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Homeland Security

Scenario 4: Biological Attack - Plague

Executive Summary

Casualties 2,500 fatalities; 7,000 injuries
Infrastructure Damage None
Evacuations/Displaced Persons Possibly
Contamination Lasts for hours
Economic Impact Millions of dollars
Potential for Multiple Events Yes
Recovery Timeline Weeks

Scenario Overview:

General Description -

Plague is a bacterium that causes high mortality in untreated cases and has epidemic potential. It is best known as the cause of Justinian's Plague (in the middle sixth century) and the Black Death (in the middle fourteenth century), two pandemics that killed millions. In this scenario, members of the Universal Adversary (UA) release pneumonic plague into three main areas of a major metropolitan city - in the bathrooms of the city's major airport, at the city's main sports arena, and at the city's major train station.

Timeline/Event Dynamics -

Plague cases rapidly occur in the United States and Canada. As a result of foreign and domestic travel, rapid dissemination to distant locations occurs. By Day 3, the plague spreads across both the Pacific and Atlantic oceans and by Day 4, the plague is confirmed in eleven countries other than the United States and Canada.

Secondary Hazards/Events -

As the financial world in Major City and elsewhere begins to realize the likelihood of an epidemic, a huge sell-off occurs in the markets. There is a high absentee rate at banks, other financial institutions, and major corporations. Adding to these complications is the fact that bank and other financial customers may be staying home. As a result, the phone systems at financial institutions may become completely tied up, with far fewer transactions than normal occurring. The fear of plague has raised memories of the anthrax incidents of 2001, which may cause many citizens to be afraid to open their mail.

Key Implications:

Morbidity and mortality totals by the end of the fourth day are indicated in Table 4-1. Although the specific assumptions that underlie these totals are not generally available, nor can they be reliably recreated, the parameters affecting these figures include length of incubation period following primary exposure, rate of secondary transmission, incubation period following secondary exposure, and timing and effectiveness of the intervention.

Illnesses and Fatalities by Country
Illnesses Fatalities
United States 7,348 2,287
Canada 787 246
Other Countries 33 10
Total 8,168 2,543

Table> 4-1 Total illnesses and fatalities by country by the end of the fourth day (end of the exercise)

Although the actual physical damage to property will be negligible, there will be an associated negative

impact of buildings and areas that were or could have been contaminated. Service disruption will be significant for call centers, pharmacies, and hospitals due to overwhelming casualty needs. It will be necessary to close or restrict certain transportation modes. The threat of reduced food supply will cause food prices to rise. A huge sell-off in the economic markets is possible, and loss of life will result in a decline in consumer spending and subsequent loss of revenue in the metropolitan area. An overall national economic downturn is possible in the wake of the attack due to loss of consumer confidence.

Many people will be killed, permanently disabled, or sick as a result of the plague. The primary illness will be pneumonia, although the plague can also cause septicemia, circulatory complications, and other manifestations. The long-term effects of antimicrobial prophylaxis in large numbers will require follow-up study. The associated mental health issues relating to mass trauma and terrorism events will also require assessment.

Mission Areas Activated:

Prevention/Deterrence/Protection - This area requires knowledge of persons with the skills to grow and aerosolize plague, reconnaissance of supplies and laboratories, and public health protection measures.

Emergency Assessment/Diagnosis - Although health professionals should rapidly recognize the seriousness of the incident, diagnosis of the plague may be delayed. Detection of the plague should initiate laboratory identification of the strain and a determination of the potentially known antimicrobial drug resistance. Origin of the initial contaminant should be traced back to the source.

Emergency Management/Response - Identification of drug-resistant plague strains would require full utilization of personal protective equipment (PPE) and quarantine measures. Response will require provision of public alerts, mobilization of the National Strategic Stockpile, activation of treatment sites, traffic and access control, protection of special populations, potential quarantine measures including shelter-in-place recommendations, requests for resources and assistance, and public information activities. Effective communication between U.S. and Canadian governments is vital.

Incident/Hazard Mitigation - Victims must receive antibiotic therapy within 24 hours to prevent fatality. Exposed victims must be isolated and minimizing disease spread will require epidemiological assessments, including contact investigation and notification.

Public Protection - Victims must be evacuated and treated (and/or self-quarantined), and antimicrobial prophylaxis will be necessary for exposed persons, responders, and pertinent health care workers. Mobilization of the Strategic National Stockpile for additional critical supplies and antibiotics will be necessary. The public should be informed of signs and symptoms of plague.

Victim Care - Victims will require treatment or prophylaxis with ventilators and antibiotics, as well as information measures for preventing spread of the disease. Advanced hospital care will be required for those with pneumonia. The U.S. Department of State's Bureau of Consular Affairs will need to be involved in order to assist foreign populations residing in the United States, or U.S. citizens exposed or ill abroad.

Investigation/Apprehension - Point-of-source exposures and plague strain must be determined using victim trace-back, criminal investigation, and laboratory analyses.

Recovery/Remediation - Extensive decontamination and cleanup will not be necessary because plague cannot live long in the environment and is viable to heat and sunlight exposure. However, some efforts should be undertaken to support political/public confidence.

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