Chat transcript
Dr. Coule of MCG discussing anthrax: October 22, 2001
On Monday, October 22, MCG doctors gathered at the WJBF-TV studios to answer questions about anthrax from callers in the Augusta area. An emergency room doctor from MCG, Dr. Coule, took time out to chat with Augusta.com users during the evening. The following is a transcript of the conversation.
Dr. Coule: Hi!. I am Dr. Coule an ER Doc at MCG, Hope I can answer all of your questions, I will try my best
PlagueMonger: Doc, have officials been truthful in saying that Anthrax is not an airborne agent, yet the fact remains that you can inhale it?
Dr. Coule: To say it is not airborne is I think less than accurate, you can inhale it, the point is that it can't just be put into the air to infect everyone
karaokequeen: I understand that Anthrax can be "killed" using hospital-grade sterilizers. True or false?
Dr. Coule: this is true, in fact it can be killed with household bleach
Dr. Coule: the spores can survive for some time in the wild, but pretty whimpy otherwise
Rae: As a school system employee, I am very concerned about what precautions are being recommended for enhancing the security of our schools against bioterrorism.
Dr. Coule: fortunately people have been worried about this for some time, people have been prediciting an attack on the US of this type for a while. Fortunately, people are also looking at this issue
Str8Fan: what are the symptoms of the skin anthrax?
Dr. Coule: the rash is very characteristic, it starts as a little wheal, but becomes an ulcer that turns black in the center. The lymph nodes nearby swell up and become painful along with fever
elvis: Has there ever been a local case of anthrax?
Dr. Coule: GA has not had a case since 1948. All of the recent powder scares have tested negative, and there have been no cases during the recent scare
Marylyn: Since mail in DC post office has been found to be contaminated, what about mail destined for other locations which has/will pass through that DC location? Can the mail "carry" the contamination to other post office processing centers and US citizens?
Dr. Coule: There is little that is known about the real risk here as this has all been theoretical before. It is now known that this is a real risk for postal workers
nrg: is anthrax a fungus?
Dr. Coule: anthrax is a spore forming bacteria
fuji6100: How long can anthrax be viable on surfaces. clothing, and other surfaces
Dr. Coule: spores are containers that are resistant to degredation by the environment
Dr. Coule: out in the environment, for example exposed to sunlight the spores can be killed quickly, in the soil they can live for >100 yrs
Chris: I hear about different colored powders being found and tested. Is anthrax always the same color?
Dr. Coule: the powder itself is not the anthrax but clumps of spores. depending on how the spores are made the powder can be different colors. In some cases there was no powder at all, but rather the spores were pressed into the paper
Dr. Coule: At least that is what was reported in the new media
downs703: Should we be concerned about small pox?
Dr. Coule: unfortunately yes, concerned but not paranoid. there is concern that the former USSR's smallpox may have been compromised, and that as the USSR collapsed that they may have gone to the highest bidder
Dr. Coule: I don't think anyone knows for sure whether or not this is true, but a watchful eye is necessary as small pox does represent a real threat
meg: how long can u live w/out medical attention once infected?
Dr. Coule: it depends on the type of infection. Inhaled anthrax untreated is almost universally fatal within a week to 10 days. cutaneous anthrax has a much lower mortality untreated. If treated early the mortality is dramatically reduced. Skin anthrax treated is little more than just a nuisance
james134: Where in Augusta can I go to get tested?
Dr. Coule: I am not aware of anyone who is doing testing on individuals unless there is a significant concern about exposure. For example if you spent 2 days in the NBC building in NY around the time that the letter was received, then that would be a resonable reason to test, otherwise routine testing is not recomended because you can get false results
downs703: Dr, is contamination of water possible?
Dr. Coule: possible yes,likely no. You would need a masssive amount of anthrax to do this as the dilution makes it more difficult. Chlorine in the water would also kill the bacteria and spores if in high enough concentration
PlagueMonger: If a major Hospital, like MCG, gets targeted, wouldn't that have a devastating effect on the public? What has MCG done to prevent such an eventuality?
Dr. Coule: Any public building is certainly a potential target, but such a undertaking as this is unlikely. MCG has recently modified it's air intake system prior to these events because of the proximity to public areas
Augusta Green: How much exposure to Anthrax spores is required for someone to become ill?
Dr. Coule: it is estimated that 8-10K of the spores are required to be inhaled to cause the inhaled form of the disease. The range in monkey studies if 2,500-14 K or so (if my memory is correct)
MRyder: If a person goes to the doctor with flu like symptoms, will they automatically test for anthrax?
Dr. Coule: No. Routine testing is not recommended. There are certain signs on exam that would lead one to be concerned about anthrax and therefore prompt testing. Certainly if an obvious target or high risk persons were to become symptomatic then testing would be considered. For example if a Senator had a the flu, he should probably be tested, for the average person, probably not.
downs703: Is it possible to survive anthrax w/o medical attention?
Dr. Coule: anthrax infections can occur in three forms, skin, inhaled, and ingested. The inhaled form is almost universally fatal if untreated. the skin and ingested forms also have a high mortality if untreated, but the good news is that treated they are almost all curable
nrg: Does anthrax exist in the wild or was it manufactured?
Dr. Coule: anthrax occurs naturally and has occurred in humans who are exposed to sheep for example. Sheep herders who would have cuts on their hands while shearing sheep get the skin form or possibly inhale the spores. Countries adapted this to make it a weapon
T: What other antibiotics besides Cipro are effective against anthrax?
Dr. Coule: there are many antibiotics that are effective. Amoxil, penicillin, doxycyxline, levaquin to name a few, Cipro has been the recommended drug to use, but others are certainly effective
foxfiregirl87: I would like to know what anthrax dose to your body?
Dr. Coule: anthrax is carried to the lymph nodes where the cells there try to destroy the bacteria. This infection typically continues to get worse and the body's attempt to get rid of the bacteria causes other organs to fail. These responses of the body cause the blood pressure to drop and eventually death. This is of course if untreated and for the inhaled form of the disease
bigdog: Does Cipro have any side effects?
Dr. Coule: any medication has potential side effects and therefore should not be taken without an indication. The biggest concern is if someone has a serious allergic reaction to the medicine. The most common side effects from cipro are sensitivity to the sun, upset stomach and rash
MRyder: Might there be any specific indication that would distinguish anthrax from flu?
Dr. Coule: swollen lymph nodes can but do not usually occur in anthrax. Of course this can occur with something as simple as strep throat or a cold. There is a characteristic finding on chest x-ray that can also clue someone in that someone has anthrax and not flu
elvis: Are there any samples of Anthrax in Augusta hospitals, being used for a study?
Dr. Coule: No. Only specialized labs are allowed to have anthrax for testing or study
meg: DR SHOULD WE ALL GET A FLU SHOT????
Dr. Coule: The flu vaccine is difficult to manufacture, so I doubt that there will be enough flu vaccine for everyone to get vaccinated. Certainly high risk individuals should get a flu vaccine. Healthcare workers, persons over 65, persons with serious medical conditions such as emphysema
PlagueMonger: What do they mean my Weaponized Anthrax?
Dr. Coule: you can't just go out and get some anthrax, put it in an envelope and mail it to someone. Weaponizing a biological agent means putting it into a form that will allow it to survive to the intended target and deliver a sufficient amount to cause disease
Dr. Coule: In Tokyo the cult that released the Sarin in the subway tried on at least 8 occassions to spread anthrax unsuccessfully. In other words they got anthrax, but couldn't weaponize effectively
shygirlga: if a person inhales anthrax, who has lung disease, such as asthma, copd, etc......what is the chances of recovery
Dr. Coule: untreated, inhaled anthrax is almost universally fatal, if treated early there is a chance for survival, but other medical conditions such as COPD may make recovery less likely
fuji6100: What is the window of treatment time after a supposed anthrax exposure
Dr. Coule: the incubation period (or the period from infection to disease) is variable. Most persons will show some symptoms within a few days, there are some reports mostly from an accident in Russia that suggest that there are some cases which can present a week or two or three later. Most cases are within a few days of exposure
kris: what are the chances of spores being passed along in the mail to other letters the infected letters come in contact with?
Dr. Coule: I don't think anyone knows for sure, most information of this type is theoretical (i guess). I think it is probably unlikely that enough would be contaminated on the outside of the envelope, plus when this is exposed to the sunlight this will kill the spores and bacteria. So I think the risk is very minimal
Carolinagirl: How is mcg prepared to treat patients coming into the ER with just routine flu-like symptons?
Dr. Coule: I know when I see a patient in the MCG ER that I am thinking in the back of my mind, Is this ANTHRAX? I am also asking, as I suspect my collegues are about occupations that would but someone at risk, and thus raising my suspiceon even more
Dr. Coule: For example high profile individuals, postal workers etc.
PlagueMonger: Doc, if anthrax is wimpy... why all the public panic?
Dr. Coule: Anthrax spores in sunlight are wimpy for example. If you took anthrax spores and put them on a sidewalk, they would all be killed quickly. Houshold bleach can kill the spores and the bacteria... so yea wimpy if caught before they get into the body or early in infection. If inhaled in sufficient quantity and if antibiotics are not started early enough, then... that is where you have a problem... thus the reason for the concern
Str8Fan: Are most doctors now familiar with spotting the symptoms of anthrax?
Dr. Coule: I know that all of my collegues at MCG ER were already familiar but have certainly beefed up on our knowledge of the subject. Most doctors will have certainly been reading up on the subject
mbrunson: Does anthrax have a smell?
Dr. Coule: No the spores of anthrax do not have a smell. Of course I wouldn't recommend smelling something that you were concerned about ;-)
Dr. Coule: O.K. I hope you guys have found this helpful. Goodnight! :-)
MODERATOR: Thank you all for joining us today. Check Augusta.com for future chats. Thanks again.
