rest of the day was going over specific select agents. A select agent is one that we think can be used for biological terror or warfare. They're cheap or easy to obtain, easy and inexpensive to produce, easy to deliver, difficult to detect, cause a large of casualties, and cause widespread fear and terror. The ones we had lectures on today were anthrax, tularemia, plague, brucellosis, Q fever, and agriculture agents.

We finished with a lecture on the epidemiology of bioterrorism, which gets to the question of, how do you know if an outbreak is natural or intentional? There are 11 clues that something might be an intentional attack:
1) Highly unusual event with an unexpected number of casualties. For example, 751 cases of salmonella in one month in one county in Oregon is very unusual (in the case of the Rajneeshee salad bar debacle).
2) Higher morbidity or mortality than expected. This would make you think that something might have been modified in a lab.
3) Unusual disease. When West Nile Virus appeared in New York in 1999, it had never been seen in the States before, and this made people suspect that it was some sort of biological attack (it wasn't).
4) Point source outbreak
5) Lower attack rates in protected populations
6) Multiple or serial epidemics
7) Dead animals of multiple species
8) Reverse or simultaneous spread between animals and humans. Usually human disease follows animal disease, so if it happens the other way around, that's a little bit suspicious.
9) Usual manifestation of disease. 95% of anthrax is cutaneous, so if there's a lot of inhalational anthrax and not very much cutaneous, that might mean that somebody released aerosolized anthrax.
10) Downwind plume pattern. This was seen after the accidental release of aerosolized anthrax from an anthrax factory in Sverdlosk
11) Direct evidence. This is rare, but was seen with the 2001 anthrax letters (they included a letter saying exactly what it was).

It was a long day with a lot of information thrown at us (most of which was a review). Now I'm heading off to bed so I can do it all over again tomorrow.