"My talk is basically the same, but since the terrorist attacks and deaths resulting from anthrax this fall, I am more in demand by groups that respond to disasters such as Disaster Psychiatry Outreach in New York City," Diamond told Psychiatric News.
He believes that all physicians including psychiatrists should be informed about biological and chemical agents if they are going to help the public cope with a possible bioterrorist attack. Biological agents include bacteria, such as anthrax and the bubonic plague; viruses, such as smallpox; and toxins. Chemical agents include nerve gases and hallucinogens, said Diamond.
Unlike conventional warfare, which is visible to its enemies, biological or chemical agents can be dispersed invisibly into the air through public ventilation systems or infected people, said Diamond, who is also a clinical professor of psychiatry at George Washington University School of Medicine.
"Physicians would be the first ones to respond to a bioterrorist attack because people would turn to them to treat their symptoms," said Diamond.
If tests confirmed that patients had anthrax or a highly contagious disease such as smallpox or the plague, physicians would notify local public health officials, said Diamond.
He predicted that once the media picked up the story and published it, potentially thousands of people would seek tests for possible exposure and treatment, if available.
When a nerve gas called Sarin was released into the crowded Tokyo subway system in 1995 by a religious cult, 5,510 people sought medical treatment. Of that number, 12 died, 17 were critically injured, 1,370 suffered mild injuries, and 4,000 had no injuries, said Diamond.
He anticipates that if a similar attack occurred in the United States, the health care system would be overwhelmed. "The recent anthrax threats showed how primary care physicians were so busy dispensing antibiotics they did not have time to explain confusing terminology surrounding the tests and exposure to anthrax. This underscores the need for psychiatrists to have factual information to reduce people’s confusion and anxiety," said Diamond.
He said he received calls from patients who were confused about why they were told to take antibiotics when their tests came back negative. "I explained that the nasal swab test was designed to show only whether anthrax spores were in their nose. A positive test did not mean they definitely had the disease although they were at higher risk of infection. Likewise, a negative test did not mean they had no risk of contracting the disease. Because inhalation anthrax can be fatal, people at risk of exposure were given antibiotics as a precautionary measure until further tests showed they were not at risk," said Diamond.
People also may be anxious about the threat of future biological or chemical attacks or attribute recent physical symptoms to the disease after they heard about cases of contamination, said Diamond. He referred to this phenomenon as "mass psychogenic illness."
Although anthrax has been used recently as a biological weapon, Diamond recommended that psychiatrists learn about the symptoms and manifestations of other biological and chemical agents because "we don’t know which one might be used next."
Reports from Russian scientists who emigrated to the United States in the last decade have confirmed that the Russians have the capacity to transmit highly contagious bacteria and viruses including smallpox in missile warheads, according to an article in the October 28 Washington Post Magazine. In addition, other countries may have bought or stolen this technology from the Russians, according to the article.
The possibility of a bioterrorist attack involving the smallpox virus has not been ignored by the federal government, which has accelerated the production schedule of a vaccine.
Smallpox was declared eradicated by the World Health Organization in 1979, and at its urging, most countries stopped making the vaccine shortly thereafter, according to the Mayo Clinic.
Because smallpox is so highly contagious and can be transmitted through viral particles in the air, Diamond thinks terrorists on a suicide mission in the United States could simply infect themselves with the virus and rapidly spread the disease by talking, coughing, or sneezing in public places.
Psychiatrists should also be aware that the goal of terrorists is to instill fear and panic in a population, said Diamond. "Although psychiatrists and mental health professionals cannot prevent physical casualties, we can play an important role in mitigating the psychological casualties, which most likely will be the largest group of affected individuals," said Diamond.
Information on various biological and chemical agents can be accessed at the Mayo Clinic Web site at www.mayoclinic.com/invoke.cfm?id=MH00021 by scrolling down to "Managing Your Physical Health." The Centers for Disease Control and Prevention also has educational resources on numerous diseases including anthrax, the plague, and botulism at www.cdc.gov/health/diseases.htm. ▪