March 2002 • Volume 8 • Number 3 |
 Raymond Weinstein, M.D., juggles a busy family practice in Dale City, Va., with his bioterrorism preparedness activities. |
Most days you'll find FP Raymond Weinstein, M.D., in his Potomac Family Health offices in Dale City, Va. As a member of a five-physician primary care group spread across three office locations, Weinstein spends the lion's share of his time seeing patients.
But on the first Tuesday of every month, you can pretty much count on finding him in a wholly different setting.
"I founded the Potomac Hospital/Greater Prince William County Chem-Bioterrorism Preparedness Committee in 1999 to help prepare Potomac Hospital for the possibility of a chemical or biological terrorist attack," explained Weinstein. "Although everyone thought this was an extremely remote possibility, and I initially had trouble getting doctors in the community to participate, I felt there was enough of a chance that it was worth the effort."
He started the committee with two other staff physicians from Potomac Hospital in Woodbridge; the hospital's infection control nurse; the local district director of the Virginia Department of Public Health; and Weinstein's son, a paramedic. But the committee now encompasses a far more diverse group. Representatives from HHS, CDC, FBI, Red Cross, local emergency response teams and others join community physicians and infection control and ER staff at the committee's monthly meetings at Potomac Hospital.
"We've grown to directly serve the two hospitals in the county, plus the local Kaiser outpatient facility and several hospitals in other counties," Weinstein said. "We also serve the medical community in the entire region with educational opportunities and materials."
Weinstein is an active member of the Metropolitan Washington Council of Governments Bioterrorism Task Force. Barely a fortnight before the Sept. 11 attacks, the task force completed a regional defense planning guide, an endeavor that had been in the works for two years.
"I believe all the preparation paid off, since this area was ground zero for the anthrax attacks, with seven of the 11 inhalational anthrax victims," said Weinstein. "Three of the victims were right from this community, and all were properly and quickly diagnosed, and all survived. I would like to think that our planning, preparations and educational efforts were at least partially responsible for our success."
Those efforts were apparent at the committee's Feb. 5 meeting, when Weinstein delivered a comprehensive overview of smallpox. In developing the presentation, he consulted with D.A. Henderson, M.D., a member of the World Health Organization team that successfully worked to eradicate the disease as of 1980, and now director of the HHS Office of Public Health Preparedness.
How bad would a bioterrorist attack with smallpox be? "It's the worst possible thing that could happen," said Weinstein. The extreme contagiousness of the disease, coupled with its multiple forms and the difficulty of treating those affected, have made it a focus of CDC's bioterrorism preparedness planning.
Weinstein's view is shared by others on the committee, notably Jared Florance, M.D., director of the Prince William Health District, based in Manassas, Va. Florance delivered the public health complement to Weinstein's address at the meeting.
INTERFACING WITH PUBLIC HEALTH
Understandably, said Florance, a primary concern of public health officials is disease surveillance by individual physicians, both in hospitals and out in the community. "Right now we rely on their intuitive surveillance. I get calls from docs all the time saying, 'This event is weird; it's something different,'" he said.
But other surveillance methods may be in the offing, Florance said, namely, using diagnostic codes to pinpoint suspicious disease outbreaks. "Everybody codes, right? Well, at some point we may be looking for ways to gather that information." Tracking certain codes could permit early identification of a potential disease cluster, allowing public health officials to interrupt the spread of disease.
"That's our end of it, which relies on information from the wider medical community, not just the ERs," said Florance. "What we're missing right now is a way to get that information from them to us in a way that doesn't add burden."
 FP Ray Weinstein, M.D., left, and Jared Florance, M.D., director of Virginia's Prince William Health District, discuss integrating the medical community with the public health system to respond to potential bioterrorist attacks. |
MAKING CONNECTIONS
Help is on the way, Florance added, citing HHS' recent announcement of major funding to shore up state public health systems and help create that critical liaison to the private medical community.
"That's exactly what we've been talking about," agreed Bowman Olds, a senior consultant and analyst with Science Applications International Corp. of McLean, Va. "How do we connect the local with the state with the federal system?"
Olds, a member of the team in charge of security for the 2002 Winter Olympics in Salt Lake City, said there is no one finger to be pointed for the confusion generated by last October's anthrax cases. "It's not just public health that was caught unprepared," he noted. "It was everybody.There've been some valuable lessons to be learned, and we're going to continue to learn -- as long as we can recognize that fact."
"This may be a time to reach out," said Florance. "It doesn't take very many people in a community to say, 'How can we help you if this happens?' You've got a lot of family physicians who've got M.P.H.s or who have other skills. I can't think of a place where they'd be more helpful."
"Doctors need to be able to recognize a bioterrorist attack, know how to react to it and not be afraid of it," Weinstein said, virtually echoing the description of the sentinel family physician given last fall by AAFP President Warren Jones, M.D., of Ridgeland, Miss. "We (the committee) are the only group I know of that's collecting information, creating and utilizing preparedness plans, providing education, and promoting communication between the private medical community and the public health community -- which is critically important when you're dealing with bioterrorism," said Weinstein.
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.