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CNN Live Event/Special

America Strikes Back

Aired October 13, 2001 - 12:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
(BEGIN VIDEO CLIP)

GEORGE W. BUSH, PRESIDENT OF THE UNITED STATES: Our nation is still in danger, but the government is doing everything in our power to protect our citizenry.

(END VIDEO CLIP)

DARYN KAGAN, HOST: Is America prepared for germ warfare? We'll review the public health dilemma. Can doctors answer patient demands and quiet fears?

And what's the possibility of a biochemical attack? The reality of this frightening scenario.

The horror of last month's terrorist attacks is still burned in the public's memory. We'll discuss the emotional toll on the victims, their families and the nation.

Plus we want your questions, phone calls and e-mail on CNN, "America Strikes Back."

Hello, I'm Daryn Kagan in Washington, D.C., today. Joining me is CNN medical correspondent Elizabeth Cohen.

Elizabeth, good to have you with me here in the nation's capital.

We, over the next two hours, Elizabeth and I and a number of incredible guests and other correspondents will be focusing on health. We're talking about physical and mental. We're going to look at your health concerns in the midst of the Anthrax scare and as U.S. officials warn of possible new terrorist strikes in the days ahead. We'll be talking both mental and emotional health in the aftermath of last month's attacks in New York and the Pentagon.

And as we explore these issues, it's not just our show, it is your show at home, as well. We really want to hear from you. You can phone in with your questions. You can also send us e-mail at security@CNN.com. Once again, that address is security@CNN.com. And we'll pepper your questions and comments throughout the two hours with our guests.

First, though, of course we want to bring you up to date on the latest developments as America strikes back. And the latest does start with military news; it is coming from near Afghanistan's capital of Kabul. This morning a U.S. Navy jet apparently accidentally dropped a precision bomb on a civilian area. Reports of casualties on the ground cannot be confirmed at this time.

Also, in New York, an NBC employee is being treated for Anthrax exposure after she opened a threatening letter which contained a powdery substance. Other NBC employees lined up to be tested. Incidents in Reno, Nevada, Culver City, California, also raising alarms, but tests there have yet to find any trace of Anthrax.

I want to show you some late numbers that we have for you. It is a CNN-Time poll that is sampling opinions on the dangers of Anthrax. The people were asked if local officials were prepared to deal with it. Twenty-nine percent of those surveyed believe yes; 63 percent said no. That is a big topic which we'll be talking about today.

They were also asked about concerns that someone in their family will be exposed to Anthrax. Fifteen percent said they are very concerned; 32 percent are somewhat concerned; and 52 percent are not concerned at all.

Once again, if you're one of those who believe that you are concerned, you're going to have a chance today to talk to doctors and experts about what you can do to protect yourself and also your family and your loved ones.

More now, though, on the civilian casualties in Afghanistan. CNN's Sheilah Kast is at the Pentagon.

Sheilah, what can you tell us about what they're calling an errant bomb?

SHEILAH KAST, CNN CORRESPONDENT: Daryn, the navy jet was targeting a helicopter at the Kabul airport with, as you said, with a smart bomb. And somehow, the precision-guided missile went astray by about a mile and landed in a residential area. The Pentagon does not know how many people were killed, and it does not know why the bomb missed its intended mark by so much.

The Al Jazeera Arabic-language television network had reported that a U.S. bomb fell in what Al Jazeera described as a very poor residential neighborhood; destroyed homes there. Al Jazeera had reported that one person was killed and three injured, including a woman and a child. As I said, the Pentagon cannot confirm that.

But on this question of civilian casualties, U.S. Defense Secretary Rumsfeld was asked just two days ago about that risk, especially in the Kabul area. And he said then there was no question that there would be what he called "unintended loss of life in a military operation." And he added, "No question that the U.S. government regrets such loss of life" -- Daryn.

KAGAN: Sheilah Kast with the latest from the Pentagon.

Sheilah, thank you very much. The commander in chief, President Bush, is at Camp David in Maryland once again this weekend. Let's check in with our White House correspondent Kelly Wallace, who is near Camp David.

Kelly, so far any reaction from the White House on this errant bomb and its possible effects?

KELLY WALLACE, CNN WHITE HOUSE CORRESPONDENT: No, Daryn, so far no reaction. We have some calls to administration officials; waiting to hear back.

WALLACE: But not likely or not clear if there will be any formal reaction, other than what the administration has said in the past, following what Sheilah said, that there will most likely be some civilian and military casualties in this campaign, and also, that this campaign is in no way targeting the people of Afghanistan but it is targeting the terrorists and those who harbor them.

Now, we do know that President Bush met via video teleconference with his national security advisers for about 30 minutes this morning. Joining the president at the presidential retreat: CIA Director George Tenet, his national security adviser Condoleezza Rice, and also his chief of staff Andrew Card, and other advisers participating, again, via that secure video conference from Washington.

We do also know, of course, that the president went on the radio again today to give a weekly progress report on this campaign. The president talking about the military side here, saying that the first phase, what he called the first phase of this military campaign, is a success. He says that it has weakened the Taliban's military and has crippled their air defenses.

But then, Daryn, he definitely focused on some jitters in the United States, some concerns on the part of the American people about an FBI alert that came out Thursday, saying that there could be terrorist attacks in the United States or against American interests overseas over the next several days; and then, of course, the latest case of Anthrax in New York on top of three cases in Florida.

The president's message, something he's been trying to do, almost day after day, is basically try to reassure the American people that the government is doing everything it possibly can to protect the nation.

(BEGIN AUDIO CLIP)

G.W. BUSH: I understand that many Americans are feeling uneasy, but all Americans should be assured, we are taking strong precautions. We are vigilant. We are determined. The country is alert, and the great power of the American nation will be felt.

(END AUDIO CLIP)

WALLACE: And again, that is a message we are really seeing the president put forward almost daily since the September 11 attacks. And then, Daryn, one other note to let you know. The administration, so far, saying that it doesn't have any evidence right at this point in time to link the New York Anthrax case with the Florida cases with the September 11 terrorist attacks.

But, as we've been reporting, Vice President Dick Cheney, in an interview on Friday with PBS, saying he has some suspicions that Osama bin Laden and his associates definitely trained in using these substances, and so he has some suspicions that perhaps bin Laden and associates could be involved -- Daryn.

KAGAN: Kelly, want to focus a little bit more on this Anthrax, in light of yesterday's confirmation that yet other attack has happened in New York City, as you mentioned.

Has the president or any of his aides, besides the vice president, talked even more about that, given the light of the news?

WALLACE: More about that and -- president certainly did talk about it on Friday, and his aides also. You know, the administration saying it's trying to be forthright with the American people and give the American people the facts.

The president was notified about this latest case Friday morning, and then he and his aides decided to speak publicly about it. Early in the afternoon, we saw Health and Human Services Secretary Tommy Thompson and other officials hold a news conference. And then, the president, at the end of an event to honor Hispanic Heritage Month, the president did talk about this.

Again, it's constantly changing, sort of, public relations strategy for this administration. But there was a sense that the president should talk about this. He said there's obviously reason to be concerned, but that the government is responding rapidly, that Americans should be calm and that the government, again, is doing everything it possibly can to protect the American people.

So it is constantly something we're seeing this White House do -- try to walk a delicate balancing act; let people know the facts, but at the same time, try not to get people all worried around the country -- Daryn.

KAGAN: A difficult balance, indeed. Kelly Wallace, thank you. Very near Camp David with the president. Appreciate that.

Now we want to go back to the military angle. Want to check in on Pakistan, and we find our Christiane Amanpour in Islamabad.

Christiane, can you bring us the latest news from there?

CHRISTIANE AMANPOUR, CNN CHIEF INTERNATIONAL CORRESPONDENT: Well, you've already reported the Pentagon saying that it one bomb had gone astray and there are potential civilian casualties. We have no way of confirming that yet. We wonder whether pictures will come out. We assume they will. There are very few foreign reporters, if any, inside Afghanistan, and those local news agencies who are there have their movements very severely restricted.

However, there have been pictures -- a combination, the latest we have received from Al Jazeera and Reuters -- of the aftermath of previous attacks, the previous night's attacks. There were pictures from the hospital inside Kabul, which showed some injuries, showed some children, women and men who the Taliban claim have been injured in the previous night's attack.

We've heard also from doctors there saying these were hit by shrapnel.

We also have heard from civilians, at least according to this news agency reports that have come out, saying that they have been very frightened by the bombing and that many of them are planing to leave.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE (through translator): It was 10:00 until 3:00 and suddenly I saw a flash on top of my house, followed by an explosion. We came out and saw all houses had collapsed. It was the enemy's plane, and a woman was crying. We dug out three wounded from here and one dead.

UNIDENTIFIED FEMALE (through translator): We have forgotten our own names and can't even understand what we say to each other.

(END VIDEO CLIP)

AMANPOUR: So there you heard sort of the fear from ordinary civilians.

Obviously, these very large bombs that are being dropped have a huge impact in terms of sound, in terms of reverberation, in terms of what people feel when they do fall around the towns on various targets. So we have heard of people who want to now pack up and try to flee.

We've called Kandahar tonight, our sources there, who they say that there were more attacks underway after nightfall on Kandahar, particularly around on military targets, and that at least the army corps commanders' headquarters there, we were told, was under attack.

And again, they say that they have heard also the reports that bunker-busting bombs are being used. And they report also what we know, that when those are used, they make a very, very large impact and sound, and they do have obviously a reverberating impact that does rattle people, as we've been able to tell from the people we've been able to talk to.

But in Kandahar, they are not reporting any civilian casualties -- Daryn.

KAGAN: And, Christiane, what kind of impact and reverberations is this having on anti-American sentiment in Pakistan?

AMANPOUR: Well, we had protests yesterday, but those had been called for and those were expected, and those were a very small minority of the population here. But there have been none of those kinds of disturbances today.

Obviously, you know, and everybody has acknowledged this, if there is civilian casualties, well, then those then to inflame people's passions. But so far, all of the protests, not only in Pakistan but elsewhere around the Islamic world, have been for the most part peaceful, although loud and noisy, but controlled -- Daryn.

KAGAN: Christiane Amanpour in Islamabad, Pakistan.

Christiane, thank you very much.

All right, now we're ready to roll up our sleeves and get to the subject of our two-hour special here, the medical whodunit of Anthrax and the medical national alert. We're going to talk to doctors in New York and Florida. That is just ahead.

Once again, a reminder, we want you to participate. We want you to e-mail your questions to security@CNN.com or give us a phone call. The number is 1-888-CNN-0561.

Our coverage of American Strikes Back continues from Washington, D.C.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

TOMMY THOMPSON, SECRETARY OF HEALTH AND HUMAN SERVICES: Anthrax is not contagious from one person to another. And I want to reiterate that because there's so much speculation about that. "Can I get it from somebody that has it?" Anthrax is not contagious from one person to another.

(END VIDEO CLIP)

KAGAN: We're going to learn a lot more about Anthrax. Those are words of reassurance from Health and Human Services Secretary Tommy Thompson.

Welcome back to CNN. I'm Daryn Kagan. Along with me is our medical correspondent, Elizabeth Cohen, here in Washington, D.C.

It is a nervous nation that was shocked by word of Anthrax cases, first in Florida, one man died, and then in New York.

And joining us now in our New York bureau is Thomas Johnson. He is an expert on chemical and biological agents, also an assistant professor at Long Island University.

Professor, good afternoon, and thanks for joining us.

DR. NORINE JOHNSON, PRESIDENT, AMERICAN PSYCHOLOGICAL ASSOCIATION: Good afternoon.

KAGAN: From what you've been able to see from the three cases in Florida and the one case we know about in New York City, do you see any common link between the four?

JOHNSON: Only in the possibility that the delivery system might be very similar, in that they might have been delivered by an envelope containing spores. However, in the New York case, I understand they have not documented the fact that it was delivered by an envelope. They only had a suspicion.

KAGAN: So the delivery might be different, but the way each of these people got Anthrax could be different. Let's go over the different ways...

JOHNSON: Right.

KAGAN: ... just to start with a primer of the different ways you can get Anthrax. If you can explain the difference between inhaling it, touching it or actually eating something that is contaminated with Anthrax?

JOHNSON: Right. Anthrax can be contracted as a disease in three ways. The first way and most common way it occurs is cutaneous, or on the skin. But it requires a break in skin surface, a cut, a minor abrasion of the skin, for the Anthrax to actually penetrate. Anthrax itself has no ability, of and by itself, to penetrate the skin.

And one of the other interesting things about cutaneous Anthrax is that even untreated, there is almost an 80 percent survival rate with people who never even receive medication for cutaneous form.

The other way you can get it is uncooked meats in particular; meats that were contaminated by Anthrax and you ingest it. Now, that's a little bit more serious. That will cause a number of gastrointestinal problems, and of course the toxins that could be released could be fatal in the good number of cases, especially if untreated. But cooked meat, standard cooking of meat would effectively wipe out the Anthrax if it was on meat.

KAGAN: So we certainly don't want to scare people out there, and they shouldn't be afraid of eating meat right now.

JOHNSON: Absolutely not, no.

KAGAN: The difficult part of this discussion is passing the education and allaying people's fears but not even passing more fear along. And we'll try to do that as our two hours go on.

Professor Johnson, I want you to stand by right now. We're going to bring in Dr. Larry Bush. He is actually the doctor that treated Bob Stevens, Bob Steven being the first man that we know in this case who got Anthrax and then later died.

Dr. Bush, thanks for joining us this morning.

DR. LARRY BUSH, INFECTIOUS DISEASE EXPERT: Sure.

KAGAN: Or this afternoon, actually, here in D.C. and also in Florida.

L. BUSH: My pleasure.

KAGAN: As I understand it, when you had your first contact with Bob Stevens, when you were called in, Anthrax was not the first thing that came to your mind of what this man might be suffering from.

L. BUSH: Exactly. When I first saw Mr. Stevens I already had some clinical information, and I had his spinal fluid to look at, so he had bacterial meningitis as a diagnosis that I was coming to see when I came to the emergency department at JFK Medical Center.

Looking at the spinal fluid, it was obvious there was a large quantity of bacteria in there. And on the initial stain that we do, looking at bacteria, it was a gram-positive rod, a boxcar-shaped organism that was not something I would normally see as a cause of bacterial meningitis. So my...

KAGAN: Just to clarify for our audience, you are an infectious disease specialist, correct?

L. BUSH: Correct, I'm an infectious disease specialist at the hospital.

KAGAN: Are you almost nostalgic for the day when you would be called in to look at something like this and Anthrax wouldn't be the first thing that would come to mind?

L. BUSH: Well, certainly Anthrax wasn't on my mind when I first looked at him. But as I looked at the spinal fluid, it was obvious that there was a bacillus organism in there, and bacillus-causing meningitis is very uncommon to begin with. So it's a short differential diagnosis, or a short list of which bacilli may cause an overwhelming disease like this, and Anthrax was right up there on the top of the list.

KAGAN: Professor Johnson, I have a question for you. If I were a wacko, and let's say a reasonably intelligent wacko, how difficult would it be for me to get ahold of Anthrax, turn it into a powder and send it into the mail?

JOHNSON: Well, Anthrax is pretty much ubiquitous in the soil, maybe more in some places than others. Now you have to have pretty good microbiology experience and training and education. You have to grow it. You have to grow it in such a way that it would be -- the bacillus germinates into a spore, which is it's dormant form. Then you have to have that mature spore in some sort of delivery form. You have to figure out how you're going to weaponize it.

KAGAN: But is it difficult? I was speaking to a colleague of yours this morning who said, you know, a couple of college microbiology classes and you could probably figure it out. Would you say that's accurate? JOHNSON: That's accurate. But remember, too, the cult that attacked the Tokyo subway system with sarin gas had a very, very expensive laboratory, approximately $30 million worth of laboratories; Ph.D.s in chemistry and biology working on this. And they attempted to use Anthrax. They actually did spray it off a roof of one of their buildings in Tokyo and they infected no one.

KAGAN: For our viewers out there, also for Professor Johnson, I'll tell you, I will vouch for Elizabeth's mental health. I have known her for a number of years, and she is no wacko. She is just fine.

(LAUGHTER)

KAGAN: I want to bring Dr. Bush in one more time, ask you if you're familiar with the other two cases of the people who were exposed in Florida, what their status is and how they're doing?

L. BUSH: Well, the second case, actually, was a colonization case of a man who worked in the mailroom at the AMI building, and he was hospitalized in a hospital south of where I am. He was found to have a respiratory infection that was not clinical Anthrax. But at that time, his nasal swab for the spore was detected, which obviously was a concern in that he worked in the same building.

Since that time, they had closed the building, as you know, and they called all of the workers in to do nasal swabs and interviewing. And at least, at this time, a third case of now a colonization case of another employee has been detected down here in Florida. She's on prophylactic antibiotics, as are all of the employees from the AMI building.

KAGAN: And so they're doing OK...

L. BUSH: Yes.

KAGAN: ... as far as we know?

L. BUSH: As far as I know, they're clinically fine.

KAGAN: And whereas -- we have a lot of questions about where this came from. One thing we do know, these people didn't get it from each other, right? Because it's not contagious once you have it.

L. BUSH: Exactly. I mean, it appears at this time that they all contracted at least a colonization, and in Mr. Stevens' case, the disease, the active clinical disease, with contact with the organism in the building where they worked.

KAGAN: Dr. Bush, Professor Johnson, we're going to have you stand by. Our viewers are phoning in, a lot of e-mail, a lot of questions for both of you on Anthrax.

And those questions and the answers are coming up after this. First a quick break. Stay with us.

(COMMERCIAL BREAK)

KAGAN: Welcome back. We continue our conversation about Anthrax and bioterrorism. As we mentioned off the top of our two-hour show here, it's not just our show, it's your show as well. We're including your e-mail and your phone calls with questions for our quests.

And our guests are, right now, Professor Thomas Johnson and Dr. Larry Bush.

Gentlemen, thanks for staying with us. We have a caller now with a question. The caller is from New Jersey.

Go ahead. Caller, can you hear us?

CALLER: Hello?

KAGAN: Yes, go ahead. What's your question for either Dr. Larry Bush or...

CALLER: My question is that when an envelope is opened and it contains the powder which has the spores, what is to prevent it from being airborne?

KAGAN: Professor Johnson, why don't you take that one?

JOHNSON: You're going to have to literally throw that powder up in the air somehow and aerosolize it. So it's you really interacting with that powder that's going to do it. So if you start vigorously opening up that envelope and dumping it out all over the place, snapping open the paper, yes, you could aerosolize it. So be gentle with your mail.

KAGAN: Be gentle with your mail, but it's not like if someone just opens a package or an envelope in the middle of a mailroom or in the middle of an office, that suddenly everybody in that office has a chance of being contaminated. You really have to try hard to come in contact with these spores.

JOHNSON: Right, I think at least the preliminary evidence from Florida shows that if indeed Mr. Stevens opened it at his desk in the office, I mean, one spore ended up on his keyboard, from what I understand. And if that's the case, then you might say that he got an overwhelming dose, but it really didn't even spread too far from his desk.

KAGAN: But isn't it even possible, though, that -- just to focus on Mr. Stevens for a second -- that he didn't get it from his keyboard, maybe he was infected...

JOHNSON: No, no...

KAGAN: ... and that came from him...

JOHNSON: No, I'm sorry...

KAGAN: ... as he was touching his... JOHNSON: No, he didn't get it from his keyboard.

KAGAN: OK.

JOHNSON: If he opened up his mail, opened up a piece of paper and aerosolized it, you know, it didn't even travel that far...

KAGAN: All right, Dr. Bush...

JOHNSON: ... from where he opened it.

KAGAN: All right, thank you, Professor Johnson.

Dr. Bush, this is e-mail is going to be for you. It's going to be from Mike. He's wondering what I think a lot of Americans are wondering about, the symptoms and what they should look for when a person first comes in contact with Anthrax. Are they easily distinguishable from other forms of illness such as the flu or the common cold?

And perhaps, the first thing you should talk about is, you might not have any symptoms when you first come in contact with Anthrax. There could be a long delay.

L. BUSH: Correct. There is very little described of outbreaks of clinical Anthrax, as you know. Inhalation Anthrax has only been described in this country in approximately 18 people, the last one approximately 23 years ago.

So most of this is from micro-biologic and clinical data that has occurred elsewhere in the world; the last large group of inhalation Anthrax being in a microbiology lab accident in Russia in 1979.

But the initial symptoms of inhalation Anthrax, which would involve your respiratory system, could have an incubation period of a few days to a couple of months after a contact of inhaling the spores. Because once the spores are inhaled, you may have an upper-respiratory tract illness, like a flu-like viral illness or a upper-respiratory tract bacterial illness. And this may become quiescent until the organisms in the lymph glands in the middle of one's chest develop a hemorrhagic or a necrosis and spread from there possibly throughout the body.

So obviously, this time of the year particularly coming up, there will be a large amount of people with upper-respiratory tract symptoms. And I think, common things being common, they will be not Anthrax.

I think the fact that the health providers in the country right now have a heightened awareness of this disease, it will make them at least take a better history since they cannot, by looking at these patients physically, know whether this is Anthrax, particularly with the inhalation form.

COHEN: Professor Johnson, I have a question for you. As terrible as this situation has been in New York and Florida, it's only a few cases. It is not the worst-case scenario. We don't want to scare anyone, but could you tell us -- paint a picture of a worst-case scenario for bioterrorism.

JOHNSON: Well, the worst-case scenario is probably in a military sense. If our ground troops are under an artillery attack and one of those artillery projectiles contains Anthrax and explodes, they would have no idea whether or not it was just an airburst of an ordinary high explosive as opposed to Anthrax.

Then, days later, the troops would be infected and in large numbers. Also, the plume or the cloud of the Anthrax could travel meteorologically in a pretty good direction, depending again on weather conditions. So the spread of Anthrax could be quite high.

It's going to be very, very difficult in a non-combat situation to aerosolize it in sufficient quantities to affect a large civilian population. And not without -- because the key element must be, it's got to be clandestine to be effective.

KAGAN: And actually, that's a perfect transition for our discussion, as it's going to continue. How difficult is it to do this, and is the United States ready to handle such an attack? We will get to that in a moment.

Our thanks to Professor Thompson in New York, Dr. Bush in Florida. Gentlemen, thank you.

Much of the burden of these health scares is falling on public health workers. We will talk about that. Are they ready? Are the nation's doctors ready to handle this in the cities and states involved? When we come back, public health experts are going to grade the preparedness of the United States.

Keep those e-mail and phone calls coming.

(COMMERCIAL BREAK)

KAGAN: We're looking at the scene outside a Washington, D.C., metro this week. That was as emergency workers rushed in to cope with what they feared was a biological or chemical weapons attack. It was not. But officials there and around the country are on guard.

Joining us now here in Washington, the former commissioner of public health in the District of Columbia, Mohammad Akhter. He is now executive director of the American Public Health Association. Also with us, Dr. Margaret Hamburg. She is former commissioner of health for New York City. She is now with a new organization called Nuclear Threat Initiative here in Washington.

I am sure -- first of all, welcome to both of our guests. Good to have you with us.

And I'm sure in your profession, you have been privy to lots of information, that you know a lot more than we do and have maybe more trouble sleeping at night than some of us because of all the information that have. (LAUGHTER)

KAGAN: Dr. Hamburg, let me start with you, focusing on New York City, because in fact, we've already gotten a number of e-mails about this. Is New York City ready to handle a bioterrorist attack?

MARGARET HAMBURG, FORMER COMMISSIONER OF HEALTH FOR NEW YORK CITY: Well, New York City is very prepared to handle a range of naturally occurring or intentionally caused events, as long as they are on a small scale. And we've seen that repeatedly. We're seeing it now in the...

KAGAN: We've seen the one case...

HAMBURG: ... the one case at NBC News, the fact that they were able to rapidly identify and put in place the right control response for West Nile, a disease that was completely unexpected in that part of the world.

We know that New York City over the last decade, I'm happy to say much of it during the time I was commissioner, has consistently upgraded both its on-the-ground capacity to do disease tracking, disease investigation, as well as the laboratory support for that effort.

But I think that, looking across the nation, we need to continue to strengthen our public health infrastructure, and there's a great deal more that can be done. And I hope this will spur us on to recognize how important that is.

KAGAN: We're going to talk about the things that could be done in a moment.

First of all, though, September 11, as horrendous and as terrible as it was, it really wasn't a test for New York City, because what happened at the World Trade Center really included more fatalities than injuries. So it really didn't test how the city's hospitals would do in the case of a massive attack.

HAMBURG: No, it certainly tested many systems of emergency response and preparedness, but with respect to a biological event, it really did not. And you're right, sadly there weren't casualties to manage in the hospital care system. And there was not an infectious disease agent that we needed to worry about, in terms of containment and control.

KAGAN: So that test has yet to be done.

Let's bring in Dr. Akhter here.

You wrote a very strong editorial in The Washington Post this week. And I just want to take one little quote from it. Very short, but I think it gets your point across, where you write: "The only scarier than an outbreak of the Black Death is knowing our public health system is woefully unprepared to do much about it."

That is a very scary thought for people across America, Dr. Akhter.

DR. MOHAMMAD AKHTER, AMERICAN PUBLIC HEALTH ASSOCIATION: It is true. You know, the big cities, New York, South Florida, the Los Angeles, they have good systems. They are fully prepared. They have done their work right. And they can respond.

KAGAN: The big cities.

AKHTER: The big cities. Once you go to Carbondale, Illinois, or some small town in Missouri, you know, you see these huge gaps where there is no communication between the health departments or there is no communication between hospitals and the doctors, and where there is an awful lack of knowledge and information about these diseases.

You know, we've never had these diseases on our society. So our physicians are not knowledgeable about these things. And so, until people become knowledgeable in medicine, if your mind doesn't know, your eyes don't see what you're looking at...

KAGAN: Education is important.

AKHTER: ... and so, that is very important.

KAGAN: Elizabeth, why don't you jump in here.

COHEN: Well, both of you have testified to Congress several times and have said, you know what, we have a lot of work in front of us. We've got to beef up infrastructure for hospitals and public health agencies. We need to increase our intelligence and our communication. Those are the kind of things that take years, and we don't really have years.

HAMBURG: Well, some of it is under way, and I think we have a good foundation. But we have to build on it, we need to strengthen it, we need to expand it. And we need to enter into some new areas as well.

And it will take time, but we're not starting from scratch, and also we're not inventing new activities.

And I think the good news here is that the investments that we're going to make are going to have a lot of benefits for naturally occurring infectious disease threats. We're not really prepared as a nation to deal with a very serious flu outbreak, and it could happen this season, let alone a large-scale bioterrorist attack.

COHEN: So knowing the extent to which we are so unprepared, I mean, how do you sleep at night?

HAMBURG: Well, I think, you know, that we have the basic systems. And I think that, you know, that we also have to recognize that, while there is enormous attention and concern about the threat of the intentional use of a biological agent to do harm, and it is very frightening, it still remains a very low-probability event.

And we're talking here really about one death in the entire nation. That's not to discount the importance of that loss or to discount that this is something that we have to take very seriously. But I don't think that it should be keeping the American people up at night.

HAMBURG: But I think it is an issue where they should be expressing their concern to their elected officials, as well as to their medical community and their public health officials, that they want to make sure that in their region and in their community that the kinds of investments are made and the kinds of systems necessary are put into place.

KAGAN: We're going to talk more about those systems. We're going to bring Dr. Akhter back here in just a moment.

Also, more of your e-mail, your questions. You have two of the best experts in the country on how cities should be run and how they should be ready. Send them in, and we'll get to them after this break. Stay with us.

(COMMERCIAL BREAK)

KAGAN: An important source of information for you about the news of the day, the terrorism investigation and how public health authorities are responding to the Anthrax infections in Florida and New York. They can be found online at cnn.com. A good reminder, long after our discussion ends today, over the next hour or so, that resource is always there for you right on the Internet.

I want to welcome you back here to Washington, D.C. We are talking with two public health experts, Dr. Margaret Hamburg and also Dr. Mohammad Akhter, great resources to have here with us.

Welcome back to both of you.

A big question for a lot of people is what government can do. But you know what, a lot of people are sitting at home saying, I can't wait for the government, I have to figure out what I can do for myself.

And in fact, that's what Donna from Geneva, Alabama, apparently, is thinking about, because she sent in this e-mail.

And, Dr. Akhter, we're going to let you take this one, OK?

She says, "We are informed about what actions to take during tornadoes, hurricanes and floods. However, what should we do in the case of a bio or chemical warfare? Should we have an extra supply of food, gas masks, or even maybe bunkers?"

I want to go off of Donna's point and ask you two questions. First of all, I grew up in Southern California. I know exactly what to do in earthquake, because from the time you're this big in Southern California, you have earthquake drills and you know to go under the desk or into the doorway.

Why, in America, do we not do drills where we know what to do in a case just like what Donna is talking about?

AKHTER: Well, this is something very new. We never had to face this threat.

KAGAN: We didn't. But you know from your business that it's not that new.

AKHTER: So -- no, no, no. Something like Anthrax or plague or smallpox, these things are very new. And so, what we have not been able to do so far is to really present to the public at large, the health commissioner or health director, local health director, the police chief, the FBI people, get together, and say, "Folks, here is what we have made arrangements to deal with this situation."

KAGAN: So there's nothing like that out there?

AKHTER: Yes. "And here is what you will do. Stay at home and don't panic. Leave your kids at school; they're safe. We will come to you. We will provide you the information. Listen to your radio or television. If you need medication, we will provide the medication. If you need to be checked up, we will come to you. So stay calm, stay home and -- but here is what we have arranged. We have so many beds at this hospital. We are -- all the doctors are ready. They are knowledgeable about taking care of your situation. We have communications systems set up among ourselves," so people should understand that we are prepared.

KAGAN: So most communities don't have that right now.

AKHTER: No. That...

KAGAN: But you -- don't you think that would be a good idea...

AKHTER: That's absolutely...

KAGAN: ... to develop that?

AKHTER: ... essential, if you want to calm people's fear down. I think we need to be prepared, the public health community, the intelligence community, the public security people. But public need to stay calm. They need to have the information exactly, very specific to their local community, that if I am in Springfield, Missouri, what would I do?

KAGAN: All right.

AKHTER: And it should come from the local person.

HAMBURG: It's also really critical to understand that there is no generic response plan for a biological attack...

KAGAN: Because we don't know exactly what we're talking about.

HAMBURG ... because we don't know what might be used, how it might be released, where it might be released and who might be exposed. And so, for each particular instance, we're going to have to tailor a response to meet that particular context.

What we can do and must do, and government has a critical and central role to play, is make sure that the systems are in place to allow response, and that also we have thought about the different contingencies that we might see and, for example, stockpile certain pharmaceuticals, antibiotics and vaccines, that exist against the agents of greatest concern.

And we also need today to be doing the research to better prepare us tomorrow, in terms of new drugs, new vaccines and better detectors, so that we can rapidly recognize what's going on.

KAGAN: I want you to help Donna in Geneva, Alabama, do a checklist here.

HAMBURG: OK.

KAGAN: If you're living in Geneva, Alabama, would you want at your house, just to have, would you want to have an extra supply of food? Would you want to have a gas mask, or would you even have bunkers at your house?

AKHTER: I will have none of the above.

KAGAN: Really?

AKHTER: Absolutely, because in biological attack, there's a window of opportunity somewhere between 24 to 48 hours. And the government is organized in such a way that we can provide you with the drugs, with the medication, within 12 hours. CDC has made this commitment that any place in the country, if there's a need, the drugs, the supplies, the vaccines, the will be there within 12 hours.

And so, there is no urgency, like tornado or earthquake where you need to have it -- either you have it or you don't have it. There is one window of opportunity in which this thing will take place, so people need to stay calm.

The authorities need to work. The public health community need to work, very, hard and move very swiftly to serve their people.

AKHTER: But people need to be told this ahead of time.

COHEN: What do you think about in Israel, they all have sealed rooms. One room of the apartment or house is a sealed room, sealed off. They have to do it by law. Any sense in that?

HAMBURG: I think that probably provides a false sense of security. Certainly with a biological attack, unless it's announced ahead of time, or there is some fortuitous discovery, you're not even going to know that the attack has occurred until cases start to appear days or even weeks later. So you're not going to have been in that sealed room when the exposure might have occurred.

Same thing with gas masks. They don't provide you with protection unless you wear them all of the time. And I can tell you, having worn various kinds of masks for clinical purposes, they are very uncomfortable. And they're unattractive too.

(LAUGHTER)

(CROSSTALK)

COHEN: You know, I was reading a magazine about this. They painted this horrible scenario. They said two guys are at a football game and they have these little aerosol cans kind of down by the sides and they're spraying smallpox, and nobody knows it. Everybody goes home, the incubation time passes. They're all sick. They've infected their family, because smallpox is so contagious.

Is that science fiction or could that happen?

HAMBURG: Well, it's a great concern, and it's certainly our worst-case scenario that we think will probably never happen but we should be prepared for.

Smallpox currently exists in only two known stocks in the world. It's not easy to get your hands on smallpox. But I think we can't be complacent and say, "Well, therefore, something like this will never happen."

And that's why the government has a smallpox vaccine stockpiled. It's not as large we think it should be, given the changing world we live in and the growing concern about the possible use of biological agents as weapons.

And so, we are also -- I shouldn't say we -- but the United States government, our government, is also contracting to produce more smallpox vaccines so that we will have enough to rapidly get it to you if you need it in the case of exposure, because we can control and contain smallpox if we follow good traditional infection control procedures.

You identify the cases, you isolate them; you identify the people who have been exposed to those cases, and you vaccinate them. And using that technique we were actually able to eradicate smallpox as a naturally occurring disease around the globe.

KAGAN: Dr. Akhter, let's get your comment in here on smallpox. If you've never been vaccinated, if you're under 30, or maybe your vaccination has worn off, is this something to be concerned about?

AKHTER: Not at the moment. I think this depends upon what the threat level is. If we find out through our intelligence sources that there are going to be incidences where smallpox will be leaked out -- and with this thing with Anthrax, my concern is that this is in the wrong hands.

If I find out the same way about smallpox, that it's in the wrong hands, I will be very vigilant. I will say, "Let's get the stockpiles ready, let's get ourselves prepared."

KAGAN: But today?

AKHTER: Today, no.

KAGAN: OK.

HAMBURG: And the good news about smallpox vaccine is that if you have been exposed to smallpox and you can get the vaccine, it will protect you from going on to develop disease. And even in the early symptomatic stages, it will reduce the likelihood of serious and or fatal disease.

So not all vaccines work that way. Some require a longer period before they provide protection against disease. But with smallpox, if we have the vaccine and we get it to the people who need it after an exposure has occurred, we can really protect them and contain the ongoing spread of the disease.

KAGAN: Well, on that little bit of good news, we're going to have to go to a break here. We do like spreading some good news and reassuring news. It's not just all about scaring folks out in America.

I want to thank Dr. Akhter and also thank Dr. Hamburg. Thank you very much.

We're going to talk a little bit more. We're going to talk a little bit more about mourning and moving on. Of course a big part of this is not just the physical but the psychological toll of September 11 on the victims' families and the country. And we're going to talk about coping with that when we come back.

(BEGIN VIDEO CLIP)

RUDOLPH GIULIANI, MAYOR OF NEW YORK CITY: Sometimes it feels like yesterday, and sometimes it feels like a year ago or more. This has been the most devastating attack on America, on New York City ever.

(END VIDEO CLIP)

KAGAN: That was New York City Mayor Rudy Giuliani speaking at ground zero on October 11. That was exactly one month after the terrorist attacks on the World Trade Center.

We're now talking about the psychological toll of the terrorist attacks.

And before we go to that, I just want to mention that we are standing by. We are waiting for the mayor, for Mayor Rudy Giuliani. In a moment, we're expecting him to have a news conference with the latest information on that Anthrax case that turned up in New York City. When that happens -- and there you see a live picture from New York -- we will go back there live.

Meanwhile, let's talk about something that a lot of Americans are facing, and that is simply being scared since September 11.

With me, my partner today, CNN medical correspondent, Elizabeth Cohen. We're also joined here in Washington by American Psychological Association President Dr. Norine Johnson.

Dr. Johnson, welcome. Good to have you here with us.

JOHNSON: Good afternoon, and it's really good to be here.

KAGAN: It's very comforting to have you here. We can talk about kind of how this all feels. Even for those of us who might not have known anybody who was directly affected, so many Americans have been scared since September 11.

Four people in the last week we've learned about being infected with anthrax, yet millions infected with fear. What are we to do about that?

JOHNSON: Exactly. And not just fear, but some people are angry, some people are sad, and some people have found they've just long all of their emotions.

COHEN: Just kind of gone numb.

JOHNSON: They've gone numb. That's a really good way to put it. All of those are very normal reactions. And the important thing is to realize that to have emotional reactions after this horrible event that none of us understand is very normal. And emotions will change.

KAGAN: We have a lot of e-mail coming in, questions for you.

This one's from Kyra (ph). She told us that she's 14 years old. And Kyra (ph) asks you, or actually she says: "OK, I know President Bush says not to be in fear, but as a person, as a 14-year-old, that's really hard. Is there any comfort that us young people of America can take to calm us down?"

How do you talk to a teenager about what they're seeing?

JOHNSON: I would say to a teenager just what I said to you, that, actually, feeling anxious, feeling angry, feeling scared is very normal. And I think, perhaps, what the president meant is not to let fear stop you from going about your life.

KAGAN: So you just feel the feel? What do you do with that?

JOHNSON: There are several things that we need to do. We need to learn to take deep breaths. Breathing deeply, letting it out slowly really helps us...

KAGAN: Deep breaths...

COHEN: Yoga breathing.

(LAUGHTER)

JOHNSON: Exactly. There you go, you've got it. Very important.

Twenty minutes of aerobic exercise a day -- and this is what I tell my teen clients. Make sure, even though you're busy studying and there are SATs coming up right now, lots of reasons to be anxious, you've got to keep your exercise going.

And then it's very important to find somebody to talk to. It's important to talk about our fears, and we have to find people who know how to listen.

KAGAN: And we're going to use you for that, a bit more coming up.

Dr. Johnson, stand by. Elizabeth has some questions for you, and I know our viewers at home have questions as well.

Much more ahead on "America Strikes Back." We're going to take some deep breathes here and feel the feel and talk more about that.

Also, more talk on national security, plus we'll have with us the chairman of the American Medical Association, on how your family doctor may be on the front lines of the fight against terrorism.

Stay with us, and keep sending those e-mails.

(COMMERCIAL BREAK)

KAGAN: We want to welcome you back to our focus on health. That is in the aftermath of the terrorist attacks.

I'm Daryn Kagan, along with our medical correspondent Elizabeth Cohen. We are here in Washington, D.C., today. We'll be hearing more from psychologist Norine Johnson in just a moment.

First, though, we want to check our the hour's latest headlines, bring you up to date on the latest developments. And for that, we go to Donna Kelley at CNN Center in Atlanta.

Donna, hello. Good to see you.

DONNA KELLEY, CNN CORRESPONDENT: Hi, Daryn. Same to you. Thanks.

We've been scrambling. We got some news in here at CNN. We got a fax earlier today, as did a number of news agencies, in from the spiritual leader of Afghanistan's Taliban that we want to tell you about.

And our translator, who has helped us understand a little bit more of what's in here -- Mullah Mohammed Omar said today that the world's Muslims have to decide between supporting Afghanistan or the United States. And that also comes from the Afghan Islamic press.

As I say, though, CNN was also sent a fax. And so, we've had it translated, and we want to bring you, certainly, what we know at this point.

He is saying that you, the Muslims of the world, who are watching with your own eyes the American the atrocities on Afghanistan, does your faith allow you to sit silent or to support America? Mullah Omar speaking on the seventh day, of course. This is the seventh day of U.S.-led raids against Afghanistan in pursuit of Osama bin Laden.

Now, our translator has told us a couple of the other things that the Mullah has said here. He says the Taliban will not hand over anyone to the United States -- Osama bin Laden or otherwise -- will not hand over anyone; that bombing Afghanistan is masking U.S. intelligence failures for September 11; that the United States has not shown any proof that bin Laden was involved in the September 11 attacks; and also that the United States is trying to impose its laws on the Muslim world.

So once again, a fax coming to CNN that we've had translated here at CNN, and that is the latest that we have for you on that.

Also, other developments for you. Sources inside the Pentagon today confirm that a U.S. Navy jet accidentally bombed a civilian area near Kabul. The jet had been aiming a precision-guided bomb at a helicopter at the Kabul airport, but the bomb missed its mark by about a mile. No word yet on the number of deaths.

We also have our retired General Shepperd with us, and in about an hour, we'll be talking to him more about collateral damage and how that happens.

And U.S. coalition forces continue to hammer away at the Taliban military sites inside Afghanistan. Strike forces focused on the southern city of Kandahar and on Kabul.

And while the numbers of casualties continues to climb, Taliban leaders today defiantly did reject renewed demands to hand over Osama bin Laden. The Taliban says that more than 300 civilians have been killed.

In New York, more NBC News employees are being tested today for Anthrax exposure. Yesterday a 37-year-old woman inside the news operation tested positive for a mild form of the disease, and she is expected to recover.

In Indianapolis, Indiana, today, a U.S. Airways flight made an emergency landing after a flight attendant discovered an unknown substance in the plane's galley. The airliner had 60 passengers on board. It was en route from Charlotte, North Carolina, to Denver, Colorado. No word yet on what the substance might be.

And from the president, a progress report on the status of the war on terrorism. President Bush says that U.S. forces have crippled Taliban air defenses and now dominate Afghanistan's airspace. On the homefront, he warns that Americans are still in danger of terrorist attacks, but that domestic forces remain on high alert.

And in Nigeria today, an anti-American protest turns violent, when a police chief there orders officers to fire into crowds of demonstrators. Preliminary reports say at least 16 people are dead.

Those are the latest developments for you. We'll keep track of what's going on.

And back to you, Daryn.

KAGAN: All right, Donna, we appreciate that very much.

Also want to remind our viewers, we are standing by, waiting for Mayor Rudy Giuliani of New York City to come out. We expect him to talk about the latest information of that Anthrax case that became news yesterday in New York. When he begins to speak, you'll see that live here on CNN.

Meanwhile, we continue to talk about feelings and about stress of dealing with the emotional trauma. We have with us, of course, our medical correspondent, Elizabeth Cohen -- Elizabeth.

COHEN: Daryn, you know, we've been talking on this show a lot about the anxiety that all of us feel, have felt in the past month. But of course, some of us, some people were affected more than others. And I spent this past week with families who lost loved ones on September 11. Now, let's hear from them and how they're dealing with their grief.

(BEGIN VIDEOTAPE)

ELIZABETH COHEN, CNN CORRESPONDENT (voice-over): Steve Morello is gone. His daughters have accepted this and dealt with it by engraving his memory into their bodies.

ALFI MORELLO, VICTIM'S DAUGHTER: It just means so much that that just feels like it's something that's there forever.

JESSICA MORELLO, VICTIM'S DAUGHTER: It's a permanent reminder and just a permanent reminder.

COHEN: To survive what seems like the unsurvivable, Jessica and Alfi Morello also bought copies of the watch their father wore and loved. In the end, though, they say it's not photos or the watches or even each other that's kept them from falling apart. They say it's their father working from above.

A. MORELLO: We ask each other every night: How are we doing this? And we don't know. The only explanation could be that he's guiding us, taking us by the shoulders, picking us up every morning. It's the only explanation.

COHEN (on camera): Right after the World Trade Center disaster, we spent days talking to families like the Morellos right here outside the armory where families came to register their missing loved ones. A month later, we've gotten back in touch with many of the families and been struck by how much they want to talk. They want to talk about the person they lost, and they want to talk about what they're doing to get through each day.

(voice-over): Harvey Gardner lost brothers Anthony and Mark when he died in the World Trade Center explosion. Look at the necklace he's wearing in this photo; now see it on his brother, Anthony, who we met September 15 at the armory. ANTHONY GARDNER, VICTIM'S BROTHER: I'm wearing my brother's necklace. Wednesday he's going to kill me when he comes home. Wednesday, I went to his apartment, and I took it. This is his favorite necklace, and I'm wearing until he comes home. And I'm going to give it back to him when he walks back in the door.

COHEN: He never walked through the door, and now Anthony knows he never will, but he still wears the necklace.

GARDNER: I look at it as a little piece of my brother that I have that, you know, since I can't have him now, you know, this is some way to keep him close to my heart.

COHEN: And now, Anthony is pouring his grieving heart into a project. He started a support group for families who lost relatives in the explosion, to counsel each other and to share information.

GARDNER: I heard a story that other people on the 83rd floor of Building 1 did escape, so I would like to come -- get in contact with those people to find out if they even saw my brother, do they know what happened, did they see him on a stairwell somewhere?

COHEN: The Zucker family considers themselves lucky to have information about Andrew's last moments. They recently received an e- mail from his coworker.

STUART ZUCKER (reading): Andrew instructed everyone to leave the floor, patiently but forcefully. He saved other lives, including, thanks to the self-confidence he evidenced, my life, at the ultimate risk to to his own life.

COHEN: Andrew was 27 years old. His wife Erica is 4 months pregnant. The Zuckers say the information from the e-mail about Andrew's heroism, plus being together has helped the family survive.

ZUCKER: We basically have been sitting together here, in my home, for 4 weeks now, day in, day out. We eat together -- we do a lot of eating. I guess we're coping in our -- in that type of way.

COHEN: Like all the families we spoke with, they have their good moments and their bad. Their times of fond memories, their moments of darkness.

ZUCKER: I can't answer you. I don't know how I'm ever going to get over it. I don't know if I ever will. Hopefully, with time, I'll be able to function. Life has to go on.

COHEN: Elizabeth Cohen, CNN, New York.

(END VIDEOTAPE)

COHEN: We are here now in Washington with psychologist Dr. Norine Johnson to talk some more about grief and recovery.

You saw how those families are dealing with the aftermath of September 11. Can those of us who even didn't lose loved ones learn something from them about how they're getting through their days?

JOHNSON: Can you imagine how hard it is for them? One of the things that we have in this culture and other cultures are rituals to go along with death, and they usually have to do with something with the body. These families did not have the comfort of that.

So what you heard is they've put together their own rituals, the having of objects of a loved one and keeping it close to you, even doing something to your own body.

Yes, we can hold on to those memories of our country that we had before the tragedy. We can hold on to our loved ones like we saw the families gathering to eat together.

So memories are very important, objects are very important, and to know that one will go through a series of emotions, and it takes time.

COHEN: Now, it seems like, with this incident, we're hit with a double whammy. Like after Oklahoma City, we're grieving the loss of many people -- I mean, grieving the loss of thousands of our citizens. And at the same time, unlike Oklahoma City, we're scared of more things happening.

JOHNSON: That's right. That's where this is so different

This is an event that's never happened before in this country. It's not a one-time event; it's continuing. And not only do we have a war going on overseas, we don't know what's going to happen the next day here.

COHEN: You see children and adolescents.

JOHNSON: Yes, I do.

COHEN: What have they come in and said to you in the past month?

JOHNSON: Well, another thing I wanted to talk about, when you were talking about the survivors, do you know that there are over 10,000 children that have lost a parent? We are talking about a huge number of children and teens that will need support from entire communities to help them go on.

And there's a ripple effect. I heard today about a school in which one child had lost a parent, and all of the children in her class then became afraid that they would lose their parents.

COHEN: And what kind of anxieties are the children and adolescents you see? They didn't lose any, but what kind of anxieties are they bringing into the office?

JOHNSON: It really ranges. Adolescents generally start with the anxieties that are present in their life, and that's why we have to sit and listen to them. They might talk about being scared to go to the dance next weekend. They might be scared about how they're looking. But underneath, what they really want to talk about is the terror of the uncertainty of life.

With younger children, it's much more concrete. Somehow these frightening creatures, these wild creatures from the fairy stories are beginning to come true, and they're in their living room and they're in their homes.

COHEN: Oh, my goodness. Dr. Johnson, we have some phone call questions for you.

KAGAN: That we do. And we want to go ahead and bring in a phone call from California.

Do you have a question for Norine Johnson? California?

CALLER: Oh, hi. I can hardly hear you.

KAGAN: We can hear you loud and clear, so go ahead.

CALLER: What I wanted to ask is if the government has any plans to instate a larger health program around the United States, since so many of us are overwhelmed by what's happening?

COHEN: Is that a role -- do you think that's a role for government? Do you think that there's a need for that much counseling?

JOHNSON: I think that that is a beautiful question, and what she's asking is really something that would be helpful if it's asked in all communities.

Yes, I do think it is a role of government, because this is a health problem. This is not a mental health issue. This is a health problem. People are reacting in very normal ways to a tragedy and a terror and a trauma that is ongoing. And if somebody had a cold or strep throat, they would be allowed to go for treatment. People are reacting normally, and they ought to be able to go and get appropriate help for it.

KAGAN: Of course, we could do a whole show on America accepting mental health, but that's a topic for another time.

Let's go ahead and go to the phones again. I think another call from California is coming in.

Go ahead, please. Caller, can you hear us, from California?

CALLER: Hello?

KAGAN: Yes, go ahead. What's your question for Norine Johnson?

CALLER: My question deals with the effects of cumulative stress to those who were experiencing stress prior to September 11, in the military actions.

And, secondly, you've had great public service announcements advising people who need help to get help, but that's not so easy in this world.

KAGAN: First off, the idea that's a good question. The idea that September 11th didn't happen in a bubble, there was already a lot going on for a lot of people, for example, the economy was already bad and people already facing difficult job situations. That would just be one example of stress that people had, and then this comes in on top of it.

JOHNSON: And we know from the research that people who have had stress before in their lives, people who suffered abuses, children, or people who were in other traumatic situations, are really experiencing retraumatization.

So your caller said something extremely important. If you've been in a situation before where you experienced trauma, you are actually apt to re-experience that again, plus the trauma of this.

KAGAN: Now, what about the idea that people might feel, well, I know I need help, but I have no access to help? In fact, there are a lot of resources that people might not know about.

JOHNSON: That's right. And one of the things that psychologists are doing and other mental health counselors, we are actually out there helping the helpers.

You know, some of the most important people are our teachers, our firemen, our police women, and parents. So people with the mental health skills, with the counseling skills, need to go out as we've been doing and help the helpers. Then you extend the helping hand.

COHEN: You know, one of the things that I thought was interesting, we saw the gentleman who started the web site. That was his way of dealing with it.

For all of us, is doing something a good idea, not just because it's a good thing to do but it might help us as well?

KAGAN: The do (ph) thing.

JOHNSON: Yes, helping other people is very helpful to ourselves. What it does is it helps us experience our own feelings at the same time we're truly helping someone else work through what they're feeling.

His setting up a Web site is a beautiful gesture.

COHEN: Well, he hopes it will really allow people to come together and support each other. He really hopes it's a vehicle.

KAGAN: Were we able to get that web site up to show our viewers? Do we have that? OK, we'll get that a little bit later.

Let's get this question to Ron, also talking about what do you tell your kids. And I'm sure there are a lot of parents out there that have questions about this. He says, "We don't lie to our children. Since we're afraid, we can't very well tell our children we're not afraid, so what do we tell them?"

I've heard two schools of thought, that parents should talk about their feelings so that kids know it's OK to have feelings. And then I've also heard, no, don't tell your kids you're afraid, because that makes them afraid.

JOHNSON: It's frequently how we do something. It's one thing to say to a child, "Yes, I'm afraid, but, you know, I still love you and we're still here together" and to make plans for the future. "We're going to go to the park next Saturday. We're doing to play games tonight for family game night."

So I really do encourage parents to talk about the feelings, but not to exaggerate them, and to immediately talk about something in the future and that everybody is safe now.

KAGAN: Very good advice. Norine Johnson, thanks for stopping by...

JOHNSON: Thank you.

KAGAN: ... helping us take a deep breath and get in touch with our feelings. I know that's a big project for people across America.

Good to have you with us.

JOHNSON: Thank you.

KAGAN: Also, we don't have the exact web site up yet, but we do have the address for you. And we'll have that for you at the bottom of your screen so you can see where those victims, those who lost loved ones -- there you go -- who lost loved ones at the World Trade Center can connect and support each other.

Coming up next, we're going to talk about U.S. doctors, and are they prepared to cope with an emergency and with the barrage of demands from their patients? And what should you be asking your family doctor? We'll talk about that in a moment.

(COMMERCIAL BREAK)

KAGAN: Want to show you these pictures we're just getting in from ground zero in New York City, site of the World Trade Center. The discovery of yet another body in the wreckage. And as you can see, the workers have draped an American flag over that body. The pictures tell the story much more than words could. The work goes on at the site of the World Trade Center in New York City.

And with that, since September 11, physicians around the country have been getting calls from anxious patients about how they want to obtain antibiotics, they want to stockpile in the event of a bioterrorist attack. How should doctors respond? What should you say to your family doctor? With more on that, let's bring in our Dr. Sanjay Gupta, who is joining us now from Atlanta.

Sanjay, hello.

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning, Daryn. Good afternoon.

KAGAN: Good afternoon to you in Atlanta. I would imagine you've talked with a number of your doctor friends, family physicians, who are being inundated with questions and actually demands from their patients. What kind of things are people asking for?

GUPTA: Well, there certainly has been now. A lot of patients, educated people out there, who are very concerned, appropriately so I think, about Anthrax, and have heard that there are antibiotics that may offer some help, especially if taken early, Ciprofloxacin being the most commonly known antibiotic for this.

What I have been hearing from doctors and I've been urging people who've been asking me is, if you are concerned about it, go ahead and get tested for Anthrax before you go ahead and start taking antibiotics. There are some concerns about taking antibiotics indiscriminately. It can certainly have some side effects in the person and may have some side effects for a community at large, if large doses of antibiotics are introduced.

So, I've been sort of trying to justify the fears, however, also urge some prudence with regard to some of this antibiotic usage.

KAGAN: So the concerns are validated, but what you do about it might be different than what people actually want to do.

Sanjay, you stand by there. We want to get also another perspective in our coverage of health against the fight against terrorism.

And joining us from Green Way, Wisconsin, is Dr. Thomas Flaherty. He is the chairman of the American Medical Association.

Dr. Flaherty, thanks for joining us today.

DR. TIMOTHY FLAHERTY, AMA CHAIRMAN: Good afternoon. And it's Timothy Thomas. You got the middle name correct, yes.

KAGAN: Oh, it is?

FLAHERTY: That's just fine.

KAGAN: OK. Well, we'll just call you Doctor and just leave it at that.

FLAHERTY: That's fine.

KAGAN: How about that?

FLAHERTY: Tim will be fine, too.

KAGAN: OK. Well, I was raised better than that, so we'll just stick with -- we'll stick with Doctor and, hopefully, that's the biggest mistake I will make all day.

(LAUGHTER)

KAGAN: Dr. Flaherty, thank you.

What is the AMA telling doctors in the organization about what they should be telling their patients? And I'm thinking mainly of the family doctor, because I would think that's who would have the first kind of contact with patients.

FLAHERTY: Well, certainly, they're in the first line of defense, I think, the family physician, the primary care physician.

We have tried to communicate we effectively with our members, our physician members, to make sure that they are aware of the threat that has been posed by the terrorist attack. Obviously, the concern has been generalized. Even though there has been just a few cases of Anthrax reported, that has been the primary concern.

Now, our identification of the issue is very important for our physicians, but it's really the message to the physicians to really be prepared, to raise your index of suspicion in your patients that present to you.

Again, this has been relatively limited, and I think we have to take some solace in that in the fact that this has not been widespread outbreak. But, again, the threat is there.

KAGAN: The infection has been limited, but the scare and the fear has been widespread. What would you say to patients who say they want antibiotics and they want them stockpiled in their medicine cabinet at home?

FLAHERTY: Dr. Gupta gave good advice. We don't encourage that. I think this is, you know, an idea that really shouldn't be done, not something that you -- obviously, antibiotics should be available to you, and they are available to you in stockpiles. But having them at home, in preparation for or prophylactic use of, is not encouraged.

The issue of antibiotic resistance was mentioned by Dr. Gupta. I think that's a very, very important point. You only have so much resistance out there right now, and lowering the resistance to antibiotics is a very major concern that we have.

KAGAN: If we can get a doctor-to-doctor discussion going here, Dr. Gupta, do you have a question for Dr. Flaherty?

GUPTA: Sure.

You know, Dr. Flaherty, one of the things that, in medical school, we didn't learn much about Anthrax. And I think a lot of doctors probably don't know that much about it, so I think it has been a challenge to the public health system, although there have been some triumphs.

What sort of things are we looking forward to?

GUPTA: Are we looking for better surveillance systems to try and find Anthrax before it might find itself in a population? Are we looking at better ways to immunize the body against things like that? Do you know anything about that?

FLAHERTY: Well, early diagnosis is obviously very important from a public health sector.

The issue that we've tried to emphasize is what we do know about Anthrax and getting that out to our physicians.

As you've said, there has been no cases of inhalation Anthrax in this country in years since the '70s. So consequently, that delay has really put this on the shelf and we haven't paid attention to it. Now we have to pay attention to it.

And what we've done is put articles up the JAMA, the Journal of American Medical Association's web site on these bioterrorism elements, so that physicians can really be reinformed, rekindle that knowledge they got a long time ago in medical school.

COHEN: Dr. Flaherty, here at CNN, we've been doing several stories on pharmacies being overrun by people coming in with prescriptions for Cipro. And they want it, and they want it now. And they're not sick, they just want to stockpile it.

Someone wrote those prescriptions. Are you concerned at all that some of your colleagues may buckle under pressure from pushy patients?

FLAHERTY: That is a concern. I think the patients can be very demanding, and physicians try to accommodate those demands.

But obviously, this is a practice that we don't encourage, and I would discourage it very strongly. The issue of prophylactic use of antibiotics is a concern to all of us and will be a concern to all of us in the future as we have more antibiotic-resistant strains.

I think the issue for the public that they should recognize is there are supplies available of antibiotics if you do have an exposure. And that's the appropriate use, as has been used in Florida and now in New York.

GUPTA: Doctor, just going a little bit back to the surveillance techniques, thinking out the box a little bit. We learned something from West Nile virus recently, and that was, if you follow birds, there's often bird die-offs before you see West Nile virus in humans.

And I'm just trying to think from a medical angle, are we trying to make ourselves aware of any surveillance techniques for Anthrax or even some of the other bio-warfare agents we've been hearing about?

FLAHERTY: Well, I think there are for some of the bio-warfare agents. Unfortunately, for Anthrax, there is no airborne sensor right now that can be used. I don't know if there is a bird strain that we could use or not. I don't think that there is.

Obviously it's a disease that occurs in animals right now, and we do know that there's indigenous areas in the world where Anthrax is there.

But the aerosol preparation of Anthrax is the threat to the population from a military standpoint, from a weapons standpoint.

Fortunately, we've seen the delivery system has been not in an aerosol directly, but in a powder that then has been inhaled. So the exposure has been relatively limited.

Obviously, if we have a weapon-type delivery system, you'll have significant outbreak in a community, and there will be a cluster of disease presentation.

KAGAN: Doctors, let me jump in here with an e-mail from a concerned mother, who is in Louisiana. It's from Kim in Louisiana. And she would like to know what's being done to focus on children and the possibility of their exposure to Anthrax. "I heard that they could not take Cipro. I am the mother of three young children, and I'm very concerned."

I think Kim brings up a good point. We've heard a lot about Anthrax in adults, but how does it present itself in children? And is it even more lethal? And what can you do to treat it in children?

FLAHERTY: Well, the experience in children is almost non- existent. You know, the only large exposure to Anthrax that we know about is a Russian exposure that happened in the late '70s. That was at one of their biologic factories, where they had an inappropriate release of the aerosol, and they had 79 people involved. But there were no children involved at that point in time.

Hopefully, the potential for exposure to children will be much less than for adults because of the environment that they're in.

She is correct that Cipro is not recommended for children because of the potential to have some effects as far as growth and development. But there are antibiotics, penicillin being the primary one, that does have a spectrum that does include Anthrax usually, in a naturally occurring base.

I think one of the important things you should mention as we go through this Anthrax experiment is to really define what the strain is and if there is resistance to it or not from a biological standpoint.

KAGAN: Here is another disease we were talking about earlier before we went on the air, the case with smallpox. And some of us vaccinated, some of us not.

But the question from Rick in Jacksonville, Florida, he wants to know, "If someone years ago was vaccinated for smallpox, like my wife and me, are we still protected against smallpox?"

KAGAN: We were all comparing where we had the little mark, you know, whether it's on this side of your arm or your hip or somewhere else. And if you do have that, does that mean you're free and clear with smallpox?

FLAHERTY: No, not free and clear, but it certainly should give you some protection.

Smallpox vaccinations were discontinued in this country in 1972. Obviously, I qualify for smallpox, and I've got my scar on my arm, as you've identified.

We may have some limited protection. But the protection for smallpox vaccination is really usually thought to be about 10 years in duration. So if it's longer than that, you probably will have protection but not a full protection that you would have with a current vaccination.

KAGAN: Dr. Gupta, I know you did some work on some stories this is week on what the status is of smallpox vaccinations in this country. It's not like if you want one you can just go to the doctor and get one. Isn't that right?

GUPTA: People have been talking about limited supplies of vaccines, in general, and it is a little bit hard to actually quantify exactly how much vaccine is available.

And what we're talking about here, I don't think anyone is suggesting inoculating the entire country again, but I have heard from talking to some sources that there are maybe some high-risk groups that might be identified and more vaccine is being made.

In the case of Anthrax, we actually talked to some of the folks at Bioport Corporation, which is in Lansing, Michigan. Just to give you a frame of reference, Daryn, before the Gulf War, they were making about 3,000 doses a year. They were able to confirm that they're making at least a million doses a year now, so they've significantly increased production.

Incidentally, they doesn't say that that was in relationship to the September 11 tragedy, rather, that they've been increasing production for quite some time as they've thought about Anthrax.

KAGAN: Let's go back to the phones and take a question from a caller from New York.

Go ahead.

CALLER: Hi. My question also is related to vaccines, particularly with the children. Let me just lower my TV, hold on.

Why wouldn't we go ahead and get our children, at least, the smallpox vaccine?

And, additionally, the Prevnar vaccine which is, I believe, against bacterial Meningitis, would that have helped Mr. Stevens, for instance? And I know that that's available for children. As a matter of fact, I'm talking my one daughter, who doesn't have it, next week to get it.

And I think that's about it.

KAGAN: Dr. Flaherty, let's start with the smallpox vaccination. If it was good enough for our parents to get for us, why shouldn't that woman be getting that for her daughter?

FLAHERTY: Well, there's been no cases of smallpox in the world since the 1980s. So obviously, without cases, the need for vaccination is not there.

There is risk with the smallpox vaccine. We've had cases where you actually have a case of smallpox due to the vaccination. So there is some risk with the vaccine.

And I think, other than for workers, as might be identified with a smallpox outbreak, you probably would not consider vaccination.

Dr. Gupta is correct. We've got, according to the secretary of Health and Human Services, about 15 million doses of smallpox vaccination stored right now, and they're preparing another 40 million doses. These may be able to be divided, so you might be able to multiply that number, if we had divided doses.

The issue is vaccination generally and the meningitis is very appropriate. But the meningitis-type symptoms that Mr Stevens had were caused the toxin from Anthrax, rather than by a meningitis that could be treated with vaccination or could be prevented by vaccination.

KAGAN: Thanks for clearing that one up.

We go back to the phones. And this call is coming to us from Florida.

Florida, go ahead with your question for the doctors.

CALLER: Yes. My question is, do medical masks prevent inhalation of Anthrax spores? And, if so, why not have mail handlers be wearing masks and gloves immediately?

FLAHERTY: The answer is no, they don't prevent the inhalation, and even ill-fitting gas masks do not prevent inhalation of spores. So it really -- there's a concern about the protection. I had 31 years in the military and wore those protective suits for a long period of time, in training situations. And you have to have a well- fitted gas mask with the proper type of absorbent in the mask to prevent the inhalation of spores.

KAGAN: I want to get to a point, though, we were talking about toward the top there, and start with Dr. Flaherty on this one.

Are America's doctors ready? When we talk about an emergency, usually we think about firefighters or police being the front line of defense, but in this case, it's going to be doctors and other health care workers that see the sickest people first. FLAHERTY: Well, hopefully, the American physicians I think are following your lead and the lead that we've had from the American Medical Association, are becoming better informed about the potentials and risk in the diagnostic capabilities that we have as far as Anthrax and other issues of bioterrorism.

I hope that's happening. I think it is happening. In the communities that I've been in, the questions are being asked. People are sampling the AMA's web site for the information, they're sampling MedLine to get information. So I think they're trying to be prepared.

The other part of that is the coordination with the public health sector. We certainly have to have a strong public health sector that's responsive to the early diagnosis that we have to make in these situations.

KAGAN: Dr. Gupta, you mentioned, you made reference to your time in medical school. Would you think going through medical school today you'd want to learn very different things or at least additional things than you did when you went through?

GUPTA: Yes, I mean, I certainly think that some of the threats and some of the things that doctors are thinking about are certainly a lot different than they were even 10 years ago, five years ago, when I was in medical school.

But one of the points I was just going to follow up with Dr. Flaherty is that the education process actually took place pretty quickly here. And there have been some real triumphs for the public health depart with regards to Florida. We were hoping that public health officials would be able to go down and mass screen people down in Florida after the case of Mr. Stevens.

They're actually able to do that, find other exposures and treat them before those exposures could ever turn to infections. In some ways that's a real triumph. And I think it shows some of the flexibility of the public health system as well as the medical community both in Florida and in New York.

FLAHERTY: I would also compliment the public health sector of both in Florida and in New York, and the CDC, our Centers for Disease Control, have been very responsive. My concern is we have to have that level of public health involvement across the country.

KAGAN: Dr. Flaherty, chair of the American Medical Association, I want to thank you for your time, sir, for coming in and talking with us.

Dr. Gupta, you're not excused yet. We're going to see you a little bit more just ahead.

GUPTA: More school.

KAGAN: Yes. Much more -- more schooling from you for us.

But first, coming up, we're going to talk about another side of this story. We heard the mention of gas masks. They might be in high demand, but one national security expert thinks the threat of mass- destruction weapons is much smaller than a lot of us are thinking. So stay with us. We're going to allay some of those fears.

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G.W. BUSH: We contacted every crop-dust location, airports, from which crop-dusters leave. We notified crop-duster manufacturers to a potential threat.

(END VIDEO CLIP)

KAGAN: And that was President Bush assuring the nation that the government is taking appropriate action at the first sign of what he calls any credible threats. We do want to give potential terrorists -- we don't want to do too much credit about the ability to control complicated technology.

Helping us to sort through this aspect of the terrorism story is Elisa Harris. She's a research fellow at the Center for International and Security Studies at Maryland, also a former staff member of the National Security Council.

Given what you've maybe had a chance to hear what we've been talking about today, and also, I'm sure, what you've heard discussed on the airwaves since September 11, do you think people have gotten hysterical or is there a reasonable amount of fear out there?

ELISA HARRIS, UNIVERSITY OF MARYLAND: I think people are very nervous about the possibility of chemical or biological attacks. But I think it's important for them to understand that, for a terrorist group in particular, this is a very, very difficult undertaking to employ chemical or biological agents on a large scale and produce significant casualties.

KAGAN: That's a terrorist group, but as we've seen in the past, right here in this country, individuals sometimes take matters into their own hands. And in fact, we don't know who has been sending these Anthrax envelopes to different people up and down the East Coast.

HARRIS: That's absolutely right. We don't know at this point whether these are bio-crimes, copycat incidents, isolated incidents, or whether they're part of a larger, more-concerted effort by a group to cause casualties and fatalities.

COHEN: You know, I asked a guest earlier today, and I'm going to ask you the same question. If I were a wacko, a relatively intelligent wacko and I wanted to -- let's just take Anthrax as an example -- find some Anthrax, make it into a powder, mail it to someone I don't like, and I had a couple of, let's say, college microbiology courses, could I do it?

HARRIS: It would be very difficult to do. The first hurdle one would have to overcome is selecting the right strain of Anthrax, because, like all pathogens, there are different strains. Some are more lethal than others.

Once you select the right strain, if you can do that, you then have to produce it on some scale. You have to purify the agent. You have to stabilize the agent so it remains alive through whatever dissemination process.

If you're hoping to aerosolize it, you have to make sure that the particles are the right size so they get inhaled into the lungs. If they're too large, they will be caught in your nose. If they're too small, people will breathe them in and breathe them back out.

So it's very difficult to do this, much more difficult than I think most people realize.

COHEN: So you've got to get it right.

HARRIS: You've got to get it right. And as I think the cases in Florida and New York have shown, unless you get every single piece of this right, the selection of the strain, the production, the dissemination, the effects will be in fact, very, very limited.

KAGAN: Very good. We're going to have you stand by. A lot more questions for you, especially e-mail questions from our viewers. So we'll be back with you in a just a moment.

First though, we want to get in a quick break. And your e-mail coming up after this.

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KAGAN: We're going to get back to our discussion with Elisa Harris and talking more about bioterrorism and what is and what isn't probable.

But first, we have an incredible opportunity to talk with our Nic Robertson. Nic has had the chance to travel with the Taliban, and he has -- he's joining us by phone. He is in eastern Afghanistan, just outside of Jalalabad.

Nic, what have you been experiencing?

NIC ROBERTSON, CNN CORRESPONDENT: Well, Daryn, about an hour ago, the Taliban allowed in the first group -- allowed the first group of journalists into the country in about the last month, in a group of international journalists, about a dozen of them. It was under cover of darkness. There were many heavily armed Taliban, armed with machine guns and rocket launchers at the border with Pakistan.

The group of journalists is now en route for the city of Jalalabad, which has, apparently, been under attack this evening.

Now, the Taliban (OFF-MIKE) bring in journalists at this time, because they say that the world is not getting a clear view of what's happening to innocent civilians inside Afghanistan. And particularly, they brought group of journalists inside Afghanistan to visit three villages around Jalalabad that they say were completely destroyed, that the Taliban say were completely destroyed.

In fact, a spokesman for their ministry of culture and information told the journalists that they would be taken to see hospitals and these villages and injured people, and would see the sights of these bombardments.

Now, this is the first time that the Taliban have allowed in a group of international journalists, because they say a view of what is happening inside Afghanistan is not getting out to the world -- Daryn.

KAGAN: But, Nic, just so we completely understand what your view is from within Afghanistan, once you are brought in, you are you completely under their control and taken and shown things that they want you to see?

ROBERTSON: Daryn, we're about an hour into the trip, but that's the way that it will be. It will be with the government representatives of the Taliban, who will escort us on this trip and take us to visit the different facilities that they would like to us see -- the hospitals and the three damaged villages they say are damaged, on the outskirts of Jalalabad and eastern Afghanistan and any other things they would like to us see.

Now, they have warned the group of journalists that it would be unsafe for them to try and go off, gathering information and gatherings stories by themselves. So essentially, all the journalists put on notice that they must stay with the Taliban official representatives here -- Daryn.

KAGAN: There's been lot of talk in the Western media, Nick, of defection from the Taliban, from soldiers heading into Pakistan or just simply leaving the Taliban and its troops. Have you been able to find anything about that, or are you just going to get the party line from the people that you're traveling with?

ROBERTSON: Daryn, very difficult to judge at this stage. Certainly, a lot of armed Taliban along the roads driving into the country. It is nighttime here. There is a curfew in place, and there are no civilians that we have seen out on the roads.

Certainly, a large number of checkpoints that appear to be well- mapped and the soldiers that appear to be manning them appear to be well-armed, as well, Daryn.

ROBERTSON: Nic Robertson, our correspondent inside Afghanistan in the eastern part of that country, traveling with the Taliban.

Nic, we ask you, please, more than anything, please be safe as you bring us those reports.

We go from Nic to New York City, where we listen to Mayor Rudy Giuliani on the latest on Anthrax.

(INTERRUPTED FOR CNN COVERAGE OF A LIVE EVENT) KAGAN: We have been listening to New York City Mayor Rudy Guiliani giving the latest on the Anthrax situation in that city.

KAGAN: We learned in that news conference that apparently another letter sent to NBC News, that tested positive for Anthrax. But some positive news in there, in that there were two other letters sent from St. Petersburg, Florida, both with powder, and both of those letters have tested negative for Anthrax at this time.

Also, out of NBC, it looks like more employees there will have to be tested, because the original letter in question might have arrived earlier than they originally thought.

That news conference, while very informative, unfortunately ate up the time of the rest of our discussion here.

So I want to give thanks to Elisa Harris -- thank you so much -- from the Center for International Security Studies at Maryland. I'm sorry our time to talk was so short.

A big thanks to Elizabeth Cohen for helping me do the heavy lifting here in Washington today. And also our thanks to Dr. Sanjay Gupta in Atlanta.

I'm Daryn Kagan in Washington, and I will see you later today. Have a good day.

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