Counties keep grappling with bioterrorism issues

By Paul Mackie
Staff Writer

Montgomery County, Md. was too close for comfort to the epicenter of the anthrax scare in 2001. It dealt with mail destined for Washington D.C., distributed antibiotics to about 1,200 residents, and provided more than 3,000 people with "biopacks."

"It overwhelmed our personnel," said Doug Duncan, county executive, who led a workshop called "Is the Nation Vulnerable to Bioterrorism? Resources to Building Local Public Health Preparedness" during NACo’s 2004 Legislative Conference in Washington D.C. "Are local health departments ready? Your first responders are as nervous as anyone else when they’re entering an area" that may be under a bioterror attack.

Duncan’s county also recently had to deal with a major power outage that left some people without power in their homes for up to 10 days. The county distributed dry ice, but Duncan noted that plenty of anxiety results when people are forced to deal with emergencies that they’ve never experienced. "There were a lot of angry people. There was a lot of frustration. And this was just for dry ice," he said.

Gary Oxman, health officer, Multnomah County, Ore., added, "There was no anthrax within 2,000 miles of Multnomah County, but that doesn’t mean it wasn’t a problem," because citizens were still very worried.

Joseph Henderson, associate director, Centers for Disease Control and Prevention (CDC), said that prior to the September 11 attacks, terrorism in this country was almost all about bioterrorism.

"At that time, we knew that there was a tremendous quantity of materials. And we knew it was a matter of time before the wrong people got their hands on those materials," he said.

Henderson said that as little as one or two cases of smallpox in New York City today would create a huge problem, and he and the other panelists told the approximately 50 workshop delegates that all levels of government need to be prepared. However, they noted that state and local deficits mixed with homeland security needs have shifted dollars away from public health funds and services that prepare and defend against bioterrorism.

"These incidents do not occur at the state level. They occur at the local level," said Pat Libbey, executive director, National Association of County and City Health Officials. He added that local control in the decision-making process on bioterror issues needs to be clearly included in state statutes or administrative processes.

Thomas Simpson, manager, Emergency Management, Multnomah County, said, "Homeland security dollars are forcing us into a level of regional cooperation that we’ve never had before."

"There’s this notion of handoff," Henderson said. "At what point, as a county official, are you going to hand things off to a higher official or authority?"

As for Multnomah County, it continues with a local (the city of Portland and the county) approach rather than a regional one. Within that structure, there is public-private coordination, a health network that is regional, and an alert and warning matrix with 12 different color-coded hazard levels, according to Simpson, who manages emergency issues with many overlapping authorities.

The CDC’s strategy for now is detection and building an early-protection system. Henderson said the CDC doesn’t have very good decontamination strategies for the environment yet, doesn’t know what levels county officials should have in place for the need to evacuate yet, and doesn’t have enough quarantine stations located throughout the U.S. yet.

However, he did say there is about $1 billion in state and local grants available this year through the CDC for items such as statute and ordinance timelines and assessments, electronic lab systems, education, training and containment exercises.

"We try to assure that 75 percent of the money that goes to states gets passed down to the locals," he concluded.