November 6, 2014

Anthrax, the Ebola of 2001

FBI photo of anthrax-tainted letters sent to legislators and the media, 2001

Contributed by Lincoln Cushing, Archivist and Historian

With recent headlines about the Ebola situation the focus of the news, Kaiser Permanente takes seriously its responsibility to keep its employees, physicians and members safe and protected. Like other epidemics we’ve managed before, Ebola is still an emerging situation and people have real concerns about this virus.

It’s important for us as health care professionals to recall our history.

On October 15, 2001, soon after the September 11 attacks that killed more than 4,500 people in New York, Washington and Pennsylvania, letters containing anthrax spores were mailed to news media offices and 2 U.S. Senators. The pathogen infected 22 people and killed 5.

The crisis instantly affected Kaiser Permanente health care practitioners in the Mid-Atlantic States service area (Maryland, Virginia, and D.C., with more than 530,000 members). Kaiser Permanente’s response to this act of bioterrorism was centralized in an Emergency Operations Center, which became fully operational on October 23 and was vital to successful and orderly response to the crisis.

Dr. Lee Jacobs, M.D., associate editor of The Permanente Journal, described the response:

Administrative people focused on the call center and appointment capacity to provide access for worried members, the frontline clinicians appropriately adjusted their clinical approach to these patients. The infectious disease specialists dealt with the diagnostic and therapeutic aspects of this rare disease along with the stressful public relations interactions while at the same time doing their regular jobs.

To supplement their staff during the high demand period, several physicians from other Permanente Medical Groups were brought in. To be able to rapidly deploy these physicians out to the medical offices, they fast-tracked licensure, computer encounter training, and other necessary preparation so the physicians could expeditiously be equipped to see patients.

Anthrax virus
Bacillus anthracis, photo courtesy CDC

In her testimony before the House Committee on Veteran’s Affairs, KP physician Dr. Susan Bersoff-Matcha, M.D. offered more details:

The process we had in place for the use of clinical protocols served us well. The information cascaded down from infectious disease specialists to everyone on the front lines: internists, family practitioners, advice nurses. Our organization’s ability and dedication to update and distribute them frequently enhanced the effectiveness of clinical protocols.

We shared information about our patients, and we shared our clinical protocols. Johns Hopkins University Hospital, Inova Fairfax Hospital, and others used our protocols as their guide for patient diagnosis and treatment.

Through our multiple information management systems, we could track data to help us respond to issues. For example, as soon as we understood that postal workers at Brentwood could be at risk, we identified all our members who work at the Brentwood post office by the telephone exchange they provided to us for their work number.

A cadre of nurses volunteered to contact all 237 Brentwood employees. Nurses asked our members if they had gone to D.C. General for testing, if they had received their medicine, were they taking it, and how did they feel.

Even in areas far away from the nation’s capital, measures were taken to safeguard public health. In California, Kaiser Permanente quickly sent its members “Anthrax Exposure Risk Assessment Guidelines” drawn from the California Department of Health Services.

After it was over, this extraordinary handling of the crisis was widely reported — and applauded — in both professional journals and the mass media. Lessons were learned, alliances built, and procedures honed. That is the legacy that Kaiser Permanente will draw upon in handling Ebola.