Re: WNV and Bioterrorism

Very interesting idea about Albanian refugees. The timing and geography are right. Having people settle along
Pelham Parkway (in proximity to the Bronx Zoo where the first bird deaths were identified) and in the right part
of Queens, is certainly suggestive. It should be easy enough to test with a serosurvey of both Albanian visitors
and non-Albanian neighbors.

I am surprised that there isn't a lot more serosurvey work being done. There is a fair literature on serosurvey
studies in Africa and the Middle East. Those serosurvey results which have been published are awkward to
interpret because they don't publish complete data (number and age distribution of people tested and number of
positive in each subgroup).

The interstate trucking connection is also feasible, although if you had only one infected mosquito biting one
bird, it would take more than one year to set up an avian epizootic, much less a human outbreak..

I suspected that WNV had been in the NY area for 2-3 years prior to 1999 (so the Albanian arrival is OK, but a
little tight). I figured that by 1999 when we had the NYC epidemic, the virus was present over a much wider area
in birds----perhaps even up and down the entire Atlantic coast. This may be testable if people had saved
archived specimens (bird or human) for other purposes.

Mike Gochfeld

"Patricia Doyle, PhD" wrote:

> Hello Dr. Gochfeld: I had an interesting email exchange with a doctor who,
> when in government service, resettled refugees. He suggested that it was
> quite possible for WNV to have silently arrived with Albanian refugees prior
> to 1999. It could have been here since 97 or 98.
> Another thought, is that the westward push has been helped by humans. I am
> not referring to intentional, but rather, spread inadvertantly. Mosquitos
> can hitch rides along the interstates. I recently did a radio show on the
> subject and a caller to the show said that he had been one of Ohio's WNV
> victims. I asked if he lived near an interstate and he, with a bit of
> question in his voice, replied "yes, less then a mile." Another caller to
> the show was a long haul trucker and he stated that when he arrives at
> various destinations he finds all sorts of insects near the radiator etc.
> Then, we can also think about semi open animal lorees traveling the
> interstates with buckets of water and straw and hay for animals.
>
> During the summer there is much more interstate vacation travel, especially
> this year since many people opted for a US vacation. It only takes ONE
> mosquito infected in NY or Ohio to bring the virus west. If you combine
> this with the possibility that the virus was brought here with Albanian
> refugees one or two years earlier, then it is a bit easier to understand.
> Incidently, some of the Albanians settled in the Pelham Parkway section of
> the Bronx, some in Queens, around Astoria, New York. I lived in Yonkers and
> there was a large Albanian community there as well and I am sure, also in
> New Jersey.
>
> Patricia Doyle
>
> >From: Michael Gochfeld <gochfeld@eohsi.rutgers.edu>
> >Reply-To: gochfeld@eohsi.rutgers.edu
> >To: lcl3@cornell.edu
> >CC: WESTNILEVIRUS-L@cornell.edu
> >Subject: Re: WNV and Bioterrorism
> >Date: Fri, 13 Sep 2002 13:55:41 -0400
> >
> >During the first few weeks when WNV was first detected in New York fall,
> >1999 someone raised the spectre of biological terrorism. It is hard to
> >imagine an organism less well-suited to biological terrorism----yet,
> >even unintentionally it certainly created panic. Ironically, if you
> >compare the news clippings from Sept-Oct 1999 for WNV with the clippings
> >of Oct 2001 for Anthrax, you would get the impression that WNV was a
> >better terrorizing agent. Ironically, too, the number of deaths was on
> >the same order of magnitude (7 vs 5). But before we let this ARBO
> >virus off the hook, let's remember that Venezuelan Equine Encephalitis
> >virus was developed for biological warfare. So it's not out of the
> >question. It was an "incapacitating/non-lethal" virus which was
> >developed as a first strike agent.
> >
> >According to the Judy Miller book GERMS, the reason that the US decided
> >not to use incapacitating agents is that enemies might still consider
> >this germ warfare and might respond with a lethal agent.
> >
> >I'm not sure what authorities Leahy was referring to (CDC or FBI), but
> >it would certainly be nice to have research into how WNV moved so
> >quickly westward (about twice as fast as I predicted). A logical
> >assumption is that it was moving ahead of the documented occurrences or
> >inother words that it was already present in an area for 1-3 years
> >before cases were first identified. Perhaps retrospective examination
> >of archived blood specimens might answer this question. As I've
> >previously mentioned, this was done successfully with Legionaires
> >disease which was found to have occurred prior to the recognized
> >outbreak in 1975.
> >
> >Mike Gochfeld
> >
> >Lois Levitan wrote:
> > >
> > > (1) NYTimes article: "Vermont Senator Wants Study of Terror Link to
> > > West Nile Virus"
> > > (2) Lois Levitan, comments on "Terror Link to West Nile Virus"
> > > (3) Science Commentary: "Enhanced: Public Health vs. Civil Liberties"
> > >
> > > (1)
> > > NYTimes Sept 13, 2002
> > > Vermont Senator Wants Study of Terror Link to West Nile Virus
> > > By CHRISTOPHER MARQUIS
> > >
> > > WASHINGTON, Sept. 12 - Senator Patrick J. Leahy, Democrat of Vermont,
> > > said today that the authorities should examine whether the spread of
> > > the West Nile virus in this country is a result of biological
> > > terrorism.
> > >
> > > "I think we have to ask ourselves: Is it a coincidence that we are
> > > seeing such an increase in West Nile virus, or is that something that
> > > is being tested as a biological weapon against us?" Mr. Leahy, who is
> > > chairman of the Senate Judiciary Committee, said in a radio interview
> > > in Waterbury, Vt. "There are some people, credibly, who feel that it
> > > is a test of our defenses and is a biological weapon or somebody
> > > doing this for commercial purposes."
> > >
> > > -----------------
> > > (2)
> > > In today's New York Times, Senator Patrick Leahy is quoted as asking
> > > for investigation into the possibility that the current WNV outbreak
> > > is a result of biological terrorism. This question was asked before,
> > > at the time of the initial WNV outbreak in NYC in 1999.
> > >
> > > Evidence (and logic) indicated that the answer is "no," although I do
> > > not know if the rejection of this hypothesis has been expressed
> > > formally and/or officially. In press briefings in that first year,
> > > CDC listed bioterrorism as one of the possible means by which WNV
> > > might have entered this country, but spokespersons did not seem to
> > > support the hypothesis nor to bring it up more recently.*
> > >
> > > An article in the New Yorker -- "West Nile Mystery: How did it get
> > > here? The C.I.A. would like to know." Richard Preston. Oct 18 & 25,
> > > 1999 -- focused attention on this hypothesis, but presented a body of
> > > evidence that essentially rejected it. For example:
> > >
> > > "An Army expert on bioweapons told me [Richard Preston] that the
> > > military has known for some time that Soviet biologists working for
> > > the USSR's biowarfare program had evaluated the West Nile virus for
> > > use as a biological weapon. 'The Russians did this kind of crap back
> > > in the seventies...They abandoned it because it didn't work very
> > > well...'"
> > >
> > > "I [Richard Preston] spoke with a person at the CDC who said 'We're
> > > taking it seriously. We'll see where the data takes us. It could be
> > > done. You'd have to bring in a lot of mosquitoes....' He went on,
> > > 'But West Nile is not a great biological weapon because it doesn't
> > > hurt most people very much.' "
> > >
> > > Before this call for investigation goes too far, in terms of
> > > allocating resources or feeding panic, some key characteristics of
> > > WNV should be recalled:
> > > ---WNV is primarily a disease of birds that cycles between infected
> > > birds and mosquitoes;
> > > ---historically only sporadic outbreaks have affected people (and <
> > > 1% of people infected become seriously ill);
> > > ---with the possibility of only rare exceptions, people are "dead end
> > > hosts" to the virus and can't pass it on to other people or to
> > > mosquitoes that bite them (i.e., it is not highly infectious);
> > > ---with the exception of horses, WNV does not seem to affect domestic
> > > animals nor animals of commercial value (livestock, poultry), so is
> > > unlikely to disrupt the domestic food supply or to affect food
> > > security;
> > > ---the elderly population at greatest risk from serious WNV illness
> > > would generally not be considered a key target of one's enemies.
> > >
> > > *Other candidates for carrying the WNV into the US that were
> > > mentioned by CDC at that time included: infected mosquitoes, people,
> > > legally or illegally imported birds, or birds migrating across the
> > > Atlantic Ocean. Ornithologists have said that the last mentioned of
> > > these would be extremely unlikely, and would have caused a very
> > > excited stir in the bird-watching community had it been seen. More
> > > recently, in a March 5, 2001 National Public Radio interview, a CDC
> > > scientist reported on results of a simulated probability model that
> > > pointed to infected frogs from Western Asia as the most likely means
> > > of WNV entry into the US. Little has been heard about this
> > > hypothesis since. Most persons talking about this subject in recent
> > > years have repeated that the answer is simply not known--e.g., CDC's
> > > Petersen and Marfin introduce their recent publication "West Nile
> > > Virus: A Primer for the Clinician" (2002) by saying "It remains
> > > unknown how the West Nile virus came to North America."
> > >
> > > Lois Levitan
> > > Cornell University
> > > Center for the Environment
> > > Environmental Risk Analysis Program
> > >
> > > ----------------
> > > (3)
> > > Science 297 (5588, Sep 13 2002): 1811.
> > > Science and Policy
> > >
> > > PUBLIC HEALTH:
> > >
> > > Enhanced: Public Health vs. Civil Liberties
> > > Ronald Bayer* and James Colgrove [HN9]*
> > >
> > > The history of American public health [HN1] is punctuated by
> > > controversies over the extent to which government may legitimately
> > > impose restrictions on liberty in the name of the common good and
> > > over the extent to which protection of the public's welfare has
> > > served as a pretext for erosion of fundamental rights [HN2] . The
> > > shattering of the illusion of American continental impregnability by
> > > the events of 11 September 2001, and by the subsequent anthrax scare
> > > have again provided the occasion for a debate over core values of
> > > public health, as proposals were made to enact a model emergency
> > > health powers act [HN3] that would have radically enhanced the power
> > > of the state.
> > >
> > > In the late 1990s, the threat of bioterrorism [HN4] surfaced as a
> > > concern of public health officials and experts (1, 2 ). Of special
> > > concern were inadequacies of the existing public health legal
> > > infrastructure. After 11 September, the Centers for Disease Control
> > > and Prevention called on its Collaborating Center for Law and the
> > > Public's Health at the Georgetown Law Center and the Johns Hopkins
> > > University School of Public Health to quickly prepare a model public
> > > health emergency act as a template to assist state legislators in
> > > updating their laws. On 30 October, a model act was released to the
> > > public (3).
> > >
> > > In the face of challenges that posed a "substantial risk of a
> > > significant number of human fatalities or incidents of permanent or
> > > long term disability," state governors were to be given the authority
> > > to declare a public health emergency, if necessary, without
> > > consulting public health officials. Governors could mobilize state
> > > militia and initiate a range of extraordinary measures that would
> > > last for 30 days and could then be renewed. The state legislature
> > > could intervene to override the executive decision only after 60 days
> > > and only by a two-thirds vote of both chambers. Health-care
> > > providers, medical examiners, and pharmacists would be required to
> > > report to public health authorities within 24 hours the name and
> > > other identifying information of individuals with conditions that
> > > could be related to bioterrorism or other fatal or dangerous
> > > infectious agents. The public health authority would be granted the
> > > right to "compel" individuals to undergo medical examination,
> > > testing, and vaccination or treatment. Those who refused were to be
> > > liable for misdemeanors and subject to isolation or quarantine.
> > > Health-care providers who refused to be party to such interventions
> > > were subject to criminal prosecution. In all, the act was a stark
> > > expression of the view that a public health emergency might
> > > necessitate the abrogation of privacy rights [HN5], the imposition of
> > > medical interventions, and the deprivation of freedom itself.
> > >
> > > Although some lawmakers endorsed the model act and moved swiftly to
> > > introduce versions of it in their state legislatures, many
> > > policy-makers and health advocates viewed it as a grave threat.
> > > Notable were proponents of civil rights and liberties [HN6] , those
> > > committed to protecting the privacy of medical information, and AIDS
> > > advocacy groups. George Annas of Boston University described the act
> > > as "the old Soviet model of public health (lots of power and no
> > > standards for applying it)" (4 ). The Association of American
> > > Physicians and Surgeons denounced the act, which "turns governors
> > > into dictators," permitting them to "create a police state by fiat"
> > > (5 ). Finally, with its authorization of mandatory vaccinations on
> > > penalty of criminalization and quarantine, it was inevitable that the
> > > act would draw the ire of antivaccination advocates (6).
> > >
> > > Cosmetic and substantive changes were evident in the second draft,
> > > released at the end of 2001 (7 ). For example, the act's subsection
> > > that described "control" of property and concerned those who viewed
> > > it as an invitation to unwarranted seizures, was now softened to
> > > "management" of property. The subsection dealing with compulsory
> > > powers over individuals was no longer termed "control of persons,"
> > > but "protection of persons." The new draft eliminated references to
> > > "epidemic and pandemic diseases" as events that could warrant
> > > declaring a public health emergency, as critics had asserted that the
> > > flu and AIDS could trigger such a declaration. The sweeping authority
> > > of the governor to impose a state of emergency with very limited
> > > legislative oversight was now subject to the possibility of an
> > > override by a simple majority of both legislative houses. Although
> > > mandatory reporting by name remained, some steps were taken to assure
> > > that the data would be protected from unwarranted disclosure and
> > > misuse. Criminalization of refusals to undergo treatment and
> > > vaccinations were gone, although those who declined such
> > > interventions would still be subject to isolation and quarantine.
> > > Gone, too, were criminal sanctions for physicians and other
> > > health-care providers who refused to impose treatment or vaccination,
> > > although their licensure could be endangered. The capacity to move
> > > swiftly was now surrounded by extensive due-process procedures.
> > >
> > > These changes satisfied some of those who had opposed the first
> > > draft. However, the New York Civil Liberties Union challenged
> > > virtually every provision of the revised act, arguing that the
> > > changes that had been made were inadequate and that the limited
> > > procedural protections and judicial review left open the possibility
> > > that fundamental rights could be violated (8 ). The Association of
> > > American Physicians and Surgeons denounced the new draft as a
> > > "disingenuous effort to mute criticism." The new draft still
> > > imperiled clinicians and those who owned medical facilities whose
> > > property and talent could be "commandeered." The revised act was
> > > "still a prescription for tyranny" (9) [HN7].
> > >
> > > It was against a backdrop of such fervid attacks and more sober
> > > critiques that the work of state legislatures took place. Although
> > > some states considered legislation based on the revised version,
> > > others moved to adopt even more scaled-back versions. By July 2002
> > > emergency health powers legislation had been passed in 19 states and
> > > introduced in 17 others (10) [HN8].
> > >
> > > The choice before us is the extent to which we are willing to limit
> > > liberty to face threats of uncertain but potentially catastrophic
> > > dimensions. In the 1980s, the AIDS epidemic had provided the occasion
> > > for the articulation of a new paradigm of public health, which
> > > contended that protecting public health and civil liberties were
> > > mutually compatible. For a behaviorally transmitted virus, it was a
> > > matter of strategic importance to engage those most at risk in the
> > > work of prevention. It was inevitable that, in the shadow of 11
> > > September, the conflict over rights and dangers would resurface,
> > > shattering the illusion that public health and civil liberties can
> > > exist in a conflict-free relationship.
> > >
> > > References
> > >
> > > 1. J. Bor, Baltimore Sun, 27 December 2001, p. 1A.
> > > 2. Cantigny Conference: State Emergency Health Powers and the
> > > Bioterrorism Threat, Cantigny Conference Center, Wheaton, IL, 26 to
> > > 27 April 2001; www. nationalstrategy.com/april%20conference.htm.
> > > 3. Center for Law and the Public's Health, The Model State
> > > Emergency Health Powers Act [Draft as of 23 October 2001] (Center for
> > > Law and the Public's Health, Washington, DC, 2001)[PDF].
> > > 4. G. Annas, letter to J. Hodge, 1 November 2001.
> > > 5. www.aapsonline.org/testimony/emerpower.htm.
> > > 6. www.909shot.com/PressReleases/prsmallpox.htm.
> > > 7. Later version of (3), draft as of 21 December 2001 [PDF].
> > > 8. New York Civil Liberties Union, "Testimony of Robert Perry on
> > > Behalf of the New York Civil Liberties Union before the Assembly
> > > Standing Committee on Health and the Assembly Standing Committee on
> > > Codes Concerning the Model State Emergency Health Powers Act," 14
> > > March 2002.
> > > 9. www.aapsonline.org/testimony/emerpower2.htm.
> > > 10.
> > > http://www.publichealthlaw.net/MSEHPA/MSEHPA_Leg_Activity_050102.pdf;
> > > some of these bills were not based on the model act.
> > >
> > > The authors are with the Center for the History and Ethics of Public
> > > Health, Department of Sociomedical Sciences, Mailman School of Public
> > > Health, Columbia University, New York NY 10032, USA.
> > >
> > > *To whom correspondence should be addressed. E-mail: rb8@columbia.edu.
> > >
> > > Numbered Hypernotes
> > >
> > > 1. Public health in the United States. A number of Web sites
> > > provide basic information about public health in the United States.
> > > The American Public Health Association site offers links to recent
> > > news, policy projects and legislation, and books, as well as its two
> > > monthly publications, The Nation's Health and the American Journal of
> > > Public Health. Press releases from the U.S. Department of Health and
> > > Human Services highlight government-sponsored public health
> > > initiatives and legislation. The U.S. Centers for Disease Control and
> > > Prevention site contains information on diseases and environmental
> > > health risks, and a subsection of the National Institutes of Health
> > > site is dedicated to health information. The National Health
> > > Information Center has a searchable Health Information Resource
> > > Database. Healthy People 2010 is a statement of national health
> > > objectives designed to identify and reduce treatable health threats.
> > >
> > > 2. Public health law. The Medical and Public Health Law Site
> > > sponsored by Paul M. Herbert Law Center at Louisiana State University
> > > offers an Introduction to Public Health Law. The Duke Health Policy
> > > Cyberexchange offers links to local and national government
> > > departments involved in health policy. The Center for Law and the
> > > Public's Health at Johns Hopkins and Georgetown Universities houses
> > > resources on public health law, ethics, and policy for public health
> > > practitioners, lawyers, legislators, policy-makers, and others. The
> > > site contains a comprehensive bibliography listing books on public
> > > health law, politics, and ethics. Thomas: Legislative Information on
> > > the Internet is a Library of Congress site that contains links to the
> > > full text of federal legislation, the Congressional Record, and more.
> > >
> > > 3. Model State Emergency Health Powers Act (MEHPA). The latest
> > > version of the Model State Emergency Health Powers Act (PDF format)
> > > can be accessed online, and a critical review of the proposed
> > > legislation is available on the Medical and Public Health Law site.
> > > The American Civil Liberties Union (ACLU) web site features a Q&A on
> > > MEHPA; and the Association of American Physicians and Surgeons (AAPS)
> > > site lists a number of articles on emergency powers legislation.
> > >
> > > 4. Bioterrorism. The U.S. Centers for Disease Control and
> > > Prevention have a special program dedicated to Bioterrorism and
> > > Public Health Preparedness. Facts, FAQs, and news updates on
> > > biological agents and threats can be found on the CDC's Public Health
> > > Emergency Preparedness & Response site. A special issue of Emerging
> > > Infectious Diseases was dedicated to Bioterrorism as a Public Health
> > > Threat. The Center for the Study of Bioterrorism at the St. Louis
> > > University School of Public Health provides a variety of links to
> > > bioterrorism-related information including educational materials,
> > > Internet resources, and journal articles. A Webcast of a symposium on
> > > bioterrorism is available through the Harvard School of Public Health.
> > >
> > > 5. Privacy of medical information. A fact sheet on Protecting the
> > > Privacy of Patients' Health Information was published by the U.S.
> > > Department of Health and Human Services. One of Lawrence Berkeley
> > > National Laboratory's projects on Ethical, Legal, and Social Issues
> > > in Science provides basic information about protection of medical
> > > privacy. The Electronic Privacy Information Center highlights news
> > > and legislation on medical privacy and includes a bibliography
> > > listing pertinent books and government reports. The Health Privacy
> > > Project web page of Georgetown University's Institute for Health Care
> > > Research and Policy provides links to introductory materials on
> > > health privacy, information about state and federal privacy laws, and
> > > numerous consumer and patients' rights organizations.
> > >
> > > 6. Public health and civil liberties. The American Civil Liberties
> > > Union posts an array of feature articles and resources on civil
> > > rights issues ranging from privacy to national security. The New
> > > England Journal of Medicine published an article entitled
> > > Bioterrorism, Public Health and Civil Liberties. An article posted on
> > > Harvard Public Health Now reviewed U.S. civil liberties and human
> > > rights since the attacks on September 11.
> > >
> > > 7. Attacks on the second MEHPA draft. The testimony of Robert
> > > Perry, executive director of the New York Civil Liberties Union, can
> > > be found at the NYCLU Web site, which also hosts a section on civil
> > > liberties after 9/11. The AAPS testimony on the MEHPA second draft
> > > can be found at the association's Web site.
> > >
> > > 8. State MEHPA legislation. The American Legislative Exchange
> > > Council is tracking the status of MEHPA across the United States and
> > > has also drafted a discussion report (PDF format) on the legislation.
> > > The text of MEHPA legislation from individual states is available
> > > online and the AAPS site includes links to information about state
> > > MEHPA legislation.
> > >
> > > 9. Ronald Bayer and James Colgrove are with the Center for the
> > > History and Ethics of Public Health, Department of Sociomedical
> > > Sciences, in the Mailman School of Public Health at Columbia
> > > University.
> > >
> > > Full text with links to resources and hypernotes:
> > > http://www.sciencemag.org/cgi/content/full/297/5588/1811
> > >
> > > --
> > > Lois Levitan, PhD Program Leader
> > > Environmental Risk Analysis Program
> > > Center for the Environment
> > > 213 Rice Hall, Cornell University
> > > Ithaca, New York USA 14853-5601
> > >
> > > Phone: (607) 255-4765 Fax: (607) 255-0238
> > > Email: LCL3@cornell.edu
> > >
> > > Program Email: envrisk@cornell.edu
> > > Web:http://www.cfe.cornell.edu/ERAP
> > >
> > >
> >-----------------------------------------------------------------------------------------------------------
> > > WESTNILEVIRUS-L is an email discussion group for communication
> > > and discussion about West Nile Virus, particularly regarding policy,
> > > risk reduction and public education issues. It is moderated by
> > > Dr. Lois Levitan at Cornell University's Center for the Environment.
> > > To subscribe (or unsubscribe), send an email request to
> ><envrisk@cornell.edu>.
> > > Subscribers can post to the group by sending an email to:
> > > WESTNILEVIRUS-L@cornell.edu. WESTNILEVIRUS-L readers are encouraged
> > > to submit information from their locale. Archives are posted at:
> > > http://www.cfe.cornell.edu/erap/WNV/WNV-L_ArchiveIndex.html
> > >
> >------------------------------------------------------------------------------------------------------------
>
> Patricia A. Doyle, PhD
> Please visit my "Emerging Diseases" message board at:
> http://www.clickitnews.com/emergingdiseases/index.shtml
> Zhan le Devlesa tai sastimasa
> Go with God and in Good Health
>
> _________________________________________________________________
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Received on Tue Sep 17 11:55:59 2002