YOU: the Biological Bomber

Suicide bomber attacks are a fact of life in other nations. Suicide bombers are notorious for strapping on an explosive-laden vest, walking into a soft target location, and...detonating. Corpses, walking wounded bloodied and maimed walk in the midst of collapsed buildings and broken glass. (more on soft targets: Mall shootings here, MD shot in hospital here, 2011 planning problems here

Envision the carnage and hysteria caused by a suicide bomber.

Now envision a bombing scenario that's exponentially more deadly. More lethal than conventional explosives with an impact far greater than a nuclear weapon. In this attack there will be no detonation, no big bang to call us to action. Chances are we wont even know this bombing has taken place until our hospitals are overflowing.

The biological bomber is one such scenario. A Typhoid Mary of our time, rather than strapping on explosives, the biological bomber infects themselves with a disease and goes into society with the intention of infecting as many people as possible.

Like their suicide bomber counterparts, the biological bomber may actually be bombers working in a coordinated simultaneous attacks on several locations. Unlike suicide bombers who can only blow themselves up once,  multiple biological bombers in a coordinated attack could infect hundreds in multiple locations. Would you be able to recognize a biological attack?

The biological bomber will want to spread a disease that is transmitted easily from person to person. A disease that has a lingering incubation period, a disease that will present with commons signs and symptoms of flu. Diseases of interest may come from the Centers for Disease Control and Preventions category A list. Something exotic like Smallpox, plague, or the Nipah virus may be the choice. Even seasonal flu would make an effective agent of attack. The strains of Type A influenza included in seasonal flu vaccine are know to anyone who can search the internet. A would-be biological bomber would only need to infect themselves with a flu strain not included in the vaccine or some novel stain of virus to bypass our first line of biological defense. Of course, our ability to obtain vaccine and other medications will be an issue.

Soft targets and locations of critical infrastructure would be prime locations for the biological bomber attack. Shopping malls, sporting events, and public gatherings make the list of potential targets. Of all the soft target/critical infrastructure locations, your local hospital takes the prime spot on the list. Hospitals hold special value for the biological bomber:

1. Many patients have compromised immune systems making them more susceptible to infection and a greater mortality.
2. Hospitals have a large transient visitor population in the form of visitors and suppliers. These people will move in and out the hospital and into the community and will help spread any disease. 
3. Medical providers in the hospital will also be at risk for infection...a biological attack on a hospital may cripple the ability to respond to the medical needs of a community. Forget about surge capacity...there will be no capacity when physicians, nurses, and non-clinical staff become too ill to work or refuse to report to work. (not to mention a lack of preparedness on the part of many health care systems)

YOU: The Biological Bomber. 
Much of what you've read about the biologic bomber is theory; apocalyptic, cataclysmic theory. But there is a biologic scenario that puts you in the staring role and can be every bit as dangerous as the terrorist biological bomber.

Failing to practice the personal responsibility of hand hygiene, respiratory etiquette, and appropriate social distancing when ill puts  you in a position to spread disease including seasonal flu or other diseases. These simple practices along with getting the appropriate vaccines can help prevent YOU from becoming an unwitting biological bomber.

Vaccine and non-pharmacological interventions (hand hygiene, respiratory etiquette, appropriate social distancing) are also effective methods used to prevent the spread of disease, naturally occurring or otherwise. Proper use of these interventions along with personal protective equipment will boost protection for health care and traditional responders adding to our resiliency.