Andrew Artenstein on bioterrorism

Andrew W. Artenstein, M.D., is a clinical assistant professor at the Medical School's Division of Infectious Diseases. A former member of the Walter Reed Army Institute of Research, Artenstein works in Memorial Hospital of Rhode Island's Division of Infectious Disease. He spoke about bioterrorism recently with the George Street Journal's Scott J. Turner.

As a medical scientist, what is unique about fighting bioterrorism?

There are very few people with clinical expertise in this area. Most physicians just haven't seen these diseases. Never before has infection been sent through the mail. It's history in the making. Among the experts and specialists, this situation requires forward thinking; the ability to conceptualize and be creative in bouncing ideas and information off each other. Physicians like to be scientific and base decisions on data; on what we know. Unfortunately most of what we know about anthrax is based in naturally occurring infection. This is man-made material.

What's the difference?

When made by bioterrorists, the substance may not behave as it does in the natural environment. It may not look the same or act the same when transmitted to infect. We need to keep in mind that this may be an uncommon event but that it still may present itself atypically.

What do you tell fellow emergency-response personnel, including physicians?

Be alert and more cautious than ever to other possibilities. Adapt and evolve judgments based on circumstances. Biological attacks are insidious. There are no recognizable events. You recognize something happened in retrospect. You don't get clues unless people get sick. That means doctors and allied health professionals will often be first to respond. We in the medical community need to be mindful of who is coming to see us.

Doesn't anthrax inhalation resemble the flu initially?

There a lot of illnesses, when you have certain symptoms, which can look like other things. There are some pretty nonspecific symptoms if you inhale anthrax, for example. With the flu season coming, you can expect to see more of these types of symptoms. Most people who present with flu-like symptoms, though, probably have the flu virus.

Is the health-care system up to the task?

There is a functioning public health system in place nationwide. The system is working but not seamlessly and not flawlessly. But all of us are on such a steep learning curve. These are groundbreaking events. For the foreseeable future, it will be a tough job for health care providers, but doable. We have faced other new infections before. Health systems are in place and poised to do it again. We are armed with a lot of information and expertise and talent and good organization at national, regional and local levels. One silver lining that I can see here is that we have revved up the systems, which will help us prepare for the future and allow us to build upon everything we learn. It's a challenge, though. To suggest otherwise would be dishonest.

What do you say to the public?

All of us need to be better educated about the threats and illnesses. The more we know, the more reassured we will feel and the better off we will be. For example, there are treatments for most of these illnesses. They work for many if applied early. There is a great deal of fear in some areas, such as New York or D.C., and there is some reason for it. It is not appropriate to say there is no reason to fear, but I don't think fear should be paralyzing us. It's important to be concerned because concern drives government and other systems to prepare. We have to go about our business, but with added concern. Show concern in various ways to be alert; notify authorities of threatening letters or packages. Don't let terrorists think we are allowing them to paralyze or frighten us into acting unnaturally. That is not useful in any sense.