Next we'll move onto brief five-minute discussions from some of the panelists. The first invited panelist is Dr. Fernando Guerra, who I introduced earlier, is head of the San Antonio Metropolitan Health District.

Applause

Thank you very much Dr. Stewart, and thank all of you for joining us this evening. One of my public health colleagues Dr. DA Henderson, former dean of the school of public health at Hopkins, and who really was one of the leaders in the worldwide effort to eradicate small pox in the 70s had this to say when he testified before the United States Senate committee on health, education labor and pension a few weeks ago: "There will be no discrete event, no explosion, no immediately obvious disaster to which firefighters and police and ambulances would rush. We would know we had been attacked only when people begin appearing in emergency rooms and doctor's offices with inexplicable illnesses or with seemingly common illnesses of unusual severity. The first responders to bioterrorism would be the health care workers and public health officials. Our ability to affectively deal with such an event depends directly on the capacity of our medical care institutions and the public health system to quickly recognize that an attack has occurred, to promptly identify those who might be at risk, to deliver affective medical care possibly on a scale that we couldn't even imagine and should the bioweapon prove to be transmitted from person to person to rapidly track and contain the spread of disease."

I think he states it very clearly and that's what for a number of years we have recognized in our community and certainly throughout the country in terms of the public health responsibility as we try to have in place a system that will assure the health and the safety and in many instances the survival of a population and a community and certainly in today's world we're talking about not maybe in just one locale but perhaps in any number of others. And so it is that public health in a community like ours we must have in place that system that assures the preparedness for the prevention of first of all these different infectious agents, these chemical agents, where we can hopefully have a consistent vigilance and the surveillance for early detection and trying to take those steps to contain it, to mitigate it or to initiate whatever that response is. And this requires a constant level of training and preparation and the development of those competencies and the capacity that go along with it. And I can only try to give you a some level of assurance that here in San Antonio and in the public health department and with the other municipal departments that we work very closely with as part of the first response team, and you'll hear more about that from Chief Miller, but we have tried to build up that capacity-a staff that has certainly trained, in going back three or four years, to begun to develop some expertise for not just the early recognition and infection but what we do in terms of responding to an incident and having all of the appropriate protective gear and also the way that one secures the collection of the specimens and processing those because so many of these become actual criminal investigations. The FBI agents and law enforcement agents are involved and the specimens are brought into a laboratory. In our community we do have the capacity as a level two laboratory for the region, to quickly process the specimens and try to get very early identification. The capacity that exists in a laboratory like ours today gives us the opportunity to rapidly transmit the information from a specimen that is processed to a state laboratory and to the center for disease control in Atlanta to transmit that electronically to get a confirmation. We presently have on order special equipment to try to even shorten the period of time for early identification and recognition. The diagnosis and the characterization, which you heard from Dr. Paterson, is so important to recognize in that early phase.

In this time of increase in the respiratory infections, Susan, as we do our usual flu surveillance, which is both active and passive for the community, we set up sentinel sites around the community so that as individuals present a variety of clinical studies whether in the public and the private sector, on a regular basis during this season we collect samples specifically to try to identify the different strains of flu virus that come into this community. At the time some of these emerging threats that are out there, we are adding to the panel of infectious agents that we screen for some of these. So that if they're to same specimen we can begin to process some of the specimens in a way that hopefully if we are dealing with an organism like anthrax that we will be able to try identify that early, and as you and as Dr. Paterson suggested, so many of these actually mimic flu-like illnesses. So the earlier we can try to recognize those and take steps to try identify the individuals that are infected and take steps to prevent again, the spread.

Response to all of this is tremendously important, and you'll hear from some of the other panelists of how the different components fit together, but I can only tell you that the physicians in those clinical setting on the front line, have a tremendously important role to help identify some of the early cases. It's only when they start reporting into a centralized reporting system that is part of the health alert network that we have in place in our community-whether it's through it's emergency departments in hospitals or physicians, offices that's part of our ongoing both active and passive surveillance will give us an opportunity to begin to identify and recognize clusters that have to be recognized and certainly the context of some of these biological agents. And these are all connected to communication systems that allow us to hopefully have the kind of response in place to that can prepare our community and to give the greatest assurance that we possibly can.

Just a brief comment about the health authority role within the public health responsibility. The health authority, which is the role that I occupy as the director of health for the city and the county, carries with it the responsibility to move quickly to assure the health and the safety of the population that is within our jurisdiction. We have within our larger metropolitan area, any number of geopolitical delineations that have their own incorporated communities that are outside of our usual areas of responsibilities. In the instance of some of these emerging threats, we have the authority to move in to those communities that would allow us, if necessary, to issue quarantines, to take those steps to try to contain some of the infectious agents from spreading across geopolitical boundaries and that's an important consideration because it also, if you could just imagine in a hospital type of setting, if several patients present to an emergency department with an infectious illness such as inhalation anthrax which fortunately does not spread so much or does not spread from individual to individual. But nonetheless, those individuals have to be kept in a fairly controlled setting. Staff have to be protected and for all intensive purposes some of the capacity of that type of facility is restricted. Let alone something like smallpox, has a tremendous potential for spreading from individual to individual, such an institution would then have to be quarantined, corded off, patients would have to be moved out of that facility. So all of these are important issues that come into play during such times as the response for some of these emerging throughout. And finally I would just say that, as a community, San Antonio certainly has had in the background, as you heard from Dr. Steward and you'll hear from some of the panelists, the opportunity to attract some additional support from some of the federal agencies to continue to build that capacity and with some of the recent legislation that has been introduced, our hope is that we'll continue to add to that, to have the sort of equipment of place and certainly the level of expertise to give this community the greatest assurance if we should have to respond to one of these emerging threats.

And I thank you very much for your interest.