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http://www.nytimes.com/2002/12/15/magazine/15SMAL.html?tntemail0

Smallpox Martyrs

By PETER LANDESMAN

he next terrorist attack on America could once again be brought via commercial airliner. The simplest way to deliver the deadliest bio-weapon of all, smallpox, is also the most low-tech and efficient. All you need is a suicide volunteer, and we now know they are legion. Infect him in Baghdad or Karachi or the Gaza Strip; have him sit out the virus's two-week incubation period until he begins to cough and get woozy. Then buy him a plane ticket from New York to Los Angeles, or from Chicago to Atlanta. All he has to do is watch the in-flight entertainment and emit the occasional cough. A sneeze works, too.

Such a person is now referred to by public-health officials with a disconcerting name: the smallpox martyr. Even before boarding his plane, the ''human missile'' crisscrosses the airport, stands in line at check-in, at the Starbucks stand, in the bathroom, at security. Whenever he coughs, some people close to him will breathe the virus in, and it will lodge in their lips and noses, and they will carry it inside them onto their own planes, passing it to the passengers directly around them. In the airport alone, experts estimate, a smallpox martyr can infect between 3 to 20 other people. And in a confined space with internally circulating air, that number could be even greater.

Americans wouldn't hear anything for another two weeks as the virus incubates. Then in different corners of America, wherever those planes landed, hundreds if not thousands will come down with the ''flu.'' Their backs will ache. Their fevers will spike. Their skin will darken until it looks charred, and then things will really get bad. There is no treatment. By this point, a vaccine is useless.

Such an outbreak would be very hard for authorities to track. (Consider how difficult it was for the Centers for Disease Control to track 18 cases of anthrax.) Even after authorities have become aware of an outbreak, a third of those who contract smallpox will die, but not before infecting others, a third of whom will also die. And so on. (Smallpox killed 500 million people in the 20th century alone before it was declared eradicated in 1980.) One smallpox martyr could, in theory, bring the United States to a standstill.

The government is soon expected to announce plans to vaccinate some members of the military as well as the 500,000 health-care workers expected to respond to a smallpox outbreak. The vaccination itself does not come without complications; out of every one million recipients, as many as 50 could have serious medical complications, even fatal ones. But this is a cost Americans must bear, say experts who are busily developing strategies to battle a smallpox epidemic. The strongest plan involves ''the vaccination ring,'' in which all those who could possibly have come into contact with a victim are vaccinated. The idea is to corral the virus and prevent it from spreading to new social networks. Some experts think this may work, but others are doubtful. Indeed, if an outbreak occurs, the only sure way to fight it is to go inside and shut your door.

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ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.