BEATING BACK THE DEVIL: On The Front Lines with the Disease Detectives of the Epidemic Intelligence Service

July 2002,
Anniston, Alabama

The cinder block hallway is wide, white, and chilly. Brilliant fluorescent light glares off the slick paint. The light makes pools of brightness on the linoleum, leaving the ends of the corridor in shadow.

In one of the pools of brightness, a body is lying on a gurney.

A crew of health care workers huddles around it. They are shrouded in baggy white coveralls, thick boots, and black rubber gauntlets that reach their elbows. Heavy military respirators mask their faces, tugging down their heads and cutting off their peripheral vision. Their instructor stands at the side of the stretcher; when his voice booms out, the faceplates swivel in his direction like a nervous flock of periscopes.

"Someone has placed a device in a trash container at the food court in the mall," he says. "It contained Sarin gas. Several people have collapsed. This is one of them."

The Tyvek suits crinkle as the workers crowd the gurney. They are anxious in the unfamiliar surroundings, nervous about the task in front of them, eager to get started treating their patient. Their instructor knows this. He knows they have been taught to move quickly and decisively. He also knows, as they will learn, how much danger their rapid reflexes could put them in now.

"Your training is to get the patient to treatment as soon as possible," he says. "But you need to cut his clothes off first. You need to wipe him down with decontaminant. If you rush into the emergency room with this person, you may create a bigger problem than you already have. People in that emergency room may die because of you."

Clutching sponges, four of the health workers crouch awkwardly by the stretcher, taking care not to kneel and contaminate the fragile suits that protect them from poison-gas residue. One eases off the patient's shoes. Two cut carefully through his clothing with scissors, pulling the cloth away from his skin. The fourth, at the head of the stretcher, monitors the victim's vital signs.

Or would, if he had any. The victim's chest is not rising. The fingers seeking a pulse make no dent on his plastic skin. The body on the gurney is a training dummy, a jointed plastic mannequin wearing thrift-shop clothes and a synthetic wig that the sponges have knocked askew.

It looks like a joke figure, something to stuff in a porch rocking chair on Halloween, but there is nothing light-hearted about this training session. Instead, it is tense and solemn. It represents the first time in more than fifty years that the U.S. government has prepared its disease detectives for an ugly possibility: that the health problems they will be chasing may be deliberately caused.

The members of the group around the gurney are the newest enrollees in the Epidemic Intelligence Service of the U.S. Centers for Disease Control and Prevention. The CDC is the Pentagon of public health in America, the place where threats are identified and control strategies are launched. The EIS is its Special Forces.

The members of the disease detective corps have always been young, highly trained, and fiercely committed. They expect to be summoned in the middle of the night for a crisis halfway across the country, or the world. But they have never before been trained to be the first responders to radioactive, chemical, and biological attacks.

The EIS was founded in 1951 because health authorities feared Korean War troops had been exposed to biological weapons. The fear was groundless, then. Fifty-one years later, bioweapons have not yet been used against U.S. troops—but they have been against U.S. civilians. It is reasonable to believe they will be used again.

It is ten months since two hijacked planes brought down New York City's World Trade Center, and nine months since a set of mailed envelopes, loaded with finely milled anthrax, accomplished the first fatal bioterrorist attack in American history on American soil. The eighty-nine doctors, Ph.D.s, veterinarians, and nurses in this EIS class applied for their jobs before the World Trade Center was attacked. They were offered their positions, and accepted them, months afterward—with the understanding that preparing for the possibility of terrorism would be part of the job from now on.

"We can't prevent a terrorist attack," the instructor says. "But we can be better prepared. If you respond properly, you may save a lot of lives, including your own."

But it was one thing to agree to be prepared and another to experience it. It is difficult to move in the billowy suits, and impossible to laugh or catch someone else's eye through the tunnel vision of the faceplate. The loose boots make it hard to walk and impossible to run, even with a drill instructor shouting at their shoulder blades. One of the doctors is clenching his fist to control his anxiety; another is breathing deeply to keep her rising claustrophobia under control.

They have been on the job for three weeks.

Over the instructor's shoulder, a window set into a door offers a glimpse of a disaster scene: a restaurant patio strewn with bodies. Through a second door, there is a second disaster scene: a subway platform, eerily deserted. Both rooms are stage sets, meant to provide practice in the possible varieties of disaster. They serve as a warning: The EIS officers must be prepared to combat terrorism, but they cannot predict where or how it will appear.

Behind this training session lies an assumption: There will be another terrorist attack, of some kind, and the EIS will be the ones who respond to it. They will have to calm panicked citizens, rally dazed medical personnel, and organize care of the victims. They will be the most knowledgeable people on the scene of a disaster, and they will have to take charge for the first few hours—or, if things go very badly, for the first few days.

Until that happens, they will take up the daily jobs of disease detectives, racing to health problems that range from small clusters of foodborne illness to nationwide outbreaks of newly discovered pathogens. But first they will spend a week in this disused Army hospital, learning to rush toward threats that any sensible human would run from.

"I cannot emphasize this enough: You are a target, a target, a target," their trainer tells them. "If they take you out, there will be no one to hold the line on whatever epidemic they have caused."