Reopening Public Facilities
AFTER A BIOLOGICAL ATTACK

A Decision Making Framework

Committee on Standards and Policies for Decontaminating Public Facilities Affected by Exposure to Harmful Biological Agents: How Clean Is Safe?

Division on Earth and Life Studies

Board on Life Sciences

NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
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Reopening Public Facilities after a Biological Attack: A Decision Making Framework Reopening Public Facilities AFTER A BIOLOGICAL ATTACK A Decision Making Framework Committee on Standards and Policies for Decontaminating Public Facilities Affected by Exposure to Harmful Biological Agents: How Clean Is Safe? Division on Earth and Life Studies Board on Life Sciences NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Reopening Public Facilities after a Biological Attack: A Decision Making Framework THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, D.C. 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This material is based upon work suported by The Regents of the University of California Lawrence Livermore National Laboratory under Subcontract No. B530522 as part of the Restoration and Domestic Demonstration and Application Program funded by the Department of Homeland Security through Interagency Agreement No. HSHQPB05X00123. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the Lawrence Livermore National Laboratory or the Department of Homeland Security. International Standard Book Number 0-309-09661-8 Library of Congress Cataglog Card Number 2005929183 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055, Washington, DC 20055:800-624-6242 or 202-334-3313 (in the Washington Metropolitan Area); Internet, http://www.nap.edu Copyright 2005 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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Reopening Public Facilities after a Biological Attack: A Decision Making Framework THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralp J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Reopening Public Facilities after a Biological Attack: A Decision Making Framework COMMITTEE ON STANDARDS AND POLICIES FOR DECONTAMINATING PUBLIC FACILITIES AFFECTED BY EXPOSURE TO HARMFUL BIOLOGICAL AGENTS: HOW CLEAN IS SAFE? KENNETH BERNS (Chair), University of Florida, Gainesville, Florida RONALD M. ATLAS, University of Louisville, Louisville, Kentucky MANUEL S. BARBEITO, Biosafety Consultant, Frederick, Maryland JACQUELINE CATTANI, University of South Florida, Tampa, Florida LEE CLARKE, Rutgers University, New Brunswick, New Jersey CHRISTOPHER J. DAVIS, CUBRC, Inc., Buffalo, New York, and Washington, DC PATRICIA FELLOWS, DynPort Vaccine Company, Frederick, Maryland CHARLES N. HAAS, Drexel University, Philadelphia, Pennsylvania THOMAS INGLESBY, University of Pittsburgh Medical Center, Baltimore, Maryland HARVEY W. KO, Johns Hopkins University, Laurel, Maryland R. PAUL SCHAUDIES, Science Applications International Corporation, Rockville, Maryland MONICA SCHOCH-SPANA, University of Pittsburgh Medical Center, Baltimore, Maryland JOHN D. SPENGLER, Harvard School of Public Health, Boston, Massachusetts JAMES TUCCI, K&J Consulting, Cantonment, Florida JAMES WILDING, Metropolitan Washington Airports Authority (retired), Glenwood, Maryland Board on Life Sciences Liaison to the Committee RANDALL MURCH, Virginia Polytechnic Institute and State University, Alexandria, Virginia Staff KERRY A. BRENNER, Study Co-director EVONNE P.Y. TANG, Study Co-director FRANCES E. SHARPLES, Director, Board on Life Sciences EILEEN CHOFFNES, Senior Program Officer BRIDGET K.B. AVILA, Senior Program Assistant (until March 2004) SETH H. STRONGIN, Senior Program Assistant KATE KELLY, Editor

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Reopening Public Facilities after a Biological Attack: A Decision Making Framework BOARD ON LIFE SCIENCES COREY S. GOODMAN (Chair), Renovis, Inc., South San Francisco, California ANN M. ARVIN, Stanford University, Stanford, California JEFFREY L. BENNETZEN, University of Georgia, Athens, Georgia RUTH BERKELMAN, Emory University, Atlanta, Georgia R. ALTA CHARO, University of Wisconsin, Madison, Wisconsin DENNIS CHOI, Merck Research Laboratories, West Point, Pennsylvania JEFFREY L. DANGL, University of North Carolina, Chapel Hill, North Carolina PAUL R. EHRLICH, Stanford University, Stanford, California JAMES M. GENTILE, Research Corporation, Tucson, Arizona ED HARLOW, Harvard Medical School, Cambridge, Massachusetts DAVID HILLIS, University of Texas, Austin, Texas KENNETH H. KELLER, University of Minnesota, Minneapolis, Minnesota RANDALL MURCH, Virginia Polytechnic Institute and State University, Alexandria, Virginia GREGORY A. PETSKO, Brandeis University, Waltham, Massachusetts STUART L. PIMM, Duke University, Durham, North Carolina BARBARA A. SCHAAL, Washington University, St. Louis, Missouri JAMES TIEDJE, Michigan State University, East Lansing, Michigan KEITH YAMAMOTO, University of California, San Francisco, San Francisco, California Staff FRANCES E. SHARPLES, Director KERRY A. BRENNER, Senior Program Officer MARILEE K. SHELTON-DAVENPORT, Senior Program Officer ROBERT T. YUAN, Senior Program Officer ADAM P. FAGEN, Program Officer ANN H. REID, Program Officer EVONNE P. Y. TANG, Program Officer JOE C. LARSEN, Postdoctoral Research Fellow DENISE GROSSHANS, Financial Associate SETH H. STRONGIN, Senior Program Assistant MATTHEW D. MCDONOUGH, Program Assistant

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Reopening Public Facilities after a Biological Attack: A Decision Making Framework Preface The impact of bioterrorism was brought home to the American public in the fall of 2001. Although there had been earlier instances of bioterrorism, as well as threats and hoaxes in recent years in Japan and the United States, the juxtaposition of the biological attacks of 2001 to the events of September 11, and the use of highly lethal preparations of anthrax, had a profound effect on the national psyche. Private and government facilities alike were affected, and considerable challenges were encountered in the process of cleaning up the affected facilities. The decontamination efforts were heavily publicized, time consuming, and very expensive. Sampling and decontamination approaches and parameters had to be decided upon very quickly. Plans had to satisfy scientific criteria to show that individuals reentering the area would not become infected and, as important, address the concerns and fears of people who used the facilities. Eventually, all of the public and private facilities were successfully decontaminated (although there was a considerable delay, caused by financial concerns, in the cleanup of one private site). However, given the urgency, and lack of preparedness with which decisions were made in 2001 and 2002, it seemed likely that the process could be improved with advance planning. This study was requested to help provide a framework for the restoration of contaminated facilities should it be necessary in the future. Specifically, the study was undertaken to consider the question of “How clean is safe?” and to address the criteria that must be satisfied to determine that the site of a biological attack is fit to use again. The 2001 anthrax attacks revealed our vulnerabilities, and suggested that a more widespread attack could have serious consequences for the ability of the country to function. Following the 2001 attacks, alternative locations were found so that essential work could continue. However, if a major transportation terminal

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Reopening Public Facilities after a Biological Attack: A Decision Making Framework for planes or trains were to be taken out of commission, it would be extremely difficult or perhaps impossible to relocate those services elsewhere. In addition to the large costs of a cleanup, the financial consequences and impact on commerce and society could be enormous. If a larger number of sites were attacked and the areas that had to be cleaned up were more extensive, the costs could rapidly escalate to a level that might prove unsupportable (depending in some part on just how essential or irreplaceable each site was deemed to be). The final costs would depend on the approach taken to decontaminate, the parameters that need to be satisfied in terms of test results, the extent of testing, and the evaluation of acceptable risk. To make recommendations about these issues, the committee considered many questions. What are the best ways to assess the presence of the agent? What are the best tests and how should they be applied? How much and what type of sampling is enough? How sensitive do the tests need to be? How many organisms constitute an “infectious” dose? What tests are necessary to declare an area safe? Risk analysis constitutes a major component of this study. The participation and confidence of the affected stakeholders in the process of cleanup and the overall response to a bioterrorism incident are crucial. The recommendations of this report provide guidance on scientific and social science issues because both areas are important to creating a systematic approach to developing standards for effective remediation after a biological attack. Kenneth Berns Chair, Committee on Standards and Policies for Decontaminating Public Facilities Affected by Exposure to Harmful Biological Agents: How Clean is Safe?

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Reopening Public Facilities after a Biological Attack: A Decision Making Framework Acknowledgments This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Roy M. Anderson, Imperial College, London, United Kingdom Peter Biggins, Dstl Chemical and Biological Sciences, Porton Down, United Kingdom Margaret Coleman, Syracuse Research Corporation, Syracuse, New York Baruch Fischhoff, Carnegie Mellon University, Pittsburgh, Pennsylvania David Franz, Midwest Research Institute, Frederick, Maryland Terrance Leighton, Children’s Hospital Research Institute, Oakland, California Harold Lewis, University of California, Santa Barbara, California Richard Marchi, Airport Council International-North America, Washington, DC Shelly Miller, University of Colorado, Boulder Sandra Crouse Quinn, University of Pittsburgh, Pennsylvania Although the reviewers listed above have provided constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of

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Reopening Public Facilities after a Biological Attack: A Decision Making Framework this report was overseen by R. Stephen Berry, James Franck Distinguished Service Professor Emeritus, The University of Chicago and Richard B. Setlow, Senior Biophysicist, Brookhaven National Laboratory. Appointed by the National Research Council, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author committee and the institution.

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Reopening Public Facilities after a Biological Attack: A Decision Making Framework Contents     EXECUTIVE SUMMARY   1 1   INTRODUCTION   11      2001 Attacks and Cleanup,   11      Context of the Study and Charge to the Committee,   13      Content and Structure,   18      Conclusion,   19      References,   21 2   INFECTIOUS DISEASE THREATS   23      Ability of Microorganisms to Infect People,   23      Infectious Disease as a Weapon,   25      Agents of Concern to National Security and Public Health,   28      Biological Agents Considered in This Report,   29      Natural Background,   36      Conclusion,   39      Findings and Recommendations,   39      References,   40 3   POLICY PRECEDENTS IN DECONTAMINATION   42      Microbial Decontamination in Food and Water Supplies,   43      Biosafety in Microbiological and Biomedical Laboratories,   44      Environmental Infection Control in Health Care Facilities,   45      Decontamination of U.S. Army Biological Warfare Laboratories,   45      Development of Superfund and Remediation Plans,   47

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Reopening Public Facilities after a Biological Attack: A Decision Making Framework      Remediation Experiences in the U.S. Nuclear Weapons Complex,   50      Findings and Recommendations,   52      References,   54 4   ANTHRAX DECONTAMINATION AFTER THE 2001 ATTACKS: SOCIAL AND POLITICAL CONTEXT   56      Uncertain Science, Certain Social Division,   57      Case Study Selection,   59      Conclusions,   71      Findings and Recommendations,   71      References,   72 5   FRAMEWORK FOR EVENT MANAGEMENT   74      Findings and Recommendations,   78      References,   79 6   HAZARD IDENTIFICATION AND ASSESSMENT   80      Identification of the Agent,   81      Evaluating the State of the Agent,   83      Evaluating the State of the Contaminated Building,   86      Findings and Recommendations,   86      References,   87 7   FACTORS INFLUENCING EXPOSURE TO HARMFUL BIOLOGICAL AGENTS IN INDOOR ENVIRONMENTS   89      Exposure,   90      Sources,   92      Building Design and Operations,   93      Heating, Ventilating, and Air Conditioning Systems,   95      Transport and Fate of Harmful Biological Agents,   95      Deposition,   96      Resuspension,   97      Preparing and Operating Buildings for a Bioterrorism Attack and Subsequent Operation,   99      Findings and Recommendations,   101      References,   103 8   ANALYZING HEALTH RISKS   105      Assessment of Risks Posed by a Biological Hazard,   105      Dose–Response: Principles and Uncertainties,   107      Findings and Recommendations,   115      References,   118

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Reopening Public Facilities after a Biological Attack: A Decision Making Framework 9   SAMPLING STRATEGIES AND TECHNOLOGIES   120      Sampling and Identification,   120      General Sampling Plan for Quantifying the Extent of Cleanup,   123      Findings and Recommendations,   133      References,   135 10   DECONTAMINATION PRACTICES AND PRINCIPLES   137      Processes for Decontamination of Harmful Biological Agents and Other Response Options,   137      Decontamination of Harmful Biological Agents by Chemical and Physical Methods,   139      Examples of Decontamination: Hart Senate Office Building and American Media International Building,   149      Finding and Recommendations,   154      References,   155 11   SAFE REOCCUPATION OF A FACILITY   157      Planning for Biological Agent Attack,   160      Building Declared Contaminated,   163      Findings and Recommendations,   168      References,   169 12   HARMFUL BIOLOGICAL AGENTS IN A PUBLIC FACILITY: THE AIRPORT SCENARIO   170      Planning Can Make a Major Difference,   172      Findings and Recommendations,   174     APPENDIXES     A   STATEMENT OF TASK   177 B   PRESENTATIONS TO THE COMMITTEE   179 C   ALL FINDINGS AND RECOMMENDATIONS   182 D   OTHER RELEVANT CASE STUDIES   193 E   WERE THE 2001 ANTHRAX EXPOSURES CONSISTENT WITH DOSE–RESPONSE: THE CASE OF THE AMI BUILDING   199 F   BIOGRAPHICAL SKETCHES OF COMMITTEE MEMBERS   204

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