It takes teamwork and 21st century technology to take on an Old World foe.
That's the lesson state officials learned two years ago when a simulated release of the pneumonic plague tested the network in place to protect Illinois against real acts of bioterrorism.
Known as TOPOFF 2 — indicating participation of top officials from two states, 19 federal agencies and the Canadian government — the drill was designed to show how leaders would respond to an attack involving biological weapons of mass destruction.
Last month, New Jersey and Connecticut were grappling with TOPOFF 3, the most recent mock biological terrorism trial. It appeared they too were battling an intentional release of imaginary plague.
In Illinois, the May 2003 five-day exercise began with the simulated aerosol release of the plague at three Chicago locations: O'Hare International Airport, Union Station and the United Center, where, according to the script, the Blackhawks were playing an imaginary NHL playoff game.
All three targets could draw thousands of people from throughout Illinois and some from across the globe. But as the drill simulated, most of those infected would soon flood Chicago-area hospitals showing signs of a highly contagious airborne disease, one that can kill if antibiotics aren't administered within 24 hours and one that could be mistaken for a more common case of pneumonia.
Indeed, as the infection spread rapidly, the simulation showed the potential strain such an attack could place on area hospitals, as well as morgues. Moreover, the drill, which also simulated a terrorist-led "dirty bomb" attack in Seattle, tested the mettle of government officials who would have to find the root of the problem, keep the public from panicking and coordinate the response of nurses, doctors, police and fire officials, some of whom would be working around the clock amid potential chaos.
This premeditated bedlam gave the state a rare opportunity to test its emergency response infrastructure against a biological terrorist attack of unprecedented proportions. And while most would argue no state is entirely prepared for acts of bioterrorism, the federal exercise helped Illinois implement several security upgrades, some of which have garnered national recognition.
"We were lucky, as a state, to be able to participate in TOPOFF 2," says Dr. Eric Whitaker, director of the Illinois Department of Public Health. He says the drill helped the state test its "surge capacity," or its ability to quickly respond to such emergencies as an act of bioterrorism, and then sustain coordinated cooperation among a multitude of federal, state and local agencies.
"When you have a mass casualty episode or incident, you need an influx of staff to help deal with it, but then the question becomes how do you contain and maintain a high level of service over a long period of time," Whitaker says. "We have worked together with sister agencies, local health departments and hospitals to think about how to do that."
By at least one indicator, that work has begun to pay off. In October 2003, five months after TOPOFF 2, Gov. Rod Blagojevich announced that Illinois was the first state to receive the federal government's highest rating for its ability to respond to acts of bioterrorism. Earning "green" status from the U.S. Department of Homeland Security and the U.S. Centers for Disease Control and Prevention means that, in the event of an emergency, Illinois is adequately prepared to distribute vaccines, antidotes and other medical supplies from the Strategic National Stockpile.
Illinois is one of only six states to receive the adequate rating, according to a December 2004 report from Trust for America's Health, a nonprofit nonpartisan national advocacy group based in Washington, D.C.
The analysis, Ready or Not? Protecting the Public's Health in the Age of Bioterrorism, examined 10 key factors. Illinois drew positive marks in half of those categories. In addition to being prepared to dispense the emergency medical supplies, Illinois drew praise in the report for maintaining its public health spending despite tough budget times and for electronically monitoring disease outbreaks. It lost points for having insufficient laboratory capacity and too few scientists to respond to acts of bioterrorism, including a suspected outbreak of biological agents such as anthrax or the plague.
"Illinois is kind of right in the middle of the pack," says Michael Earls, spokesman for Trust for America's Health and co-author of the report. "Overall, the state mirrored what we found in a lot of the nation on the whole, which is, while progress has been made, certainly it has been incremental progress and only in some directions."
In the past, a sound public health system was one capable of confronting a problem once it has been identified. But in the age of bioterrorism, the network also must be judged by its abilities to detect potential disasters and minimize them before they begin to wreak havoc.
"There's two different paradigms that need to be thought through," says Dr. Michael Allswede, director of the Strategic Medical Intelligence initiative at the University of Pittsburgh Center for Biosecurity. "Emergency management people look at only one paradigm, which is, an event occurs and causes smoke and fire."
Under former U.S. Attorney General Janet Reno, Allswede served on an advisory board for the precursor to what is now the Department of Homeland Security. More recently, he participated in TOPOFF 2, serving as a medical evaluator for the Chicago-area response to the drill.
Allswede says the exercise reinforced the notion that government agencies can be fairly adept at sharing information, but typically the sharing doesn't start until after a disaster has been confirmed, which can be a fairly easy task in the case of a tornado. It can be a much more difficult undertaking to diagnose and confirm an outbreak of the plague.
"The problem is that if you have an illness that occurs in a population, that may also be a public health emergency. That may also be a criminal act. That may also be an incident of national security. We're just not very good at making those transitions and sharing information quickly."
Mike Chamness chairs the Illinois Terrorism Task Force and, under former Gov. George Ryan, he also directed the Illinois Emergency Management Agency. The task force is responsible for formulating policy, while emergency management handles response. Chamness says the state's disaster response strategy stresses communication among agencies.
Illinois has been recognized for innovation. Last fall, the state won an award from Harvard University's John F. Kennedy School of Government for creating a trio of Weapons of Mass Destruction Teams. The teams enlist staff from half a dozen state agencies, including police, environmental protection and public health. The state also can deploy dozens of trained hazardous materials teams across Illinois.
The state has worked to strengthen the bonds between county and municipal forces. In 1968, the state deployed a mutual assistance alarm network for fighting fires. And today roughly two-thirds of the state's fire departments are signed up to assist neighboring communities. For instance, when the LaSalle Bank fire in Chicago's Loop raged for more than five hours last December, outside firefighters were called in to help extinguish three other blazes within city limits.
TOPOFF 2 revealed the need for a similar network of police departments. With its own officers occupied by the drill, Chicago needed hundreds of reinforcements to assist in patrolling city streets. The state was charged with mustering those support troops from neighboring police forces. Now, a newly created law enforcement assistance network links every county sheriff's department in Illinois and some 600 local jurisdictions.
While state and federal officials would coordinate the response to an act of bioterrorism, TOPOFF 2 showed the critical support role required of local units. The state Department of Public Health realized this as well and sped up efforts to create a mutual assistance network of county and municipal health departments. All but two of the state's 95 local health agencies have signed onto the statewide pact. Illinois also has volunteer emergency response teams composed of medical professionals.
While the state has worked to bolster its response capabilities, it also has tried to tackle the much more difficult task of preventing acts of bioterrorism. "The lesson we learned from TOPOFF is that we have to improve our proactivity and not only be responsive," says Whitaker, the Illinois public health director. The state has installed multiple environmental sensors to search the air for deadly pathogens such as anthrax. But, Whitaker says, because of security reasons he cannot reveal how many of the devices are in place, nor would he say what types of facilities they monitor.
Allswede, the biosecurity expert, says without a defined front such technology only goes so far. "The medical system and public health system has a grand challenge to become more self-aware," he says. "And I think it is more important to develop that aspect than it is to put monitors around or detectors around because detectors work pretty well if you have a perimeter to defend, but not very well if you have the cluster of targets — bars, restaurants, homes, schools, dormitories, auditoriums, stadiums — that comprise American society. We don't have enough detectors to create a network."
To that end, Illinois has installed an electronic method of disease reporting. Fully implemented earlier this year, the system allows doctors and hospitals to rapidly report cases of infectious disease. The state public health department can step in if it notices an uptick in any particular ailment. This could serve as an early warning for bioterrorism because the early signs of biological agents such as anthrax can mirror symptoms of more common infections.
Public health isn't the only state agency that sought to improve detection methods. "After Blagojevich took office in 2003, he wanted us to invest more heavily on the prevention side. And, frankly, it was the right time to do that because you get to a certain point in building up response capacity that it's actually overkill," says Chamness, the terrorism task force director.
Under Blagojevich, Illinois also has established a Statewide Terrorist Intelligence Center, a covert, around-the-clock operation where, Chamness says, staff "spends all day doing analysis of terrorism-related information, all the way down to local traffic stops."
And the state has used $2.4 million in federal homeland security dollars to purchase two portable devices that use low-level gamma rays to peer into semitrailers and shipping containers. The equipment has helped haul in $2 million in drugs and other contraband, which Chamness says illustrates how most anti-terrorism infrastructure is a dual-purpose tool. What can help the state respond to a dirty bomb could also prove valuable in natural disaster responses. For example, the state is in the process of equipping every county and several other key dispatch sites with a satellite communications system that allows them to receive messages from the state, even when phone lines are jammed and cellular connections are down. The satellite system was tested on a smaller scale during TOPOFF 2.
Such advances should certainly help, but not without teamwork, which is why it seems appropriate for Allswede to employ a technology metaphor to describe the current level of biosecurity and the challenges ahead.
"The state of preparedness, to me, is a lot like software development in the 1970s. There are lots of companies, lots of different philosophies, lots of different products out there. Nothing necessarily integrates very well with anything else, which is kind of the stage of development we're in," Allswede says. "Our grand challenge is trying to create integration. The problem is, we as a nation have created a system of government that has lots of checks and balances and lots of different levels and lots of shared, plural authority, so that there isn't really one major place or one major authority that will make a single decision and change the world. And that's to our benefit."
Illinois Issues, May 2005
