Back in the mid-to late 1990s, Annie Jacobsen explains (in Biological War), Congress and the White House launched a series of domestic preparedness programs requiring the federal government to regularly sponsor full-scale biological-attack exercises — so America’s federal, state, and local law enforcement and first responders would be aware of how to deal with a catastrophe of this magnitude, “in advance of an actual incident”:
These were live-action exercises involving thousands of participants, not just tabletop discussions.
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One of the first unclassified exercises was called TOPOFF 2000, a full-scale, multi-agency, multi-jurisdictional simulation (TOPOFF stands for Top Officials). One part of the scenario involved an attack by terrorists who covertly deployed pneumonic plague inside the Denver Performing Arts Center, in downtown Denver, Colorado.
The scenario’s authors based their infection rates on pneumonic plague’s natural contagiousness of R0 2.4 on average.
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The exercise abruptly ends after the fourth generation of infected. What you don’t learn, unless you really dig into the details, is that the reason the exercise stops is because the Denver healthcare system essentially collapses. In the after-action summary, TOPOFF’s coauthor, Dr. Thomas V. Inglesby and his colleagues, write, “Health department officials became exhausted and a feeling of hopelessness quickly overwhelmed a number of [those] participating.”
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Supplies ran out.
First responders could not triage victims fast enough.
Hospitals were overrun.
There was widespread confusion about who was in charge at the federal level. Inglesby found jurisdictional overlaps between the Department of Justice (the law enforcement lead), FEMA (in charge of consequence management), Health and Human Services and CDC (in charge of co-managing public health), and the Defense Department (providing military support).