FRIDAY, DECEMBER 20, 2002
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The Day They Quarantined N.Y.
Exercise Called ‘Red X’ Terrifies Authorities
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- It was a hot day in June and scores of New Yorkers were dying, the hospitals were overwhelmed, and the city’s emergency services were strained to capacity trying to deal with a biological attack.

Mayor Bloomberg, Police Commissioner Ray Kelly, Fire Commissioner Nicholas Scoppetta, Deputy Mayor Marc Shaw, and John Odermatt, the head of the city’s office of Emergency Management struggled to keep casualties to a minimum and to do their best to make sure the city did not shut down.

If it doesn’t sound familiar it’s because it happened only on tabletops in the Brooklyn headquarters of the city’s emergency management office.

It was “Operation Sandbox,” a drill organized by Mr. Odermatt and his staff to keep the city’s leaders prepared.

“This city is better prepared than any other major city,” the mayor said. “There’s nothing we do that we shouldn’t question every day and say, ‘How can we do it better?’ If we ever get into a situation where we are afraid to ask if we could have done it better, we are in big trouble.”

It was not the first bio-terrorism drill the city had run, and it would not be the last.

In May 2001 — before the attacks on the World Trade Center — the city’s emergency management office, then under the direction of Richard Sheirer — organized “Red X,” in which terrorists attacked New York with a biological agent.

“Five minutes into the exercise you forgot it was an exercise,” Mr. Sheirer recalled. “We virtually quarantined Manhattan.”

A second part of the exercise called “Tripod” tested the city’s ability to dispense medication in large quantities on an emergency basis.

Mr. Sheirer said the city’s response to the Trade Center attacks benefited from the drills.

“It all boils down to practice,” Mr. Sheirer said.

And with the threat of a biological, radiological, or chemical attack on the city a realistic threat, the city’s health infrastructure has been struggling to stay prepared.

“The threat of bio-terrorism reminds everyone that the public health is integral to public safety,” the city’s health commissioner, Dr. Thomas Frieden, told The New York Sun. “We look at the threat from two angles: detection and response.”

Detection involves the department monitoring patters of illness, ambulance runs, emergency room visits, and prescriptions, according to Dr. Frieden.

“We are paying attention to more than 30,000 pieces of information that are collected every day,” he said.

As a result, health officials who once found their preparations to limited to things like the flu, tuberculosis, AIDS, and more commonplace health emergencies, now find themselves drawing up plans to respond to everything from anthrax to smallpox to dirty bombs.

A recent study by The Federation of American Scientists said the explosion of a dirty bomb at the lower tip of Manhattan would contaminate an area of well over 1,000 square miles, extending over three states.

There would be a one-in-ten risk of death from cancer in an area of about 300 city blocks. Contamination in Manhattan would result in a one-in-a-hundred chance of residents dying from cancer.

“It used to be unrealistic to even think that a dirty bomb could be detonated in New York City,” Senator Schumer said. “In this new world, the unthinkable has been thought of and we need to respond.”

Dr. Neal Shipley, the director of emergency medicine at North General Hospital in Harlem, said dirty bombs are almost the least of the terrorism-related concerns facing the city’s health community.

“I’m much more concerned about a biological attack than a chemical or radiological attack,” he said. “As horrible as it may be with a bomb, you know what’s happened, you know who the injured are, and you know what the danger zone is. If someone attacks with smallpox it could be days before anyone realizes what’s going on. And by then, it will almost be impossible to know how widespread the problem is.”

That point was made perfectly on September 11, 2001, when thousands of people — many covered with ash and debris — made their way by foot, car, train, and boat to more than 100 hospitals.

“If the attack had had a biological component and those thousands of people had spread out like that, the consequences could have been horrific,” according to Susan Waltman, senior vice president and general counsel of the Greater New York Hospital Association. The association and New York State recently established computer networks to help officials detect attacks.

The system was put to the test in a tabletop exercise in which dirty bombs were detonated at Rockefeller Center and Penn Station.

More than 60 hospitals in the New York metropolitan area participated, working from their facilities and responding to the scenario, conducting actual assessments of their current surge capacity and event-related visits.

While 95% of participants were able to access the system successfully and enter data, nearly 20% were unable to receive information through the online forum.

One official involved in the exercise said that while they won’t have a full evaluation for a few weeks, “things could have gone smoother. Things will have to go smoother.”

Dr. Shipley, meanwhile, said that the city recently secured $40,000 grants for hospitals to use for bio-terrorism preparedness. His hospital plans to use roughly half for training and about half for equipment.

“Unfortunately that amount only scratches the surface of what we need,” he said.

Officials say the need for training is urgent because the city’s first responders need to change the way they do business.

“Most emergency workers have the same instinct on how to respond to an emergency and that’s quickly,” Dr. Shipley said. “And in the event of a biological attack, that can have deadly consequences.”

Experts point out that mistakes in the initial response can lead to other problems as well.

After anthrax was discovered in the city, well-intentioned investigators delivered all sorts of possibly contaminated furniture and equipment to a city lab, resulting in the lab becoming contaminated.

The defense department then had to fly tons of equipment to the city so new labs and evidence rooms could be set up.

“Too many of the first responders, not necessarily just in New York but around the country, are not prepared for a chemical or biological attack,” according to Stephen Flynn of the Council on Foreign Relations. “This could lead to the unnecessary loss of thousands of lives.”

Commissioner Kelly is intent on making sure his officers don’t make mistakes and are ready for the next attack.

The department has hired two infectious-disease experts to prepare officers to protect against chemical and biological attacks.

Dr. Kevin Cahill, director of Lenox Hill Hospital’s Tropical Disease Center, is the department’s chief medical adviser for counterterrorism, and Dr. Dani-Margot Zavasky, a former infectious-disease doctor in Salt Lake City, is the department’s liaison with the health department.

“The department faces challenges now that were unimaginable in the past,” Mr. Kelly said.

Dr. Cahill has formed an advisory board of experts in nuclear, radioactive, chemical, and biological threats and the department plans to equip officers and supervisors with radiation detectors and protective masks.

Most officials fear a smallpox attack the most.

“If terrorists were to send 10 people with smallpox onto 10 separate subway cars, the number of dead would be seemingly incalculable,” said John Timoney, the former first deputy commissioner of the New York City police department.

The threat of a smallpox attack is real enough that the federal government has started a program to vaccinate first responders around the country on a voluntary basis.

“Smallpox is a very bad disease,” according to Dr. Frieden. “One third of the people who get it die.”

Last week, the city’s Health Department announced vaccinations in New York would begin next month.

The plan calls for starting with health personnel and hospital workers around the city.

“Although we don’t know the likelihood of such an attack, the fact is being ready is one of the best forms of defense,” Dr. Frieden said. “Vaccinating key personnel before a bio-terrorist attack is an important step in the city’s preparedness.”

At the same time, health officials are developing a plan for mass vaccinations if possible. Dr. Frieden pointed out it has been done before. In 1947 more than six million New Yorkers received shots in 28 days.

And yesterday, Governor Pataki announced what health officials hope will be another important step: an emergency alert system to notify tens of thousands of doctors across the state in the event of a chemical or biological attack.

“Physicians are on the front lines in health emergencies, whether they result from emerging disease outbreaks or a terrorist event,” Mr. Pataki said.

The $1.8 million program is the first statewide alert system designed to rapidly inform doctors of suspected terrorist attacks, sudden disease outbreaks, or other public health emergencies.

Nationally, the Centers for Disease Control maintains a Web site with information for health emergencies for both public and medical personnel.

The city is also finishing work on what Dr. Frieden described as “a state of the art bio-terror research lab” that will open around the middle of next year.

Dr. Frieden said a major goal for his department is to make sure all the bio-terrorism preparations translate in ways that will be useful for the day-to-day activities of the city’s health-related infrastructure.

“Everything we do should be dual use,” he said. “The monitoring we do, the training we do. “It should be as applicable to our jobs as it is for preparing for something worse.

“The more drills we have, the more we talk with each other, the more prepared we will be the next time we have to face a crisis.”



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