Are We Prepared For Biological Threat

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Are We Prepared For Biological Threat ?

• Alistair
• McGregor

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Never apologise, never explain

• The Singing Detective
• Dennis Potter

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Are We Prepared For Biological Threat ?
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NO !
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Biological Threat / Bioterrorism

• What are we talking about ?
• biological agents
• key properties ( CDC )
• morbidity / mortality
• ease of transmission / distribution
• public panic / social disruption
• requirement for special public health action

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Biological Threat / Bioterrorism

• Natural v Engineered
• Incidental v Deliberate
• DOES IT MATTER ?
• Police, Army, ASIO Yes
• Public Health, Hospitals NO

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A BUG IS A BUG IS A BUG

• ( OR IS IT ? )

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COMMUNICABLE v BIOTERRORISTBUGS

• Notifiable
• MROs (eg VRE)
• IMD
• Influenza A
• SARS
• etc, etc, etc

• CDC Category A
• Anthrax
• Botulism
• Plague
• Smallpox
• Tularemia
• VHFs

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STATE v COMMONWEALTHBUGS

• Notifiable
• MROs (eg VRE)
• IMD
• Influenza A
• SARS
• etc, etc, etc

• CDC Category A
• Anthrax
• Botulism
• Plague
• Smallpox
• Tularemia
• VHFs

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BUT WHAT IF THE BUGS GET CONFUSED ?

• Notifiable
• MROs (eg VRE)
• IMD
• Influenza A
• SARS
• Anthrax, Botulism, Plague, Smallpox, Tularemia,
  VHF

• CDC Category A
• Anthrax
• Botulism
• Plague
• Smallpox
• Tularemia
• VHFs

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Bioterrorism in Hobart - Part 1

• October 2001 White Powder Incidents
• October 2002 Bali
• In response
• high level interdepartmental group established
• Commonwealth input
• planning, training, equipment, exercises with a
  focus on emergency response
• ongoing activities

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But meanwhile back at the RHH ..
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Bioterrorism in Hobart - Part 2

• October 2001 IMD ( Type C )
• 5 dead, several disabled
• rapid widespread transmission
• public panic
• social disruption
• special public health action required

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Bioterrorism in Hobart - Part 2

• November 2001 MRSA
• rapid widespread transmission at RHH
• public panic (?)
• disruption of hospital services
• wards closed, surgery postponed

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Bioterrorism in Hobart - Part 2

• March 2003 SARS
• August 2003 Influenza A
• 3 in ICU, staff affected
• October 2003 NLV2 ( Noro virus )
• gt50 patients
• gt100 staff

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Bioterrorism in Hobart Post September 11

• Commonwealth Bugs
• White Powder / Anthrax
• CBR Committee

• State Bugs
• IMD
• MRSA
• SARS
• INFLUENZA A
• NLV2
• RHH (PH)

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Biological Threat - Where are we at?

• Good individual components
• Emergency services
• Public Health
• DEM
• RHH Infection Control
• but a complete disconnect

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DISCONNECT(Or is the brain bone connected to
the reality bone ?)
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DISCONNECT

• Commonwealth - State
• Community - Hospital
• Emergency response - Ongoing care
• Hospital - Hospital

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Biological Threat - The RHH

• Lack of essential infrastructure
• DEM decontamination, isolation facilities
• Wards isolation wards / areas
• Laboratory capacity PC 2 only

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Biological Threat - The RHH

• Inappropriately organised
• No ownership of Infection Control
• Code Brown inappropriate for this scenario
• Need BT SWAT teams
• Under resourced
• people, equipment, training

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Are We Prepared for Biological Threat ?
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NO and YES
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YES

• Do run of the mill stuff very well
• MROs ( MRSA, VRE )
• Healthcare associated infections
• surgical site infections
• outbreak control
• Excellent Infection Control Unit
• Well supported by Public Health

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NO

• We would struggle to cope with any significant
  outbreak, particularly of an airborne agent, be
  it deliberately engineered or not.
• Manage but at what cost ?

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The Somme
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Biological Threat - What do we need?

• Hard decisions and straight answers
• Better integrated, generic approach
• Resourcing
• Leadership

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Gallipoli
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