Jewish World Review Oct. 26, 2001/ 9 Mar-Cheshvan, 5762

Charles Krauthammer

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Anthrax: The new AIDS? -- THE bad guys know how to start a bio-panic. Don't go for the jugular. Go for the megaphone. Hit the media and the politicians. They have unique access to the national consciousness, and they have been filling it with all-anthrax all-the-time.

We have had three deaths. All are tragedies, and the last two, the postal workers in Washington, were tragically unnecessary. Unnecessary in the sense that if we knew two weeks ago what we know today -- that anthrax spores can traverse an envelope -- the postal workers would have been tested and prophylactically treated.

The problem is that until now we have had almost no clinical experience with anthrax. My brother has been a pulmonary doctor for 30 years. He never saw a case of anthrax. Never heard of one. Never read about one. All our knowledge is gained either from animal experiments, or from the Soviet 1979 anthrax leak at their bio-weapons lab. Unfortunately, the Soviets shrouded that incident in so much secrecy (for years, they even denied it) that we know almost nothing about how the victims were treated and responded.

With anthrax we are where we were in the very earliest days of the AIDS epidemic -- trying to figure out how it spreads and how it can be detected. As we develop clinical experience, we are learning. But while the science is accumulating, the public is fearful. Public information has been sporadic, chaotic, even contradictory. Tommy Thompson and Tom Ridge are earnest, but too new and uncredentialed to be reassuring.

We need an articulate and credible doctor as the government's single official spokesman on the bio-weapons war front. It could be the surgeon general, or perhaps Dr. Anthony Fauci who runs the infectious disease section of the NIH. During the AIDS years, Fauci spoke clearly and reassuringly to an epidemic that was far more mysterious and widespread than anthrax is today. Have him brief the press and the nation. Every day. Same time. The way Gens. Colin Powell and Norman Schwartzkopf did during the Gulf War. He knows medicine. He knows government. And with his experience with AIDS, he understands the psychology of hysteria.

He might begin by debunking some of the anthrax myths. Foremost among these is the Cipro craze, abetted by columnists in a tizzy at having to wait a month for their back-ordered drug, and politicians demagoguing to break its manufacturer's patent. Why is Cipro recommended? Because it happened to have been used effectively on animals infected experimentally. And because Bayer was the one company that bothered to get FDA approval for the treatment of a disease that nobody had seen in the United States since 1978.

But Cipro is just one fluoroquinolone, a class of antibiotic. The other fluoroquinolones should be equally effective. Moreover, naturally occurring anthrax is susceptible not just to Cipro (i.e., fluoroquinolones) but to two other extremely common classes of antibiotic: tetracycline (and the related doxycycline), and penicillin (the oldest and most ubiquitous).

Why Cipro? Because the Soviets, bless their hearts, spent decades trying to produce a strain of anthrax resistant to all potential antibiotic cures. They achieved, as Jimmy Carter once said of the Iran rescue mission, a partial success. The Soviet strain is resistant to penicillin and tetracycline. That is where Cipro comes in. But unless you inhale the Soviet strain -- and there is no evidence that the bad guys have any of it; all the anthrax cases thus far are non-Soviet types -- you are safe with garden-variety penicillin and tetracycline.

The panic-mongers are worried that we might not have enough 60-day doses of Cipro for a mass outbreak. But we could easily use other fluoroquinolones. And we only have to give Cipro (or its fluoroquinolone equivalent) for the first few days until we get back the bacterial sensitivity results. Unless we get a result that says this is the Soviet strain, we can switch to the ubiquitous penicillins and tetracyclines (which are more benign and can be given to children more safely).

So the government speaks with one voice. And panicked columnists cool it. What do ordinary citizens do?

Carry on. Particularly the boomers, the generation that often expresses anguish at not having served when we were younger. Well, we are too old now to serve in Afghanistan. But we can set an example by refusing to be driven out of our offices in panic. If need be, send the younger staffers home. But unless the threat is real and present, we must not do a House of Representatives and simply close shop and flee. We will never be the Greatest Generation. But we can be a pretty good one. What did you do in the war, Daddy? I went to the office.

And one more thing. Get your flu shot. Now. When flu season hits, tens of thousands of Americans are going to show up in emergency rooms thinking they have anthrax. The entire health care system will grind to a halt as alarm, safety precautions, moon suits and a zillion tests clog up the system.

It takes two weeks for a flu shot to give immunity. Get yours now, and spare our country your sniffles and coughs for the rest of the winter. Last year's flu shot was an individual convenience. This year's is a civic duty.

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