Preparing for Bioweapons: Anthrax

Disclaimer.  I am not a licensed health practitioner.  This is just another post on knowledge and understanding you might wish to acquire in advance of a disaster in case no higher care is available.  As long as our society is functioning, you should leave anything more substantial than applying a Band-Aid to the professionals.  No medication, including those available over the counter, should be taken without consulting a physician.  Information shared here is for educational and entertainment purposes only.  It is not medical advice nor a substitute for licensed medical care. 

As far as bioweapon use goes, opinions vary over whether anthrax is an effective bioweapon likely to be used in the future.  Anthrax is a category A/tier 1 bioweapon like smallpox, plague, botulism, and tularemia.  The spores are easily found in nature, can be readily produced in a lab, and last a long time in the environment.  There are still large areas in Russia that aren't used due to the land becoming contaminated from a laboratory accident.  Anthrax spores can be disseminated into food, water, powder, or sprays where they cannot be seen, smelled, or tasted.  As many readers will recall, anthrax was employed as a bioweapon nearly two decades ago.  In 2001, powdered anthrax was put into envelopes and mailed.  Twelve postal carriers and ten others became ill; five died.  The powdered spores are easily spread through the air.  The one thing in our favor is that anthrax can only rarely be passed from person to person. 

Anthrax is a disease caused by toxins produced by the Gram-positive Bacillus anthracis bacteria.  Diagnosis can only be confirmed with laboratory tests.  Very few US doctors have ever seen or treated a case of any type of anthrax, and unfortunately for us, most anthrax symptoms look a whole lot like influenza.  

There are four forms of anthrax: 

Cutaneous anthrax develops 1-7 days after exposure.  The anthrax spores get into the skin through a cut or scrape, usually in the course of handling infected animals or dealing with contaminated animal products like wool or leather.  The most common locations for infection are on the head, neck, forearms, and hands.  Symptoms include:

• A group of small blisters or bumps that may itch
• Swelling around the sore
• A painless sore or ulcer with a black center that appears after the small blisters or bumps develop

Cutaneous anthrax is the most common and least dangerous form, with a 20% mortality rate without treatment and virtually 100% survival with treatment.   This is the only form of anthrax that is contagious from person to person, and even that only rarely occurs.  Amoxicillin may be used to treat cutaneous anthrax.[1] 

Inhalational anthrax usually develops a week after exposure, but it may take up to two months.  It starts in the lymph nodes in the chest before spreading to the rest of the body.  The bacterial spores produce toxins that cause the initial influenza-like symptoms.  This is often followed by a symptom-free period, and then a day or two later the patient presents with a high fever, shortness of breath, and coughing up blood.[2]  This is the most deadly form of anthrax.  This is due to the fact that while antibiotics will kill the bacteria, unfortunately, they do nothing against the toxins.[3] With the best treatment, it still has a 45% mortality rate.  Without appropriate treatment, there is an 85-90% mortality rate.  Symptoms include:

• Fever, chills, and drenching sweating
• Chest discomfort, shortness of breath, and coughing
• Confusion or dizziness
• Nausea, vomiting, or stomach pains
• Headache
• Extreme fatigue and body aches

Inhalation anthrax is not contagious, but it has a high fatality rate.  Due to their elevated risk, livestock workers and others at high risk are often vaccinated against anthrax.  The treatment for inhalational anthrax is ciprofloxacin (500 mg) or doxycycline (100 mg), intravenously if available, for 60 days.[4]

Gastrointestinal anthrax is extremely rare in the US.  It is contracted by eating contaminated meat, usually from unvaccinated animals.  It usually develops 1-7 days after exposure.  Without treatment, there is a greater than 50% mortality rate.  With treatment, the mortality rate is 40%.

Symptoms include:

• Fever and chills
• Swelling of neck or neck glands
• Sore throat and painful swallowing
• Hoarseness
• Nausea and vomiting, especially bloody vomiting
• Diarrhea, possibly bloody
• Headache
• Flushing (red face) and red eyes
• Stomach pain and abdominal swelling
• Fainting

The treatment protocol is the same as for inhalational anthrax.

Injection anthrax has never been reported in the US.  It has occurred in northern Europe among heroin users.  Symptoms include:

• Fever and chills
• A group of small blisters or bumps that may itch, appearing where the drug was injected
• A painless skin sore with a black center that appears after the blisters or bumps
• Swelling around the sore
• Abscesses deep under the skin or in the muscle where the drug was injected

While the symptoms of injection anthrax are similar to those of cutaneous anthrax, injection anthrax may spread faster through the body.

The following list of bullet points is a direct quote from the CDC website regarding their preparedness for an anthrax (or any bioweapon) attack.  

• Providing funds and guidance to help health departments strengthen their abilities to respond to all types of public health incidents and build more resilient communities.
• Providing training in emergency response for the public health workforce and healthcare providers, as well as leaders in the public and private sector.
• Coordinating response activities and providing resources to health departments through the CDC Emergency Operations Center.
• Regulating the possession, use, and transfer of biological agents and toxins that could pose a severe threat to public health and safety through the CDC Select Agent Program.
• Promoting science and practices to strengthen preparedness and response activities.
• Ensuring that the United States has enough laboratories that can quickly conduct tests when anthrax is suspected.
• Working with hospitals, laboratories, emergency response teams, and health-care providers to make sure they have the medicine and supplies they would need if an anthrax attack occurred.
• Developing guidance to protect the health and safety of workers who would be responding during an anthrax emergency.

We've already witnessed the CDC's response with COVID, the lack of preparedness with even gloves and masks, the disinformation regarding effective treatments.  The lack of testing and then over-testing.  Do you honestly believe they have medicine stored for you?  Do you believe they would give it to you in a timely manner?  Do you still believe in the Easter Bunny?

The following quote is also from the CDC's anthrax webpage:

"If an anthrax emergency happened in your area, your community might need to receive large amounts of antibiotics and medical supplies from the federal government. The supplies would be sent to sites that are usually called points of dispensing (PODs). PODs would be located in your community in safe, familiar places such as schools or convention centers.

In an anthrax emergency, you would be able to find out where the nearest POD is located and what to bring to the POD by listening to news updates on TV and the radio, visiting your health department’s website, and staying alert for messages from community leaders.

PODs are designed to provide medicine to a large number of people in a short period of time, so you could expect to stand in line. While at the POD, you would be asked to fill out a form that includes some basic information about your medical history. Once you complete your form, a POD staff member would review it and determine which antibiotic is best for you."

Their assurances of being prepared do not give me warm fuzzies, even if the public were perfectly well-behaved and rational about the threat of anthrax.  Just imagine a greater threat of anthrax than COVID has turned out to be, with a totally stressed-out populace, in a country that does not produce its own antibiotics, and certainly not in sufficient quantities to deal with a widespread anthrax bioattack.  It would be really wise to have your own supplies for your family on hand.  Because it's going to require 120 pills per person, whether it's ciprofloxacin or doxycycline, you can bet that no one around you is going to have any to spare.

Links to related posts:
Smallpox
Acquiring Antibiotics
Ciprofloxacin
Doxycycline
Preparing for Biological Warfare

References:
[1]  Dr. Joseph Alton, The Survival Medicine Handbook, 491.
[2] Survival and Austere Medicine, 3rd Edition, 369.
[3]Dr. Joseph Alton, The Survival Medicine Handbook, 263.
[4] Cynthia Koelker, Armageddon Medicine, 489.
https://www.cdc.gov/anthrax/bioterrorism/prepare.html