The following was an Assignment for my Homeland Security Organizations Class. I am proud to say I received a 100% for this Critique and some very nice comments from my instructor.
A CRITIQUE OF JOURNAL
ARTICLE
“PATHOGEN’S FOR
KNUCKLEHEADS”:
INVISIBLE AND
INFECTIOUS
Richard G. Hildreth
HLSS 301 Homeland
Security Organization
Professor Michael
Thornal – Instructor
December 18, 2012
As Christina Flowers stated in her
article “Pathogen’s for Knuckleheads” Invisible and Infectious 1,
“the Nation’s collective ignorance of Pathogen 101 basics can no longer be
acceptable.” Many gaps exist in our
nation’s ability to recognize, respond to and mitigate against a natural or
terrorist caused biological incident. The gaps in training of our first
responders and of policy leaders about pathogens and the bio terrorism threat
could lead to confusion, slow response and unnecessary loss of life.
Many articles in the November 2012
edition of DomPrep Journal (Domestic Preparedness Journal) addressed the current
level of Bio-preparedness in the United States and where we need to improve. Christina M Flowers, MPH (Master of Public
Health) describes how little training and information is available to our
responders and the gaps in our national preparedness this issue creates. Her intent
of this article is not to point fingers at first responders or an unwillingness
to learn but to point out this complex topic is very frustrating to prepare for
and deal with.
First responders in the United States
are often well versed and trained in dealing with incidents involving Chemical,
Radiological and Nuclear weapons.
Awareness Level Trainings often include information on IED’s (Improvised
Explosive Devices), WMD’s (Weapons of Mass Destruction) and TIC’s (Toxic
Industrial Chemicals); the author contends that training should also include
information on pathogens, recognition of Bio-Terrorism and the unique response
and communication challenges that
bio-terrorism events create. The threat from pathogens is complicated by the
fact it is invisible to the human eye, has the ability to modify itself;
adapting to both the host (patient or victim) and response attempts (becoming
drug resistant). Additionally, because of the time required for incubation
periods, responders are often not aware of the threat for days after the
outbreak or release of potentially dangerous substances has occurred. By the time the threat is recognized it is more
difficult to properly isolate the victims or control its spread. This is why it
is so critical that Public Health Officials and the CDC (Center for Disease
Control) be integrated into local emergency planning, training and exercises.
In her description of what a pathogen
is, the author defines the word as “an infectious agent that results in and
causes disease. “ Its roots are from the Greek words “gen” which means “giving
birth to” and “pathos” which means “suffering”. Pathogens are often living
organisms themselves or at least derived from organic processes. Because of
this, pathogens often have well defined habitats and life cycles that can tip
off responders if they know what to look for.
Although the natural defense of the human immune system does limit
infection of some traditional pathogens, less typical pathogens might require
specialized antibiotics such as Cipro (ciprofloxacin) or streptomycin. The author notes that some biological toxins
such as Ricin, developed from castor beans, currently have no known antitoxins.
The article then goes on to discuss the
different processes used to transmit infectious pathogens. Pathogens can be
transmitted by contamination of food or water (ingestion), airborne droplets
(inhalation) or trans-dermally (absorption).
As we learned with viruses such as AIDS (Acute Immune Deficiency
Syndrome) some are transmitted by bodily fluids such as blood or saliva. Some pathogens such as Staph naturally occur
in the host body but become dangerous when something happens to upset the
natural balance. The variety of methods
of transmission only makes the subject of pathogens more complex.
Bioterrorism has been used or attempted
many times throughout history. The author points out that corpses infected with
the plague were catapulted over the walls by the Tartars in their siege of Crimea. One of the most well-known instances of a
bioterrorism attack inside the United States was a 1984 attack by followers of
the Bhagwan Shree Rajneesh. In this attack these followers sprayed salmonella
on the salad bars of Dalles, Oregon area restaurants. The intent was to sicken
area voters so they could take control of local elections. Another example of an attack inside the US
was the 2001 Anthrax laced letters that were mailed to Members of Congress and members
of the press. The author points out that
many of these pathogens are easily obtained on the open market and as living
organisms can be easily replicated or grown by terrorist.
Ms. Flowers then defines the
differences between the three categories of pathogens defined by the CDC.
“Category A” agents such as anthrax, smallpox, plague and botulism pose a
significant risk to national security because of their ease of transmission and
how rapidly an outbreak could spread creating a large number of casualties.
“Category B” pathogens including salmonella and ricin are still easy to spread;
however they result in more moderate illness and a reduced death rate than
Category A agents. “Category C” are
emergent diseases that as of yet have not been classified as A or B.
There are many challenges in identification
or recognition of a Bio-Terrorism attack. In addition to the complexities of
technologies required to accurately identify specific pathogens, the incubation
time required between exposure to a pathogen and visible signs of disease delay
response. This is where an understanding of public health monitoring is needed.
Unexpected spikes in flu like symptoms, high fever, rash and gastrointestinal
illness are closely watched and evaluated by epidemiologists. In the event of
an outbreak these spikes might be the earliest warning that an attack has
happened. Unfortunately, it is often
days or weeks after the attack was actually made and the terrorist have long
since left the area.
After identification of a pathogen has
been made there are several methods for response. Although specific response plans might be
different depending on the type of pathogen, the first task is to limit the
spread of disease. This might include quarantine for a pathogen that can easily
spread person to person or social distancing measures such as closing of
schools, daycares and public gathering locations. Responders need to be not
only aware of what PPE’s (Personal Protective Equipment) is needed but also
what the limitations of those PPE’s are.
The final challenge the author describes
is public communication. In the event of
a potentially deadly pathogen, it is critical that responders provide the
public with accurate and reliable information.
These communications need to be simple, straightforward and include
specific instructions as to what to watch for and where to find additional
information. These communications need
to be repeated on a regular basis and be structured so they inform the public
with the seriousness of the incident without creating undue alarm of fear. Effective communications will not only help
in mitigating fears and restoring confidence; they may also benefit by
providing responders with additional information that might assist in tracking
or investigating an incident.
Although I find the topic and thesis of
this article of critical importance, I am not sure the author really showed a
complete or scholarly review of information or presented her findings in a
unique way. I agree that our first
responders need better training on awareness and response to biological
pathogens; however I found the article rushed, disjointed and lacking in
originality. I have also identified
areas that were not addressed. I feel
that adding these issues would add to the value of this article.
One of the most obvious points I feel
was overlooked is how we can address this issue. I have long been a supporter of cross
training between responder disciplines and would have liked to see comments on
both existing programs available and training programs that should be developed
for the future. Louisiana State
University operates the National Center of Biomedical Research and Training
(NCBRT) 2 which is an existing DHS training partner providing
awareness and responder level training to emergency responders. Training is available online and field
delivered classrooms and is 100% funded by the Department of Homeland Security.
This is an effective way for local government agencies to build the capacity
needed and address some of the gaps presented in the author’s thesis.
I also believe there should be more
distinction between the challenges of facing a naturally occurring outbreak and
one caused or aggravated by an act of terrorism. Although many of the preventative and
response measures might be similar; in the response to a terrorist event
evidence preservation and law enforcement also play a role.
I know that many health departments and
healthcare facilities have well developed planning guides for various pathogens
and threats. The author could have at
least referred the reader to guides or plans that represent best
practices. One example that I have found
is an exceptionally well written and complete plan that would have supported
the thesis by addressing the gaps is the 2002 California Hospital Bioterrorism Response Guide 3.
Although it was designed for the Healthcare industry it visually describes the
extent of the threat and provides best practice response tactics for
Bioterrorism as a whole and for individual pathogens.
A final area that I felt should have
been at least broached was the legal and policy impacts of Quarantine and
Social Distancing Measures. Although responders themselves might not need to
understand these impacts, it does provide them information they might need to
pass on in order to gain policy support for training. As a practitioner the more information that
the author can provide me to use in convincing my superiors of the need and
value of training the more value it has for me.
As a whole, I did not find that the
article was poorly written, it just didn’t include new information that was of
value to me as a practitioner. I know that the author might have been
constrained by a word limit; however elimination of some more irrelevant
information (at least as to supporting her thesis) and inclusion of the
information that I referred to would have, in my opinion, made it a much
stronger article. I agree that the gaps the
author identified in our responder’s ability to respond to Bio-events are valid
concerns. I know some communities and
individual responders have worked to close this gap themselves, but they seem
to be the exception and not the rule. The author missed a great opportunity to
reach out to emergency management/ homeland security professionals and promote
what I feel is an important point.
1-
Flowers, Christina M.
"Pathogens for Knuckleheads: Invisible and Infectious."
Domestic Preparedness Journal 6, no. 11 (November 2010).