Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe

Living Terrors is a book that should be read by all Americans. Thebook is written by Michael T. Osterholm, Ph.D. and science journalistJohn Schwartz. It is based largely on Dr. Osterholm's experience asan epidemiologist, his expertise in biological weapons, and hisefforts to educate the public on the threats of bioterrorism. Heillustrates several points about the unique aspects of this threat bybeginning chapters with fictional vignettes about hypotheticalbioterrorists. The emphasis is on the general anonymity of theperpetrators, ready availability of biological agents, and thedifficulty tracking the terrorist. He uses the subsequent chapters toargue that the bacteria and viruses are readily available and thetechnology for dispersing easily learned. He discusses estimates ofpotential loss of life and economic damage from a bioterroristattack.The second half of the book describes a hypotheticalsmallpox attack on the city of Chicago. Most Americans over the ageof thirty have some recollection of smallpox vaccinations theyreceived as a child. The wild form of smallpox was eradicated in 1977and the World Health Organization recommended discontinuingvaccinations against it in 1980. The only remaining smallpox was inlaboratories in the United States and the Soviet Union. The authorspresent evidence here that other countries have this agent and thatthe combination of high infectivity, high lethality, and low immunitymake it lethal if dispersed by a terrorist.Living Terrors alsofocuses on systems and logistics that need to be addressed. Bothantibiotics and immunizations are effective in specific situations,but there are currently not enough doses to have much of an impact inthe event of an attack. Civil defense preparedness is also lacking.The type of response needed for a chemical weapons release is comparedwith biological weapons. Early identification of the infectiousdisease is critical since many of the diseases appear to be similar toupper respiratory infections. Quarantine and respiratory isolation ofindividuals affected with smallpox is also the best initialintervention to prevent subsequent waves of infection. The morespecific issue of containing patients in negative air pressure roomsis contrasted with the fact that there are only 60 such rooms in thestate of Minnesota's 144 hospitals. The associated public healthissues of decreased bed capacity and physician time to devote to theseissues are discussed. One of Dr. Osterholm's recommendations involvesincreasing the "slack" in the system. He points out thatfor smaller disasters, such as plane crashes, the current systems aredeficient and these deficiencies would be greatly amplified in abioterrorist attack. Many physicians have never seen a case of smallpox or anthrax and would benefit from the appropriate training.Appropriate training programs exist, but don't target local healthsystems.The legal responses by both local officials and federalofficials as well as law enforcement a

I'm part of the problem! I'm one of those individuals that Mike Osterholm talks about in this very important book. Unfortunately he is right on target. The federal response, of which I'm supposed to be a part of, remains disorganized and lacking leadership. In my small way, I thought I could help change that as part of the public health leadership within the great governmental bureaucracy. In fact, I read Living Terrors hoping to convince myself that Dr. Osterholm was wrong. However, as I watch the political paralysis occurring around the election results and the continued stalemate, even within the Administration, I'm not optimistic. We can't get influenza vaccine to the general population this year, how are we ever going to respond to an unplanned crisis of the likes of a bioterrorism event? Even the recent passage of the Frist/Kennedy legislation to improve the public health infrastructure (and response to bioterrorism) gives me concern. In that legislation much of the control of funds to support bioterrorism response will still be under the control of the Depts of Defense and Justice; not HHS, the public health/medical research arm of the federal system. The above comments are really just setting the table to say, if you really care about our future and the potential of what bioterrorism can and will do to our country, you should take to heart what Dr. Osterholm has said. I know my coworkers who have read the book all wish our bosses and their bosses would read it and take it to heart. I'm afraid that is not going to happen on this watch and I'm not optmistic it will happen on the next one, regardless of who is President. If we are to get our act together, it will have to come from the people...who in turn get their local, state and federal elected officials to REALLY understand the issues and respond accordingly. Dr Osterholm's book should be the their Bible. It's the best we've got.

As a first responder (fire fighter / paramedic) and as a paramedic that works in a hospital ER, I found this book to open my eyes on the events that could effect all of our lives. This book is a MUST read for our community leaders and policy makers. Anybody that thinks that Bioterrorist will not strike at our home have not read this book, or live in the stone age. This book drives the point home, and needs to be read by Doctors, and Goverment Officals.It is a very quick read, and easily understood by the target readers.

This book should be read by every public health, medical and emergency response professional throughout the world. In addition, it would sure be helpful if the media, government officials and military experts also took a crack at it. We might finally have a chance at coming up with a rational and practical response to this likely diaster. Dr. Osterholm is out there...some would say he has crossed the line with hype. Unfortunately, as an infectious disease physician, I have followed his work for the past 20 years and he has challenged us on numerous occassions with predictions that have all come true. I hope he is wrong (but I really don't think so), but if he is not, his book contains the only rational discussion of the issue of bioterrorism in print today and without a doubt the only plan for what we must do to prepare ourselves. Finally, its a book the makes sense to average citizen. I had to fight my teenage son all weekend for the only copy in our house.

It arrived late on a Thursday evening. Like the rest of the world, I had much to do over the coming weekend. I would get to it when I had time. Unfortunately, I made the mistake of picking up Living Terrors late that night and scanning the cover jacket. The next thing I knew, I was finishing the second chapter. What was I thinking? By 6 a.m. Sunday morning, I had completed the book and began to consider what I could say to emphasize its critical message. I had yet to get to my weekend chores.First, a disclaimer. While at a national meeting on infectious diseases in the fall of 1998, almost solely out of curiosity, I decided to listen to a presentation on "Bioterrorism" by Dr. Osterholm. I was familiar with him from a distance - he was a well known expert in food borne illnesses and the like, while at the Minnesota Department of Public Health. Like a child being told by his older sibling that there is no Santa Claus, what I heard that day I desperately wanted not to be true, but in my heart, like that child, I knew it was, and I could not go back. Since that time, I have become more and more interested in bioterrorism (defined as the intentional use of biologic agents or their products for the purpose of producing disease among humans, animals or plants) while at the same time convinced that Dr. Osterholm's concerns are right on the mark. It was with this bias that I eagerly awaited publication of his book.As one who grew up during the Cold War, I remember all too well the fears of nuclear war - the civil defense drills and the scenes on black and white television of a simulated nuclear blast with instructions to "take cover". These fears were magnified many fold as I grew older, married, had children and began to slightly understand the true implications of it all. I vaguely recall also of hearing of biologic or germ warfare, but these terms had no real meaning to me at the time.As the Cold War wound down, the Berlin Wall fell, and disarmament began, one could almost hear a collective sigh of relief......until THIS! Michael Osterholm and John Schwartz shock us back to the reality that the war is not over and the bad guys are still out there. They argue convincingly only that the rules have changed, the enemy is more elusive, and an attack, this time in the form of a lethal and quite possibly contagious agent, when (not if) it comes, will be devastating. Depending on the circumstances, the biologic agent chosen, the method of delivery, and the degree of contagiousness, tens, hundreds, or even thousands may die and an untold number left standing will be paralyzed with fear as they wait to see if they, too, will fall victum. Like a Steven King novel, as you read this book, the hair on the back of your neck will begin to rise and your palms will begin to sweat. But this is no novel, and their concerns are not fiction.Living Terrors does not lose you in the science; rather, the far bigger fears of the authors are dramatically emphasized in a series of