Molly J. Hall, Ann E. Norwood, Robert J. Ursano, Carol S. Fullerton

Disclosures

Biosecur Bioterror. 2003;1(2) 

In This Article

CBRNE Weapons and Fear

CBRNE weapons are especially effective at causing terror.[3] As is the case with radiation, biological agents are invisible, odorless, and imperceptible to humans. Their effects are not immediate but delayed and often protracted. Dormant biological agents such as anthrax spores can persist undetected for years in the environment. Ongoing risk of exposure or contracting the illness is difficult to assess, which heightens a sense of vulnerability, loss of control, and anxiety. Biological agents such as smallpox that cause disfigurement and deformity amplify horror. The potential for person-to-person transmission of contagious illnesses is even more terrifying.

In the face of these fears, government and health officials must be prepared with a crisis response mentality at the start.[4] Rumors and misinformation quickly establish public mistrust and, coupled with a response that is perceived to be slow or ineffective or one that appears to protect some but not others, may lead to desperate measures by desperate people. The risk of panic is heightened when people believe that there is a small chance of escape, that they are likely to become infected, and that there are limited resources available on a first come, first served basis.[3] A range of negative outcomes are possible including a vulnerable population's refusal to accept preventative measures or treatment regimens such as isolation and quarantine; inappropriate, ineffective, or dangerous use of prophylaxis; social disruption; and civil violence. Beyond the immediate human health toll, there is the damage inflicted by ethnic stereotyping, stigmatization, and finally staggering business and economic losses.

By the last week of April 2003, citizens began to flee Beijing, China, a city with a population of 14 million and just under 700 confirmed cases of SARS, ignoring official appeals for people to avoid travel. People surged into grocery stores, emptying shelves, in spite of the government's televised reassurances that stocks were not threatened.[5] A gowned and masked man was photographed escaping from a window of the Taipei Municipal Hospital in Taiwan after the facility had been closed.[6] A riot broke out in the rural community of Chagugang, China, when the townspeople responded to false news that a school, recently closed with no explanation, was to become a hospital for patients ill with SARS.[7]

In the event of a bioterrorist attack, the public must rely on media and opinion from medical and scientific experts who may disagree and increase public fear and anger. Most biological weapons produce diseases that are rarely seen in American medical practice. Physicians have limited experience with diagnosis, treatment, and outcome. Availability of medical treatment may be limited; there is uncertainty about efficacy and there are concerns that some vaccines may be ineffective or dangerous. As was seen during the anthrax attacks, the infectivity of the spores differed from what was expected, spread and aerosolization was underestimated, and the pulmonary form of the illness responded to treatment in some cases. The majority of postal workers offered the anthrax vaccine declined, electing continued treatment with antibiotics instead.

Biological agents, like radiation, are viewed as dreaded, catastrophic, and likely to be fatal. As the threat is continuous and unpredictable, the fear becomes more pervasive, and ordinary life more constricted. The recent sniper attacks in Washington, DC, in the fall of 2002, occurred in a city that had endured a series of terrorist events, including the anthrax mailings. The sniper attacks embodied all of the characteristics of situations we fear most and evaluate as highest risk.[8] No one was safe and there was no pattern that would have allowed people to reasonably change behavior to decrease risk. Victims included adults and children, both genders, and multiple racial and ethnic groups. The sniper attacks generated more fear and distress, caused more behavioral change, and had more severe social and economic consequences than the anthrax attacks.[9,10] Fifty percent of those surveyed about the sniper were very worried or somewhat worried about becoming a victim while 33% surveyed about anthrax in the Washington, DC, area were very or somewhat worried that they would contract anthrax. In response to threat, people change their behavior and develop routines that they believe minimize risk. Forty-four percent of people threatened by the sniper significantly altered or eliminated outdoor activities, while 34% of people questioned in the wake of the anthrax mailings were taking some precautions opening the mail.

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