Philadelphia doctors serve as bioterror sentinels : LUSENET : Grassroots Information Coordination Center (GICC) : One Thread

Headline: Philadelphia doctors serve as bioterror sentinels -- Experts at six hospitals are filing daily reports.

Source: Stacey Burling, Philadelphia Inquirer, 15 October 2001


As Timothy Babinchak, an infectious-disease doctor, walked from his office to Thomas Jefferson University Hospital to make rounds one morning last week, he noticed a smudged but neatly addressed package for Jefferson in the middle of the street. A bystander told him a deliveryman had dropped it. Babinchak picked it up and took it to the hospital information desk. In these times when people are so anxious about anthrax, he figured he had saved the Philadelphia police a hassle.

Then Babinchak, trailed by a cadre of doctors in training, was off to several hours of visiting dreadfully ill patients with everything from AIDS to bed sores.

It was a typical day for him, in atypical times. After the World Trade Center and Pentagon attacks, the anthrax cases in Florida and New York have heightened awareness that terrorists could use germs instead of airplanes next time. Doctors such as Babinchak, who are experts on obscure diseases, are likely to be among the first to figure it out.

Since Sept. 11, infectious-disease specialists at six sentinel hospitals in Philadelphia - Jefferson, the Hospital of the University of Pennsylvania, Hahnemann University Hospital, Temple University Hospital, Medical College of Pennsylvania Hospital, and Albert Einstein Medical Center - have been asked to report each day to the city Health Department about patients with pneumonia, meningitis, blood infections, diarrhea, botulism-like syndromes or rashes with fever, and people who die with "unexplained fever."

Such viral and bacterial illnesses, often involving surgical patients and people with chronic diseases, are seen all the time in hospitals, but now they are getting extra scrutiny because of the possibility that their symptoms are manifestations of a biological attack.

"We want to start hearing about things when it's even a suspicion," said Caroline Johnson, medical specialist with the city Health Department's Division of Disease Control. The hospitals are reporting 40 to 50 cases a day, she said, but none on closer look have turned out to be exceptional.

Babinchak, who typically sees about 20 patients a day, is among the doctors who report. On rounds last week at Jefferson, he went from floor to floor, checking charts and talking to doctors about surgical patients who were having complications and other people suspected of having infections.

Did any of his patients that day make him suspicious of foul play? "No more than I was when I picked up the box in the middle of the street," said Babinchak, who thinks average people should worry more about who is driving their children's school bus than about bioterrorism.

The medical community's awareness of the possibility of bioterrorism has been increasing for several years, he said. "We always look for those things, but, by the same token . . . I don't have a paranoia that everything I may see is a potential biological pathogen."

He said his years of training and experience would help him differentiate between patients with more mundane pneumonia and anthrax victims. Babinchak said doctors would find anthrax, a bacterial disease that starts with flulike symptoms, by doing "all the routine things we do every day."

Doctors in the Philadelphia area paid special attention to the threat of biological assault during the Republican National Convention last year. The systems put in place then serve the region well now, public health officials said. Also, some health departments already were on extra alert this summer because of West Nile virus, a viral disease transmitted by mosquito bites.

In both New Jersey and Pennsylvania, doctors already are required to report about 60 diseases, including plague and smallpox, that could be used as weapons. The idea of the enhanced reporting is to pinpoint a potential problem even before a diagnosis is made. A health department receiving similar reports from several hospitals might be quicker to spot a dangerous trend than would an individual hospital.

While other area health departments have not asked doctors to report as frequently on suspicious cases as Philadelphia, they have sent out notices describing possible bioterrorism agents. Health departments in Bucks and Montgomery Counties are making more frequent contact with infection-control officers in area hospitals, hoping that will help them identify patterns more quickly. In New Jersey, the health departments in Newark and in Bergen and Middlesex Counties are taking similar measures.

Andre Weltman, a public-health physician with the Pennsylvania Health Department, said doctors everywhere were on the lookout. "Obviously, every physician in the country and every physician in Pennsylvania knows what's going on," he said. "Everyone's on alert for anything unusual in their clinical practices."

Because some possible biological agents first appear as flulike symptoms, Weltman is hoping more doctors will use quick tests to identify patients who really have the flu this winter. Sorting out truly worrisome cases will remain difficult, though, because many other winter bugs have similar symptoms.

Lewis Polk, director of the Bucks County Health Department, said that, until recently, most doctors could assume that their patients were suffering from naturally occurring diseases. That no longer is true.

"We're just trying to say everybody should have what they call in medicine 'a heightened index of suspicion,' " he said. "We can't just follow the familiar paths."

Roger Pomerantz, Jefferson's chief of infectious disease, agreed. "You're going to have to start thinking about diseases that you didn't think about other than as a rare disease on a test question on the infectious-disease boards," he said.

In a move he would have found unthinkable before Sept. 11, Pomerantz is thinking about seeking funding to develop a more effective anthrax vaccine, which is not available to the general public.

He also is wondering if his department should begin studying smallpox again. "There are issues in bioscience we thought were dead," he said, "and clearly are not."

-- Andre Weltman (, October 15, 2001


Thanks for this article. Its quite reasuring to know that people like you are out there on the front lines, and watching. suzy

-- suzy (, October 16, 2001.

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