In a simulation of what public health experts and government leaders fear could be a real-life nightmare, a woman walked into a Frederick emergency room yesterday displaying symptoms of history's most virulent disease: smallpox.
About 2 p.m., actress Amanda Strand told doctors in the fake emergency room that she had a rash and a 103-degree fever. Within 20 minutes, a SWAT team in dark-blue body armor had stormed in, barred the doors, and duct-taped the vents.
A helmeted doctor with a pistol strapped to his thigh informed everyone they would be unable to leave for eight to 10 hours and would then be quarantined or monitored by health officials for at least 17 days.
The federal government has warned that should a terrorist bring smallpox into the United States, counties could be on their own in confronting the disease for up to three days. Yesterday's drill, held at Hood College, was part of Frederick County's efforts to ready itself for a bioterrorism attack -- a possibility, officials say, given the presence of Camp David near Thurmont and Fort Detrick in Frederick.
"It could happen here, and it's not enough to have some outdated plan sitting in a book somewhere," said John Vitarello, a Frederick cardiologist who helped devise the smallpox response plan and the simulation. "We've tried to look at every detail and every contingency that could occur under an outbreak, and now we've practiced it."
Biological defense and public health experts praised Frederick County for the timeliness and thoroughness of its efforts.
"I think the folks in Frederick are extraordinary," said Elin Gursky of the ANSER Institute for Homeland Security in Arlington, Va. "They're showing rare vision and awareness of the problem. These are not people who were charged with doing this, but they've recognized the problem on their own, and they're filling the void, coming forward in a remarkable way."
Health officials around the Baltimore-Washington area said the Frederick simulation was the most thorough response they have heard of in the state, though most other counties have revised their emergency response plans in the last year and some, such as Howard, expect to run simulations.
Since the Sept. 11 attacks on Washington and New York and the subsequent anthrax scares, bioterrorism has become a hot subject in government and media circles, with speculation often centering on smallpox because the disease spreads easily and is deadly, killing one in three who are infected.
The medical community declared smallpox eradicated in 1980, and the last U.S. case occurred more than 50 years ago.
But bioterrorism experts speculate that hostile nations such as Iraq may have obtained samples of smallpox, and as a result, federal, state and local officials have spent the last year revamping plans for confronting an outbreak.
CDC guidelines
This week, the Centers for Disease Control and Prevention released comprehensive guidelines describing how local health officials should set up vaccination clinics.
The Bush administration is discussing vaccinating all 280 million Americans, the Associated Press reported yesterday, though the vaccine kills about one in every million people and causes severe side effects.
Federal officials say they could now vaccinate a little more than half of all U.S. citizens.
Vitarello said that he, like most people, grew interested in bioterrorism after the Sept. 11 attacks. He felt the personal connection to world events, he said, when he heard a cousin's nephew had died in the World Trade Center collapse.
Unwilling to leave his community's safety in someone else's hands, he sought training from experts on nuclear, chemical and biological warfare, accruing nearly 700 hours and often rising at 4 a.m. or 5 a.m. to sketch emergency plans for Frederick County. Then, he and others who share his passion helped county officials craft a detailed response plan.
They were amazed at the scope of the undertaking -- isolating the initial victim and all those potentially exposed, creating vaccination and quarantine centers, closing off roads, communicating with the press and with state and federal officials.
Vitarello hopes to conduct similar drills for possible anthrax, dirty bomb and chemical attacks. He and other county officials said they were pleased with the drill.
"I don't think it could've gone any better considering how little time we've had to prepare," said county Sheriff James Hagy. Drills almost never simulate real emergencies, but they at least give police, doctors and emergency workers a feel for techniques, said James E. Bowes, head of the county's health department.
"You can plan but it won't happen this way," said Bowes, who worked with smallpox patients as a medical student in 1947. "Still, it's good for the ego to think you're in the lead on confronting these issues, and I think we are."
Response plans can't be deemed sound until practiced, others said.
"You'll be amazed at what you discover when you practice, silly little things that just blow your plans to shreds," said state health Secretary Dr. Georges Benjamin.
Potential problems
County officials said the planning and drill have helped identify several potential problems.
The county did not have enough protective suits for workers who would have to treat the infected or enough respirators for patients.
Potential quarantine sites had improper ventilation. The county also had no written plans to provide linens or food to quarantined patients. Vitarello and friends have solved those problems.
It also became apparent that the county's public health staff, with only a few doctors and about 50 nurses, would not be able to run both quarantine and vaccination centers.
So Frederick officials included plans to shift scores of doctors from Frederick Memorial to the centers and to enlist hoards of retired nurses, doctors and veterinarians to give vaccinations and monitor the potentially infected.
The Frederick plan revolves around a group of 37 doctors, emergency workers and police unified under three commanders. All members will be on the same beeper system and respond immediately to a biological or chemical attack scene.
Vitarello hopes all the organization will help ward off panic should an attack occur.
"Above all, we're trying to vaccinate against fear," he said.