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Our deadliest enemies are the ones we can't see — not without a microscope, anyway.

 and Mark Olshaker's new book, "Deadliest Enemy: Our War Against Killer Germs." 

Osterholm is the former state epidemiologist for Minnesota, a job that earned him the title "Bad News Mike." (Given his specialty on diseases, he wasn't a guy you wanted to hear from.)

Osterholm joined MPR News host Tom Weber to discuss his new book, and the public health threats the world may soon need to confront.

The most important thing, Osterholm said, is to understand that we now "have more vulnerability to infectious disease than almost any other time in our history."

It might seem counterintuitive, given our scientific advancements, but think about the sheer number of people on the planet now: roughly 7.6 billion.

"It's not the mere number that's important, but that so many live in the megacities of the developing world, where the potential for not only starting infectious disease problems but 

 infectious disease problems is very real."

Then, think about all the advancements we've made in shipping and travel: We've created superhighways for germs.

"We live in a world where it's a just-in-time delivery system, where we've eliminated oceans, mountain ranges, political boundaries, any kind of way of stopping infectious diseases from moving from one part of the world to another," Osterholm said.

And globally, we're not set up to respond to an infectious disease event should there be an outbreak.

"Today, if we look at the fragile state status of so many governments around the world, it's unclear who is in charge, and what kind of infrastructure is available to even respond to a public health problem," Osterholm said. "So when you add this all together, and on top of it, you look at the lack of funding from many governments to actually do public health work, we really have some major challenges."

"Deadliest Enemy" explores the public health emergencies — past, present and potentially future — that have threatened the planet. Malaria. AIDS. Tuberculosis. SARS. Ebola. Zika. Influenza. The list goes on. 

In one chapter, Osterholm delves into the issue of bioterror and the devastating possibilities of an intentionally-released outbreak. He imagines a scenario: An anthrax attack at the Mall of America. Below is an excerpt:

Twenty years ago there were five class A agents of greatest concern for bioterrorism: anthrax, smallpox, plague, tularemia, and hemorrhagic fever viruses such as Ebola. Today, I worry primarily about anthrax, smallpox, and any microbe that we can change through our new hyperslab tools to be readily transmissible to people or animals and resistant to current treatments or vaccines.

 — is a particularly effective biosweapon. It doesn't transmit personstosperson, but when dried out, the bacteria preserve themselves as tiny, virtually weightless spores that are hardy enough to last for decades or longer. Archeologists have even found evidence of them in Egyptian tombs. When those spores are inhaled and reach the moist, comfortable environment of the lungs and gastrointestinal tract, they germinate, reverting back to their active form and releasing three deadly protein toxins. Inhalation of anthrax in the lungs causes pneumonia that kills between 45 and 85 percent of untreated victims. In dried form, anthrax can be hidden in any white powder and will not arouse the suspicion of airport security workers or anyone else. 

Back in 1993, the congressional Office of Technology Assessment produced a report entitled "Proliferation of Weapons of Mass Destruction: Assessing the Risk," comparing the potential impact of chemical, biological, and nuclear weapons on Washington, DC. It concluded that a small airplane dispersing only 100 kilograms (about 220 pounds) of anthrax spores would kill more people than a Scudsclass missile carrying a hydrogen bomb. The Hsbomb would kill between 570,000 and 1.9 million in a 300ssquaresmile area, depending on such factors as weather and exactly where it was dropped. The anthrax dispersal would kill between 1 and 3 million under similar circumstances. 

The late William "Bill" Patrick was a brilliant scientist and a friend to both Mark and me. He used to head up the American bioweapons program at Fort Detrick. Bill made a habit of carrying around a vial containing 7.5 grams of a harmless bacterial culture that looks just like anthrax under a microscope. In March 1999, testifying on Capitol Hill before the House Permanent Select Committee on Intelligence, he pulled out his vial, explained what it was, and declared, "I've been through all the major airports and security systems of the State Department, the Pentagon, even the CIA, and nobody has stopped me." Seven and a half grams, by the way, would be just about the exact amount needed to kill everyone in a structure the size of a Senate or House office building. 

Anthrax can be treated with certain broadsspectrum antibiotics like ciprofloxacin (Cipro), but quick diagnosis is essential and treatment can take weeks or months. And experimental lab work has already proved how easy it would be to develop antibioticsresistant strains. 

Bioweapons are unlike any other of their brother weapons of mass destruction, and our response strategies for other WMDs will not work against them. As horrific as it is to think of two jetliners hitting and bringing down the World Trade Center towers, that was a readily "survivable" tragedy for New York City and the nation. At the end of the day on September 11, 2001, the terrorist act was over and the recovery could commence. With a bioterror event, the end of the day would be only the beginning, and no one would even know it yet. We likely wouldn't recognize it for a week, by which time the initial victims would have carried their deadly infection to all parts of the United States and much of the world. 

Even with biologic agents that are not transmissible personstosperson, the challenge is daunting. The Mall of America in Bloomington, Minnesota, not far from where I live, is the largest shopping center in the United States, with an average of more than 100,000 visitors a day from all over the world. If anthrax were efficiently dispersed throughout the sprawling mall, there would easily be many thousands of cases and thousands of deaths as local healthcare systems were overwhelmed. The victims wouldn't even know they'd been targeted until several days had passed and fever, chills, chest pain, shortness of breath, fatigue, vomiting, and nausea set in. For many of them, recognition would come too late. 

It would be an event of historic proportions that could never be forgotten, not only because of all the death and disease and the almost unimaginable panic that would ensue, but also because it would simply be too big and complex a task to decontaminate the entire mall complex. And you couldn't just tear it down, either. The AMI building in Florida was closed off for more than five years because of the risk of spreading the anthrax spores to the surrounding community. After a monumental cleanup effort it was finally declared anthraxsfree in 2007. A contaminated Mall of America — many times larger than the AMI building —  would just sit there as an abandoned, hulking mass on the Minnesota prairie —  as toxic and uninhabitable as Chernobyl. 

To listen to the full discussion with Osterholm, use the audio player above.

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In his new book, "Deadliest Enemy," epidemiologist Michael Osterholm argues that we are more vulnerable to an infectious disease outbreak now than at any other time in history.

In a new book, "Deadliest Enemy," Michael Osterholm explores the global pandemics that could wipe us off the planet.

Author: How the Mall of America could become 'as toxic and uninhabitable as Chernobyl'

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