Welch Wanderings continued

Mission Possible:
EIS Investigates Attacks

Early on the morning of Sept. 14, only two planes were flying in American airspace that weren't part of the U.S. military. One was Air Force One, which was taking the president to New York.

The other was an Australian Air Force C-130, ferrying 34 Epidemic Intelligence Service (EIS) officers from Georgia to New York, according to Douglas Hamilton, EIS director. Faced with a commercial airline industry slowly recovering from the shutdown of American airspace and a U.S. military reluctant to lend out its planes, EIS accepted the Australian offer of transport in the C-130 (which was being retrofitted at an air base in Georgia).

Strapped to his seat in the belly of the huge transport plane and surrounded by the duffel bags, suit-cases, and files of his fellow officers was Reuben Varghese, MD, MPH '99. Varghese and his colleagues were joining two EIS officers who had hitched a ride Sept. 11 on a U.S. pharmaceutical stockpile plane that landed in New York hours after the terrorist attacks. The EIS officers went there to monitor for any signs of the release of communicable agents.

Alex Langmuir, MD, MPH '40, founder of EIS, would have been proud. "Langmuir's spirit was that you didn't get answers by sitting in an office," Hamilton says. "You only got information by going in the field and collecting data there. That's the driving force of this program."

Begun by Langmuir and staffed by numerous School alumni and faculty over the past five decades, EIS retains a special connection to the School.

Langmuir, a former associate professor of Epidemiology at the School, wheedled funds in 1951 from a reluctant U.S. Congress by submitting a report that detailed the dangers of biological warfare. Hamilton suspects, however, that Langmuir had another motive for forming an intelligence branch of disease detectives. "My sense was he was a pretty clever guy and he started EIS with the primary goal of increasing epidemiological capacity in the United States in general," he says. Ironically, Langmuir's EIS is a powerful resource in the battle against the latest instance of biological warfare: this fall's anthrax attacks by mail.

Since Sept. 11, 112 of the 146 current EIS officers have been deployed to respond to the World Trade Center attacks and the anthrax mail attacks, according to Hamilton. Four alumni from the School are serving in their first year of the two-year commitment. (The number of alumni in their second year at EIS was not available at press time.)

Langmuir taught EIS officers that answers were found in the field, not the office

School alumni currently working as EIS officers join a long list of School faculty who are veteran EIS officers, including: Alfred Sommer, MD, MHS '73; D.A. Henderson, MD, MPH '60; Robert Lawrence, MD; Neal Halsey, MD; Bernard Guyer, MD, MPH; Henry Mosley, MD, MPH '65; Kenrad Nelson, MD; Kathy Helzlsouer, MD, MHS '88; Gordon Smith, MD, MPH; and Stan Becker, PhD '78.

"A lot of people in EIS have come through Hopkins," Hamilton says. "Hopkins certainly has one of the premier MPH programs in the world. When we see someone coming through Hopkins, that credential definitely gets our attention." -BWS

The School Post-9/11

In the wake of Sept. 11 and the recent anthrax bioterrorist attacks, students, faculty, and staff have taken on additional responsibilities and endeavors as the School confronts the latest threat to public health:

  • On Oct. 24, Lynn Goldman, MD, got a call from the president of the American Postal Workers Union, asking her to provide technical advice to a group of Washington, D.C., postal workers on how to protect against anthrax. Goldman, a professor of Environmental Health Sciences, quickly pulled together a team at the School, and two days later, she and Clifford Mitchell, MD, MS, MPH '91, an assistant professor of Environmental Health Sciences, were meeting with the postal employees. "It was obvious the workers had received most of their information from the press," says Goldman, "so we're now working on getting them consistent information."

    On learning about how mail-sorting rooms operate, Goldman was struck by how the letter-sorting equipment was cleaned by means of compressed air. "I began to wonder, Could the cleaning machines blow anthrax spores right out of a sealed envelope and then disperse them throughout the room? Can spores be transferred between letters?" Goldman's team will develop a training program for postal workers on recognizing chemical and biological hazards and what to do about them.

  • In the past few weeks, the Office of Communications has seen a tremendous spike in interest from the media and general public requesting both information and interviews with faculty about bioterrorism. "The School is an institution full of experts and, through us, the media and general public can learn about bioterrorism and public health," says Tim Parsons, associate director of Public Affairs. "It is our responsibility to help inform the public about these important issues, however we can."

    On many days in October, Parsons and Ming Tai, media relations coordinator, were together fielding more than 100 phone calls from CNN, the New York Times, the BBC, the New Delhi Telegraph, and many other news organizations.

  • After Sept. 11, the work of Ellen Silbergeld, PhD, on how agriculture's overuse of antibiotics produces drug-resistant superbugs, took on increased urgency. One of the antibiotics used in factory farms to boost the growth of chickens and turkeys is enrofloxacin, which is largely metabolized by the birds into a drug called ciprofloxacin, or Cipro — the principal drug now used to fight anthrax in humans.
    "If people are now using B. anthracis as a warfare agent, shouldn't we be asking whether our agricultural practices are compromising Cipro's ability to fight anthrax in humans?
    -Ellen Silbergeld

    "The organism that causes anthrax, Bacillus anthracis, like most bacteria — which are smarter than we are — can develop resistance to Cipro," notes Silbergeld, a professor of Environmental Health Sciences. "If people are now using B. anthracis as a warfare agent, shouldn't we be asking whether our agricultural practices are compromising Cipro's ability to fight anthrax in humans? And hadn't we better be doing something about this milieu of resistance that's being inadvertently created by the uncontrolled use of enrofloxacin in poultry?"

  • The Student Outbreak Response Team (SORT) organized a weeklong lecture series on the topic of bioterrorism in early November. Angeline David, MHS candidate in Epidemiology and co-coordinator of SORT, felt that informing students was important. "As future public health practitioners, we wanted to be proactive and help students be more aware of the current issues," she says.

    The series examined bioterrorism and its public health effects from various perspectives, including risk perception and management, public health preparation for bioterrorism, and psychological concerns. - Jennifer Hudman & Rod Graham

    The Wounded Mind

    Within a month of Sept. 11, David Vlahov, PhD '88, launched a telephone survey of 1,000 people to look at post-traumatic stress disorder (PTSD) and other early psychological reverberations among New Yorkers.

    "This initial rapid assessment is to provide a sense of the magnitude and scope of the psychological impact," explains Vlahov, an adjunct professor of Epidemiology and director of the New York Academy of Medicine's Center for Urban Epidemiologic Studies. "Our results will be used by the Commissioner of the New York City Department of Health to help plan services and allocation of resources when the city applies to the Federal Emergency Management Agency for assistance."

    Although PTSD has been called shell shock and battle fatigue, this common mental disorder (estimates of its prevalence range from 3 to 10 percent of the U.S. population) is by no means the exclusive province of combat veterans. Survivors of rape, domestic violence, child abuse, accidents, natural disasters — and terrorist attacks — are all susceptible to the flashbacks and nightmares, the avoidance behaviors, and the emotional numbing that mark PTSD.

    Vlahov, who also plans to recruit another 2,600 adults and children in New York for long-term follow-up, is not the only person from the School interested in PTSD. Howard Chilcoat, ScD '92, MHS '91, studies the disorder as well.

    "If almost 6,000 people died in the Sept. 11 catastrophes," says Chilcoat, "then every member of each of those 6,000 families, as well as those close to the deceased, are at risk of PTSD."

    Asked what the signs of the disorder are, Chilcoat, an associate professor of Mental Hygiene, explains that, to be diagnosed with PTSD, a person must first have been exposed to a traumatic event and then have exhibited at least some features from each of three symptom clusters: 1) intrusive memories, fantasies, and nightmares of the trauma, as well as physiological or psychological distress when exposed to cues that remind of the event; 2) hyperarousal symptoms like insomnia and an exaggerated startle reaction; and 3) emotional numbing and avoidance of situations resembling the trauma.

    What about all the millions who watched the World Trade Center towers collapse on TV? While Chilcoat is quick to note that PTSD can at times be overdiagnosed, he does think some people who watched the catastrophes unfold on television could now be at risk for the disorder.

    "There are definitely people out there not related to the victims of Sept. 11 who should be on guard for signs of PTSD," he cautions. "If after watching the catastrophes you notice yourself losing interest in people and activities, or feeling emotionally numb or hopeless or both, these are red flags for post-traumatic stress disorder." - RG

    Debugging Trauma Care

    For much of her career, Ellen MacKenzie, PhD, has tracked the outcomes of traumatic injuries and studied the workings of trauma centers — hospitals that have the equipment and expertise to handle the most gravely injured patients. She got an earful from her surgeon friends after Sept. 11.

    "The trauma surgeons I spoke with in New York worried that even though they were well prepared, they would have been utterly swamped if things had turned out well [and there had been] many more survivors," says MacKenzie, a professor of Health Policy and Management and director of the School's Center for Injury Research and Policy.

    Although not focused specifically on bioterrorism, much of MacKenzie's research is, in fact, aimed at streamlining disaster relief efforts. She and her colleagues, for instance, have been analyzing emergency triage decisions to pinpoint exactly which injuries pose the greatest threat of death or future disability. "We are also investigating whether a person with a particular injury who is sent to a trauma center fares better than another person with the exact same injury who ends up at a regular hospital," she says.

    Another problem many of the New York surgeons noticed: the lack of communication among hospitals and between hospitals and the broader public health system. As it happens, MacKenzie and her colleagues are working with the American Trauma Society to compile a complete inventory of U.S. trauma centers, with an eye toward linking them up via the Internet and an electronic newsletter. - RG

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