Ricin attacks will continue

The news that three envelopes intended for President Trump, Secretary of Defense James Mattis, and Chief of Naval Operations Adm. John Richardson triggered alarms in Washington yesterday. The envelopes — apparently sent by a former Navy sailor  — contained the toxic substance ricin, understandably causing concern.

This is especially true as this is the 17-year anniversary of the anthrax attacks, which also exploited the postal system to cause harm. Though extreme concern is justified, it is important to remember that ricin — despite its lethality — is more of an assassin’s weapon than a weapon of mass destruction.

{mosads}Ricin is a deadly toxin that interferes with basic cellular functions and can be delivered via injection, inhalation, ingestion and contact. It is a generated natural product that results when castor beans are made into castor oil. Thus, the detection of ricin always signals a human-initiated process. Castor beans are easily accessible all over the country, and recipes for making ricin abound on the internet.

This ubiquity and ease of manufacture underlie the interest in its use for nefarious purposes by, usually, unsophisticated lone actors. The most famous case of ricin poisoning, however, was state sponsored.

In 1978, Soviet-influenced Bulgarian intelligence agents deployed an umbrella injection device in the successful assassination of journalist and activist Georgi Markov on London’s Waterloo bridge. Because of its lethality, as demonstrated in the Markov assassination, ricin is considered a bioweapon and terrorist groups such as ISIS and al Qaeda as well as nations like Iraq have experimented with its use.

Medical consequences

The lethality of ricin derives from its ability to stop protein synthesis and halt the machinery of cells. This is usually manifested by the onset of respiratory distress, seizures, profuse diarrhea, and vomiting about four hours after exposure — depending on the route and amount of exposure. As little as 500 micrograms can be lethal.

Death occurs about three days after exposure. The care of patients poisoned with ricin is complicated by the fact that there is no specific antidote. Healthcare providers would deliver supportive care with measures such as intravenous fluids to prevent organ failure and supplemental oxygen. There have been efforts to develop vaccines against ricin, but none are currently available.

Ricin attacks will continue

Because of the ubiquity of castor beans and the ease of basic weaponization —which is significantly easier than developing other environmental agents such as anthrax, tularemia, plague, or botulism into a bioweapon — additional ricin attacks should be expected. In 2013, for instance, ricin was mailed to then-President Obama, Sen. Roger Wicker (R-Miss.) and Mississippi Judge Sadie Holland and resulted in a multi-decade jail-term for the perpetrator.

In 2014, an actress mailed ricin to Obama and to New York City Mayor Michael Bloomberg, and in 2011 a group of men was arrested for plotting to use ricin in a multi-city attack. The letter to President Trump represents the third consecutive president targeted with ricin; President George W. Bush was also an intended recipient of such a letter in 2003.

Bcause ricin is not contagious and these attacks are likely to be non-sophisticated, the impact of such events is likely to be delimited — hence its use as an assassin’s tool or a panic-ensuing tactic. It will be essential to confirm the presence of ricin and trace its origin and investigate the perpetrators of this attack.

However, though ricin hasn’t been used in a wide-area attack to date, that doesn’t mean a motivated individual, organization, or state couldn’t do so in the future. Our lack of specific countermeasures means we remain vulnerable to both targeted and indiscriminate use of this toxin.

A detectable threat

Despite that vulnerability, it is fortuitous that an effective detection system is in place that can identify packages and letters containing hazardous materials before they reach their intended targets. Incidents that involve actual chemical or biological agents, no matter how crude, are occurring against a background of disruptive and costly “white powder” events that happen frequently across the country.

Today’s ricin attack should serve as reminder to the public and policymakers that 17 years after anthrax, the threat of bioterrorism persists and that biosecurity deserves to be considered a key component of national security.

Dr. Amesh Adalja is board-certified in infectious disease, critical care medicine, emergency medicine and internal medicine and is a senior scholar at the Johns Hopkins Center for Health Security. Follow him on Twitter @AmeshAA.