Preparing for the Worst

Past a strip mall outside Washington, and down a nondescript road, the federal OEP keeps a warehouse of equipment that can all but navigate the end of civilization. It has the world's most sophisticated portable morgue units, each one able to support numerous autopsies. Another pile of boxes unfolds to become a full operating theater that can support open-heart surgery, if need be.

All this equipment can function during "catastrophic infrastructure failure," said Gary Moore, deputy director of the agency. And all of it can be loaded onto a C-5 transport plane and flown anywhere in the world. The federal government has massive resources--twelve fifty-ton pallets of drugs called the National Pharmaceutical Stockpile, which can get anywhere in the country in seven to twelve hours. After the New York City laboratory became contaminated, the Defense Department flew in six tons of laboratory equipment and turned a two-person testing operation into ten laboratories with three evidence rooms, a command center and seventy-five lab technicians operating around the clock.

This monumental surge capacity is crucial to preparedness. So are supplies. Dr. Kohl at Long Island College Hospital, who describes himself as a "paranoid of very long standing," feels ready. He's got a padlocked room full of gas masks, Geiger counters and Tyvek suits of varying thicknesses, most purchased after the anthrax attacks. Pulling one off the shelf, he declared confidently, "You could put this on and hang out in a bucket of Sarin."

But none of this can replace the simple stuff: hospital beds, trained people, fax machines, an infrastructure adequate for everyday use. Indeed, as states slash their public health and medical budgets, the opposite may be happening: We are building high-tech defenses on an ever-weakening infrastructure. In Colorado, for example, Governor Bill Owens cut all state funding for local public health departments in part because the federal government was supplying new funds. Public health officials there suddenly have federal money to hire bioterror experts but not enough state money to keep their offices open. While the Larimer County health department got $100,000 in targeted federal money, it lost $700,000 in state funds and fifteen staff positions. A spokesman for Governor Owens did not return calls seeking comment. States across the country are making similar cuts, said Dr. Gursky of the ANSER Institute, their weakened staffs left to prepare for bioterror while everyday health threats continue unchecked.

From her office window, Dr. Ruth Berkelman, director of Emory's Center for Public Health Preparedness, can see the new, $193 million infectious-disease laboratory rising on the CDC's forty-six-acre campus. While the new laboratory and information systems are needed, she says, if we detect smallpox, it's going to be because some doctor in an emergency room gets worried and "picks up the telephone."

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