Just as “disasters are an opportunity for development”, the Second World War is known to give birth to “huge advances in medical knowledge and surgical techniques”. This article would provide you with the highlights in history of the friendly use of medicine out of which some good and bad has resulted.
If I poisoned your fields with bio-agents as an answer to your attempt to poison mine, it can be duly regarded as good and bad. Biological warfare is a deliberate use of various agents to spread disease amongst plants, animals, humans and everything and anything.
Some of the most common and deadly agents known to have wiped out populations are as follows: Among bacteria are Anthrax, Plague, Tularemia, Brucellosis, Q Fever; among viruses are Smallpox, Viral Equine Encephalitis and those responsible for Hemorrhagic Fever (Filo/Flavi Viruses); and toxins include Ricin, Botulinum, Mycotoxins and Saxitoxin.
Wars forced companies to develop highly effective medicine and techniques on an industrial scale. Pre-war penicillin discovery by Sir Alexander Fleming increased the chances of survival of appalling casualties and henceforth the treatment. In addition to pioneering the work on skin grafts and blood transfusion, refining in the war years were preventive medicine for malaria, tetanus, gangrene, pneumonia and gonorrhea.
HISTORY OF BIO-WEAPONS
The Romans attempted the first ever use of biological weapons (BW) by poisoning water supply of the enemies using battered animals. Later, this thought was elaborated by the Mongols in 1346 that used corpses infected with plague instead of animals to stretch a bigger picture. In 1710, the Russians defeated Swede enemies by plague-infected corpses. The British didn’t lag behind who in 1767 aided the Indians with blankets initially used to protect smallpox victims.
A popular weapon, Anthrax, was first used by the Germans in 1916. They also used Glanders, which is an infectious disease caused by Bacterium Burkholderia Mallei, to infect equestrians and feed to the allied forces. Romanian sheep, Argentinean mules and American horses, all had been used to feed the human agenda.
The Japanese stepped in to poison Soviet water supply with intestinal typhoid at the former Mongolian Border in 1937. Ever since Japan began its offensive program, at least 10,000 prisoners have given their lives. Japanese plague-fans dropped rice and wheat mixed with plague carrying fleas over China and Manchuria.
In 1942, the US began their biological offense program. Various tests were conducted henceforth in San Francisco and New York. Germans too tasted the use of offense in 1945 followed by Iraq which embarked to develop a biological offensive program which included toxins like botulium toxin, aflatoxin and anthrax.
In 2001, the anthrax attacks in the United States, also known as Amerithrax, occurred over the course of several weeks beginning on Tuesday, September 18, 2001, one week after the September 11 attacks. The Daschle Letter containing 2gm powder in an envelope, with 100 billion – 1 trillion spores (10 (11) – 10 (12) cfu), was mailed to several media offices and two Democratic US senators, killing five people and infecting 17 others.
There are several reasons why many advocate bioterrorism. A biological agent self-replicates within the victim, has relatively low costs of production, requires a small dose (1gm of toxin could kill over one million people), appropriate particle size and stability in aerosol, ease of dissemination, insidious symptoms, prolonged incubation period and difficult detection. Owing to multiple feasibility features, a biological attack could be planned and placed on a moving or stationary position. The ease of modes (frozen/dried) and methods of delivery (bomblets) are also contributing factors.
Biological Weapons still depend upon the susceptibility of the aggressors and Mother Nature; temperature and sunlight, environment persistence of some agents like anthrax, relatively longer incubation period, advanced and specialized infrastructure for development among others maybe limiting parameters. Not only are a wide variety of biological agents genetically being modified to withstand antibiotics and other treatment regimens, but also mocking sensitive detection systems.
I find it extraordinary to have SARS, MERS and other challenging diseases with resistance patterns escalating regions. Some are difficult whereas some are easy to grow; incapacitating agents like VEE, Bacillus Anthrax, Plaque, Yersinia and various forms that cause Hemorrhagic fever have high fatality rates once established in a non-immune host.
Viruses are quite attractive weapons for both engineering and harvesting techniques, which is a rather effortless treatment complexity. If you sense an unusual disease entity, large numbers of civilian and military casualties, aerosol route, morbidity limited to the localized geographical area and multiple dead animals, run for your life!
The unusual pattern of victims showing at a health site and vague clinical features should raise suspicion for a covert biological poisoning. Accessible laboratory screening should be implemented immediately and common bio-agents should be cultured by standard methods until specifications can be made available.
There are more specific methods for mass spectrometry of toxins, antibody and antigen tests, DNA probes and detection of metabolic products. Vaccines, anti-virals, antibiotics and other antidotes should be available en masse to avoid overwhelming supplies. Common sources like food and water should be protected, vector control measures, indoor movement, issuing Personal Protective Equipment may all be temporary measures.
Conventional decontamination methods like chemical, heat or UV may also be utilized. Such detention tactics are deemed impractical and reason for terrorists to continue to implement attacking strategies. Development of the public health systems, public education and programs (workshops/drills), governmental incentives for research and development into biological attack and countermeasures since biological weapons are now being engineered, all have been undertaken to forbid the use of biological weapons.
The strategies have been targeted to enhance disaster preparedness and response capacity, when initiatives should strictly be taken to promote preventive tactics, interdicting arsenal, registering/documenting purchases, imposing strict penalties and regular screening and inspection of suspected regions. Disaster management should come into action when a biological intervention is suspected. Disaster management should be an integrated system of hospital management.
PREVENTION FOR BIOLOGICAL WEAPONS
Dr Rezwan Naseer, General Director of Punjab Emergency Service (Rescue 1122), proposed a disaster preparedness program. Dr Naseer anticipated a safety community development program through injury prevention research, school safety program, community safety officers and teams. The program is to expand to other provinces of Pakistan; in Khyber Pukhtunkhwa (K-P), Azad Jammu and Kashmir (AJK), Gilgit-Baltistan (GB) and Balochistan.
Dr Sheraz Afridi, Accident and Emergency – Khyber Teaching Hospital, introduced a course called Major Incident Medical Management Support (MIMMS). The aim of such a service was to provide the knowledge and skills needed to effectively manage the scene of a major casualty incident supported by a “methane message” for better understanding.
M: My call/sign/name – major incident STANDBY or DECLARED
E: Exact location
T: Type of incident
H: Hazards, present and potential
A: Access and egress
N: Number of severity of casualties
E: Emergency services – present and required.
Certain systems which have been developed to detect biological attack are: SMART (Sensitive Membrane Antigen Rapid Test) JBPDS (Joint Biological Point Detection System) BIDS (Biological Integrated Detection System) IBAD (Interim Biological Agent Detector) and The Tactical Biological Standoff Detection System.
Bio-terrorism Outlawing Washington Conference (1921–1922), the Geneva Conference (1923–1925), and the World Disarmament Conference (1933) forbid the use of biological weapons.
However, the Geneva Protocol did not prohibit the development, production and stockpiling of biological weaponry. Failure to decommission the arsenal is perhaps best illustrated by the super powers. There are several events in history of a seemingly incidental or offense-free warfare, while pushing agendas for peace, sponsoring and staging attacks and establishing grounds for hostile purposes.
But when our great doctors, health workers, activists and freedom fighters rising to the challenge of the civilian war magnificently are being shut out from raising their voices, then who am I write this piece on warfare?
About the author: Dr Eman A Khaled is currently working as a Junior Resident in Diagnostic Radiology, Karachi, Pakistan. She is originally from Barcelona, Spain and also works with Pfizer and Pakistan Red Crescent Society. She is also involved in clinical research at King Fahd Medical and Research Center, Saudi Arabia.