Dire straits: Plague released at concert

Tabletop scenario from first case to aftermath

Bioterrorism
Watch

Highlights of a recent bioterrorism tabletop exercise run by planners in Ohio included the following timeline of events:

Sunday, March 17, 2002, Portsmouth, OH

8:00 a.m.: At the emergency department (ED) of Southern Ohio Medical Center (SOMC), a doctor has just come on duty and sees her first patient, a 22-year-old woman. The patient’s sister says the woman has been complaining of chest pain and has a temperature of 102 degrees F. The sister worries that the patient may have caught the "bug" through her position at the Shawnee State University (SSU) dormitory mailroom where she works part time. A rapid flu test shows a negative result.

The physician is suspicious in light of the national anthrax cases five months earlier and orders a sputum and blood culture. Transport assistance is requested for sending the cultures to the Ohio Department of Health (ODH) laboratory for anthrax testing. The woman is admitted. The Portsmouth City Health Department and Scioto County District Board of Health are notified of the situation. In turn, the ODH and Ohio Emergency Management Agency (EMA) duty officer are called.

2:00 p.m.: The 22-year-old woman admitted to SOMC earlier this morning develops severe respiratory complications and dies. A full autopsy is ordered, and the physician awaits the preliminary results of the sputum and blood cultures. As the day progresses, local emergency medical services (EMS) become overwhelmed with patients presenting with flu-like symptoms. People presenting with the most severe symptoms, including high fever and difficulty breathing, are hospitalized; however, with many more sick waiting in the ED, the hospital beds and wards are filling rapidly.

5:00 p.m.: Traffic around SOMC becomes impassible, and several ambulances are severely hindered. Medical facilities request security assistance from local law enforcement agencies.

10:00 p.m.: Six patients admitted during the day with the severe flu-like symptoms also die. New cases continue to arrive at SOMC with an increase in the number of patients reporting each hour.

Monday, March 18

8:00 a.m.: Overnight, a public health emergency was declared in Scioto County. A request was made by Scioto County Health, via the Scioto County EMA and elected officials for state support in the growing crisis.

A Level 2 emergency status is reached in Scioto County. The state assessment room is activated to support the events in Scioto County.

10:00 a.m.: The preliminary tests of clinical specimens taken from the 22-year-old woman who died Sunday are complete. The ODH Lab notifies the local health departments that the specimens have tested negative for Bacillus anthracis. The laboratory begins rule-out testing for other pathogens.

3:00 p.m.: Epidemiological evidence points to an event three days earlier as a common activity of the majority of new patients. On Friday, March 15, a popular regional band performed at SSU in Portsmouth. The band is well known for use of visual enhancements. Approximately 2,000 students and community members attended the concert.

4:00 p.m.: Hospital supplies are insufficient to meet demand. Fifteen additional patients have died, and 111 are listed in critical condition. Reports now include similar symptoms among several health care workers and first responders. SOMC hospital beds are full.

5:30 p.m.: ODH Lab staff notifies Scioto County local health officials that the 22-year-old patient’s cultures are preliminarily positive for Yersinia pestis. Local health officials inform local health care professionals and EMS personnel that, in order to prevent the spread of disease, patients having confirmed pneumonic plague should be isolated until sputum cultures are negative for Y. pestis bacilli.

Those suspected of having pneumonic plague should be isolated for 48 hours after antibiotic treatment begins.

Wednesday, March 27

It has been 10 days since the first victims arrived at SOMC and local clinics. There have been no further cases of illness identified in Scioto County in the past seven days.

Waiting for signs of recovery

Resources begin to flow into the area as a result of national public outreach. Visitors, however, avoid the area and the impact of the event on the local economy becomes apparent as local businesses are slow to reopen.

The psychological manifestations associated with this event are widespread. Although school reopens, many students withdraw from classes for the quarter. Local residents, still frightened and shocked, look to local and state officials for guidance as they attempt to return to normalcy.