How do you fight an invisible danger?

In our ongoing series of conversations about Urban Bioterrorism, — we have been struck by several recent realities that confirm our policy of policing the Homeland is wide open to creative and pernicious exploitation of our febrile border defenses.

Our current policy for fighting terrorism on American soil isn’t working. We seek to only deter and then punish the body.

We log citizens and their behaviors while completely ignoring the reality that the most dangerous threats to health, freedom and liberty are microscopic and undetectable — and those dangers live inside people instead of being carried by people as recognizable weapons of mass destruction.

Last week the Associated Press reported in a prescient article titled — Superbugs Emerge Among Urban Poor — that a drug-resistant staph infection is spreading in the Chicago urban core.

Infections are up seven-fold because of crowded living conditions in public housing and in prisons and because big cities create close person-to-person contact that allows easy propagation of disease:

The superbugs, first seen mainly in hospitals and nursing homes, have turned up recently among athletes, prisoners and people who get illegal tattoos. Called methicillin-resistant staphylococcus aureus, or MRSA, these staph germs can cause skin infections that in rare cases have led to pneumonia, bloodstream infections and a painful, flesh-destroying condition. MRSA is hard to treat because the bacteria have developed resistance to the penicillin drug family.From 2000 to 2005, the infection rate seen in patients seeking care at Chicago’s main public hospital and its affiliated clinics climbed from 24 cases per 100,000 to 164 cases per 100,000, the study found.

This week we were reminded of the biotoxin terror living among many of us: Pernicious Tuberculosis. “TB Andy” is the new “Typhoid Mary” and we slowly realize our shared memory as a cogent nation has gone dormant and forgetful.

We must remember the greatest way to defeat a nation is to threaten the Public Health of its citizens. Remember one of the most effective battlefield tactics is to severely wound your opponent instead of killing them because wounded soldiers need attention and care and they drain the economic system in their homeland for the rest of their incapacitated lives.

Governments can warn, punish, detain and incarcerate carriers of infectious diseases — but how does one detect an imminent and obvious danger without becoming a paranoid Carceral Nation?

Do we require medical exams before passengers are allowed international travel on an airplane? Do we do blood tests at the security gate?

How could we ever prevent a determined Bioterror attack if terrorists provided 100 disease carriers and placed all of them on different flights into the USA to spread disease and fear over a prolonged period of time? How long is the incubation process? How long would it take the CDC to discover the terroristic scourge? What if only the terrorists had the antidote — would we pay the terrorists to heal an endangered nation? We still haven’t figured out the cause of The Smell in New York City. Was it a test pattern for a future evil effort?

Tuberculosis is a longtime enemy of healthy people and it lives and thrives in the urban core where people do not seek — and are not regularly offered — routine healthcare checkups. Tuberculosis might just be the perfect Bioterror weapon transmission method because of its long history in humankind and in its commonality among carriers.

Will those who test positive for tuberculosis — mainly those who are poor and living in the urban core — be rounded up and incarcerated “for their protection” and the greater goodness of our Public Health system? Will a positive TB test become the new scarlet letters?

We better start thinking creatively for ways to fight Bioterrorism — or we risk having the microscopic view of infections becoming our new national identity.


  1. Hi David,
    Bioterrorism, chemical warfare– scary stuff.
    I watched Andrew Speaker’s interview this morning with Diane Sawyer and was glad I was not on the plane with him.
    I don’t know if I believe him when he says “they” told him he was not contagious. I do believe he thought his very survival was at stake and was willing to do anything to get back to good medical care. The thought of dying in a foreign country you believed had substandard care might prompt one to actions otherwise unthinkable.
    I think it was his own private war. Was he being inconsiderate– yes, but who is to say what each of us would do if we were in his shoes?
    I hope he was right. I hope he was not contagious. I don’t believe he deserves to be crucified for this.

  2. Hi Donna —
    I believe him when he says he wanted to get back to the USA so he would not be detained and then die in Italy.
    I do not believe he wasn’t told he had TB and should not travel — if you have it you are considered at risk and a risk to others because it can turn on you in an instant. His Xrays confirmed his infection.
    He was in complete self-preservation mode — his marriage was more important to him than the safety of others — and he was selfish and dangerous.

  3. Hi David,
    Yes, that is my take on his situation. I am in complete agreement with you.
    I think he now regrets what he did, but would he do it differently if he had it to do over? Probably not.
    It tends to chill one to the bone when you find out you have a disease that could be fatal. A few months before my husband and I got engaged, he was travelling out West with some friends and started displaying neurological impairments– he had trouble opening doors (and beer cans). He ended up checking himself into Denver General and received a diagnosis of Guillian Barre Syndrome, a rare neurological disease (not contagious) origin unknown that does not have a cure. Fortunately, he fully recovered, much to the surprise of the six neurologists who advised him to stay in Denver and start immediate treatment. He just wanted to go home, so that’s what he did. He reasoned if he were going to die, he wanted to be at home, rather than in a hospital several hundred miles away. A couple of months later, his syndrome arrested itself.

  4. In many ways, Donna, I feel “TB Andy” is a predator. How he behaved in this situation was horrible and arrogant and I am concerned for his new wife because he obviously believes in a universe where the sun revolved around him.
    I think the issue here is being a danger to others. Your hubby’s amazing story is one of great self-determination while “TB Andy’s” was only about selfish preservation.

  5. Hi David,
    Yes, I agree that Speaker’s disregard for the welfare of others is horrible. But do you think he even stopped to think “If I get on this plane, I could kill other people,” or did he just react, much as a wild animal would run from danger? He said in the Sawyer interview he had been wrought with anxiety for the last few weeks.
    I often wonder about those who run in a fire and trample those in the way. We discussed this some already this week. Can we blame them for instinct? What if they don’t have the courage of the brave? What about the kids that ran from the gunman at Virginia Tech? I wouldn’t label them predators.
    Just a lot of musing going on here about human nature and the essence of our being. Maybe its too early for this discussion?

  6. Donna —
    TB Andy knew he was infected and a danger to others. Watch the CDC press conference. Of all the government agencies, the CDC is pretty well run mainly because medical doctors are in charge and not politicians. Their story and Andy’s story do not match up at all. He was told to stay in Italy and private arrangements were being made by the CDC to bring him safely home. I’m sure the Italians didn’t want him hanging around…
    I am more bothered by the TSA agent who had instructions to stop him at a checkpoint but did not. Big Security Hole. It will be exploited later by those with constant evil intent.
    Many people do not understand why people leapt to their deaths from the World Trade Center. There have been studies done with rats that — when cornered by fire — they will leap to their deaths than run through the flames:
    The threat to TB Andy was within him — he had nowhere to run and nowhere to escape — so sitting in Italy or getting on a plane doesn’t remove the danger to himself.

  7. Hi David,
    It’s ironic — or is it — that TB Andy’s father-in-law works at the CDC as a TB researcher, according to reports.
    The case shows that our health defense system isn’t set up to deal with people with infectious diseases. A news report suggests that current laws could be challenged as unconstitutional — the order to detain Speaker wasn’t issued by a judge, but was issued by the CDC. Also, the same report suggests that health officials are having a hard time gathering information about passengers and others who might have been exposed.

    Some legal scholars said the absence of clear guidelines could lead to a legal tangle that might stall government quarantine actions during an outbreak of pandemic flu or other contagious diseases.

    The border guard thought the order was discretionary and admitted Speaker. If I was the guard, I probably would have done the same thing if the guy looked healthy and was a U.S. Citizen. I doubt any border agent wants to risk detaining a citizen and risk the firestorm that could result from such a decision. Especially, when “aliens” are routinely “paroled” into the United States, despite not having proper paperwork and documents.
    Nobody at the airports or airlines seemed to have a way to keep him off of an airplane, despite reports he was on the no-fly — and the detain at the border — list. The first line of defense should have been at the airline check-in counter.
    As for MRSA and other coming super bugs, we need to get prepared for more stories like the one in Chicago. Our county is adjacent to Cook County and its jail has experienced MRSA outbreaks and had to stop accepting new prisoners last summer because the jail was under quarantine for a couple of days.
    My wife works in the health care field and has been concerned about MRSA for years. I also remember seeing a MRSA poster at my son’s pediatrician’s office 9-years-ago advising healthcare providers to undertake universal precautions to prevent the spread of the disease.
    A huge problem is people demanding antibiotics from their doctors when they aren’t needed. Also, poverty often means many people are living in close quarters in less than optimal conditions.
    I just hope that we learn from these events before the bad guys do.

  8. Hi David,
    Excellent point about Speaker’s danger within.
    Good link to your article on fire.
    The most afraid I have ever been was when I went through fire-fighting training in the Navy. The Navy requires all personnel go through this training because of the fire aboard the USS Forrestal One-hundred thirty-four lost their lives in “the single worst Naval casualty event of the Vietnam War.” The men aboard the carrier did not know how to properly don the OBAs– oxygen breathing apparatus– that could have saved their lives, nor were they all trained to fight fire, only a select few that were designated as the fire-fighting team. The fire engulfed the carrier and pandemonium ensued.
    During my training, I had to don the OBA. I do not do well with masks, and the first thing I did was hyperventilate. I forced myself to calm down and deal with the mask.
    We first had a “dry run” to determine our positions with the hose. Then, they lit off a mock building. When I started to enter the room, it was full of smoke and it blinded me. I panicked. The training officer, who had seen this many times before, grabbed the ring on the front of my suit and pulled me into the building. Our team put out the fire, but I have never been so afraid of anything in my life. Further, as an officer, I had to show leadership by being the first in line!
    I have the utmost respect now for firefighters.

  9. Chris —
    I think this episode with TB Andy has let the secret out of the bag. The borders are not secure. We have no way to legally detain a biological threat living inside someone’s body.
    Should vaccines be mandated by law? I know during the first Gulf War there were shots against Small Pox that soldiers were required to take and the infection rate from the vaccine was something like 1 in 1,000 so you knew a lot of soldiers had the potential to risk getting seriously ill.
    There were some soldiers who refused to take the vaccine and they were fully prosecuted under the Code of Military Conduct — and I am in favor of that. You join the Armed Forces — your body and being no longer belong to you — and if Saddam was going to zap you with militarized Small Pox, you better be inoculated or you become a carrier who can infect thousands on the battlefield.

  10. That is a scary experience, Donna, but I’m glad they trained you. Can you imagine being unprepared and having to fight your way out of a fire and your own worry?
    Firefighters have a tough job. There aren’t many people willing to run into a burning building.
    There is great conflict and tension in NYC between the firefighters and the NYPD. The NYPD get the first call on a Bioterror outbreak — when the firefighters are the ones who have the equipment and the training to deal with just such an emergency.

  11. Hi David,
    I once saw a training film for firefighters dealing with hazardous chemicals.
    One of the scenarios was a police officer pulling over a truck for some routine violating. During the stop the officer realizes that the leaking chemicals are toxic.
    When the firefighters get the call and approach the scene, they stop upwind and pull of binoculars to read the placards on the side of the truck to determine the threat and call back to HQ to get detailed information about the chemical before they approached the scene.

  12. Hi Chris!
    That story shows just how powerful and deadly the right/wrong chemicals can be in the wild of society. We need to have a more powerful and ready defensive system.
    With terrorism we take a borders approach. We don’t put enough energy or money on what if the initial border is broken? Then what? What’s the national response?
    I think the reason we don’t go into the second line of defense planning is because we’ve put all our money and hope at stopping threats before they cut through our barriers and that’s just wishful, non-realistic hoping.

  13. As an international citizen, I had to go through all kinds of medical tests possible along with a TB test and had to come out with a clean chit to get official approval and proper document before travelling to USA.
    I have seen some students had to wait to be paid their health insurance as a part of their work contract till they came out clean.
    I am sure visitors and tourists need their records to be clean before travelling.

  14. That’s how it should work, Katha! Carefully check everyone in and out of the country — but when our own citizens misbehave and get away with it — that creates lots of problems that reverberate throughout society.

  15. Yes David, I agree that’s how it should work.
    I also feel things are tighter where the lisk is less.
    I am clueless how Andrew was infected in the first place – it might be a result of globe trotting –
    I also do not know why the border security allowed him in.
    From my personal experience I can say, those who travel worldwide legally for business, tourism, study or other diferent purpose are way far to be exposed to the reasons those generally cause TB.
    Security has to be more tight where the risk is greater, or there has to be other resources to fight it.

  16. How would one determine if a regional outbreak of TB was an act of bioterrorism using Molecular Epidemiology? This was a question poised to me in my CLS class. Any ideas?

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