DC attack: Anthrax rumors turned up pseudopatients’

Hospitals were on alert for bioterror before 11th

In a stark commentary on the state of the world, some hospitals in Washington, DC, had implemented syndromic surveillance for the commonly suspected bioterrorism agents days before a hijacked airliner struck the Pentagon on Sept. 11, 2001, Hospital Infection Control has learned.

Health care facilities were geared up because of threats circulating to disrupt an upcoming meeting of the International Monetary Fund (IMF), which cancelled its planned conference after the terrorist attacks on the 11th, says Allan J. Morrison Jr., MD, MSc, FACP, a bioterrorism expert and health care epidemiologist for the Inova Health System in Washington, DC.

"Protests have become much more violent and disruptive," he says. "There were vows by members of organizations who commonly protest the IMF and the monetary policies to bring Washing-ton to a standstill. That heightened the concern about a possible bioterrorism event to the extent that the syndromic surveillance was felt to be appropriate. So, those plans were already under way." 

Thus before and after the attacks, participating hospitals in Washington were on a bioterror alert along with health departments, clinics, emergency departments, urgent care centers, and sentinel primary care physicians, he says. "There was also an increased linkage with a regional medical examiner’s office because autopsy findings could be a sentinel event," Morrison adds.

The Inova Health System comprises four hospitals in the District of Columbia area, including one in Alexandria, VA, that received some of the Pentagon victims. "As the epidemiologist for the health system, I was in my office when the first reports came over," Morrison says. "We had just come back from an infectious disease section meeting at Fairfax Hospital."

Immediately after the attack, the hospital put disaster plans in place that included rapid discharge of patients to free up beds for potential causalities. Unaware of what they might be dealing with, Morrison and colleagues determined how many negative and positive pressure isolation rooms were available in the hospital system. "We did an infrastructure resource review in case of a hemorrhagic virus or, God forbid, smallpox," he says. "Early on, there were rumored reports that there had been anthrax released [at the Pentagon]."

The result of that rumor was an influx of "pseudopatients," he says. "People who were down in that area — because of the smoke and dust and rumors about a biologic release — presented to be evaluated for health care fearing that they had been exposed to a biologic [pathogen]." Morrison says. "This happened in Japan with the sarin [gas] release in the subway. You have a lot of real patients and then you get pseudopatients. They tend to outnumber the actual patients by a factor of about two to one or three to one."

Those patients were more in need of mental health care, chaplain services, and general emotional support, he says. "They are patients, but they are not [physically] sick. They have tremendous angst. Having said that, they are still a burden to the health care system trying to provide care for the real patients."

All measures went smoothly, but Morrison is far from convinced that the city is ready to deal with a bioterrorism event. "The caveat is that we didn’t have the pressure of hundreds or thousands of people presenting at our doors," he says. "We had the concern that it might be true, but not the actual event. It was physical disaster, not a biologic disaster," he points out. "I don’t want to take too much comfort in the orderliness that took place, because I am not convinced that we are at the place we need to be."