Fellow citizens: There is no

reason for panic, just caution.

I am writing to reassure the

general public that the professionals working in public health services

have been aggressively addressing the terrorism issue for the past four

years. With support from the Department of Defense, Department of Justice,

National Health Service, CDC and a host of others, we have worked and

will continue to work to improve the ability to rapidly recognize unusual

diseases, improve communications between hospitals, EMS, fire, police,

resource physicians, and public health.

A successful response to this

threat will require a coordinated team effort. We have carefully studied

response scenarios. There are guidelines that cover most practical questions

on the basics of handling "suspicious for terrorism" threats.

No guideline can address all potential situations, so judgment on the

scene, coupled with resource phone calls, will no doubt be required on

some cases.

The first thought in each event

obviously goes to the safety of the people involved at the scene. Local

professional judgment calls should always take precedent until further

information is available.

While no one is completely

happy with our level of competency, I think that the events of the past

few weeks have proven that despite determined attack, we can minimize

the real threat to the general public.

I am confident that our president,

working with other leaders of the free world, with the forces at their

command, are dealing a mortal blow to our enemy in what appears to me

to be a world war on terrorism. I believe that these cowardly acts of

bioterrorism on our soil are the desperate shots of a weak and dying criminal

faction.

While there will likely be

more incidents in our future, I have no doubt in our ability to prevail.

I want to emphasize that most of the current incidences of powder exposure

are extremely low risk for biologic contamination.

There is no reason for panic,

just caution. Most scenarios are presently managed over a one-week period

of time. It also takes time to determine not only if a risk exists, but

of what type. Powders being tested nationwide are overwhelmingly testing

as negative for anthrax, but any could be anthrax or some other biological

agent.

Treatment, if needed, could

vary depending on the agent detected. Unfortunately, this type of substance

analysis takes time, about three to four days for preliminary and three

to four more days for confirmatory tests. This is usually within the window

for successful use of antibiotics to prevent or treat illness.

Taking antibiotics without

knowing if they are needed and for what specific germ is always unwise.

Generally speaking, then, time

is on our side. Patient, scientific analysis will lead to wise decisions

without risking lives.

Each of these cases of "terroristic

threat" is a potential crime scene. First, call 911. The local police

may also be called in some situations to protect evidence and pursue their

functions unimpeded. It is quite possible that the local police will need

to call in the FBI.

Only the police, sheriff, FBI

or other official peace officers are able to collect evidence with proper

chain of custody that will stand up in court. We want to be able to prosecute

the perpetrator. It sometimes seems counterintuitive to call the police

for a medical situation, but this is the case.

Any trained official can work

with most threats to gather evidence or to decontaminate a suspicious

material by using simple protective equipment such as rubber gloves, surgical

masks, and perhaps a disposable gown. This is not always an incident requiring

hazardous material equipment unless the exposure of a toxic substance

has been confirmed or is readily identifiable as hazardous.

Cleanup in the case of powders

of unknown origin should be done with water/Clorox solution of 10 to 1

ratio by trained professionals after the collection of evidence. All attempts

at cleanup should be directed at preventing evidence becoming airborne.

Wash with water to reduce the risk of remaining contaminant.

Our duty to the "war effort"

is the education and reassurance of citizens involved, both at the scene

and afterward. The enemy's goal is terror. Our goal must be to thwart

this attack through reassurance of the truly low risks involved and our

capability to contain the event.

This nation is the most capable

nation in the world to deal with this threat. We have not completely covered

all scenarios, but we have, by all judgments, performed well in the first

battle. Compare what is going on in the rest of the world, Afghanistan,

for example, with what we are dealing with, and you get a true perspective

on the severity of risk.

Should you have any questions,

call your local health department. If unable to reach them, please call

District Four Health Services at 706-845-4035. After business hours, holidays,

or week-ends, you may call the Public Health Information Line to reach

a nurse on-call at 1-800-847-4262.

Michael L. Brackett, M.D., FAAFP

District Health Director

District Four Health Services

LaGrange, Ga.