If you lived in Switzerland, an alert from the national government about increasing risk of nuclear, biological, or chemical (NBC) attacks, whether by hostile governmental forces or terrorists, would be a signal to inspect your shelter and update your supplies. Your NBC shelter would be in place already.

Even a state of hot war with a power known to have used chemical and biological weapons (CBW) against an adversary failed to spark any serious American civil defense against this threat. The foremost world supplier of filter systems (LUWA) brought its sole American representative home. Little more can be expected of the federal government any time soon, despite the headlines that "Clinton seeks $2.8 billion to fight cyber, chemical, and germ strikes" (AP 1/23/99). As Rep. Curt Weldon (R-PA), Chairman of the House Armed Services Subcommittee on Research and Development stated: "We have been grossly underfunding programs to protect our information assets" (emphasis added).

The Domestic Preparedness hotline given in the last issue, (800)368-6498, provided some Internet addresses for further information. Apparently, you must be "authorized" to have your questions answered; you will be asked to identify yourself and your employer when you call. Resources are being targeted for first responders.

An indexed, illustrated, 721-page hardbound textbook entitled Medical Aspects of Chemical and Biological Warfare: Part I, Warfare, Weapons, and the Casualty, edited by Drs. Frederick Sidell, Ernest Takafuji, and David Franz, is available "gratis to qualified applicants," according to a recent review (JAMA 280:1199, 10/7/98). FAX a request on your letterhead to Mr. Wallace, (202)782-7555, or mail to his attention at Borden Institute, Textbook of Military Medicine, MCCS-GBI, Building 11, Room 1-117, Walter Reed Army Medical Center, Washington, DC 20307-5001. A small handbook by Dr. Sidell is available for $12 postpaid from HB Pub, PO Box 902, Bel Air, MD 21014.

Anthrax is frequently discussed as a likely biological agent. It has been weaponized by many possible belligerents, is highly lethal, and persists as a spore for a long time. It is thought that Bacillus anthracis may have been the cause of the "murrain of beasts" and the "plague of boils and blains" afflicting the Egyptians and their cattle in 1491 B.C., as described in Exodus (WE Farrar, "Anthrax: from Mesopotamia to molecular biology," Pharos, Spring 1995: 35-38).

The cutaneous form of anthrax was fatal in 10 to 25% of cases before the antibiotic era. The gastrointestinal form causes 25 to 50% fatalities. Inhalation anthrax and anthrax meningitis claim nearly 100% fatalities.

Naturally occurring anthrax is nearly always quite susceptible to many antibiotics, including penicillin G. However, the London Telegraph reported (4/5/97, quoting Jane's Land Based Air Defense 1997-98) that Russia has developed a new strain that is totally resistant to all known antibiotics.

When people ask us which antibiotics they should store to protect against anthrax and other possible agents, the answer is that we do not know. Doxycycline and ciprofloxacin are best guesses (see November issue). A measure of desperation might be intravenous vitamin C. Decades ago, an obscure private doctor reported using this treatment for snakebite and polio. No controlled experiments were done (or could be done), and no peer-reviewed papers were published in accepted journals. There was little interest in this work after the discovery of antivenin and polio vaccine. Some physicians interested in alternative medicine reportedly give IV vitamin C for the common cold: its effectiveness has not been proved. One demonstrable effect of vitamin C is to destroy macromolecules such as proteins and nucleic acids. The host may tolerate this better than invading viruses or foreign proteins can.

Two things can be said about antibiotics with reasonable certainty: In a mass casualty event, supplies will quickly be depleted. And in a major terrorist threat, mass distribution channels could either break down or be shut down in an attempt to prevent wider dissemination of toxic agents. Any centralized response system is very likely to fail. Civil defense measures of all types need to be widely dispersed before an event occurs. Terrorists or invaders are highly unlikely to attack a predicted target according to a scenario foreseen by government planners.

At this point, it appears that in any major use of weapons of mass destruction, civil defense will be up to individuals. At the June 5-6 annual meeting in Seattle, Sharon Packer will discuss shelter construction and Cresson Kearny will discuss expedient measures to defend against CBW.

What should a prudent individual do if there is news of an attack nearby? It depends. But the best advice might be to stay home. Emergency facilities will be mobbed by the panic-stricken as well as the critically injured.

The question you should ask yourself today is: How long can you stay home?

Especially if utilities are cut off.

You can live for weeks without food. But do you have water? Necessary medications? The means to stay warm? A source of light? A supply of batteries? A battery-powered radio? Some cash to meet immediate needs if banks are closed for a time? Have you downloaded and printed any information you may want from the Internet, before it and/or your computer are down? Have you reviewed and made notes from past DDP meetings (e.g. 1996 presentations on extreme cold and contaminated water by Jim Phillips and Gary Barnes; yearly presentations by Cresson Kearny and Conrad Chester [the latter through 1995]; CBW updates by Hal Strunk, Michael Baker, and Ed Eitzen)?

Before the outbreak of hostilities in the Gulf War, the Israelis recognized the inadequacies of their civil defense. At the 1991 DDP meeting, General Yaacov Lapidot of Israel stated: "We estimated more people will be wounded or killed when they rush from their beds to the shelter than from the missiles." Moreover, the threat of CBW was believed to be worse than from explosives. As CBW agents are denser than air, it is safer to be several stories above ground. Therefore, the sealed room concept was developed. The alarm system was in total disrepair, so the national radio became the alarm, transmitting a "silent wave" at night.

Sealing the cracks with duct tape is not enough, as gases may diffuse through the walls. Thus, a positive pressure needs to be maintained inside. An expedient method suggested by the late Dr. Conrad Chester of Oak Ridge National Laboratory is to use a vacuum cleaner to bring air from the outside through a dust-filled bag. (The vacuum cleaner exhaust is the room air supply.) To maximize the effectiveness, buy a new vacuum cleaner with a HEPA filter. Of course, this requires electricity.

The 1991 audiotapes are not on the DDP CD-ROM, but audiocassettes are still available at $8 each. A limited number of CD-ROMs from 1992-1997 DDP meetings are available at $5 to cover shipping and handling; an updated version including 1998 is not yet completed but should be available soon.)