• Are children at greater risk for certain types of bioterrorism than adults?
• Should I be vaccinated against smallpox or anthrax?
• What should I do if I find myself in the middle of a biological or chemical attack?
• Should I buy a gas mask?

     You will find the answers to these and more than 120 other questions in the chapters that follow. My purpose in writing this book is to help you be better equipped to protect yourself and your loved ones if a bioterrorist attack occurs in your community. You will discover how germs, when used by terrorists, might affect your life and the lives of your family members—and what you can do about it.

     Everyone has concerns, and indeed many have real anxiety, in these times of heightened alert about potential terrorist activity in our communities. I’ve found that a little bit of information goes a long way in transforming that chronic and sometimes debilitating anxiety into a quiet, healthy resolve.

     Bioterrorism is now a reality in the United States. Terrorists have used anthrax bacteria to infect, to kill, and to terrorize innocent people. In a sense, we were lucky: they could have used it as a weapon of mass destruction. Each of the biological agents I talk about in this book has been identified by our intelligence and public health experts as a potential bioterrorist weapon.

     Since we as a nation are vulnerable to bioterrorism, it only makes sense that each of us does everything in our power to minimize our own vulnerabilities. The best way to begin to do that is to understand how viruses and bacteria might be used against us. My goal is to jump-start that process by concisely answering the questions and concerns, both conscious and unconscious, that we all have in these unusual times.

     We learned much from the anthrax attacks in the fall of 2001. On October 4, just three weeks after the terrorist attacks on Washington, D.C., and New York City, we saw the first stories about the infection of a photo editor and, soon after, his coworker in Florida. A few days later, we heard about the infection of an NBC employee in New York. And on October 15, a letter laden with deadly anthrax was opened on Capitol Hill in the office of Senate Majority Leader Tom Daschle. Within days came the deaths of two Washington, D.C., postal workers.

     We learned that every moment counts when terrorists turn a deadly biological agent into a weapon against us. We learned that viruses and bacteria can paralyze a community. We saw how conflicting messages about who is at risk, who should be taking antibiotics, and how mail should be handled all led to confusion, distrust, and even heightened fear, sometimes bordering on panic. Gaps in our public health system—the result of twenty years of neglect and underinvestment—became glaringly apparent. Our level of preparedness simply has not been what our nation deserves. Our government must address that level of preparedness, and the first steps are being taken (see chap. 11).

     But the focus of this book is on you and what you need to know to be prepared.

     Preparation against bioterrorism calls for a team approach. There can be no spectators. You are the key player. And being the key player means you have great responsibilities. Each of us is responsible for the safety and security of family members and loved ones. Each of us is responsible for demanding that our local governments provide for the security of our communities by creating a public health system that can respond quickly and efficiently.

     Increased understanding of what is known today—even though, as we all have witnessed, this knowledge is changing rapidly—and what you can do to minimize the risk we now know exists can best be achieved by providing you and your family with as much basic, useful information as possible.

     The format of this book is straightforward question and answer. The questions came from people like you, the reader. It’s my hope that I cover not only the obvious questions we all have but also the questions that many of us just might not yet have thought of.

     The perspective I bring to this book comes from my own experiences as a surgeon, senator, and parent. As a heart and lung transplant surgeon who routinely gave my patients strong immunosuppressive medicines that made them more susceptible to infections, I, by necessity, became a specialist in infectious diseases. As a U.S. senator, I have participated with my colleagues in the legislative response to improving our preparedness for, and response to, potential bioterrorist attacks. And as a husband and a parent of three teenage boys, I—like so many—look to my family’s security as the most important thing in my life.

     Everywhere I’ve gone—from school and church events with my own family, to public meetings and campaign appearances as a U.S. senator—I’ve been asked most of these questions many times. The answers are not the same as they were even a few months ago, and indeed the answers will change over time. This book addresses each question and provides the most up-to-date and accurate answer possible at the time of publication.

     But our knowledge in this field changes daily, so no book can ever stay perfectly current. Given the limitations of the format, I’ve done my best to share what we know now, at the time of publication. However, methods of surveillance, diagnostic tests, and treatments are always improving. To help you keep up with changes as they inevitably develop, I have provided a list of what I consider to be some of the best, most useful, and most trusted Internet websites on bioterrorism.

     This book, I hope, will be a useful and accessible reference to check something you heard at work, or on the television or radio, or in the coffee shop. My dream is to have the book sitting on your nightstand or maybe in your kitchen next to the telephone, available to answer that specific question that flies through your mind at any time of the day. I’ve discovered that television, because it is so transient, cannot provide this information in a way that you can access easily when you might need it. And the Internet, which I rely on extensively as a rapid and efficient communication tool, is just too disorganized for quick reference. Also, the integrity of the information you find on the Web is not always clear. So use this book as a ready reference.

     I hope that you will want to read the book from cover to cover. Particularly, I urge everyone to read chapter 2, which focuses specifically on what you can do to reduce the vulnerabilities for yourself and your family. But I understand that many of you will want to skip around, focusing first on the answers to the questions you’ve already thought of.

     You might want to glance through the questions on a particular biological agent that you’ve heard about or that is in the news. Or go straight to the index for the topics that interest you the most. Do glance at the photographs, just so you will have a visual impression of what these biological agents look like and some of the rashes they can cause. Sometimes just looking at the pictures helps reduce the mystery around these agents.

     Most of all, I hope this book will serve as a useful and friendly reference for you and your family as we address the fact that our lives could be touched by this new form of terrorism. An informed family will be a family prepared.