"Distinguishing Smallpox From Chickenpox," as published in Skin & Allergy News, December, 2001
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"Vaccines, Therapeutics, and Prophylaxis for Selected Biological Warfare Agents," as published in Skin & Allergy News, November, 2001
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What they're saying in the media:

• "No Place to Hide," The New York Times Magazine, October 14, 2001
• "The Faceless Enemy," The New York Times Magazine, October 14, 2001

• The most serious and debilitating “disease” that could result from a terrorist attack involving biologicals or chemicals is PANIC.  This could kill and injure more people than the agents used in the attack, and could paralyze  our health care delivery mechanisms.   Panic must be avoided, by personal and societal preparation, the best of which methods is information.  Thus, this offering.
• In this “new world order”, there are no longer victims, by-standers, hostages or just plain folk.  Rather, we are all soldiers - on alert and ready to act when necessary.  Get used to it.
• The only guarantees in life are “death and taxes”.  No, modern science will never discover a preventative or cure for death.  And yes, there is an after-life. Prepare for it.
• Whether preparing for a terrorist attack or for a final exam, be “process-oriented”, not “outcome-oriented”.  Outcomes have too many variables to hope to be in control of.  But it is our individual part of the process on which we should make maximum effort.  That approach will result in our being much more effective in all our endeavors...and also in being at peace with the outcome, whatever that may be.

BIOLOGICAL WARFARE AGENTS: THE “A” LIST

1)  ANTHRAX:

• Not contagious; that is, not spread from person to person like a cold or like tuberculosis.  Contact with an original source is required.
• Comes in cutaneous, intestinal and inhalational forms.  Only the inhalational form produces the most serious consequences, through the production of a potent toxin.
• The inhalational form, if not diagnosed and treated very early,  will produce hemorrhagic lymphadenitis, mediastinitis, meningitis, and likely death.
• Two stages: early (hours to days) severe flu-like symptoms, multi-system.  The disease must be suspected, diagnosed and treated in this stage;  it also must be reported to the authorities at this stage; a second stage of high fever, increasing shortness of breath, sweats, shock and possible mental obtundation secondary to meningitis.  A chest x-ray will likely show a widened mediastinum due to the large and hemorrhagic lymph nodes.  Death is likely.
• Early treatment includes antibiotic prophylaxis if you may have been exposed to a source of anthrax.  Definitive treatment if necessary should be by intravenous administration of Cipro, Doxycycline, or high-dose Penicillin.  Treatment should be continued for two months, in view of the possibility of delayed recurrence.
• One on-going line of research involves a synthesized variant of the toxin which may be able to act rapidly as an anti-toxin, and which also is immuno-genic, meaning that it can also work to immunize against future infection.

• Highly contagious viremia, with a 12 - 14 day incubation period.
• Sudden high fever, headache, backache, prostration, abdominal pain and delirium.  Then comes the rash: involving the mouth and face and spreading centrifugally (mainly the extremities), and demonstrating various stages of eruption at the same time in different locations, from papular (pimple) to vesicular (water blister) to pustular and encrusted.  This differs from chicken-pox, where the illness is not as severe, where the lesions mainly involve the torso, and where the lesions tend to be all at the same stage at any one time.
• A hemorrhagic or malignant form develops even more quickly.
• Treatment is supportive, with antibiotics used only for secondary infection.
• Requires strict quarantine of patient and contacts, vaccination of contacts, and immediate notification of authorities.
• Survival is likely with prompt and comprehensive support.

• Operates by means of a potent toxin produced by the organism.
• May be contracted  food-borne, by wound infection, intestinal source and by terrorist inhalation source.
• Acts by blocking acetyl-choline, the messenger chemical at nerve endings without which  paralysis develops.
• Not contagious.
• An acute and afebrile illness, developing hours to days after the exposure and lasting weeks or months, if  prompt treatment avoids prompt death by suffocation.
• Produces a symmetric, descending flaccid paralysis beginning with the cranial nerves (resulting in double vision, difficulty swallowing and speaking), and soon producing paralysis of the respiratory muscles.
• Differs from Guillain-Barre  paralysis, that may occur after a viral illness or after some vaccinations, which produces an ascending paralysis.
• Main treatment is prompt diagnosis, support (including total assisted ventilation if needed) and equine anti-toxin (which may produce an allergic reaction).
• Antibiotics are useful only for secondary infection.
• Requires prompt notification of authorities.

• Highly contagious, from animals (fleas) and humans (droplet spread).
• Bubonic, pneumonic and septicemic varieties.
• Can produce severe respiratory symptoms (shortness of breath, cough and coughing up of blood - an important sign - and pneumonia) as well as fever, gastro-intestinal symptoms, in addition to very painful “bubos” - tender, swollen lymph nodes typically in the axillae and groin areas.

Chemical Warfare Agents

• Pulmonary: (e.g., phosgene) irritates and destroys respiratory tissue
• Cyanide: blocks the release of oxygen into tissues; kills quickly.
• Vesicants: (e.g., nitrogen mustard) irritates and destroys any tissue with which it comes in contact.
• Nerve gasses: act to produce excess acetylcholine at the nerve endings, the opposite of the action of botulism toxin, but with similar results - and very quickly. (Sarin, VX...)
• Incapacitating Agents; eg. hallucinogens, riot gases (mace...)

GS