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A National Security Concern? 10,000 Infected Balloons Over America?

Recent events created by China highlight my significant and long-held concern regarding protecting America’s national security critical infrastructure. 

By

Healthcare Business Review | Monday, February 13, 2023

Recent events created by China highlight my significant and long-held concern regarding protecting America’s national security critical infrastructure (including our government agencies, corporations, schools, sports facilities, and hospitals—and the workers that propel them and the family members that sustain those workers) from infectious disease spread sneak attack using 10,000 secretly launched small, infected balloon bombs over America. 


But this short piece is hypothetical. I am not pointing the finger at China or in any way  chastising the Biden Administration for its handling of the Chinese-Spy-Balloon Affair. Using the highly concealed, short-range launch approach I discuss later, China could do it and get away with it. But the execution of the malicious strategies I examine here would almost certainly involve a smaller, more deceitful, less-ethical, and more hostile country than China.

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For decades, when I was on the faculty at Harvard and afterward, I have identified and scaled this kind of concern in a few of my talks and papers, especially over the past four years.


I hypothesize that the next world war, World War III (there is always a next world war), will be primarily (of course not totally) biological. America’s enemy would selectively use various arms, mainly the wide-scale spread of highly contagious but controllable infectious diseases. 


It is essential to an enemy that the impact of these diseases be “controlled” both in target and in effects. Indiscriminately killing or permanently disabling millions of Americans and destroying their homes, work facilities, and roads through what amount to carpet-bombing would be unethical, counter to the Geneva Convention, and counter-productive to the follow-on needs of conquerors. 


Winners want to avoid being exposed to the expense and delays of rebuilding the critical infrastructure and retraining workers in a conquered territory, which we had to do in post-war Germany and Japan. 


But is America prepared for such a simple and inexpensive attack on its people? I am no longer FDA’s principal deputy commissioner and COO. So, I no longer have the national security clearance to access possibly relevant confidential US Government documents. Accordingly, I can only say, as far as I know, most of the dollars spent on protecting America’s people and our national security critical infrastructure are not spent on simple and low-cost but significant threats, such as bioterrorism or large-scale biological attacks. 


In hours, the disabling America’s ability to immediately and effectively respond to such an attack, including our ability to manufacture essential finished goods and maintain a continuous supply of critical materials needed to manufacture those goods, is not only possible but, by using the means, I will briefly describe here, an existential threat. Accordingly, protecting Americans and their ability to respond to and recover from a biological weapons attack should, at the very least, be of significant concern to our government and business leaders. Is it top of mind? Regrettably, I don’t think it is.


With the ways and means we now have, could we quickly and effectively respond to such an attack? Unfortunately, for many reasons, we are significantly unprepared to do so.


For example, the US and many other countries still rely primarily on management strategies and tools developed to combat the 1918 Flu Pandemic. Or they employ minor variations or improvements thereof. Yes, vaccines, tests, and therapies have improved. But skilled risk management of their use and the use of other protective measures are mainly absent.


But what is the evidence of this lack of preparedness to macro and micro-manage a sneak attack of the size I believe likely? The evidence includes the fact that in two years, over 1M Americans were killed by COVID-19 just in the US. Then and since, the management strategies and tools for optimizing the use of advanced vaccines, tests, and therapies, or other significant means of protection, have not significantly improved, or improvements have not been installed at scale.


The jury is still out, but it increasingly appears that many of those million-plus deaths were avoidable. In other words, they, and the far more numerous other harms, such as long-term or even permanent heart, lung, and brain damage, might have been prevented if the proper management strategies and tools were, in advance, widely deployed and properly and aggressively used at the time.


So, in observation of and in response to America’s reckless lack of preparedness, what might a hostile nation do to conquer America or at least knock America off the world stage?  If I were the President of a hostile foreign government (or even the leader of a significant terrorist group), I would realize that a preemptive (sneak) attack using nuclear and chemical weapons would be counter-productive in many ways. It would easily be detectable and defensible, at least in terms of retaliation.


For example, because of early, long-range detection (by such means as advanced radar) and countermeasures, retaliation would be equally strong and swift due to America's overwhelming preparedness. And preparedness for such a chemical or nuclear attack, in terms of mitigation measures, for example, increased immediate detection measures that enable sheltering and the physical hardening of some aspects of critical infrastructure, would be effective in reducing or limiting the destructive (to infrastructure) or harmful (to people) impact of the attack. But infected small balloons are all but undetectable by any means. And launched in thousands, they would immediately overwhelm America’s in-place defenses.


Instead, most American national security spending has been for decades focused on preventing and reducing the effects of chemical and nuclear weapons launched, easily observably, at a distance or at high altitudes by hostile foreign countries. And to a far lesser extent, reducing their effects when they are planted and exploded by domestic terrorists on domestic soil.


Historically, this central focus on nuclear and chemical warfare and weapons is not misplaced. By any measure, nuclear and chemical weapon attacks were and continue to be significant existential threats. But current protection from the more likely attack by biological weapons is weak at best. 


So, preparedness for a nuclear or chemical attack is only one part of the equation. Our need for our nation’s and its people’s national security protection now goes well beyond that. But, unfortunately, the door for what I believe to be the more likely means, biological attack, is not only un-safeguarded but is also unlocked or even wide open.


In a biological attack, it is closed facilities that are, on the one hand, the most dangerous. But on the other hand, they become the safest places to be with the availability and use of the right tools and strategies.  


Preparedness for biological attack must take place on at least three levels: (1) in our critical government agencies, (2) in our critical organizations, such as manufacturers, schools, sports auditoriums, and hospitals, and (3) in our homes. 


Preparedness cannot and does not need to be everywhere. For example, while devastating, a sneak attack using biological weapons that knocks out ten government agencies, 100 manufacturers or hospitals, 1k schools, or 10k homes will not bring America to its knees. But if those numbers are multiplied by 100 or 1k, if well targeted, and all these attacks are occurring on a single day, such an attack will.


For many reasons, for a hostile country, very low-cost, heavily-distributed hostile measures, such as infected small balloons pre-programmed and automatically piloted, make the most sense. For example, they make a hostile country’s (or significant terrorist’s) budget stretch much further so more bombs can be made and transported.


The volume of infected-balloon bombs used in the sneak attack and the nearness of launch makes it more challenging for a target country, such as the US, or target cities or other critical areas within that country to detect and guard against. 


From the perspective of the hostile nation, this strategy of large numbers of “heavily distributed” balloon bombs will work best. For example, from an attacker’s perspective, the balloons must be many and very widely distributed. 


So, what are the correct number of infected balloons and the breadth of their distribution? 10k or 100k, at least, released in a way that they will cover much of America’s airspace over heavily populated sectors or other critical areas. 


And America’s detection tools and defenses against the balloons and their cargo must be heavily distributed, too. There is a saying in the terrorist and sneak-attack space: “ To protect a city or a building, we must be right 100% of the time.


The attacker need be right only once.” To be correct, even close to that number, I would protect nearly every significant building, including almost every critical work facility. And where reasonably needed and affordable, nearly every home of the workers who make those facilities run.


I am particularly concerned about biological weapons that create asymptomatic infections until death or paralysis. Or those that have a significant delay in expressing their symptoms.


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Former University of Cambridge Department Head of Estates Joins Anenta to Establish and Run New Facilities Management Division

Anenta, one of the UK’s leading healthcare waste management service providers, has appointed Karen King, former Department Head of Estates at the University of Cambridge, as Head of its newly formed Facilities Management (FM) division. King joins the business which supports over 20,000 public and private sector sites throughout England, including GPs, Pharmacies and hospitals.  King, who was previously responsible for the University of Cambridge Department of Physics portfolio of buildings – including the new world-class Ray Dolby Centre – will develop Anenta FM Services leading its delivery of soft and hard FM services to new and existing customers. Launching first in London and then Cambridgeshire, before rolling out nationally, Anenta FM Services is committed to working with local specialist companies to deliver a faster response, better local knowledge, greater flexibility, and more competitive pricing. This approach is designed to deliver a more sustainable solution that minimises environmental impact while keeping more money in the local economy.  Anenta's specialist FM team will help it stand out in the sector by identifying and removing unnecessary services that customers frequently pay for as part of dated, legacy contracts.  Utilising its proprietary technology, bespoke FM solutions, expertise in best practice, compliance and statutory requirements, Anenta FM services aims to shake up the market. This will be delivered by improving service levels and identifying savings that can be returned to clients. As part of this approach, Anenta FM services will implement contracts where whole-life costs are factored in, including mobilisation, planned preventative maintenance, reactive repairs and lifecycle savings.  Providing greater transparency and delivering reduced business disruption, this approach will ensure customer equipment lasts longer, resulting in fewer breakdowns or expensive emergency repairs. It also means that business-critical equipment will be replaced at the right time, avoiding the likelihood of catastrophic failure. Hard FM services provided by Anenta FM Services will include electrical, mechanical, plumbing and heating maintenance, along with fire safety, emergency lighting and gas servicing. Its soft FM offering will encompass cleaning, waste management, grounds maintenance, pest control, window cleaning, furniture purchase, office moves and health and safety, aligning services with the needs of the building. Commenting on her appointment, Karen King, new Head of Anenta’s Facilities Management division, said: “We aim to make an immediate impact by doing things differently at Anenta. Our focus will be on delivering transparent solutions that factor in whole-life costs as well as necessary work and maintenance. Unlike competitors that tender for contracts based on lowest headline prices, which fail to factor in real world costs, we’ll deliver tenders based on true lifetime value.  “By working with specialist local businesses overseen by our team of FM management experts, we believe we can build better solutions, improving levels of service, and lowering customer costs compared to the big national players.”  William Cunningham-Davis, Anenta’s Director of Development & Partnerships, added: “Karen brings with her many years of industry expertise and knowledge allowing us to build an FM solution that's both agile and highly effective. Combined with our technology and sector know-how – which has already saved our clients over £13m, plus a further £35m through efficiency improvements – we believe we can shake up the sector and give customers a better and more comprehensive service.” An industry expert, Karen King has served on the Premises and Facilities Management Editorial Advisory Board for five years and is part of the judging panel for the PFM awards. For more information about Anenta FM Services email karen.king@anenta.com , or call Karen King direct on 07861390821. Visit https://www.anentawaste.com/sectors/facilities-management-estates-services/ for full details. ...Read more

The Evolving Role of The Imaging Director

When I first entered leadership in radiology, being a successful imaging director was largely about being a strong clinical and operational leader. You needed to understand your modalities, manage your staff, maintain your equipment, control your budget, meet regulatory requirements, and make sure patients moved efficiently through the department. Those responsibilities have not gone away. If anything, they have become more complex. What has changed is everything that has been added to them. Today’s imaging director is still responsible for the clinical operation. But the role now reaches into information technology, workforce strategy, capital planning, construction, finance, regulatory compliance, patient access, data analytics and increasingly, artificial intelligence. Decisions that once may have involved selecting a piece of imaging equipment can now require months of planning involving IT infrastructure, interfaces, cybersecurity, construction, service agreements, software licensing, data storage and integration with other hospital systems. Staffing is a good example of that evolution. Earlier in my career, staffing was not nearly the challenge it is today. There were more technologists available and competition for staff was significantly different. Today, particularly since COVID-19, we face technologist shortages while also adapting to a workforce looking for schedules that better fit their lives—four 10-hour shifts, three 12-hour shifts, Baylor shifts and other alternatives. Technology has undergone an equally dramatic transformation. Imaging services is now one of the most technology-dependent areas of the hospital. Picture archiving and communication system (PACS) is only the beginning. 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