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DHMH Daily News Clippings
Friday, September 28, 2001
News Clipping Archives
Grim future predicted for Medicaid program (Annapolis Capital)
Allegany youth aren't saying 'no' (Cumberland Times-News)
Flu vaccine shipments late (Cumberland Times-News)
Possibility of germ warfare causes worry (Cumberland Times-News)
Brain-injured lose suit for community care (Daily Record)
One for the road? (Frederick News-Post Editorial)
Maryland braces for bioterrorism (Montgomery Gazette)
Big Push to Accelerate Vaccine Effort (New York Times)
County, municipalities set meeting to discuss emergency readiness (Prince George’s Gazette)
Fewer lacked health insurance in U.S. last year (Baltimore Sun)
'Desperately ill' man receives third mechanical heart (Baltimore Sun)
FDA approves first genetic test for mutating HIV (Baltimore Sun)
CDC backs Nov. flu shots for healthy, citing shortage (Baltimore Sun)
Judge finds no violations of mental patients' rights (Baltimore Sun)
Pastor set to tackle HIV/AIDS issues (Baltimore Sun)
Boy, 5, recovering from bacterial meningitis (Baltimore Sun)
Grants offered to programs to prevent substance abuse (Baltimore Sun)
Flu Is Due; So Are Lots of Shots (USA Today)
West Nile Found in Crow in Charles (Washington Post)
Challenge to Confinement by Md. Rejected (Washington Post)
Bioterrorism Vulnerability Cited (Washington Post)
Delay in Flu Shots for the Healthy Urged (Washington Post)
Special Report: Aftermath of Terror (Wall Street Journal)
Recent Stress May Boost The Risk of Heart Attacks (Wall Street Journal)
Terrorist Attacks Renew Concerns About Smallpox (Wall Street Journal)
Novartis Says FDA Approves Foradil For the Treatment of Smoker's Cough (Wall Street Journal)
Attack expert puts stress on preparedness (Washington Times)

Grim future predicted for Medicaid program
By the Associated Press
Annapolis Capital
Thursday, September 27, 2001
Health-care providers presented a grim picture of the state's Medicaid program yesterday, warning that doctors are leaving the program because they aren't paid enough money to cover their costs.
Representatives of hospitals, doctors and managed-care organizations pleaded with members of the House Environmental Matters Committee in Annapolis to use their influence with the governor to get more money for the HealthChoice program that serves 420,000 Medicaid patients.
"We ask you for your help," said Michael Johansen, lobbyist for Maryland Physicians Care, a managed care group owned by hospitals in Allegany and Washington counties and Baltimore.
Del. John Hurson, D-Montgomery, chairman of the committee, reminded Mr. Johansen that Gov. Parris N. Glendening has complete control over what goes in the budget.
But he said there are "a few guerrilla tactics we can use to get them to wake up to the fact that we need some more funding in this program."
Mike Morrill, Mr. Glendening's communications director, said the governor already has approved a significant increase that far outstrips the rate of inflation.
"Given the budgetary situation that's coming up, we're going to be very cautious about pouring money out without ensuring that in the long term, we are getting the value for Maryland taxpayers that they should be getting for that money," Mr. Morrill said.
Federal rules require Maryland to ensure recipients enrolled in HealthChoice have at least two managed care choices in their region.
Recently, however, managed care companies have been leaving the program or refusing to take new patients because they say they aren't receiving the money they need to stay in business.
One more managed care group's defection or patient refusal will mean the state will have to revert to a "fee-for-service" system to cover new Medicaid recipients. That system doesn't handle special needs or preventive health, according to MedChi, the state medical society.
The funding problem is caused by payment rates the state sets for member organizations and their physicians. While the rates are adjusted every year to account for cost increases since 1997, before HealthChoice was established, they were too low to begin with, critics charge.
Priority Partners, a managed-care organization owned by Johns Hopkins Medicine and the Maryland Community Health System, has announced it will stop accepting new patients on Jan. 1 unless Medicaid payments are increased.
Anne Arundel Medical Center spokesman Marty Harlan said the Annapolis hospital does receive HealthChoice patients and said the program "is truly underfunded."
But AAMC is not as heavily impacted as are more urban hospitals, because most Medicaid recipients live in the Baltimore area.
There is also a problem on the Eastern Shore, where payments are so low that specialists have dropped out of the HealthChoice program, said Dr. Fayette Engstrom, an Easton pediatrician.
"There is just no question that the Medicaid system is in crisis," she said.
Debbie Chang, deputy secretary of the state Department of Health and Mental Hygiene, said the agency is proposing to increase payments to health care providers by $80 million in 2002, not counting additional funds to cover an anticipated growth in the number of Medicaid patients. That amounts to an overall 7.9 percent increase.
Del. Michael E. Busch, D-Annapolis, said the HealthChoice program is still experiencing "growing pains," but the state is committed to making it work.
"I think it's really going to take another year or two for everything to really filter out, and to have enough data to know where there's waste and where there's need," Mr. Busch said. "It's not like the state is not continuing to increase funding."
Capital News Service Writer Nora Achrati and Staff Writer Tim Hyland contributed to this story.
Published September 27, 2001, The Capital, Annapolis, Md.
Copyright © 2001 The Capital, Annapolis, Md.

Allegany youth aren't saying 'no'
James Rada
Cumberland Times-News Staff Writer
Thursday, September 27, 2001
CUMBERLAND -- The latest Maryland Adolescent Survey shows that Allegany County still has plenty of work to do to help its students choose not to use alcohol, tobacco and drugs.
"I can't really say that things are remarkably worse except in the area of Ecstasy," said Lorelee Farrell, assistant supervisor of health and family life for the Allegany County Board of Education.
The survey is based on the results from 1,448 students from Allegany County in the sixth, eighth, 10th and 12th grades.
In the area of Ecstasy use, in 1996, only 7.9 percent of 12th graders had ever used it. In 2001, that number is now 14 percent. This is the 12th highest in the state.
"The kids are not getting the message. This is very dangerous and deadly," said Farrell.
While the county is seeing declines in hallucinogen and methamphetamine use, Farrell said it is a possibility the students could be shifting to Ecstasy.
The numbers, at least for the 12th-graders, are also creeping up for use of the three most common drugs: alcohol, tobacco and marijuana.
Among 12th graders:
* Those who have ever used cigarettes is 64.9 percent, which is the highest in the state.
* Those who have ever used any form of alcohol is 83.4 percent, which is the third highest in the state.
* Those who have ever used marijuana is 55.3 percent, which is the fourth highest in the state.
In the younger grades, there are drops in nearly all of these areas instead of increases. Farrell feels this indicates that there is a general trend toward less drug use. She hopes that the trend will
continue as the students get older.
"We've made progress in a lot of ways, but we will always have work to do," said Farrell.
She pointed to actions that the board has taken recently that she feels will help continue to keep the general trend downward. The board changed its tobacco-use policy to get smoking teens into
cessation programs at the health department, and the board has started a new middle school program called Lifeskills.
"We've certainly been working on reducing tobacco use. That's been a huge effort among a lot of people," said Farrell.
The county is comparing the 2001 study results against the 1996 study results rather than the 1998 results. The 1998 study had so many problems that it was released a year late, and the state hired another company to conduct this year's study.
Farrell feels the information in this year's study is not only accurate but useful.
"It's a wake-up call for health organizations, law enforcement, schools -- private and public -- and parents," said Farrell.
She feels parents need to talk to their children about these issues.
"Parents need to know where their children are, who they are with and what they are doing. On prom night, there shouldn't be parties in private homes where alcohol is served to young people," said Farrell.
Copyright © 2001 Cumberland Times-News

Flu vaccine shipments late
Health officials don't expect shortage, however
Sam Shawver
Cumberland Times-News Staff Writer
Thursday, September 27, 2001
CUMBERLAND -- Delayed flu vaccine shipments could postpone the Allegany County Health Department's annual vaccination clinics until November. Local health officials say there's no shortage expected this year, but it will take some time for the vaccine shipments to arrive.
"We received a partial shipment of 500 doses, but that isn't enough to schedule a clinic," said Sue Ottmar, director of nursing for the county health department.
"A total of 2,500 doses have been ordered, but we're not certain when the remaining shipment is coming in," she said. "I've read that there are actually more doses being produced, so there's no
shortage this year."
Last fall a limited supply of the vaccine caused the state to delay flu vaccination clinics until November.
"Usually our clinics are scheduled in mid-October, but we're probably looking at November again this year," said Ottmar.
The health department isn't the only agency having problems with vaccine shipments. The Western Maryland Health System is also experiencing delays.
"We're expecting our first shipment of flu vaccine by the end of October," said Kathy Rogers, community relations director for WMHS.
County Health Officer Ed Dressman said the shipping delays may be partially due to some institutions filing double orders for the vaccine to offset any possible supply shortage.
The vaccination clinics focus on individuals who are considered at high risk of contracting the virus, including people over the age of 65 or those under 65 who have chronic medical problems,
according to Ottmar. She said people who provide care for high-risk individuals should also be vaccinated.
"The vaccine doesn't make people sick because it is produced from a killed virus," said Ottmar. "It's proven to prevent influenza by stimulating the immune system to produce antibodies."
She said some people may become ill after receiving a flu shot because they have already contracted a virus before the vaccine is administered.
Dressman said the health department will schedule the vaccination clinics shortly after the final shipment of vaccine arrives.
"We just don't have enough vaccine to set up our clinics yet," he said. "Our first clinic each year usually draws about 1,200 people."
Copyright © 2001 Cumberland Times-News

Possibility of germ warfare causes worry
Local health officials watch for evidence
Sam Shawver
Cumberland Times-News Staff Writer
Thursday, September 27, 2001
CUMBERLAND -- Recent news reports on the possibility of bioterrorism being used against the United States have some area residents worried. But precautions are already being taken by
local health officials, according to the county's chief health officer who was part of a statewide teleconference on biological and chemical warfare on Wednesday afternoon.
"Surveillance has been going on all summer at area hospitals, but efforts have been stepped up since the terrorist attacks on Sept. 11," said Ed Dressman, health officer with the Allegany County Health Department.
"The Centers for Disease Control and the state Department of Health and Mental Hygiene are asking emergency departments to be on the watch for any unusual occurrences, based on past
experience, that might indicate exposure to a harmful biological agent," said Kathy Rogers, community relations director for the Western Maryland Health System.
"But we are certainly seeing nothing unusual at this time," she added.
Dressman said a biological agent would be extremely difficult to deliver in this area.
"There's very little possibility of contaminating the water supply with a live virus due to the sheer volume of stored water and chlorination," he explained. "It would have to be extremely
Viruses could be sprayed into the air, so the local health department was recently asked to contact area companies that spray for mosquitoes to see if they had any equipment missing. Dressman said all the hardware was accounted for.
"The only local mosquito spraying is done by the state Department of Agriculture around the canal area," said Dressman.
Still, local citizens are growing apprehensive about biological attacks after hearing reports on television and radio.
Two of their greatest concerns are the anthrax and smallpox viruses.
"We're already getting phone calls asking about vaccinations against these diseases," said Dressman. "But that's not going to happen. There is a very small supply of the smallpox vaccine
available, and that is being administered by the CDC. It would probably only be used in the area of an attack."
He estimated that it would take nearly two years to develop more smallpox vaccine.
"There is also a shortage of the anthrax vaccine, which is being held for our military forces," he added. "If people want more vaccine for these viruses they should be contacting their  congressional representatives."
Dressman said health officials are concerned that people will begin hoarding medicines without cause.
"We don't want the public stockpiling antibiotics or getting on antibiotics for no reason," said Dressman. "It only makes the situation worse and there's no need to do that."
State health officials are currently compiling information on what antibiotics are available and where they are stored.
The health department is also sharing information with WMHS about the properties of possible biological or chemical agents used by terrorists.
"We're trying to get information out to various health agencies and to the community," said Dressman.
Health department representatives will be meeting soon with county and hospital officials to update emergency plans to deal with the possibility of a terrorist attack.
"A lot of our plan was developed during the Y2K situation," Dressman noted.
Copyright © 2001 Cumberland Times-News

Brain-injured lose suit for community care
By Peter Geier & Barbara Grzinicic
Daily Record Legal Affairs Writers
Friday, September 28, 2001
The state has no duty under the Constitution or the Americans with Disabilities Act to provide developmentally disabled adults with community-based care, rather than institutionalizing them, a federal judge in Baltimore has ruled.
Judge Catherine C. Blake’s 84-page opinion, issued late yesterday, comes in a seven-year-old class action naming 12 brain-damaged representative plaintiffs who claim they were denied appropriate care. At present, some have died, some have been placed in community settings and only three remain in state institutions.
“The evidence spread before the court reflected contrasting perspectives on a very difficult set of circumstances,” Blake wrote. “The plaintiffs’ pain and frustration was genuine and understandable; the defendants’ efforts to provide a stable, safe and caring environment also were genuine and commendable, if not always successful. In the end, the plaintiffs have not shown sufficient reason for the court to order the State of Maryland to do more.”
Yesterday’s decision comes five years after summary judgment was denied, four years after a 32-day bench trial was held, and two years after the case was rebriefed following the Supreme Court’s decision in Olmstead v. L.C., which dealt with the ADA rights of a mentally retarded individual who was involuntarily institutionalized.
Philip J. Fornaci, executive director of the Maryland Disability Law Center, expressed anger and disappointment at having waited “such a long time not to have gotten a more favorable result.”
“We’re extremely disturbed by this decision,” Fornaci said, “first of all on behalf of our clients, then for the 60 traumatically brain injured and nonretarded developmentally disabled people currently in psychiatric institutions in Maryland that have been waiting for this decision.”
Maureen M. Dove, the attorney general’s chief of litigation, had not had a chance to study the opinion, but praised its result.
“As you can see, the court concluded that they didn’t prove either the ADA or the Due Process claims,” Dove said.
Cost-based defense
While the Olmstead Court determined that “[u]njustified isolation … is properly regarded as discrimination based on disability,” Blake wrote, the state can raise a “cost-based defense” to show that proposed modifications to its program would be a “fundamental alteration” and therefore, unreasonable.
“Most importantly, the ADA is not reasonably read to compel a State to put patients at risk by closing its institutions or to drive a State to move institutionalized patients into “inappropriate” settings,” Blake wrote.
She reviewed the state’s history of placing members of the traumatic brain injured/nonretarded developmentally disabled population into the community, and ultimately concluded that progress has been acceptable.
“ ‘The State’s responsibility, once it provides community-based treatment to qualified persons with disabilities, is not boundless,’ ” Blake wrote, quoting the plurality opinion in Olmstead, “and the court must consider the totality of the expenses and programs undertaken by the State when evaluating the fundamental alteration defense.”
Fornaci, however, criticized Blake for taking “pieces of that decision that are most favorable to the state’s position” and, essentially, missing its point.
“The bottom line is that Olmstead recognizes the urgency of the situation — that it’s a gross violation of these folks’ civil rights,” he said. “[Blake] does not recognize that; she does not see it as urgent.”
Balancing interests
Blake also found the plaintiffs were not denied their “substantive liberty interests that require the State to provide adequately safe conditions, reasonable freedom from bodily restraint, and ‘minimally adequate or reasonable training to ensure safety and freedom from undue restraint,’” citing the 1982 Supreme Court decision in Youngberg v. Romeo, which addressed the rights of a mentally retarded individual.
While the plaintiffs claimed their institutionalization departed from the acceptable standards of care, defense experts countered that treatment methods are “always a balance,” and that the hospitals had considered the relevant factors and struck an appropriate balance.
The plaintiffs also claimed the hospitals were too noisy and chaotic, and that the staff members were inadequately trained, to provide the low-stimulation environment needed to “habilitate” brain-damaged subjects. The state denied the assertion, and Blake ruled for the state.
Fornaci said the plaintiffs are considering their options.
“The main thing to keep in mind is that the folks in question here have been waiting years to get out of settings that they don’t want to be in and that are harmful to them,” he said.
Yesterday’s opinion is available as RecordFax #1-0927-40 (84 pages).
Copyright © 2001 The Daily Record. All Rights Reserved.

One for the road?
Frederick News-Post Editorial
Friday, September 28, 2001
It's official. Get caught driving in Maryland with a blood-alcohol level of .08 or more and you're in a world of hurt. Beginning Sept. 30, Maryland's new, lower tolerance level for drinking drivers will be in effect, and the state has a $2 million war chest (provided by federal grant as a reward for passing the more-stringent limit) with which it will enforce the new standard.
You'll be seeing signs everywhere announcing the new tougher limits, and you'll be taking a chance of getting pinched by a sobriety checkpoint (a sobering thought) if you have too much to drink and then drive.
We needed this legislation. It's hard to argue with statistics like the $850 million annual cost associated with alcohol-related crashes. And last year alone, 195 people were killed and upwards of 6,000 injured in Maryland driving incidents that involved alcohol.
This is a new reality for people who routinely have a couple of drinks and drive. They may soon be legally over the limit of .08 after those couple of drinks. Social-drinking drivers may be wondering just how much they can consume and still be driving legally. How quickly alcohol is consumed, the consumer's body weight, liver function and other variables may come into play.
Relying on your own judgment as to whether you can drive safely will probably continue to get a lot of people into trouble. As a general rule, if you've been drinking and decide you're OK to drive, to paraphrase Bill Clinton, it's the alcohol, stupid.
Some people will probably resort to buying breathalizers to measure their blood alcohol content. The best and safest rule to apply from now on, however, is that if you plan on driving, just don't drink at all. If you want to party and need transportation, make sure you have a designated driver or take a cab or public transportation.
This legislation reflects a new resolve in the public consciousness about drinking and driving. Fines and other penalties for driving while intoxicated are stiff these days. Thinking about having a few belts and then driving? Forget about it.

Maryland braces for bioterrorism
by Manju Subramanya
Montgomery Gazette Staff Writer
Friday, September 28, 2001
ROCKVILLE -- In November, Montgomery County health officials battled a mock attack of anthrax, mobilizing hospital beds, antibiotics and personnel in rapid-fire sequence to deal with a catastrophic epidemic.
The exercise was part of a daylong drill against bioterrorism. But in the wake of the Sept. 11 strikes in New York and Virginia, the county is familiarizing itself with the scenario once again.
"We think it is appropriate emergency preparedness," said county health officer Carol Garvey. "We could have a flu epidemic that could be as disastrous as the attack."
The preparation for a chemical or biological attack -- in the works for three years in Montgomery County -- swung into high gear at the county and state level following the carnage at the World Trade Center and the Pentagon.
Within hours, the Maryland Department of Health and Mental Hygiene activated a series of steps.
All counties were asked to take stock of their antibiotics and pharmaceuticals and send counts to the state.
The state sent letters and e-mails to all private physicians and hospitals, urging them to step up monitoring and maintain "a high level of suspicion" about symptoms that seemed out of the ordinary, unusual X-rays or an unexpected spike in emergency room patients.
"We are in a state of heightened alert," Julia Casini, medical coordinator for emergency preparedness and response at the Maryland Health and Mental Hygiene department, said Tuesday. "Even if the threat is zero, the outcome would be significant.
"We are not playing with the odds," she said.
The water supply
Neither is the Washington Suburban Sanitary Commission, the Laurel utility that supplies water to about 1.6 million customers in Montgomery and Prince George's counties.
The utility is maintaining round-the-clock security at all its facilities -- reservoirs, filtration and wastewater treatment plants -- until further notice, said spokeswoman Liz Kalinowski. In Montgomery County, WSSC has a reservoir in Gaithersburg, a filtration plant in Potomac, two
wastewater treatment plants in Damascus and Germantown, a dam in Brookeville and a laboratory in Silver Spring.
A handful of customers has called WSSC, asking: Is the water safe? Are you taking security measures?
"We are taking all appropriate steps to safeguard the water," Kalinowski said, saying the utility runs about 600,000 laboratory tests annually to ensure water quality.
Casini said she is "fairly confident" about water safety.
"It is extraordinarily difficult to contaminate water supplies," said Casini, who holds a medical degree.
The huge amounts of water in reservoirs, for instance, would dilute any chemicals added to it, she said.
And if a biological agent were added to the reservoir, it would not last long, she predicted.
"Bacteria don't do well in sunlight."
Metro is testing
Just as customers have been calling WSSC about their water worries, some have called the Washington Metropolitan Area Transit Authority to ask if Metro is safe to ride.
Could the Sarin nerve gas attack that killed 12 in Tokyo's crowded subway in 1995 happen here?
"We have an aggressive, proactive, ongoing detection program for chemical testing in our Metro system," said Metro spokeswoman Lisa Farbstein. The testing has been in place since 1999, making Metro one of the few transit agencies in the county with such a program, she said.
Farbstein said she could not discuss the testing details because she is wary of giving out too much information.
That sentiment is echoed by WSSC's Kalinowski and the state's Casini. In this changed world, caution is the watchword. "We are walking around nervously," Casini said.
Farbstein noted that Metro also has 300 police officers patrolling the system. Some are highly visible, sporting reddish pink fluorescent vests; other plainclothes officers are blending in with the crowds, she said.
Many are putting in additional hours, working 12-hour shifts instead of eight-hour ones since Sept. 11.
An attack in Metro would pose unique problems, said Montgomery County's Fire Marshal and Bureau Chief Theodore Jarboe.
"It is underground, confined, with limited access and a lot of people," Jarboe said. "It is more challenging for responders."
The germs
County and state officials are concerned about anthrax and a host of other agents that terrorists could make into weapons: smallpox, the plague, botulism and the Ebola virus.
Anthrax, normally found in cattle, kills more than 85 percent of the people infected. Antibiotics are effective only if they are given before the symptoms appear, Garvey said.
Vaccines against anthrax are available only to the military. However, the county can request vaccines from Walter Reed Army Medical Center in Washington, D.C., in an emergency, Garvey said. The military hospital is one of two military hospitals -- the other being the National Naval
Medical Center in Bethesda -- that sit on a hospital committee in the county's emergency management group.
While anthrax cannot be spread from person to person, smallpox is extremely contagious. The virus was eradicated in 1980, but samples remain with the federal Centers for Disease Control in Atlanta and in Koltsovo, Russia. Smallpox is fatal in 30 percent of unvaccinated people.
The United States stopped smallpox vaccinations in 1972, so many people are extremely vulnerable to an attack, Garvey said. CDC holds a stock of smallpox vaccine, whose estimates range from 7 million doses at the low end to 12 million to 15 million at the high end. More are in
production by a private company.
But Casini said it requires a great deal of sophistication to aerosolize -- or convert into a mist form -- agents such as anthrax.
And dispersing the agent -- whether biological or chemical -- is not an easy task.
This week, the Federal Aviation Administration briefly grounded cropduster planes for a second time after authorities found a cropdusting manual in a suspected terrorist hideout.
"No one is saying it couldn't be done," said Donald Vandrey, spokesman for the Maryland Department of Agriculture, which licenses cropdusters. "But it's not as simple as dumping something in the tank and starting to spray."
In Maryland, 57 individuals from 18 firms are licensed to perform cropdusting. The department issues licenses to individuals only after they complete mandatory training with the state, Vandrey said.
"Cropdusters are calibrated and designed to handle very specific chemicals," he said, saying anyone who tried to load chemicals into a cropduster tank could end up killing himself. "It is not the easiest way to perform terrorism."
The same applies to mosquito-spraying trucks, he said. The state owns 12 to 15 trucks and hires sprayers on a seasonal basis.
Immediate vs. insidious
Montgomery County's response to a chemical or biological attack will vary depending on what form it takes and what agent is used.
A chemical attack -- such as nerve gas -- will be apparent immediately, Garvey said. The fire department will be the first to respond, followed by police.
A biological attack will be more insidious: Patients will arrive at emergency rooms over a period of days. The incubation period for smallpox, for instance, is 12 to 14 days after infection.
Doctors at hospital emergency rooms will be the first to detect something unusual and will report any out-of- the-ordinary pattern to the county health department. The county will alert the state, which will notify the Centers for Disease Control, said Richard Helfrich, senior administrator for emergency management at the Montgomery County Health and Human Services Department.
The county also will inform police, who will get in touch with the Federal Bureau of Investigation.
Meanwhile, the county's Emergency Management Group will have swung into action, activating the Emergency Operations Center in Rockville.
Just as they did in November's drill, officials will have to make quick decisions: Do we move people out of the area? Do we quarantine those affected?
If the county's stock of antibiotics runs out, the state will call on neighboring counties to ship in more.
As a last resort, the governor would have the option of calling on the federal government to send "push-packages" from a national stockpile of pharmaceuticals -- parcels of medication and equipment that could be flown in from the closest military bases, just as they were sent to New York City two weeks ago.
Simultaneously, hospitals would begin clearing beds for mass casualties.
Hospitals prepared?
The concern is that hospitals in the state do not have the surge capacity that they had 20 years ago.
Hospitals are grappling with financial pressures and "just-in-time staffing," said Monica Schoch-Spana, a medical anthropologist and research associate at Johns Hopkins University's Center for Civilian Biodefense in Baltimore. "If there is anything out of the norm of the projected load, they are unable to cope."
In Montgomery County, officials faced a true test Sept. 11 on how quickly they could mobilize hospital beds. Within three hours of the attacks on the World Trade Center, the county's five hospitals freed up 174 beds. Forty more were available in the next hour, Garvey said. In addition, three trauma teams stood at the ready at Suburban Hospital in Bethesda, the county's designated trauma hospital.
Montgomery County is "very far ahead of the curve," said the state's Casini, noting that the county's proximity to Washington warrants that level of preparedness.
On Thursday, the county and state kicked off a three-day bioterrorism conference at the University of Maryland Shady Grove Center in Rockville -- its second in two years.
The Sept. 11 hijackings were "a tremendous wake-up call to the nation that terrorism is still alive and the U.S. is vulnerable," fire marshal Jarboe said before the conference. "It reinforces the need for emergency responders throughout the country to prepare."
The conference attracted about 180 people from 19 states and Canada, including firefighters, FBI agents and public health officials.
"It tragically comes at a time when we are reminded of the multiple hazards out there," Montgomery County's chief administrative officer, Bruce F. Romer, said minutes before he headed into the conference, which was closed to the public because of the technical and
sometimes confidential nature of the discussions.
The county has been reviewing all its emergency preparation procedures since Sept. 11, Romer said.
"The citizens should be comforted -- our public safety personnel have long placed a high value on preparedness."
Still, Schoch-Spana wondered if the nation's public health systems could handle the mass casualties that could result from a biological attack.
"As a public health practitioner, I feel satisfied that public health [departments] can deal with low-end outbreaks," she said, recalling a 1984 incident in The Dalles, Ore. Members of the Bhagwan Shree Rajneesh cult contaminated salad bars in 10 restaurants with salmonella germs and caused hundreds of people to fall ill. "As a society, we have to try and see what steps we need to take to deal with large-scale scenarios."
She referred to a 1993 analysis by the congressional Office of Technology Assessment: One hundred kilograms of anthrax released upwind in a major city could kill between 130,000 and 3 million people, depending on the weather and other variables.
Washington, D.C., was the model.
Copyright C. 2000 Gazette Newspapers

Big Push to Accelerate Vaccine Effort
By Melody Petersen and Andrew Pollack
New York Times
Friday, September 28, 2001
With concerns growing about the threat of terrorism using biological weapons, the government is
stepping up its effort to enlist biotechnology companies to develop and produce vaccines, drugs and other defenses against such an attack, according to industry executives.
But many of the projects, like the manufacture of a smallpox vaccine, are years from completion.
The Biotechnology Industry Organization, the main trade group for biotechnology companies, sent out an "urgent official request for information" on Monday after meetings with Tommy G. Thompson, the health and human services secretary, and Department of Defense officials. The request asks the roughly 1,000 members what technologies they have that could be used to defend against biological or chemical attacks.
The letter also said the government wanted to make sure companies were safeguarding their own
technology from being used to create biological agents. Specifically it urged that procedures be set up to raise an alert if the companies get an unusual order for their products.
Carl B. Feldbaum, president of the trade group, said the response to the letter had been
"overwhelming," though he would not discuss the content of the answers.
Even before the attacks on the World Trade Center and Pentagon, the government had begun working with a number of biotechnology companies. Last year the Department of Health and Human Services gave a $343 million contract to OraVax (news/quote), a company in Cambridge, Mass., to produce 40 million doses of a new smallpox vaccine. But the first doses are not expected to be delivered until 2004.
Executives at the company, which is now owned by Acambis (news/quote), a British drug maker, said they would try to speed up manufacture of the vaccine if the government asked, but would not say to what degree they could do that.
"Certain things are in our control and certain things are not," said Gordon Cameron, the chief financial officer at Acambis. "This is a new vaccine that has to be tested."
The Defense Department has paid for the production of an anthrax vaccine for soldiers for years, but that program has been plagued by problems. Bioport, a Lansing, Mich., company, now has the government contract, but it is currently unable to produce the vaccine because its factory is being renovated to meet Food and Drug Administration standards.
Last year, the Defense Department entered into a research partnership with EluSys Therapeutics, a small private company in Pine Brook, N.J., to develop an antidote to anthrax. "You will never have the entire population of the United States vaccinated against these problems so you need to have a therapeutic available," said Stephen G. Sudovar, president. But even if the company succeeds in its research, the antidote will not be available for about two years, he said.
The Defense Advanced Research Projects Agency, an arm of the Pentagon, is working with academic scientists and more than a dozen other companies on research that could take a decade to bear fruit.
Isis Pharmaceuticals (news/quote) in Carlsbad, Calif., for instance, is working on drugs that could kill all bacteria. Egea Biosciences of San Diego is working on ways to quickly develop vaccines to any pathogen. Cepheid of Sunnyvale, Calif., is working on a briefcase-size machine that could perform a genetic analysis to identify an infectious agent in 30 minutes, rather than the hours or days such a job normally takes.
After the terrorist attacks, the government is likely to increase spending on defenses against biological warfare. Two days after the attacks, the Army called Bruker Daltonics (news/quote) to see if the company was prepared to manufacture many more of its bioagent detection machines than were included in a $10 million contract the government had just signed.
"They are getting ready to react," said Frank H. Laukien, president of Bruker, based in Billerica, Mass.
In the past, the Pentagon has had trouble working with vaccine manufacturers. Wyeth Laboratories, a division of American Home Products (news/quote), stopped producing the adenovirus vaccine for military recruits in 1996 after the Pentagon declined to pay for factory improvements needed to meet safety standards. Wyeth was unwilling to invest itself since sales of the vaccine, made only for the Defense Department, were tiny and dwindling. The military ran out of the vaccine in 1999 and there has been a surge in respiratory illnesses among military recruits, including two deaths. A new contract to produce the vaccine has now been awarded to Barr Laboratories (news/quote), an Army spokesman said.
Given that big drug companies are reluctant to make vaccines because of the small market size, the Pentagon has been considering building its own vaccine plant to produce eight vaccines for military use — the existing anthrax vaccine and a new one, plus vaccines for smallpox, plague, tularemia, botulinum, ricin and equine encephalitis. It would cost $1.56 billion to build and run over 25 years, including $386 million in construction costs, the department estimated in a report to Congress in July. But production at the plant would not begin until 2008. David Satcher, the surgeon general, wrote to the Pentagon in January urging that the factory also be used to produce vaccines for civilian use.
In contrast with the large drug companies, smaller biotech companies have welcomed the Pentagon contracts because they provide money and because many of the projects can lead to commercial products.
"For the research programs here it was our largest single source of funding," said Matthew M. Loar, vice president for finance at Genelabs Technology Inc. in Redwood City, Calif. Genelabs had a $14 million three-year grant from the research projects agency to use the company's DNA-binding technology to develop antimicrobial drugs. The company is using the technology to develop commercial antibiotics.
Experts say it is vital for companies and scientists to become involved in developing vaccines and other defenses against bioterrorism. At a Senate hearing in the summer, Dr. Tara O'Toole, a senior fellow at the Center for Civilian Biodefense Studies at Johns Hopkins University, said that responding to bioterrorism with only the vaccines and drugs now available would be like "asking firefighters to battle a 12-alarm blaze without water or foam."
Copyright 2001 The New York Times Company

County, municipalities set meeting to discuss emergency readiness
by Greg Johnson
Prince George’s Gazette Staff Writer
Friday, September 28, 2001
County officials are set to meet with municipal leaders next month to discuss improving the ways emergencies are handled in Prince George's County.
Jack Sims, mayor of District Heights, said Monday other municipal leaders have contacted him since the attack on the Pentagon Sept. 11 and asked to meet with emergency officials from the county. A conference has been tentatively scheduled for Oct. 15, Sims said, and would include municipal officials as well as members of the county's office of emergency preparedness.
"I think the terrorism issue changes the dynamics of emergency preparedness and I think we have to focus on that issue," Sims said. "We'll get around the table and come up with some type of plan."
Fred Thomas, director of public safety for the county, said he would attend the meeting next month.
Thomas said the county already has an extensive plan for large-scale disasters. This policy would not be able to prevent an attack like the one launched against the Pentagon, he said, but it does provide for other agencies to support county departments called to the scene.
"No one jurisdiction can handle that type (of catastrophe)," Thomas said.
Thomas said the county's emergency preparedness plan was updated for Y2K and also includes tips learned from a disaster drill organized by federal officials last year.
In May 2000, Prince George's County emergency personnel participated in a regional exercise called "Topoff." The drill reportedly involved a scenario in which a bomb exploded at US Air Arena in Largo.
The county's emergency response was further tested Monday when a tornado ripped across Prince George's County from College Park to Laurel, killing two University of Maryland students and damaging dozens of buildings. University officials said more than 300 cars in parking lots
on the west side of the campus were damaged or destroyed by the storm.
More than 200 county fire and rescue crewmembers were dispatched to sites in College Park, Beltsville and Laurel after the tornado touched down about 5:45 p.m. Emergency personnel from Anne Arundel, Howard and Montgomery also responded.
At the meeting next month, Thomas said, officials could develop a way to coordinate county policies with the actions of municipal governments.
Under the current plan, only leaders from the area directly affected by an emergency can participate in the regional response.
"Those are the kinds of things we're going to talk about," Thomas said.
The October meeting was organized after public safety officials in the District were criticized for their seemingly inadequate response to the terrorist threat Sept. 11. Congress reportedly voted to withhold about $9 million slated for the District's use until the city government overhauled its emergency plan.
According to news reports, government cellular phones failed because the system was jammed, District police had no idea which roads to close to evacuate the city and emergency escape plans on Capitol Hill were never implemented.
Rep. Steny Hoyer, (D-Dist. 5), has been working with the U.S. Capitol Police as head of the House Administration Committee. Hoyer, of Mechanicsville, said in a statement released Monday that security procedures need to be evaluated at all federal buildings in the area.
"The events of September 11th were a wake-up call for communities that they must think about the unthinkable and be prepared to respond," Hoyer said.
County Councilman M.H. "Jim" Estepp, (D-Dist. 9) of Croom, said he did not think the county's fire department is prepared to handle large-scale emergencies.
"I think they are under-funded," Estepp said during an interview last week. "I think we are under-prepared to some extent because of the cuts that were made to the fire and (emergency medical) services in the mid-90s."
However, Thomas said the fire department had been given adequate funds and agencies in other jurisdictions would help bolster the county's response to any major emergency.
"That's the whole concept behind a mutual-aid agreement," Thomas said.
Copyright C. 2000 Gazette Newspapers

Fewer lacked health insurance in U.S. last year
But slumping economy likely to reverse trend
Associated Press
Baltimore Sun
Friday, September 28, 2001
WASHINGTON - Fewer Americans lacked health insurance last year, as a then-robust economy and government programs helped more children and poor people get coverage.
About 14 percent of Americans, or 38.7 million people, were without coverage during the entire year of 2000, down from 14.3 percent, or 39.3 million, in 1999, the Census Bureau reported today.
With unemployment low during that period, more people were able to get insurance through their employers. And analysts said more lower-income families and kids picked up coverage through programs like Medicaid and the Child Health Insurance Program.
But the overall downward trend is likely to reverse this year as the economy struggles, said Ron Pollock, executive director of the consumer group Families USA.
"As the worsening economy and the repercussions of Sept. 11 result in many people losing jobs, health coverage relief becomes increasingly urgent," Pollock said.
Since the terrorist attacks, more than 100,000 layoffs have been announced in the airlines and related industries.
"It is time to make expanded health coverage, especially through existing public programs, an important national priority," Pollock said.
Much of the decrease in the number of uninsured Americans was due to more people getting coverage through employers, said bureau analyst Robert Mills.
And while long-held disparities still existed between whites and minority groups, and the rich and poor, some positive signs emerged, Pollock said.
Among the findings:
29.5 percent of poor Americans were uninsured in 2000, down from 31.1 percent in 1999.
11.6 percent of children younger than 18 were uninsured, down from 12.6 percent.
Much of those gains came as a result of the children's health program initiated in 1997, and Medicaid, said Steven Findlay, research director at the National Institute for Health Care Management.
Those programs may become even more critical in the coming weeks and months for struggling laid-off workers, Findlay said.
Discouraging signs about the affordability of quality health care arose even before the terrorist attacks, some experts noted.
For instance, a report released this week by the Center for Studying Health System Change found the cost of health care jumped 7.2 percent last year - the largest increase in a decade.
Premiums increased 11 percent, according to the study from the Washington-based independent research organization.
"Everyone is hoping to see some dramatic turnaround," Findlay said. "But all the forces at play here would point to a decline" in the number of people with health insurance.
The census figures came from a survey of 50,000 households taken in March that was separate from the 2000 head count.
Because of a change in the questions asked on the survey, the latest results were not comparable to any figures before 1999, the bureau said.
Other findings:
American Indian and Alaska Natives were the least likely among minority groups to have health insurance.
By age, people 18 to 24 were least likely to be insured. Many of these people are in college or are just starting out in jobs that may not offer health coverage right away.
Copyright © 2001, The Baltimore Sun

'Desperately ill' man receives third mechanical heart
Patient in stable shape at Houston hospital
Associated Press
Baltimore Sun
Friday, September 28, 2001
HOUSTON - A "desperately ill" man has become the world's third recipient of a self-contained mechanical heart after a six-hour operation.
The procedure Wednesday at St. Luke's Episcopal Hospital in Houston comes after the success of two implants of the AbioCor device at Jewish Hospital in Louisville, Ky.
"The procedure ... went as expected and the patient is resting comfortably," the hospital said in a statement yesterday.
"It couldn't have gone better," Dr. O.H. Frazier, who spent more than a decade helping develop the AbioCor replacement heart at the hospital's Texas Heart Institute, told The Houston Chronicle.
"Everything looks stable now. He's not having any problems. We have some hope for him."
No chance of transplant
He told the newspaper the man had been "desperately ill for a long time" with heart failure and was not a candidate for a heart transplant because of complications involving his lungs.
The completely internal pump, made of plastic and titanium and weighing less than 2 pounds, is powered through the skin by an external battery pack.
The hospital did not identify the patient or give his age and said it would withhold any information about the patient for at least 30 days.
Officials said a news briefing was planned for today to discuss the procedure.
University of Louisville surgeons implanted the first AbioCor hearts on July 2 and Sept. 13 at Jewish Hospital in Kentucky.
The first patient, Bob Tools, is now in his 87th day.
He is gaining weight and making excursions outside the hospital. Doctors said his kidneys, liver and lungs are functioning normally.
Tom Christerson, 14 days removed from the surgery, is still in the early stages of recovery, but doctors said his condition is improving.
The heart, made by Massachusetts-based Abiomed Inc., is intended for patients with end-stage heart failure who have more than a 70 percent chance of dying within a month.
The AbioCor study is initially limited to five people nationwide. Other approved sites in addition to the Houston and Louisville facilities include Brigham and Women's Hospital and Massachusetts General Hospital, both in Boston, and UCLA Medical Center in Los Angeles.
Copyright © 2001, The Baltimore Sun

FDA approves first genetic test for mutating HIV
Baltimore Sun
Friday, September 28, 2001
The government has approved the first gene-based test to tell quickly whether an HIV patient's virus is mutating to make a particular drug therapy fail, important to know so the person can switch AIDS medications.
Visible Genetics Inc.'s Trugene is one of the most complex genetic test systems to clear the Food and Drug Administration. FDA officials described it yesterday as an important tool in helping doctors select the medications most likely to fight each patient's HIV.
The AIDS virus naturally grows resistant to medications through evolution. Experts say 60 percent of patients have a virus that is resistant to at least one drug.
Copyright © 2001, The Baltimore Sun

CDC backs Nov. flu shots for healthy, citing shortage
Baltimore Sun
Friday, September 28, 2001
ATLANTA - The federal government asked doctors yesterday to wait until at least November to give flu shots to healthy people because of delays in manufacturing the vaccine.
The Centers for Disease Control and Prevention also said this year's batch of flu vaccine appears to be well-matched to the strains of the virus circling the globe. Because flu strains are unpredictable, different vaccines must be cooked up each year.
The recommendation to limit early shots comes during the second straight year of delays by the three private companies that make the vaccine as they struggle to expand.
Copyright © 2001, The Baltimore Sun

Judge finds no violations of mental patients' rights
By Michael Scarcella
Baltimore Sun Staff
Friday, September 28, 2001
A lawsuit brought against the state by a dozen psychiatric patients claiming that institutionalization violated rights guaranteed them under the federal Americans with Disabilities Act was rejected yesterday by a U.S. District Court judge more than three years after the case was tried.
The 12 plaintiffs - described as "traumatically brain injured" or "nonretarded developmentally disabled" - sought to be removed from state psychiatric facilities on grounds that they were not beneficial to treatment and violated their due process rights, said Philip J. Fornaci, executive director of the Maryland Disability Law Center, which represented them.
"Psychiatric hospitals did not make them any better," Fornaci said last night. "They were regressing. They were being warehoused, not rehabilitated."
The federal law states that no person with disabilities can be excluded from participation in, or denied the benefits of, public services and programs. The plaintiffs argued that they were being denied community-based programs based on their disabilities, Fornaci said.
The causes of their mental conditions included a head injury in a motorcycle accident, genetically based developmental disorders and a bacterial infection that led to severe brain damage.
The state, in its defense, said the brain injuries incurred by the plaintiffs "have rendered them very difficult to care for" and that they had symptoms including "low frustration tolerance, proneness to irritability, [and] difficulty planning and directing behavior."
Judge Catherine C. Blake's 84-page opinion noted that the trial lasted 32 days and that the case "raises complex medical, social and fiscal issues not easily addressed by litigation."
She found that the plaintiffs had failed to provide sufficient evidence that community treatment was more beneficial and cost-effective than institutional care.
"The plaintiffs' pain and frustration was genuine and understandable; the defendants' efforts to provide a stable, safe, and caring environment also were genuine and commendable, if not always successful," she wrote.
"The state has managed to make them seem like monsters," Fornaci said of the mental patients. "What's made them difficult is that they don't belong in state psychiatric facilities."
Copyright © 2001, The Baltimore Sun

Pastor set to tackle HIV/AIDS issues
Reverend Warnock to be installed Sunday at Douglas Memorial; HIV, AIDS are priorities
By Laurie Willis
Baltimore Sun Staff
Friday, September 28, 2001
In the hectic days before being installed as leader of a major urban church, many pastors would be crafting sermons, neatly pressing suits and robes, or ironing out last-minute details.
The Rev. Raphael Gamaliel Warnock, due to be installed Sunday as pastor of Douglas Memorial Community Church in West Baltimore, has been doing what he does best: tackling tough issues.
At Warnock's insistence, the 700-member church plans to open a weekend of installation events with discussion of what he sees as one of the churches' albatrosses: HIV and AIDS. Today, at an early morning news conference at the church, Warnock plans to challenge Baltimore clergy to urge their congregations to get tested for the virus -- and to get tested themselves.
Then, he'll participate in a daylong symposium: "The Black Church's Response to the HIV/AIDS Epidemic."
"Everything I do is theologically and biblically informed," Warnock said this week from his study. "The Old Testament prophet Hosea said, 'My people are destroyed for lack of knowledge.' I am saying that that is literally the case with regard to HIV/AIDS. People do not know what they need to know about the virus itself, and they do not know their HIV status. If the clergy went to get tested en masse, we could create a climate where you remove the stigma."
At 32, Warnock is young to lead one of the city's largest churches. But he comes from spiritual stock.
He was born in Savannah, Ga., the 11th of 12 children born to two Pentecostal-Holiness ministers. He came to Douglas Memorial early this year from the historic Abyssinian Baptist Church of New York, where he had been youth pastor for six years and assistant pastor for four years.
The Rev. Calvin Butts, pastor of Abyssinian, said he wasn't surprised Warnock was hired.
"He's one of the brightest and most intelligent and academically prepared young clergymen in the country," Butts said. "He got along excellently with the church members of all ages. He's a forceful leader, very serious about the issues that impact especially the African-American community. He's one of the more thoughtful preachers of his generation."
Warnock replaces the Rev. Brad R. Braxton, who left after five years in July of last year to teach at Wake Forest University, making him the fourth pastor in Douglas Memorial's 76-year history.
He was selected after a national search, said Marco K. Merrick, director of the church's gospel choir and a search-committee member.
"Our goal was to bring the best candidate to the congregation based on what we believe, based on what the congregation imparted to us in a survey," Merrick said. "Reverend Warnock excelled in every category. What he imparted with us was very memorable, very indelible."
As part of the installation celebrations, Warnock and other Douglas Memorial members will attend a pastoral installation banquet at 6 p.m. tomorrow at the Renaissance Harborplace Hotel. Actor Ossie Davis will be speaker.
Warnock earned a degree in psychology from Morehouse College in 1991, a master's degree in divinity from Union Theological Seminary in New York in 1994, and a master's degree in systematic theology from Union last year.
Warnock said he sees issues in Baltimore that he wants to address -- including urban blight and high rates of sexually transmitted diseases and drug addiction.
As part of his vision for Douglas, Warnock wants to attract support from corporations and foundations to expand Camp Farthest Out, a 50-acre facility in Carroll County that provides a residential camp experience for disadvantaged children.
Warnock also said he hopes to expand Douglas' community outreach.
"I think you will see over the next few years a Douglas Church that is very much engaged in the social and political life of the Baltimore community," he said. "Whether the issue is HIV/AIDS or the education of our children, we will bring the moral authority of the faith community to bear in the critical discourse that takes place in the public square."
Copyright © 2001, The Baltimore Sun

Boy, 5, recovering from bacterial meningitis
Baltimore Sun
Friday, September 28, 2001
A 5-year-old pupil at Medfield Heights Elementary School was recovering yesterday from bacterial meningitis, the city Health Department said.
Health officials reassured parents that the potentially fatal disease, which attacks the brain and spinal cord, is unlikely to have spread to classmates. It is spread through saliva. The disease killed two students last year in Maryland, one of high school age, the other in college.
"Just having an [infected] 5-year-old in your class is no reason to worry," said Dr. Peter L. Beilenson, the city health commissioner. The child began feeling feverish Monday night and was taken to St. Joseph Medical Center in Towson. He should be able to go home in a week or so, Beilenson said.
Copyright © 2001, The Baltimore Sun

Grants offered to programs to prevent substance abuse
Baltimore Sun
Friday, September 28, 2001
Towson - Baltimore County Department of Health is making available grants up to $2,000 for community and faith-based substance abuse prevention programs.
Possible projects include alternative recreational activities for children, after-school programs, parent training classes and peer-to-peer programs. Priority will be given to programs needing start-up funding.
A total of $25,000 will be available. Applications may be obtained by calling the department's Bureau of Substance Abuse at 410-887-3828. The application deadline is Dec. 14.
Copyright © 2001, The Baltimore Sun

Flu Is Due; So Are Lots of Shots
But vaccine availability should still go to the vulnerable first, say health officials
By Adam Marcus, HealthScoutNews Reporter
USA Today
Friday, September 28, 2001
THURSDAY, Sept. 27 (HealthScoutNews) -- With the flu virus percolating quietly in scattered states across the nation, disease officials reiterated their call for healthy Americans to allow more vulnerable people first access to the vaccine as it arrives.
The Centers for Disease Control and Prevention says it expects the nation's three flu shot makers to produce 79 million doses of vaccine this year, but the batches won't be readily available until sometime in October. Even then, only about 56 percent of doses will be shipped by the end of the month, officials say. The rest will come in November and December when virus activity typically
A new report from the CDC shows sporadic reports of both influenza A and B strains this summer, with B predominating. Confirmed cases of flu cropped up in Alaska, Michigan, Missouri, Texas and Hawaii.
Each year flu kills about 20,000 people in this country. Although the vaccine is an important line of defense against the virus, it doesn't offer a guarantee against infection.
In July, before vaccine availability was clear, disease officials had recommended that the most vulnerable people -- nursing home residents, people over 65, pregnant women and people of any age with lung or heart problems or weakened immune systems -- get vaccinated as early as September. That plan has been pushed back a few weeks.
"As soon as the vaccine becomes available, those at high risk should proceed with getting it," says Curtis Allen, a CDC spokesman. Allen says people who want to get immunized should call their doctor or local health department to find out whether the flu shots have arrived.
Under the vaccination guidelines released in July, flu shots should be made available in November for those who come into contact with high-risk people, those who are between the ages of 50 and 64, and others who'd like to reduce their risk of catching the disease. The last wave of injections are intended for everyone else, but particularly high-risk groups that missed the first two rounds.
Len Lavenda, a spokesman for vaccine maker Aventis Pasteur Inc., says the Swiftwater, Pa., firm is on schedule with its delivery plan and has already begun shipping doses of its Fluzone product to doctors and other providers. By tomorrow, he says, Aventis will have distributed 25 percent of the 44 million doses it intends to produce this year.
"The CDC recommendations start in October, but there is quite a bit of vaccine already out there," Lavenda says.
Lavenda blamed last year's delays in vaccine availability in part on the withdrawal from the market of Parkdale Pharmaceuticals, one of the then-four flu shot makers, just months before the virus season began.
"Obviously we knew that Parkdale was not coming back, so we expanded capacity by about 20 percent over last year to fill in the void left by their departure," Lavenda says.

West Nile Found in Crow in Charles
Washington Post
Friday, September 28, 2001; Page B03
A dead crow found in Waldorf has tested positive for West Nile virus, marking the first reported case in Charles County this year.
The bird was collected on Monday from the 3000 block of Out of Place and was tested at a Maryland Department of Health and Mental Hygiene laboratory on Tuesday.
Officials reported that 391 birds have tested positive for the virus out of 1,242 tested this year in Maryland. Of those, 200 came from the city of Baltimore. Infected birds have also been found in Anne Arundel, Carroll, Frederick, Harford, Howard, Montgomery, Prince George's and Baltimore counties.
West Nile virus is carried by mosquitoes and is most often found in birds bitten by infected insects. The virus is rarely a threat to humans, though the elderly and infirm are at an increased risk of becoming ill from exposure. Nationwide, there have been about two dozen cases in humans this year, with one fatality, in Atlanta last month. In Maryland, five people are believed to have been made ill by the virus this year.

Challenge to Confinement by Md. Rejected
Disabled Plaintiffs' Rights Not Violated, Judge Rules in Seven-Year-Old Case
By Susan Levine
Washington Post Staff Writer
Friday, September 28, 2001; Page B05
Seven years after a dozen developmentally delayed men and women claimed in a lawsuit that Maryland was unnecessarily confining them in state mental hospitals, a federal judge ruled yesterday that institutional care did not violate their constitutional rights or the Americans With Disabilities Act.
U.S. District Judge Catherine C. Blake said that neither the Constitution nor the sweeping ADA required the state to treat such individuals in the community -- even when medical professionals considered that setting more appropriate.
Her opinion, 84 pages of review and reasoning, reflected the many questions posed by the class action.
"It is unfortunate that decision-makers on both sides were not able to reach a mutually acceptable resolution of this case years ago," she wrote in a note at the beginning.
She said in conclusion: "The evidence spread before the court reflected contrasting perspectives on a very difficult set of circumstances. The plaintiffs' pain and frustration was genuine and understandable; the defendants' efforts to provide a stable, safe, and caring environment also were genuine and commendable, if not always successful.
"In the end," she wrote, "the plaintiffs have not shown sufficient reason for the court to order the State of Maryland to do more."
Maryland officials had maintained that they had met their legal obligations by providing care in the state psychiatric hospitals while simultaneously expanding community-based treatment for these and other groups of disabled residents.
They also contended that accommodating the plaintiffs more speedily would force a "fundamental alteration" in their program that would be unmanageably expensive. Blake agreed, judging that the state's progress was legally acceptable, given available resources.
"It is a complete victory for the state," said Maureen Dove, chief of litigation in the attorney general's office. 
The 12 named plaintiffs included nine people with brain injuries and three with developmental problems unrelated to mental retardation. They represented a small class of about five dozen people in the state institutions.
Often, they were individuals with aggressiveness, confusion, memory loss and difficult behaviors.
The judge weighed their due process rights on the basis of the food, shelter, medical care and safety they were provided. She found none of that lacking constitutionally.
Phil Fornaci, executive director of the Maryland Disability Law Center, could not hide his distress last night over the case's outcome. He said the judge had misread a fundamental aspect of the Supreme Court's 1999 Olmstead ruling, a landmark determination that the ADA prohibits the needless segregation of individuals with mental disabilities.
"At a more human level, for our folks and plaintiffs to have waited this long for a decision and then have their hopes stolen from them is very disappointing," he said.
The class action was filed in 1994 by the Maryland Disability Law Center. Testimony proceeded on a stop-start schedule for four years, with closing arguments also delayed. Since 1999, the case now styled Williams et al v. Wasserman had been in limbo awaiting the judge's ruling -- making it one of the longest-running cases on the federal docket in Baltimore.
© 2001 The Washington Post Company

Bioterrorism Vulnerability Cited
GAO Warns That Health Departments Are Ill-Equipped
By Ceci Connolly
Washington Post Staff Writer
Friday, September 28, 2001; Page A16
The federal government's plan for responding to bioterrorism is a collection of poorly coordinated, often underfunded, projects that span 11 separate Cabinet-level agencies, according to the first comprehensive report on the subject since the Sept. 11 attacks.
Further, the study by the General Accounting Office warns that state and local health departments appear equally unprepared to deal with a biological assault, despite the fact they are likely to be the first to respond.
"Bioterrorism remains a low probability, but a growing probability, coupled with a high vulnerability for our nation," said Sen. Bill Frist (R-Tenn.), who, along with Sen. Edward M. Kennedy (D-Mass.) requested the report.
In this year's budget, the Bush administration has allocated $343 million for dealing with a biological attack, $113 million of which is for the Pentagon to protect soldiers in the field. The rest, which amounts to less than $1 per U.S. civilian, goes to projects as diverse as environmental assessments, pharmaceutical stockpiles and computer upgrades.
More money is being spent by the Defense Department and other federal agencies on prevention and detection, although Frist and Kennedy argue it is nowhere near enough. They have urged President Bush to spend an additional $1 billion to immediately upgrade public laboratories, train medical personnel, pursue new vaccines and therapies and secure overseas stocks of biological weapons.
"We hope you will bear in mind the special challenges posed by biological weapons," the pair wrote Bush. "A terrorist attack using a deadly infectious agent could kill or sicken millions of Americans."
In the past, many have dismissed the threat of bioterrorism as unlikely because it can be difficult to obtain, produce and deliver the deadly agents. However, the formulas "are readily available on the Internet, and the agents are relatively easy to conceal," the report notes. "According to intelligence agencies, the possibility that terrorists may use chemical or biological materials may
increase over the next decade."
Many of the gaps identified in the report -- lack of coordination, questions over jurisdiction -- are endemic to the broader challenges surrounding counterterrorism, said Jeffrey H. Smith, former counsel to the CIA and an expert on preparedness.
"But biological weapons have unique aspects," he said. "The first unique aspect is the fact that the response is largely a public health challenge. That adds a layer of complexity that the others do not have."
Yet as the Bush administration readies for war and prepares to fend off future attacks on U.S. soil, many in the health field argue it is time to elevate the issue of bioterrorism.
"We are concerned that the grave medical and public health vulnerabilities in the nation will be missed in the very, very rapid push to shore up the nation's response to terrorism," said Thomas Inglesby, a senior fellow at the Hopkins Center for Civilian Biodefense at Johns Hopkins University.
Reading from the Defense Department's report to Congress, he said the Pentagon spent $264 billion to deter regional conflicts, $28 billion to protect against a "peer" nuclear attack and $3 billion on all other biological, chemical, cyber and nuclear assaults. Of that, he said, $250 million went to public health systems. "It would be a mistake not to change the funding patterns of the past," he said.
The GAO report, which is still in draft form, found that many of the federal bioterrorism programs are still in their infancy, with little more than start-up money.
The federal Centers for Disease Control and Prevention in Atlanta formally began a bioterrorism program in 1999, although the agency did not receive its first infusion of cash -- $9.2 million -- until this fiscal year. All told, the CDC budget includes $148 million for bioterrorism, though much of that money is spent on developing vaccines or purchasing medications for national
As of January 2001, not one of the National Guard's civil support teams, designed to deploy to a contaminated area within four hours of an attack, "had received necessary certification, and none were in use." The Pentagon received $93 million for the teams, which have a broader mandate of responding to attacks by all types of weapons of mass destruction.
Other critical agencies have been left out of the discussion or continue to spar among themselves, the GAO report indicated. The departments of Transportation and Agriculture were left out of the early planning entirely.
"The FBI and CDC each have their own list of biological agents, and these lists only partially overlap," the report notes. "For example, CDC considers smallpox to be a biological agent of concern, whereas the FBI does not include smallpox on its list of biological agents likely to be used in a terrorist attack."
And while some officials at the Department of Health and Human Services have argued with the Pentagon and the CIA over what medications should be stored in the National Pharmaceutical Stockpile, the Food and Drug Administration has not been consulted at all, "despite FDA's expertise with pharmaceuticals."
The study's authors also highlight fears that state and local agencies could not manage a biological assault.
© 2001 The Washington Post Company

Delay in Flu Shots for the Healthy Urged
Washington Post
Friday, September 28, 2001; Page A36
The government asked doctors yesterday to wait until at least November to give flu shots to healthy people because of delays in the manufacture of the vaccine.
The Centers for Disease Control and Prevention also said that this year's batch of flu vaccine appears to be well-matched to the strains of the virus circling the globe. Because flu strains are unpredictable, a different vaccine must be prepared each year.
The recommendation to limit early shots comes in the second straight year of delays by the three private companies that make the vaccine. The CDC had warned of the delay early this summer.
The agency wants vaccine supplies that arrive in September and October to be reserved for health care workers and people at high risk for flu, such as those with chronic diseases.
Healthy people should wait until November and, if possible, December, the agency said.
About 56 percent of this year's 79 million vaccine doses are expected to arrive by the end of October.
The flu kills about 20,000 people a year. Those considered most at risk are people 65 and older, and those suffering from chronic illnesses such as heart and lung diseases, asthma and diabetes.
The flu season typically peaks between January and March.
Health Coverage Level Up in 2000, Report Says
The number of people in the United States without health insurance declined in 2000 for the second year in a row, the Census Bureau estimated yesterday, and it ascribed the drop to a rise in work-based coverage.
But after the agency recorded the increase in employment-based coverage, the economy cooled and the labor market softened, so analysts say recent changes are probably already pushing many people into the ranks of the uninsured.
"Unfortunately, today's new figures show where we used to be -- not where we're headed," said Jack Faris, president of the National Federation of Independent Business, referring to the economy's recent decline.
The data, taken from the Census Bureau's annual "Current Population Survey" of 50,000 households, are a key element in ongoing policy debates, not only about how to expand benefits, but also about how best to measure the number of the uninsured.
The bureau said new questionnaire techniques used in the March 2000 and 2001 follow-ups to the 1999 and 2000 population surveys in general yielded a greater estimated level of insurance coverage than did the techniques used in previous years.
The increase in the coverage levels between 1999 and 2000, however, was independent of the change in techniques, the bureau said.
Using the old methodology, the bureau had also recorded a drop in the number and proportion of the uninsured between 1998 and 1999, the first since 1987.
The Census Bureau estimated that 38.7 million people, or 14 percent of the population, were without health insurance in 2000, down from 39.3 million people, or 14.3 percent, the previous year.
-- Compiled from reports by the Associated Press and Reuters
© 2001 The Washington Post Company

Special Report: Aftermath of Terror
Experts Say Bioterrorism Threat Is Real, Yet Likelihood Is Uncertain
By Laura Johannes and Marilyn Chase
Staff Reporters of the Wall Street Journal
Friday, September 28, 2001
The attacks on the World Trade Center and Pentagon have raised new fears in the U.S. about bioterrorism, the intentional release of harmful biological agents into populated areas. Some people worry that terrorists could unleash illness and death in epidemic proportions by dispersing smallpox, plague or other agents into the air, food or water supplies. How real is this risk, and what is being done to prevent it? Here are some basic questions and answers:
Q: How many harmful agents are there, and which are the biggest threats?
A: The U.S. Centers for Disease Control and Prevention has singled out seven biological agents (see chart0) as the most likely to be a threat. But there are dozens of potential biological weapons. There also are chemical weapons such as mustard gas and nitrogen dioxide, which damage the eyes, skin and respiratory tract and can be fatal in high doses. Sarin, a nerve toxin, killed 12 people and injured thousands more when a Japanese cult poured it in liquid form in Tokyo's subway in 1995. (see related article1)
Q: How easy is it to make bioterrorism agents, to store them and to disperse them?
A: Not very. Potential bioterror agents come mainly in three forms: viruses, such as smallpox; bacteria, such as anthrax; and natural poisons, such as botulinum toxin. For bacteria and viruses, the first hurdle is to get hold of some -- which can be quite difficult. In the case of smallpox, for example, known storehouses are held in only two research laboratories, one in the U.S. and one in the former Soviet Union. However, experts believe it is likely that a small number of rogue states or terrorists may have copies of the lethal virus.
Pathogens or toxins could be placed on a warhead, sprayed from a crop-duster airplane or snuck into the food or water supplies. But in most cases, highly specialized knowledge would be needed to pull this off. Inhaled agents, such as anthrax, for example, would have to be just the right size -- about a tenth the size of a human hair -- to infiltrate the lungs.
Adding to the difficulty is that many potential bioterror agents are unstable, and likely to lose their potency when exposed to sunlight or when immersed in water. Botulinim toxin, one of the most potent poisons known to mankind, is easy to get, since the bacteria which produce it are present in soil. Small quantities of the toxin are used widely in medicines, ranging from treatments for neurological diseases to antiwrinkle therapies. But most ordinary bacteria don't make much botulinim, so producing large quantities would require significant biochemical expertise. Moreover, the toxin is "very unstable," and easily degrades when exposed to chlorine or high temperatures, says Eric A. Johnson, professor of toxicology at the University of Wisconsin, Madison.
Aum Shinrikyo, the Japanese cult, tried at least three times in the early 1990s to disseminate biological weapons, and failed each time, says Kyle Olson, an Alexandria, Va., consultant who follows the cult's activities closely. Two of the unsuccessful attempts involved spraying botulinum toxin from trucks driven around Tokyo. Most likely, says Mr. Olson, the toxin was distributed in heavy particles that fell to the ground before they hurt anyone. The cult also released anthrax bacteria from the roof of a Tokyo building, but that attempt also failed to infect anyone. Most likely, Mr. Olson says, the bacteria hadn't been turned into "spores," a condition in which they harden to protect themselves from danger. "They probably just hit the ground and died," he says. He notes that the cult's scientists were generally engineers so they didn't have the expertise of trained biochemists.
Q: How would you know if there were an attack?
A: You probably wouldn't. You might see or hear a suspicious airplane flying overhead, but anything it dropped would be invisible. If authorities suspect an attack, they can perform genetic and biochemical tests to find out what, if anything, was released.
Q: Has there ever been a bioterror event in the U.S.?
A: Yes. The one documented bioterrorism attack involved domestic saboteurs, not foreign terrorists. In September 1984, 751 residents of The Dalles, Ore., came down with diarrhea and stomach upsets after eating at salad bars in about 10 local restaurants. After an extensive investigation, members of a religious commune called Rajneeshpuram admitted pouring salmonella bacteria, a miserable but usually nonlethal bug, on salads and in coffee creamer. They said they wanted to test the bugs as a tool for incapacitating voters on Election Day. Members of the commune were indicted, pleaded guilty and imprisoned for poisoning the food supply in violation of federal antitampering laws.
Some scholars of bioterrorism believe such a scenario -- an attack with consequences that would be awful but largely nonlethal -- is more of a near-term threat than the release of a lethal agent such as anthrax because it is technically easier to pull off. "The most likely scenario for a biological-weapons attack [would be] food-borne or beverage-borne attack using salmonella, shigella or staphylococcal toxins," says Raymond Zilinskas, a senior scientist with the Monterey Institute of International Studies in California.
Q: Should I stop drinking tap water?
A: No. Municipal water supplies are actually less vulnerable than bottled water because, in most cases, they are treated with chlorine and filtered. Dr. Zilinskas advises water bottlers and private food service companies to "be careful who you hire."
Q: What harm would an attack do?
A: That would depend on what was released, and where. Ebola, since it kills quickly, would likely harm just those immediately exposed. Smallpox, since it takes a week or two to appear after exposure, could spread rapidly through the population before it was detected. Routine smallpox vaccination ceased in the U.S. in 1972, after authorities decided the risks involved in giving the vaccine were greater than the risks of getting the disease. Since immunity is believed to wear off in a decade, most Americans would be vulnerable to smallpox, which is frequently lethal. There are only an estimated seven million to 15 million doses of smallpox vaccine available; the U.S. government has contracted for the production of 40 million additional doses.
An agent monitors a security checkpoint at Detroit Metropolitan Airport's Davey terminal this week (above). Like the airline industry, many sectors are re-evaluating how vulnerable they are to
chemical, biological and other forms of terrorist attacks.
Q: Are there antidotes?
A: There are good treatments for many biological weapons, but in some cases, they must be
administered quickly to do any good. Antibiotics, for example, can effectively treat anthrax, but only if they are administered before symptoms occur, which could be as soon as a day or two after exposure. An antidote exists for botulinum toxin, but it, too, must be administered before symptoms begin, which could be as soon as 12 hours after exposure.
Q: What are federal, state and local health authorities doing to prepare for a potential attack?
A: The U.S. Department of Health and Human Services devotes $300 million a year toward bioterrorism preparedness, of which about half goes to the CDC for detection and treatment. The CDC has a network of 81 state and local laboratories nationwide responsible for rapid detection and diagnosis of illnesses cause by bioterrorism. The agency also has a stockpile of antibiotics and medications for rapid deployment in the event of an attack. Half of this stockpile is on pallets ready to be loaded on aircraft to an affected zone. The other half exists as a "virtual stockpile," a term used to refer to extra production capacity at the drug companies which the government has arranged to draw from as needed. A CDC drug shipment was rushed to New York in seven hours after the Sept. 11 attacks, but the effort later proved unnecessary because authorities determined that no biological agents had been released.
At the city and county level, some hospitals have emergency plans, but in the cost-cutting era of managed care, many don't. Citizens can inquire at hospitals and public-health departments to see whether there are local plans or resources for emergency preparedness. More details of the U.S. plan are outlined at the Web site
Q: Does it make sense to buy a gas mask just in case?
A: Some gas masks are specially made with filters fine enough to keep out many biological agents. However, they are expensive ($100 to $200), bulky to carry and may not do much good. The reason: Once you know a bioterrorism attack has struck, it is usually too late to put on the mask. "You would pretty much need to wear them 24-7 for them to do any good," says Julie Rawlings, an epidemiologist at the Texas Department of Health. The federal government says it doesn't recommend them.
Q: Should I stock up on antibiotics at home?
A: "No," says Michael Osterholm, a bioterrorism expert and professor of public health at the University of Minnesota. "The last thing we want people to do is to start self-medicating." Most people lack the expertise to distinguish a chickenpox blister from a smallpox or anthrax blister, and as a result, they might take drugs unnecessarily. Moreover, experts say, building home stockpiles siphons medication from hospitals and clinics that need them.
It's also unnecessary, says Scott Lillibridge, special assistant for bioterrorism preparedness to Health and Human Services Secretary Tommy Thompson. "We have a strategic national stockpile tailored to respond to bioterror events, and it can be deployed to anyplace within 12 hours."

Recent Stress May Boost The Risk of Heart Attacks
By Tara Parker-Pope
Staff Reporter of the Wall Street Journal
Friday, September 28, 2001
DOCTORS WARN we may see an increase in heart attacks in the coming weeks as the stress of the New York and Washington, D.C., terrorist attacks continues to take a toll.
A surge in heart-attack rates has been well documented following natural disasters, such as earthquakes. However, researchers have little experience with a man-made disaster of the scope and scale of the terrorist attacks of Sept. 11. Earthquake aftershocks generally stop in a matter of days or weeks. In the wake of the attacks, the continuing media coverage and plans for war mean the stress triggered by the initial attacks could continue for months.
"Every time people turn on the TV it revives all the panic and fear again," says Detroit cardiologist Joseph Rogers, who saw many patients with elevated blood pressure in the days after the attacks.
The people at highest risk are those who already have high blood pressure or a history of heart troubles. However, many heart attacks occur in people with undiagnosed heart disease, so even those without known problems could be vulnerable.
STRESS HAS LONG been blamed as a culprit in heart attacks, which can be triggered by a heated argument, a car accident or chronic stress related to work or a family illness.
Stress causes the body to release chemicals, including adrenaline, which can cause surges in blood pressure and heart rate. Stress also can cause chemical changes that make the blood thicker and more likely to clot. All those changes can play a role in a heart attack, which occurs when plaque breaks loose from an artery wall, causing a sudden spasm of the artery and clotting that eventually cuts off the blood supply to the heart.
Researchers have studied heart-attack rates following several earthquakes in Japan and California. One study looked at deaths from heart attack in the 16 Japanese cities most affected by the Great Hanshin-Awaji earthquake in 1995. Not only did researchers find a significant increase in heart-attack deaths following the quake, but the pattern continued for about eight weeks after the event.
Because earthquake victims experience continued stress due to aftershocks, researchers think a
comparison between earthquakes and terrorism makes sense.
"In both cases, you're not sure if it's actually over," says Thomas G. Pickering, director of integrative and behavioral cardiology at Mount Sinai Medical Center in New York, who has
worked with Japanese researchers studying the stress effects of earthquakes.
Although the body is most vulnerable to heart attack in the morning, between 6 a.m. and noon, Japanese researchers found an unusual number of heart attacks were occurring at night. "It's normally the time when the chances of having heart attack are relatively low," says Dr. Pickering. "But people were lying awake and not sleeping."
Because the terrorist attacks happened early in the morning when blood pressure is higher and blood is more likely to clot, some researchers believe it's likely that a surge in heart attacks occurred the morning of the crashes, although that data won't be available for months.
DAVID L. BROWN, chief of cardiology at the Albert Einstein College of Medicine in the Bronx, N.Y., studied two California earthquakes: One occurred around 5 p.m., the other around 4 a.m. Only the morning quake resulted in a higher rate of heart attacks.
"The issue is the people that nothing happens to on day one," says Dr. Brown, referring to the Sept. 11 disaster. "Maybe they're not vulnerable enough to the stress to have a heart attack. I'm sure their heart rates are higher and blood pressure is higher. But how long is that going to last?"
People who know they have high blood pressure or a history of heart problems should visit their doctor. In addition to having their blood pressure checked, patients should talk to their doctors about how much stress they are feeling. A beta-blocker, which essentially counteracts the effects of stress, might be prescribed.
Exercise is a powerful antidote to stress and counteracts the chemical changes that occur in times of stress. Doctors note that President Bush, who is under a tremendous amount of stress, still takes his daily jog.
Giving blood is another option. Some research indicates regular blood donors have a lower rate of heart disease. Donating blood essentially makes the blood thinner and less likely to clot. In addition, blood donation is an active way to contribute, helping eliminate a feeling of helplessness -- one factor that triggers stress.
Finally, turning off the television, working in the garden, doing volunteer work or going to a religious service all can help reduce stress. "Just do something," says Dr. Rogers. "Doing anything other than staying home alone is beneficial."
While much is unknown about the effect all this stress is having on the nation's health, one study of the 1994 Northridge, Calif., earthquake offers some encouragement. It found that while the earthquake appeared to trigger an increase in heart-attack rates, the spike was followed by a decrease in heart-attack deaths. One theory is that the people who survived were toughened by the event and more resistant to stress in general.

Terrorist Attacks Renew Concerns About Smallpox
By Gautam Naik
Staff Reporter of the Wall Street Journal
Friday, September 28, 2001
When the World Health Organization voluntarily destroyed millions of doses of smallpox vaccines in incinerators a decade ago, it capped one of the greatest triumphs in public health: The global eradication of a lethal disease that had claimed 300 million lives in the 20th century alone. No human cases of smallpox have been reported since then.
Yet a handful of laboratories in the U.S. and Europe are once again racing to replenish stocks of smallpox vaccine. The potential threat this time isn't Mother Nature but terrorists who, if they acquire even a single vial of smallpox, could use it to launch a devastating attack on a civilian population.
The smallpox virus "is the poor man's weapon of mass destruction," says Thomas Monath, chief scientist at United Kingdom-based Acambis PLC, which is leading the charge in the creation of a new smallpox vaccine. The recent terrorist attacks in the U.S., he says, "are a wake-up call that should fundamentally change the way in which we deal with bioterrorism threats."
It is unclear whether terrorists have access to the smallpox virus, but the world is woefully unprepared for an outbreak. Only 60 million doses of smallpox vaccine exist in freezers around the world, according to the WHO. The U.S. has 10 million doses; the WHO has only 500,000. And because the world's 29 vaccine-production facilities were dismantled two decades ago, new vaccines can't quickly be made.
Massive Response
Last year, the U.S. Centers for Disease Control and Prevention in Atlanta decided the potential use of smallpox in germ warfare was real enough. After inviting tenders from around the world, it signed a 20-year contract under which Acambis would supply an initial 40 million doses of the vaccine. Another company that competed for the tender, Bavarian Nordic AS of Denmark, is
trying a slightly different approach and hopes to have one million doses of its vaccine available within 12 months. And BioReliance Corp. of Rockville, Md., has agreed to supply a vaccine to the U.S. army.
Protecting people against smallpox is easy enough, provided vaccines are available. When a tiny amount of vaccinia virus, known also as cowpox, a cousin of smallpox, is injected into a person's arm, it triggers a massive antibody response and typically creates a 10-year immunity against smallpox. The telltale sign is a permanent scar or "pock" where the injection was given.
For years, viruses used for vaccines were obtained by scraping the belly of an infected calf. But it was a time-consuming and expensive method. Acambia hopes to speed up that process by using a more modern technique that hasn't been tried previously in the making of smallpox vaccines.
At the company's main laboratory in Cambridge, Mass., scientists have grown vaccinia viruses in a culture of human cells. Vaccinations in mice and rabbits have shown a good immune response, according to Acambis, but it doesn't guarantee they will work in people. Human trials are expected to start in the first quarter of next year. If these prove successful, the vaccine will become available in 2004, the company says.
Researchers at Bavarian Nordic never intended to work on a smallpox vaccine. Their main goal was, and remains, a vaccine for human immune deficiency virus, which causes AIDS. Several years ago they were experimenting with a modified vaccinia virus; like others, it could multiply quickly while triggering a massive immune response -- key attributes for fighting HIV. But after the CDC asked Acambis to make a new smallpox vaccine, Bavarian Nordic decided to join the
The Copenhagen-based company is producing its vaccine in chicken embryos. It is about to complete a clinical study of 90 volunteers in Germany, and it plans a larger trial in the U.S. next year. "We believe this is a very efficient vaccine," says Peter Wulff, the company's chief executive.
Dark Winter
Neither Acambis nor Bavarian Nordic will comment on whether they have been asked in the past three weeks by the U.S. to speed up their research efforts, given the greater perceived threat of terrorism. But plenty of people are worried. Since the U.S. attacks, at least five countries have asked the WHO for advice on how to handle a bioterrorist attack, including the use of smallpox. Health officials worry that because smallpox is a largely forgotten affliction, most doctors won't
recognize it quickly.
Samples of the smallpox virus officially exist only in two highly protected locations: a U.S. laboratory in Marietta, Georgia, and a Russian laboratory in Siberia. But U.S. government officials are worried that some of the Russian supplies may have fallen into the hands of rogue nations. Others question whether all countries voluntarily destroyed laboratory samples of the smallpox virus once the disease was eradicated.
Smallpox is deemed to be an ideal bioweapon because it is highly contagious. The virus spreads through the air when an infected person talks or coughs, and even a small sprinkling in a busy place, a subway or an airport, would travel quickly. In June, a U.S. simulation called Dark Winter suggested that a smallpox outbreak starting in Oklahoma City would spread to 25 states and 15 other countries in two weeks.
This week, the threat of terrorists trying to commandeer crop-dusting planes to spread poison has only increased fears. The WHO issued a bioterrorism warning on Tuesday. And Britons and New Yorkers have bought up virtually every gas mask available in stores.
Says Dr. David Heymann, executive director of communicable diseases programs at the WHO: "Eradicating smallpox was a great achievement. It's sad to see that because of events people are concerned and we may have to vaccinate again."

Novartis Says FDA Approves Foradil For the Treatment of Smoker's Cough
Wall Street Journal
Thursday, September 27, 2001
ZURICH -- Novartis AG said Thursday that the U.S. Food and Drug Administration has approved its asthma drug Foradil for the treatment of chronic obstructive pulmonary disease, or smoker's cough.
The FDA approved the drug in February for the treatment of asthma and the prevention of exercise-induced bronchospasm. Banking firm Julius Baer Group forecast that sales of the drug -- including sales from the treatment of smoker's cough -- will reach 600 million Swiss francs ($375.7 million) in 2004.
Also Thursday, Novartis reported that use of Foradil showed improvement in lung function when treating chronic obstructive pulmonary disease, compared with Atrovent, an inhalation solution of Germany's Boehringer Ingelheim GmbH.
The Swiss pharmaceutical company said that in the first head-to-head study between the two drugs, both Foradil and Atrovent were better than a placebo in increasing lung function. However, Foradil was "significantly better" than Atrovent at opening the airways as early as five minutes after dosage, and Foradil's effects were still evident up to 12 hours later, Novartis said.
The company's placebo-controlled study included 780 patients with chronic obstructive pulmonary disease. The company also conducted two other trials which included 1,634 patients with chronic obstructive pulmonary disease.
Side effects of Foradil include increased heart rate, nervousness, tremor, muscle cramps, nausea and sleeplessness.
In August Novartis received FDA approval to sell Zometa, its new drug for hypercalcemia, a complication of cancer. In June the agency rejected Novartis' application to sell Zelnorm, a drug for irritable bowel syndrome, and delayed by at least two years sales of Xolair, an asthma drug. Both Zelnorm and Xolair were expected to be blockbusters.
Novartis was formed in 1996 through the merger of Sandoz and Ciba-Geigy and ranks among the world's top six pharmaceutical companies, measured by revenue.

Attack expert puts stress on preparedness
Margie Hyslop and Arlo Wagner
Washington Times
Friday, September 28, 2001
In an attack using chemical, biological or radioactive weapons, the difference between life and death could depend on what people have on hand and whether they know what to look for, what to use and what to do, an expert told rescue workers in Rockville yesterday.
"There may not be much time to respond, but outcomes improve if people know what to look for, what to use and what to do," said Eric R. Taylor, a former nuclear, biological and chemical weapons officer in the Army.
Mr. Taylor, an associate professor of chemistry and biochemistry at the University of Louisiana at Lafayette, was one of 20 speakers at the second annual Decontamination/Weapons of Mass Destruction Symposium at the University of Maryland, Shady Grove Center. The three-day North American conference ends tomorrow.
What is clear is that the unanticipated attacks on civilians and military personnel in the United States have emergency managers rethinking their plans — and regular folks wondering how they would be warned in a terrorist attack, which could involve explosive, chemical or biological weapons.
"It really is dependent on the situation," said John Scholz, a firefighter and emergency-preparedness spokesman for Anne Arundel County, Md.
"With any disaster, the question is, How much time do we have?" said Reginald Parks, director of Prince George's County's Office of Emergency Preparedness.
Mr. Taylor said the Federal Emergency Management Agency could help by publishing easy guides to general symptoms of agents that might be used as weapons.
People are better prepared for an attack if they have reviewed procedures for evacuating and "sheltering in place" and have a disaster supply kit on hand.
The kit should include portable, battery-operated radios and flashlights, extra batteries, a first-aid kit and manual, any medications needed, a three-day supply of nonperishable food and water (one gallon per person, per day), a can opener, utility knife, utensils, hygiene items, toilet paper, towelettes, and baby and pet food and supplies (including carriers).
Although few people have the sophisticated garments and decontamination agents used by police, fire and rescue workers, they often can improvise with what's on hand.
"Anything that will offer a barrier between you and the agent is better than nothing," Mr. Taylor said.
A handkerchief or washcloth folded into layers can be used as a makeshift filter for breathing. Activated-charcoal masks available at hardware stores also provide protection. And while closing one's eyes can help, inexpensive swimming goggles are better.
Wearing rubberized boots, overalls, gloves, raincoats, waders and shower caps can limit exposure to some caustic chemicals and contaminants, he said.
Small doses of contaminants that adults could survive can be lethal to children, small adults and pets, so they need immediate and extra protection.
Mr. Taylor said if contaminants are released in the air, windows, doors and vents should be closed and indoor cooling systems should be turned off. If air inside a building is warmer than air outside it, contaminated outdoor air will push inside, he explained.
Although assaults might come in the form of a spray or a gas, persistent agents — including lethal chemicals — settle in low-lying areas.
That means people may be safer staying put or moving to a higher spot, rather than evacuating a building. It also means that playgrounds, sandboxes, basements and ductwork would need to be decontaminated.
Some household cleaners — including chlorine laundry bleach and a pool cleaner known as HTH — are weak versions of decontaminates the military uses, and they can help, Mr. Taylor said.
"Oxy-Clean" has been shown to destroy many pathogenic bacteria, he said. Also useful against some contaminants are hydrogen peroxide, some drain and oven cleaners, detergents, vinegar and vegetable oil.
Copyright © 2001 News World Communications, Inc. All rights reserved.