A Plague on All Your Houses

Denver readies itself for a bio-bomb but is the federal program behind this exercise a dud?

Few politicians, certainly, but many epidemiologists offer a convincing argument against directing so much money toward a national defense targeting bioterrorism. If the government is going to commit this amount of funding, they argue, more of the money should go to local health agencies on the front line rather than to the Department of Defense, which is collecting the majority of the funds right now. Because while D.C. experts worry about fictitious foreign terrorists, local officials worry about very real dangers coming from within -- an influenza epidemic, for example, one similar to the 1918 flu that decimated this country as well as others around the world, killing at least ten million people.

"I think most people in our field think it's a matter of when, not if," says Richard Hoffman, state epidemiologist and Colorado's chief medical officer.


The hypothetical scenario employed for TOPOFF is unlikely to involve anything as mundane as the flu; Hoffman is expecting the culprit to be anthrax or the bubonic plague. "I don't know the exact agent that will be involved," he says, "but I anticipate it will be some agent that we might use antibiotics to offer as a preventive therapy."

Given the large number of casualties that could result from biowarfare, Hoffman adds, "it makes sense to prepare." Besides, the exercise will give area doctors and hospitals valuable experience should Colorado ever be hit by another flu pandemic. And 82 years ago, this state was hit hard.

In September 1918, a virulent type of influenza was first noticed among a handful of sailors in Boston. Within weeks, the disease -- a plague, really, 25 times more deadly than any type of influenza before or since -- had swept to the West Coast, infecting a quarter of the country's population. That fall, the flu cut a deadly swath across the country, killing a half-million Americans.

In her 1999 book, Flu, science reporter Gina Kolata describes the horrible deaths wrought by the 1918 flu:

"It may take a few days, it may take a few hours, but there is nothing that can stop the disease's progress. Doctors and nurses have learned to spot the signs. Your face turns a dark brownish purple. You start to cough up blood. You feet turn black. Finally, as the end nears, you frantically gasp for breath. A blood-tinged saliva bubbles out of your mouth. You die -- by drowning, actually -- as your lungs fill with a reddish fluid. And when a doctor does an autopsy, he will observe your lungs lying heavy and sodden in your chest, engorged with a thin bloody liquid, useless, like slabs of liver."

Virtually overnight, the flu turned Denver into a city of "noiseless houses with the shades pulled down," author Katherine Anne Porter, a Denver newspaper reporter in 1918, wrote in her book Pale Horse, Pale Rider. As the disease took hold, public gatherings of all kind were canceled in an attempt to stop the flu's spread. "It's as bad as anything can be," Porter wrote. "All the theaters and nearly all the shops and restaurants are closed, and the streets have been full of funerals all day and ambulances all night."

At the height of the epidemic, the hospitals had no empty rooms, not even any empty beds.

Today, there are 62 acute-care hospitals in Colorado, 13 in the metro area alone; the state has a total of 9,749 hospital beds, 5,151 of them in Denver. But that number wouldn't come close to accommodating the number of victims resulting from a 1918-type flu or a major bioterrorism incident.

Either of those events would "quickly overwhelm the resources of any city," says Stephen Cantrill, associate director of emergency medicine at Denver Heath Medical Center. "You have to get creative. You may have to set up auxiliary hospitals; that becomes a possibility. Obviously, the criteria of who gets hospitalized may change. Clearly, supplies would be overwhelmed.

"Two people to a bed is scary but realistic," he says of a pandemic. "Obviously, we've come a long way in the way we care for patients, but it's a good example of completely overwhelming the available resources. That's why prevention is so important. We've avoided that in a lot of ways through vaccinations for influenza."

But because the flu virus is incredibly adept at mutating, doctors acknowledge the possibility of a new flu emerging that would be impervious to vaccines. "In 1997 it was determined that an entirely new strain occurred in Hong Kong," Hoffman says. "They slaughtered three million chickens to stop the spread. Another strain in 1957 killed 60,000 Americans. In 1968 there was a less deadly strain, but it caused far more illness."

"I think our preparedness would reduce or keep the number of sick and dying people to a minimum," he continues. "We can only try to minimize it."

And if the flu doesn't get us, there's always the prospect of smallpox or plague being used as weapons.

Bubonic plague, once known as "the Black Death," was responsible for halving the population of Europe in the mid-fourteenth century. The disease is already something of a known quantity in Colorado, since between ten and twenty cases of the hantavirus are reported every year in the Four Corners region. The plague has a short incubation period: The bacterium quickly makes its way into the lymphatic system, then migrates to the liver, spleen and brain. Victims first suffer chills, nausea and fever; as the organs hemorrhage and destruct, the skin takes on a dark pall. One in seven cases proves fatal.

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