When Every Moment Counts: What You Need To Know About Bioterrorism From the Senate's Only Doctor by Bill Frist

From Barnes & Noble

In this informative and eye-opening guide to protecting you and your loved ones from the threat of bioterrorism in the post-9/11 world, Senator Bill Frist of Tennessee answers some basic questions many Americans are asking. Is the nation's water supply safe? What steps can you and your family take in the event of a bioterrorist attack? What unique risk factors are present for your children? How dangerous is anthrax? Does it make sense to buy a gas mask, or to stock up on prescription drugs such as Cipro? Senator Frist -- the only doctor in the Senate -- also gives the reader a sense of what it was like in Washington, D.C. when the anthrax-laden letters were delivered to Capitol offices in the wake of 9/11. Clearly, there's no one better qualified than Senator Frist to give you and your family the vital information we desperately need.

From the Publisher

Bioterrorism has quickly become one of the most pressing and disturbing issues of our time. Our nation's leaders warn that the threat of germ weapons by terrorists is real, and, more importantly, that the United States remains highly vulnerable. Such statements have led to a national sense of fear and unease. Every American wants answers--what can we do to protect our families and loved ones? Enter Senator Bill Frist, M.D. At this crucial time, Senator Frist wants to provide all Americans with an accessible and comprehensive guide to dealing with the realistic threat of bioterrorism. Written in an easy-to-use question and answer format, complete with photographs of the varying symptoms and a full index, When Every Moment Counts is an essential manual for every American.

Publishers Weekly

First a Republican senator from Tennessee, brings his experiences as a heart and lung surgeon and a ranking member of the Senate Subcommittee on Public Health to this extremely informative, very approachable guide to coping with the bioterrorism threat, the only such guide available today. The book's linchpin is a chapter called "Safe at Home: A Family Survival Guide, straightforward, q&a-style set of guidelines for everything from choosing a filtration mask and putting together a disaster supply kit to preparing children for emergencies without giving them nightmares. The rest the book, also in q&a format, provides basic information on the most likely bioterrorism agents, such as anthrax, smallpox, plague and botulism. Frist clearly and knowledgeably explains the symptoms, incubation period and available treatments for each ages providing specific details, like the definition of "weaponized" anthrax and the government plan for containing a smallpox of break. Sidebars describe how the organism have been used as weapons in the past. The book also includes a chapter on chemical weapons and one on the food and water supply. Thought his tone is generally optimists Frist is candid about weaknesses in the public health system, such as the dearth of vaccine research on children or the FDA's inability to meet its food inspection goals. He's concerned, above all, about the lack of rapid communication among doctors and health agencies (citing that "one in five public health offices does not have email"), and concludes with his proposals to increase funding for state and local public health organizations and other suggestions for government. This reassuring thorough resource undoubtedly will prove a comfort to many readers-and, in the case of a bioterrorist attack, has the potential to save countless lives. This is an important book and deserves high attention and sales. Color photo insert of organisms and, to aid in diagnosis of skin rashes (comparing for instance smallpox chickenpox). (Mar.)

Publishers Weekly

Frist, a Republican senator from Tennessee, brings his experiences as a heart and lung surgeon and a ranking member of the Senate Subcommittee on Public Health to this extremely informative, very approachable guide to coping with the bioterrorism threat, the only such guide available today. The book's linchpin is a chapter called "Safe at Home: A Family Survival Guide," a straightforward, q&a-style set of guidelines for everything from choosing a filtration mask and putting together a disaster supply kit to preparing children for emergencies without giving them nightmares. The rest of the book, also in q&a format, provides basic information on the most likely bioterrorism agents, such as anthrax, smallpox, plague and botulism. Frist clearly and knowledgeably explains the symptoms, incubation period and available treatments for each agent, providing specific details, like the definition of "weaponized" anthrax and the government plan for containing a smallpox outbreak. Sidebars describe how the organisms have been used as weapons in the past. The book also includes a chapter on chemical weapons and one on the food and water supply. Though his tone is generally optimistic, Frist is candid about weaknesses in the public health system, such as the dearth of vaccine research on children or the FDA's inability to meet its food inspection goals. He's concerned, above all, about the lack of rapid communication among doctors and health agencies (citing that "one in five public health offices does not have email"), and concludes with his proposals to increase funding for state and local public health organizations and other suggestions for government action. This reassuring, thorough resource undoubtedly will prove a comfort to many readers and, in the case of a bioterrorist attack, has the potential to save countless lives. This is an important book and deserves high attention and sales. Color photo insert of organisms and, to aid in diagnosis, of skin rashes (comparing, for instance, smallpox to chickenpox). (Mar.) Copyright 2002 Cahners Business Information.

Library Journal

When anthrax began showing up in the mail in fall 2001, one of the most sought-after and frequently seen guests on news shows was Senator Frist (R-TN), a practicing physician. His calm and levelheaded replies to a flurry of questions about anthrax and other potential biohazards reassured a jittery nation. In this book, Frist provides the same quality information in a question-and-answer format that addresses major biological and (to a lesser extent) chemical threats, their signs and symptoms, their transmission, vaccines, and effective treatments. Practical suggestions on preparing a disaster kit, easing children's anxieties, and handling suspicious mail, among other issues, are numerous and well conceived. A list of reliable web sites gives readers access to current information, and color illustrations help with the identification of anthrax and smallpox. The book concludes with an excellent index. While the occasional political point slips in (e.g., Frist advocates antitrust relief to drug companies), this book remains a solid lay reader's guide. A similar title, Dr. Philip Tierno's Protect Yourself Against Bioterrorism (Pocket, 2002), covers much the same ground. Given the high interest, both could be added at a small cost to the library. Anne C. Tomlin, Auburn Memorial Hosp. Lib., New York Copyright 2002 Cahners Business Information.

Product Details

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Table of Contents

Read a Sample Chapter

ANTHRAX IN
THE CAPITOL

Bioterrorism Hits Home

For two hours that morning, we talked about bioterrorism in hypothetical terms. Now, suddenly, it was all too real.

    An Associated Press reporter asked me to respond to the news that a letter containing anthrax had been delivered to the Washington office of my colleague, Senate Majority Leader Tom Daschle. An undetermined number of staffers in Senator Daschle's Hart Senate Office Building suite had apparently been exposed to the potentially lethal biological agent when the letter was opened. President George W. Bush just minutes before had told the nation about the letter during informal remarks following an event at the White House.

    I was stunned. I had spent the morning hosting a roundtable on bioterrorism at the Tennessee Emergency Management Agency headquarters in Nashville. I listened carefully as about three dozen doctors, nurses, hospital administrators, firefighters, police, and other law enforcement, public health, and emergency personnel from all across the state talked about how unprepared they were for the growing threat of bioterrorism.

    Little did I know at the time that this initial press question would be my initiation into seven days that would severely test much of what we thought we knew about bioterrorism. Seven days that would challenge our fundamental clinical understanding of anthrax—how to diagnose it, how to treat it, how to protect those who may have been exposed—and how to communicate with the press and the public about a public health emergency withshifting facts and a fluid, rapidly evolving scientific knowledge base.

    The coming week also would bring sharply into focus the vital role our public health system plays in responding to such an attack. After all, this was part of the first biological attack on U.S. soil involving anthrax and was only the second known biological attack in the United States in at least a century (the first, in 1984, involved salmonella poisoning of restaurant salad bars by a cult in Oregon).

    The lessons learned from the abstract discussions in Nashville on Monday morning, October 15, 2001, would come alive and be played out in vivid detail in Washington over the next seven days.

Monday

As I prepared to host the bioterrorism roundtable in Nashville, a Florida man already had died of inhalational anthrax, and an assistant to NBC News anchor Tom Brokaw had been diagnosed with skin, or cutaneous, anthrax. An additional case of each form of the infectious disease would be confirmed later in the day.

    So everyone in that room knew that the threat we once considered remote was growing. Frontline responders, those who will answer that panicky phone call or first see a person with symptoms, lacked appropriate training and protective equipment. State and county public health laboratories lacked adequately trained epidemiologists and state-of-the-art facilities and equipment. Community hospitals had no system to share information with each other or with local public health facilities in a timely way.

    Vanderbilt Hospital—one of Tennessee's premier teaching and referral hospitals, where I had worked for nine years as a transplant surgeon before coming to the U.S. Senate—acknowledged that it did not have a bioterrorism preparedness plan in place and had not done training exercises to deal with this emerging threat. Nor had any of the community hospitals.

    From rural doctors to city police and firefighters to state public health officials, all the way up to the governor's office, the story was the same: They just weren't prepared to respond to what might happen.

    Following the conference, I walked into an adjacent room for a press briefing, and the question was no longer about what might happen. It was about what had already happened.

    When asked about the Daschle letter, I simply replied that I was unaware of the report but that it would have to be confirmed. To be honest, I minimized it a bit in my own mind because I recalled receiving an anthrax hoax letter three years before. If the report was correct, this would be the first witnessed exposure of multiple people to the release of airborne anthrax.

    My next scheduled stop was a speech about bioterrorism to the Nashville Rotary Club at a downtown restaurant. Ironically, I had picked the topic three weeks earlier when the meeting was booked, before anthrax was on anyone's radar screen.

    By the time I arrived at the Rotary meeting, we had been notified that my own Public Health Subcommittee staff was on the same floor in the Hart building just down the hallway from where the letter had been opened. We were told that there was apparently a large amount of a powdery substance in the letter and that nasal swab testing and distribution of a short course of antibiotics had begun for those in the Daschle suite. I sensed that the issue was escalating.

    I was able to get periodic progress reports by telephone from my subcommittee staff. At this point, the Hart building remained open and people were still at work at their desks. In fact, the building would stay open for another day and a half. The risk of exposure was unknown at the time.

    I returned to Washington that afternoon and was asked by Senate Republican leader Trent Lott to be the liaison for the Republican senators to the fledgling medical and law enforcement investigation into the anthrax exposure at the Hart building.

    Already, those within Senator Daschle's suite had been given nasal swab tests along with a three-day course of antibiotics. And a public health command room had been set up by Majority Leader Daschle in the secretary of the Senate's office on the third floor of the Capitol. It was in this room that data were reported and shared and strategies to deal with the evolving public health and environmental issues were discussed and developed.

    Officials representing many agencies—the Centers for Disease Control and Prevention (CDC), the Capitol physician's office, the Defense Advanced Research Projects Agency (DARPA), the Senate sergeant at arms, the Capitol police, Senate leadership, the deputy surgeon general representing the Department of Health and Human Services, and the director of the District of Columbia health department—were almost always in that room for the next several days, coordinating among themselves and then reporting back to their home agencies.

    To provide information to the Senate staff and the public at large, we held two press conferences on the first full day and then scheduled daily press conferences for the next week. But many staffers were still confused and anxious about their potential health risk.

    Just a few doors from Senator Daschle's suite, my own health subcommittee staff members were experiencing firsthand the difficulty in obtaining helpful information during a public health emergency. Although they knew about the letter, primarily from press reports, almost nothing else was reaching them. Like the rest of the nation outside the walls of the building, their principal source of information was TV.

    On that first day, staffers from Senator Daschle's offices turned to our health subcommittee staff with questions about anthrax and their own health risk, in part because they knew that my staff had been working on issues related to bioterrorism for a long time and in part because, as I am the Senate's only doctor, they knew that my staff and I are involved in most health-related issues. Is anthrax contagious? If I've been exposed, is my family at risk? However, no official word came from those conducting the investigation until later that afternoon, when a police officer visited my staff in the Hart building to confirm that a letter possibly laced with anthrax had been delivered to Senator Daschle's office.

    In response, they were closing off a section of the Hart building. The officer would remain on duty outside my staff's door, but the primary reason was to ensure that the press did not bother them as they continued to work. Staffers moved in and out of that wing of the Hart building, totally unaware of any health concerns.

    The ventilation system had been shut down within an hour of the incident to avoid potential spread of anthrax, and the staff was told to expect the offices to be warmer than usual. At that time, there was no discussion about their own health risk, and previous experience would suggest that they were not in harm's way.

    Nasal swabs to determine how widespread exposure to the anthrax spores had been were eventually obtained from everyone in the Hart building. On Monday, only those present in the vicinity of the Daschle suite when the letter was opened were given preventive antibiotics pending results of the nasal swab tests.

    When nasal swab test results confirmed the direct exposure to anthrax of twenty-eight people inside or immediately adjacent to the Daschle suite, anxiety across Capitol Hill soared. The innocent opening of a letter, a routine task that is done millions of times every day in offices across the country, suddenly escalated into a public health crisis that truly frightened many people who work on the Hill. Congressional mail was quarantined, and a month later, on November 16, 2001, a second anthrax-laced letter—this one addressed to Sen. Patrick Leahy—was discovered by government investigators.

    Few of the office workers on that first day really understood what a positive nasal swab meant. What about those whose tests came back negative? Did they have anything to worry about? Why did some of them still have to take antibiotics? It seemed so confusing to everyone involved, including members of the press who were trying to interpret it all.

    Anxiety was high. People were not getting the answers they needed. And it was only just beginning.

Tuesday

Staff members who had continued working in their fifth- and sixth-floor Hart offices through Monday were surprised the next morning to find a police barricade barring the entrance to the southeast corridor. They were told that they could not return to their offices and were directed to obtain a nasal swab test and more information from the medical crew.

    Hundreds and hundreds of concerned individuals lined up for the nasal swab tests in the Hart building. It was difficult for the necessary medical supplies to be maintained. Several times, the line stalled owing to lack of the antibiotic ciprofloxacin (Cipro) or the necessary sterile cotton swabs. Anyone who wanted testing simply had to show up; no one was turned away. Hundreds of people from all over Capitol Hill came to be tested, even if they were not in the Hart building. Many people showed up to be tested out of confusion, others out of fear.

    Everyone receiving a nasal swab that day was given a three-day supply of Cipro and told to return for the test results; at that time they would be told whether they would have to take the antibiotics for sixty days. Because of all the confusion, misinformation floating around, and the fact that very little information was then being made available, my staff and I immediately went to work to make the official Senator Bill Frist website a central place where anyone could go to find accurate, up-to-date, pertinent information both on anthrax generally and on the rapidly evolving situation in the Senate office buildings.

    It was not the first time my office had to deal with bioterrorism. Three years earlier, after I received the hoax letter labeled "ANTHRAX," I addressed with my staff mail-handling protocols for any letter that appeared suspicious. We were able to go back and find these protocols and post them immediately on the website so everyone had access to the information. We were among the first sites—even before the postal service—to have practical information on what to do if you received mail suspicious for anthrax.

    Working with the Capitol physician and others involved in the situation, my staff gathered information from the command-room briefings and continually updated the postings. It was obvious that people were growing anxious for information about anthrax and developments on the Hill.

    They tried to get on the CDC website, but it had crashed and no information was available on it. Where could they go to get information about their own personal health risk? Were the twenty-eight people who tested positive now infected with the most deadly form of anthrax disease, inhalational anthrax? (They weren't. The test merely confirmed that they had been exposed to the spores.) Why did some people around them have positive test results while their results were negative? How long would they be out of their offices? Should they go to work the next day?

    People were desperate for information. And desperation can lead to frustration. And frustration can lead to anger. And they didn't know where to turn.

Wednesday

Forty-eight hours after the anthrax-laced letter was opened, information was still scarce. Staff continued to show up for work, and the testing site was moved to the Russell Senate Office Building because the Hart building was closed.

    As thousands of Senate and House staff and those who had been visiting Senate buildings on Monday lined up for their nasal swabs and three-day Cipro supply, my staff busily printed out information on anthrax exposure that we gathered from my Senate website and others and handed it out to those who waited in line. They were understandably eager for information.

    The Senate and House leadership met early Wednesday morning and received reports that environmental cultures from several locations had tested positive for anthrax, suggesting an even higher potential for contamination than previously thought. Decisions were made independently by the House and Senate leadership to close their respective office buildings to allow more comprehensive testing.

    When the Senate leadership presented the decision to the full membership, though, they learned that senators felt strongly that their session on Thursday should go on as scheduled. During the meeting, I briefly addressed my colleagues, offering my views from a medical standpoint on the anthrax exposure so far. Our discussion seemed to reassure many of them.

    After hearing from officials involved in the investigation, several senators made it clear that they believed Senate business should not be stopped, because it would be a sign of giving in to the terrorists. At the time, most felt that the events occurring on the Hill were likely related to the September 11 attacks. This was, many believed, round two of the assault on the nation's capital. A plane had struck the Pentagon and killed 189. Another that crashed in Pennsylvania, killing 44, almost certainly was headed for Washington. And now, many thought, came deadly anthrax, aimed at the highest-ranking member of the U.S. Senate.

    In the end, we decided to close the Senate office buildings later that day but to stay in session in the Capitol building itself on Thursday. House members, in a separate meeting, decided to close their office buildings and to adjourn. The press made a big deal about the House leaving and the Senate staying. It was an uncomfortable situation for both houses, with accusations flying back and forth, mostly fueled by the press.

    To me, this just reflected an initial miscommunication between the House and the Senate at the leadership level, in large part arising from the lack of certainty surrounding the interpretation of environmental culture results that were slowly coming back. Apparently, House and Senate leaders had left the earlier morning meeting with different understandings as to what they would do regarding closing the buildings. Policy decisions that could affect the safety of personnel had to be made on the basis of incomplete information and inadequate science. Such is the nature of bioterrorism.

(Continues...)

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Excerpted from WHEN EVERY MOMENT COUNTS by Bill Frist. Copyright © 2002 by Bill Frist. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

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