The public health officials charged with protecting Americans against bioterrorism have long shared one major fear, and they worry about it now more than ever: Will they catch an attack in time to prevent mass casualties?
The most likely bioterrorism agents, including anthrax and smallpox, are designed to kill large numbers of people quickly. Caught early, an attack has a chance of being thwarted with vaccines and drugs.
Caught late, it does not.
"If you wait until you have people on the slab down at the ME's office, you're way behind the eight ball," said Dr. Catherine Carrubba, an emergency room physician and medical director for the city of Tampa.
"Your chance of appropriate infection control is going to be really, really hindered."
Hillsborough County officials believe they have found an answer. At his office in downtown Tampa on Thursday, on a quiet floor above the melee in the lobby of the county health department, Jordan Lewis showed off the latest weapon against bioterrorism.
It isn't a new antibiotic, vaccine or test. Rather, it is a computer system designed to monitor the symptoms of patients at Hillsborough emergency rooms, then quickly alert health officials if disease patterns suggest a biological attack.
The system, called LEADERS, was developed for the U.S. Centers for Disease Control and Prevention to detect biological attacks during major events and was deployed at five Tampa Bay area hospitals earlier this year for the Super Bowl.
Hillsborough is one of the first localities in the nation to use the system full time, and others are expected to follow. Six hospitals in Seminole County have been using it since August, and officials there hope to link hospitals in nine counties.
Oracle Corp., a Virginia-based company that manages the system, met with Pinellas County health officials last week.
"A few cases (at one hospital) might not be significant. But a few cases everywhere could be," said Lewis, director of environmental health and epidemiology for the Hillsborough County Health Department. "We'll be looking at symptoms and going back to the hospitals and back to the physicians and saying, "What's going on?' "
Tampa General Hospital put the system online Nov. 1, and eight of the county's remaining nine hospital emergency rooms are expected to have it by month's end. Only James A. Haley VA Medical Center, with its narrow patient base, isn't participating, Lewis said.
In Florida, as in most states, county health departments depend on physicians to report a variety of infectious or communicable diseases as they diagnose them, including anthrax, tuberculosis, salmonella and influenza.
But this can take days, or even weeks, and not all doctors report all they should. Doctors treating an odd case at one hospital also have no way of knowing if other hospitals are seeing similar cases.
Dr. Mohammad Akhter, executive director of the American Public Health Association, said many large health departments do have better systems, but they tend to be antiquated. The group has asked Congress for $1-billion to help local agencies install computer programs similar to Hillsborough's.
"The others are by telephone, some are by faxes, some are by postcards," Akhter said. "This would be a model."
LEADERS, which stands for Lightweight Epidemiology Advanced Detection and Emergency Response System, is relatively simple: For every emergency room patient, a doctor or nurse completes a form detailing the patient's symptoms and the patient's ZIP code.
The information is entered, via the Internet, into a central computer at Oracle headquarters. The data is continually updated and sent electronically to Hillsborough's emergency communications center.
Another computer program, developed by the CDC, searches for aberrations and flags them.
More than the average number of upper respiratory infections at TGH or St. Joseph's? Flag.
A spate of diarrhea cases at University Community Hospital? Flag.
Unexplained sudden deaths at three area hospitals? Flag.
The reports will be monitored around the clock. Aberrations will be reported immediately to health officials, who will launch an epidemiological investigation. Has the flu hit Hyde Park, or is something more sinister to blame?
"You will catch the outbreaks in the emergency rooms. If we miss one or two because (patients) went somewhere else, we should still collect enough data to find the pattern," said Paul L. Ford, TGH director of safety and security, who represents the hospital on state and local emergency preparedness teams.
"It may not be perfect, but it's better than anything that's been there before."
The system does have a major limitation: With few exceptions, it will not flag a single case, only patterns. So catching one anthrax case, as happened last month in Palm Beach County, still depends on the alertness of health care workers.
"Nothing beats human intelligence _ the front-line docs and nurses looking for illness and phoning the health department," said Dr. John Sinnott, chief of infection control at TGH and the University of South Florida. "This is a backup system to that, and it adds a greater level of security."
The system also will discover and track more pedestrian outbreaks, such as influenza or salmonella. But it was designed for bioterrorism, and the attacks of Sept. 11 and the recent anthrax cases in Florida, New York, Washington, D.C., and New Jersey spurred its creation in Hillsborough, county officials said.
The Metropolitan Medical Response System, an agency established in 1996 to develop plans for dealing with weapons of mass destruction, and the city of Tampa are providing most of the $43,000 cost for the first year, Lewis said.
The system was used during the 2000 Republican and Democratic national conventions, as well as President Bush's inauguration.
During the Super Bowl, when it was deployed among five Hillsborough and Pinellas hospitals for two weeks, it detected a weak wave of influenza and flagged a case of meningitis.
Health officials liked it so much they wanted it back for good.
"It's automated. We don't have to do anything but religiously enter the data," said Carrubba, an ER doctor at TGH and head of the steering committee of the medical response system. "It will definitely save lives if something ever happens."
By the end of the month, every patient who goes to a Hillsborough County emergency room will be checked for symptoms that could signal a bioterrorism attack. Each patient's symptoms will be entered on a central computer system designed to warn health officials of unusual disease patterns.
Among the conditions doctors will be entering:
Upper or lower respiratory tract infection with fever.
Diarrhea or gastroenteritis, including vomiting, abdominal pain, or any other GI distress.
Rash with fever.
Sepsis or nontraumatic shock.
Meningitis, encephalitis or unexplained delirium.
Botulismlike syndrome, including cranial nerve impairment and weakness.