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Mitigating the Effects of AllegedEBOLA Attacks at Multiple Airports

Dorothy A. Canter, Ph.D.JHU Applied Physics Laboratory

USSOCOM CBR Conference and ExhibitionTampa, FL

December 8, 2005

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Presentation

• USSOCOM Scenario/Presentation Assumptions

• Ebola Virus Information

• Ebola Notional Incident Timeline

• Ebola Best Case Decontamination Timeline

• Ebola Notional Public Health Timeline

• Recommended Preparedness Activities

• Potential Roles for Military in Responsesto Bioterrorism

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USSOCOM-Specified EBOLA Scenario

• Reports on blogs/websites that “FreedomFighters” infected airline passengers at O’Hare,Logan, Hartsfield and Heathrow Airports withEbola virus

• Police, FBI, TSA find crude devices in airports

• Devices, environmental samples sent to labs foranalysis

• Boston police officer reports over nonsecureradio “We found the bioweapon in the trash..”- picked up by media

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USSOCOM-Specified EBOLA Scenario

• Delta Flight 20, low on fuel, told to holdapproach pattern to Frankfurt Airport andawait further instructions

• Leader of Hartsfield baggage handlers uniontells members to stop unloading aircraft

• CNN reporter, wearing respirator, broadcasts“Breaking News”

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My Assumptions

• Releases occur at same time at all airports

• Blogs/websites report incidents within one hour ofreleases

• Devices found in trash of food court area in securearea of terminal at all four airports

• Delta flight originated at Hartsfield Airport

• Incidents will yield confirmed attacks at Hartsfield,Logan and Heathrow Airports; O’Hare incident willbe hoax

• No sensitive electronic equipment(e.g., scanning equipment) affected by attacks

• Best case response based upon significantpreparedness and response planning/training

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EBOLA Virus

• Fragile, RNA-containing Filovirus; causesEbola Hemorrhagic Fever (EHV)

• Incubation period of 2-21 days

• Symptoms include sudden onset of fever,weakness, muscle pain, headache; followedby vomiting, diarrhea, rash, impairedkidney/liver function, and internal/externalbleeding

• High mortality – no known treatment, onlysupportive medical care

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EBOLA Virus

• Human-to-human transmission throughcontact with bodily fluids

– Risk greatest during latter stages ofdisease when viral loads highest

• Cases must be isolated from other patients– Soiled clothing/bed linens must be

disinfected

• Health care workers must use strict barriernursing techniques

– Non-disposable protective equipmentmust be disinfected prior to re-use

• Airborne transmission uncertain

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EBOLA Virus

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Facts About EBOLA Incidents

• No potentially exposed passengers, airline or airportworkers will become ill for about 2-21 days, if at all

• None of the above persons will be able to transmit thevirus before becoming ill

• If anyone develops EHF, that person(s) will need to beisolated

• Fragile virus, if viable, will not live long in air or onnonporous surfaces (at most several days)

• No antimicrobial products registered by EPA for useagainst Ebola virus, but number of products areregistered for use against viruses, including Vacciniavirus, on hard, non-porous sources

• Barrier nursing equipment available in CDC StrategicNational Stockpile (SNS)

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Phases of EBOLA Airport Incidents

• Suspicious Incidents– Sufficient evidence to consider as credible

threats, no analytical laboratory confirmation– Online reports + finding of devices

• Presumed Positive Events– Positive findings in PCR, virus isolation,

antigen detection tests– Available within hours*

– US analyses done at CDC, USAMRIID only –BL-4 facilities

• Confirmed Attacks– Definitive tests at CDC/USAMRIID yield

positive findings– Results available within ½ to ¾ day*

*Source: Tom Ksiazek, CDC

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EBOLA Notional Incident Timeline

Day 1 Day 2

Loga

nA

irpor

tH

eath

row

Airp

ort

O’H

are

Airp

ort

Blog

s/Web

sites

Broa

dcas

tRe

lease

s

Rel

ease

of S

pray

SuspiciousIncidents

PreliminaryLab Results

Crude DevicesFound

Terminal OperationsSuspended

Terminal OperationsSuspended

Terminal OperationsSuspended

+

+

-

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 25 26 27 28Hour

AirportClosed

TerminalOpens

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SamplesArrive

SamplesArrive

SamplesArrive

AirportClosed

AttacksConfirmed

DefinitiveEbolaTest

+

+

-

Har

tsfie

ldA

irpor

t

PresumptivePositiveEvents

Terminal OperationsSuspended

+Samples

Arrive

AirportClosed+

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Other Notional Activities During SuspiciousIncident Phase of Attacks

• Airport managers alert Mayors who alertGovernors who alert Secretary, DHS,and President

• Airports give media interviews

• Delta flight diverted to US air basein Germany

• Hartsfield baggage handlers unload baggageafter meeting with airport management andreceipt of Fact Sheets and FAQs

• Airports on high alert globally

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Other Notional Activities During PresumptivePositive Phase of Attacks

• US airports activate Incident Command System

• EOCs activated (EPA, CDC, HSOC);PFOs appointed by DHS

• Interagency Committee on DomesticResponse Preparedness holds secureteleconference/prepares for next steps

• Decision to federalize National Guard units inaffected cities if attacks are confirmed

• Continuing interactions among governmentalunits and airport management

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Other Notional Activities DuringPresumptive Positive Phase of Attacks

• Interactions among all airports

• CDC/local health departments confer onpotential public health responses

• Continuing airport briefings of media,distribution of Fact Sheets/FAQs

• Delta flight lands at Hartsfield/passengersquarantined

• Airlines notify passengers/flight crews onaffected planes

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Responses to Confirmed Attacks

• Decontamination Activities

• Public Health Activities

• Forensic Activities

• International Coordination

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EBOLA Best Case Decontamination Timeline

Day 2

Loga

nA

irpor

tH

eath

row

Airp

ort

3 6 9 12 15 18 21 24Hour

Day 3 Day 4 Day 5

3 6 9 12 15 18 21 24 3 6 9 12 15 18 21 24 3 6 9 12 15 18 21 24

* Unified Incident Commands

CoordinateWith UICs

Agree onClean-Up

Procedures

CBIRFArrives

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Removal of Materials From Airportsfor Disposal Bleach Treatment

Removal of Materials From Airportsfor Disposal Bleach Treatment

FormUIC

CoordinateWith

HeathrowWasteRemoval

WasteRemoval

ECCMeets

AirportReopens

Har

tsfie

ldA

irpor

t

CBIRFArrives

Bleach TreatmentRemoval of Materials From Airportsfor DisposalForm

UIC*

CoordinateWith

HeathrowWasteRemoval

ECCMeets

AirportReopens

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EBOLA Notional Public Health Timeline

0 3 6 9 12 15 18 21 24Day 2 (Hours) Days

Hour 3.5Activation of Strategic NationalStockpile (SNS)

Hours 5-6Designation of Quarantine Areasin Affected Cities

0 3 6 9 12 15 18 21 24

Day

4 FBI DetectsSuspiciousActivity onVideotapes

Labs ReportVirus NotWeaponizedD

ay 5

EBF Casein Atlanta –CDC/WHONotifiedD

ay 6

3 4 5 6 7 8 9 10 11 30

3 4 5 6 7 8 9 10 11 30

PeopleFleeAtlantaPanicD

ay 6

-7

Day 13: EHF Case inLondon Suburb –Day 19: People Returnto Boston and AtlantaDay 22: QuarantineLifted for ExposedPersonsDay 30: CommissionsAppointed to InvestigateAttacks/Responses

Day

s 11

-30

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ExposedPersons

QuarantinedDay

3

FBIIdentifiesCases asPerpsD

ay 1

0

PeopleFleeBostonD

ay 9

-10

EBF Casein Boston –CDC/WHONotifiedD

ay 9

Days 1 - 4: Airlines/Airports Notify Potentially Exposed Persons

Days 3 - 22: Role of National Guard (NG) in Enforcing Quarantine

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Response Assumptions

• Significant preparedness and response planning,including regular training, has occurred inadvance

• Teams are ready and equipment is pre-positioned

• Responses are 24/7• Interagency coordination alive and well• Effective audibles were called when needed at all

airports and immediately communicated to otherairports

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• Fact Sheets and FAQs on biothreat agentsavailable at all US airports

– Cover public health, decontamination,and notification/management issues fortop bioterrorism agents

– Also distributed to First Responders,police

– Regularly updated

• Coordinated preparedness and responsetraining, including table tops

– Address both public health anddecontamination issues

Recommended PreparednessPlanning Activities

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Recommended PreparednessPlanning Activities

Decontamination Related Activities

• Prototypical Health and Safety Plans(HASPs) for airports

• Designated areas of airport for detainmentof persons potentially exposed to bioagents

• Guidance on decontamination proceduresfor various biothreat agents

• Availability of portable PPE deconunits/pre-determined sites for theirlocation

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Decontamination Activities (cont’d)

• Reachback

• Current lists of contractors withdemonstrated experience in bioagentdecontamination, waste removal

• Existing relationships with wastedisposal facilities

• Templates for remediation action plans

• Creation of Technical Advisory Committee(s)to provide guidance to airports on terrorismincidents – both real and hoaxes

• Possibly regional/national

Recommended PreparednessPlanning Activities

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Interagency Committee on Domestic Response Preparedness

• Purpose– Planning for improved responses to multiple

domestic terrorist attacks with potentiallycatastrophic consequences• Research/Training/Coordination

– Advisory role during actual responses

• Co-chaired by DHS, DOD, and DHHS• Membership

– Civilian federal agencies: DHS (OP, TSA, FEMA),EPA, CDC (NIOSH, NCID), NIH, DOT,FAA, FBI, CIA, DOS

– DOD agencies: SOCOM, NORTHCOM, STRATCOM, others– State/local advisors– Member/surrogate from each agency -

electronically connected at all times onsecure equipment

Recommended PreparednessPlanning Activities

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Potential Roles for Military in Responsesto Bioterrorism

• Transport of samples to analytical labs

• Analysis of clinical/environmental samples

• Role of CBIRF/CST units indecontaminations

• Use of National Guard armories aspotential quarantine centers/distribution ofSNS meds

• Role for USSOCOM OCONUS inidentifying/neutralizing terrorist cells

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Need to be Prepared for theNext Bioattack,

Not Just the Last One!

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If you have seen one bioattack,you’ve seen one bioattack

We need to be complete and flexibleto respond to asymmetric attacks

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Contact Information

Dorothy A. Canter, PhD

240-228-2616

The Johns Hopkins UniversityApplied Physics Laboratory

dorothy.canter@jhuapl.edu