RG Griffing SAL
2,200 and 2,300 people were inoculated in a 4 hour time
Sat Dec 7 01:49:55 2002
208.152.73.14

Pale Horse Revisited
University Health Systems Tested Small pox Readiness Tuesday; Close to 2,300 Health Workers Inoculated In The Exercise; Some Questions Arise
RG Griffing, SAL Commentary
Copyright 2002 San Antonio Lightning

RG Griffing SAL Editor/Publisher

In a test of medical readiness, University Health Systems held a mock bio-terror drill Tuesday, in which between 2,200 and 2,300 people were inoculated in a 4 hour time period. An exact number has not been tallied, as of this writing.

By all accounts things went smoothly, as health employees lined up for flu shots in 20 locations around the City. Though influenza inoculations are not as intricate a procedure as smallpox vaccinations, each shot was administered in a time mockup of what health officials say would be required.

Leni Kirkman, spokesperson for UHS, said the drill was helpful, but that some questions remain about how quickly smallpox vaccine could be delivered to San Antonio if an outbreak ocurred. No local stockpiles exist, and the vaccine would have to be shipped here in an emergency.

Kirkman says the dynamics could be much different in a mass crisis vaccination effort, but that Tuesday's action helped health workers get ready for such an event.

The drill came one week after a copyrighted series in the Lightning criticized the recent Operation Pale Horse. The exercise took place in late August. It was a Homeland Security program designed to evaluate the "handling of a bio-war or nuclear attack."

Sources tell the Lightning that the exercise went poorly. (See Stories Below)

Kirkman was at Pale Horse, and readily admits problems surfaced, but says the value of Pale Horse was learning what those problems are.

* * *

Whether Pale Horse is viewed as a disaster, as some sources have told the Lightning, or a success, as Army officials claim in published reports, depends on your interpretation of the word success.

If success means that the operation succeded in pinpointing severe flaws in the current plans for reacting to a smallpox outbreak, then Pale Horse was indeed a huge success.

Just as the sinking of the Titanic succeeded in improving maritime safety, so Pale Horse showed flaws in a system that must be improved.

Quickly.

Indeed, the results of the operation so alarmed members of the Bexar County Medical Society's Public Health and Patient Advocacy Committee, many of whom attended Pale Horse, that they authored and sent out a memo questioning region wide contingency planning. The memo was leaked to the Lightning early last week. It was dated October 14, 2002.

'As a committee we believe the presently proposed regional smallpox vaccination plan cannot work. The committee recommends instead that a community-wide smallpox vaccination plan begin immediately starting with first responders and healthcare workers.'-Bexar County Medical Society/Public Health and Patient Advocacy Committee

In an interview Tuesday, San Antonio Physician Joe Thornton, a member of the committee and an observer at Pale Horse, acknowledged that a lot of things didn't go as planned.

"We have a long, long way to go," Thornton told the Lightning.

* * *

10-21-2002

'And Behold A Pale Horse'
Secret Memo Shows Texas A Sitting Duck For Bioterror; Urges Mass Smallpox Vaccination NOW!
RG Griffing, SAL Commentary Series
Copyright 2002 San Antonio Lightning

Part One

A secret memo from a Bexar County Medical Society committee, dated 10-14-02, and obtained by the Lightning, warns that present public health response to a smallpox attack in South Texas "cannot work," and further urges mass vaccinations "immediately."

To Wit:

'As a committee we believe the presently proposed regional smallpox vaccination plan cannot work. The committee recommends instead that a community-wide smallpox vaccination plan begin immediately starting with first responders and healthcare workers. '-Bexar County Medical Society/Public Health and Patient Advocacy Committee

* * *

And I Looked, And Behold A Pale Horse: And His Name That Sat On Him Was Death - Revelation 6:8

* * *

Well placed sources tell the Lightning that the memo comes in the wake of a failed military/civilian sponsored "reaction exercise" called "Pale Horse."

The exercise took place in late August. It was a Homeland Security program designed to evaluate the "handling of a bio-war or nuclear attack."

It was, sources tell the Lightning, a fiasco.

"Imagine 12 monkeys trying to copulate with a football," one observer put it.

* * *

The operation was named by way of biblical reference, from the King Jame's Bible. Revelation, by John.

6:8 And I looked, and behold a pale horse: and his name that sat on him was Death, and Hell followed with him. And power was given unto them over the fourth part of the earth, to kill with sword, and with hunger, and with death, and with the beasts of the earth.

* * *

Over the coming week we'll tell you why a smallpox attack on the US would most probably devastate North America, and could easily begin in Texas; and how our present programs would not only NOT work, but would actually facilitate the grisly proceedings.

* * *

Part Two
Don't Panic!

First, some basic information about the disease in question. This information comes by way of Methodist Health Care System.

* * *

Smallpox is a highly contagious viral disease caused by the variola virus. Smallpox was common prior to and during the nineteenth century, but in 1977 the disease was eliminated from the world. In 1980, the World Health Organization (WHO) declared smallpox extinct and recommended that all countries cease vaccination. However, the virus is still maintained at laboratories at the Centers for Disease Control and Prevention (CDC) in the US and at the Institute of Virus Preparations in Moscow, Russia.

The incubation period for smallpox is between seven and 17 days following exposure, with the average being 12 days. The following are the most common symptoms of smallpox. However, each individual may experience symptoms differently. Symptoms may include:

*

sudden onset of:
*

high fever
*

fatigue
*

head and back aches

A distinct rash that presents with the following characteristics, most often, two to three days after initial symptoms:

*

a rash starts with flat, red lesions, usually on the face, arms, and legs
*

lesions become pus-filled and start to crust over early in the second week
*

scabs form which then separate and fall off after three to four weeks
*

the person is contagious from the point when the rash develops until the rash goes away (three to four weeks)

The symptoms of smallpox may resemble other medical conditions or problems. Always consult a physician for a diagnosis.

Smallpox can be spread from person to person through infected saliva droplets when the person is coughing or sneezing. Smallpox is also transmitted by direct contact with the lesions. A person is most infectious (contagious) during the first week of the illness when a rash has appeared. Risk of transmission remains until scabs have fallen off.

Specific treatment for smallpox will be determined by your physician based on:

*

your age, overall health, and medical history
*

extent of the condition
*

your tolerance for specific medications, procedures, or therapies
*

expectations for the course of the condition
*

your opinion or preference

Most patients with smallpox recover. However, about 30 percent of smallpox cases are fatal. The smallpox vaccine, even when given four days after exposure, can lessen or even prevent illness. If a person does become ill, treatment may include supportive therapy such as intravenous fluids, fever and pain control, and antibiotics for secondary bacterial infections. Research is ongoing to evaluate new antiviral agents as treatment for smallpox.- (Reprinted from Methodist Health Care System)

* * *

That's the disease. Here is how we plan to react to it.

The present plan will begin with the advance vaccination of "first responders." That will include EMS, emergency management, police and fire personell.

It will NOT include physicians or hospital workers. No other vaccinations will take place until a confirmed case is identified. Due to the insidious nature of smallpox, that could mean a week or more after an attack. Only then will vaccinations for the public begin.

The "Pale Horse" exercise of this past August called for the simulated vaccination of first responders only. One source familiar with the exercise said this phase "failed miserably." A full two and 1/2 days into the program the task was not completed.

That source also points out that any vision of an orderly public in a crisis situation is absurd on its face.

"People will be climbing over each other to get to the vaccine, breaking down doors. Remember, 3 out of 10 who get the disease will die. Period," he told the Lightning.

The current plan of "all at once" vaccinations would also disrupt the blood supply. Recipients of live virus vaccines are barred from donating for 28 days or more. Thus, the blood supply would be impacted, even as the terror attacks took place.

Since the vaccination uses live virus (cowpox), and the vaccinated area is left open rather than covered, the chance of incidental contact and transmission of the virus (contact vaccinia) would be high in the rush to vaccinate a large populace.

Remember, babies under 12-months-old can not receive the vaccine. It could prove fatal, even by casual contact from the mother.

* * *

The plan we outline here is for "Region 8" and encompasses San Antonio and much of South Texas; some 14-20 million people. But it is not a unique plan. In fact, it is identical to the contingency planning for the entire US.

When and if the time does come to vaccinate the general public, even under orderly conditions, it will not be the lickety-split "gun" innoculations many envision. The procedure takes between 5-10 minutes. The vaccination consists of pricking the skin 12-14 times.

Due to health risks, a medical history would have to be explored.

* * *

Not taken into account is a multi-site smallpox attack, or genetically altered "weaponized" viruses.

Not taken into account is the inability of many physicians to recognize a disease that they have never seen before, and which mimics the common flu.

Not taken into account is the fact that the vaccine is not even here, but would have to be shipped. Even then, no one is really sure if it will work, though many in the medical community feel confident that it would.

But would it get here in time?

* * *

You may be wondering why this column, so far, does not include quotes from representatives of the Bexar County Medical Society. That is because, in two days of trying, we have been unable to locate persons who will address the topic. We will keep trying.

* * *

Meanwhile, the daily headlines tell us of renewed Al Qaeda activity. Ten's of thousands of illegals enter our country each week, unchallenged. A likely war with Iraq is nearing. All across the nation, units of the National Guard and Reserves are quietly being tapped for duty.

Is a bio-attack on San Antonio unlikely? Let's pray to God that such is the case. But in a city which hosts many military bases and a large urban population in close proximity to the southern border, one must think about the unthinkable.

And if such horror should be visited upon us, we simply are not ready. That is fact.

To quote from the memo with which we began, "the presently proposed regional smallpox vaccination plan cannot work."

* * *

So what do we do?

Is the situation hopeless?

Far from it.

* * *

Part Three
The Answer

Many experts agree that smallpox is potentially the most devastating form of terrorism, short of nuclear attack.

Routine smallpox vaccination ended in the early 1970s, because a global campaign had mostly eradicated the disease in the wild.

The virus did survive in labs in the US and former Soviet Union. After the USSR collapsed, reports surfaced suggesting that the Soviets had produced smallpox in great quantities for bio-war. Some feared where the smallpox samples may have gone following the demise of the Soviets.

In October, last year, the government ordered a new stockpile of smallpox vaccine, with the first 40 million doses scheduled for delivery by 2004, to augment the small, aging stockpile already on hand. That came in the wake of the anthrax attacks which marked the first biological strike on US targets.

Today's America , according to DC based Sabine Vaccine Institute, would see 90 percent of the population at high risk, and as previously stated in this series, 3 out of 10 who get the disease will die.

* * *

So why does the government resist mass vaccination?

There appear to be some good reasons. The smallpox vaccine is not completely safe. Experts at Johns Hopkins have estimated that during previous vaccination programs, about one in 300,000 people died, or suffered brain damage. Given that rate, if all 280 million Americans were to be vaccinated, nearly a thousand people could be expected to die or suffer severe health problems.

* * *

The obvious answer is to make vaccinations voluntary but available to the general public. By doing this in advance, rather than waiting for a national crisis, we would allow for a number of advantages.

As with other medical procedures, this would give people the opportunity to fully explore with their physician whether vaccination poses a personal risk. Also, it would afford time for counseling and educating the patients, which are vital steps in live virus vaccinations.

It would also help safeguard the nation's blood supply, which would be severely disrupted during a rapid, crisis-driven vaccination program.

Should only a minority of the public chose vaccination, those people's immunity would protect them in the event of an attack. It would also slow the virulent spread of this terrifying disease, in a situation where time is of the ultimate essence.

By doing so, terrorists would be deprived of an important weapon, or at least see its effectiveness greatly diminished.

* * *

Prevention is the answer we should seek.

We can no longer wait to react to such a crisis. Reaction is simply a new synonym for failure in a post 9/11 World.

At least with action, we have some control over a situation. Otherwise, the situation will tend to control us.

And in these dangerous times, we cannot afford the luxury of inaction.

We end this series with the complete text of the confidential memo with which we began.

Though none connected with this memo have chosen to speak with the Lightning, we believe the words themselves may suffice as a warning.

* * *

PUBLIC HEALTH AND PATIENT ADVOCACY COMMITTEE OF THE BEXAR COUNTY MEDICAL SOCIETY

STATEMENT ON REGIONAL SMALLPOX VACCINATION PLAN

October 14, 2002

As a committee we believe the presently proposed regional smallpox vaccination plan cannot work. The committee recommends instead that a community-wide smallpox vaccination plan begin immediately starting with first responders and healthcare workers. The community would be offered vaccine in a progressive staged manner that would maintain an adequate blood supply* for the community, allow time to counsel persons at risk for serious complications from vaccination, provide public as well as healthcare worker education, and lessen concerns about vaccine distribution in a timely manner to a large population.

The information gained about at risk individuals will begin a registry that could guide decision-making concerning vaccine administration in the event the population is exposed to smallpox, and provide valuable information for later study.

The providing of vaccine to the majority of the community would rid the terrorists of one of the most lethal weapons at their disposal. This would give the population some control and reduce the th

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