1. Botulism

Botulism is a sneaky disease that could be lurking in the foods we eat. But you don’t have to eat the toxins responsible for this disease to contract it. You can also get botulism from inhalation or via a wound. eMedicineHealth explains the toxins are very easy to manufacture and weaponize, and because they’re so lethal, it’s easy to see how they may be used in biological warfare.

When you first contract botulism, you have days to hours before you start seeing some serious symptoms. You’ll have difficulty swallowing, blurry vision, and muscle weakness. And then the paralysis sets in, which can cause respiratory failure. Luckily, the CDC does have an antitoxin available, but that still comes with its own risks.

2. Anthrax

This may be one of the more well-known biological warfare agents on this list thanks to the 2001 attacks. While many of us may have a fear of this disease because of what we’ve heard on the news, it’s actually quite rare to contract. MedlinePlus says cattle, sheep, and goats are much more likely to come into contact with the bacteria because it lives in soil, but it’s still dangerous. The Centers for Disease Control and Prevention explains anthrax is colorless, odorless, tasteless, and can be made in a lab. Inhaling it presents the most danger, and it can kill quickly. During the 2001 attack, 22 people, including 12 mail handlers, contracted the disease, and five of them died.

3. Plague

Back in the ’50s and ’60s, the U.S. and Soviet biological weapons programs figured out a way to aerosolize the plague particles. While the bubonic plague was the one that created widespread hysteria back in the day, this method would lead to the spread of the pneumonic plague, which is a less common, but highly lethal, type of the disease, says Johns Hopkins. If an attack were to happen today, it would likely occur with the aerosol version of the bacteria, which could potentially affect hundreds of thousands of people at once. Following exposure, you’d have between one and six days before the symptoms began. And you’d need to seek help as quickly as possible to survive.

4. Smallpox

Smallpox has been eradicated since the ’70s, so it’s tough to imagine a country choosing to use it as a biological weapon. According to Baylor University Medical Center Proceedings, though, this horrifying scenario could become a reality someday, as the former Soviet Union was able to weaponize smallpox in the 1980s.

If this disease were to be used as a chemical weapon, it would cause a number of serious issues ranging from high mortality rates to total panic. Smallpox is easily transferred from one person to the next and is incredibly deadly. It takes about 12 to 14 days to experience the high fever, headaches, and rash that are common with the disease.

5. Tularemia

This disease was originally thought to be the plague back when it was first studied by the U.S. Public Health Service in 1911. GlobalSecurity.org reports the largest outbreak happened in Sweden during the ’60s, where there were 2,700 cases of infection. As far as usage for biological warfare, the Soviets were thought to have experimented with weaponizing tularemia prior to World War II. And they’re not the only ones — the U.S. also experimented with using the bacteria as a weapon in the ’50s and ’60s. If an aerosol attack were to occur, it would easily pass from one person to the next.

6. Glanders

This disease can affect people, but it’s much more common in horses, mules, and donkeys and has been used as a weapon against these animals in the past. Why attack our four-legged friends, you ask? The Journal of Pharmacy & BioAllied Sciences explains horses and mules were used as primary modes of transportation back in World War I. The German military used a glanders agent to infect these horses, which heavily impacted the opposing side’s ability to operate. Additionally, the National Center for Biotechnology Information reports the Japanese also used it in World War II to infect prisoners of war and civilians.

7. Cholera

This disease doesn’t pose much of a threat anymore thanks to antibiotics and water treatments, but developing countries without clean drinking water are still affected by cholera. Though it’s unlikely to be weaponized,  GlobalSecurity.org reminds us it was used during World War II  when the Japanese dropped cholera cultures into Chinese wells, causing around 10,000 cases to emerge. In addition, Iraq and North Korea have looked into using it as an agent. If it were to be used today, it would have to infect our water or food supply. Because the U.S. has ways of easily treating cholera, it’s less likely to be used here and more likely to be used in less developed countries.

8. Ebola

Since the Ebola scare a few years back, many have feared this disease could be used as a weapon. Here’s the thing about Ebola — it’s fragile and hard to transport, which makes it very difficult to weaponize. Stratfor explains a Japanese cult tried to obtain samples of the virus for their biological warfare program, and they failed. Even if they somehow succeeded, though, the virus would likely die on the way to the lab.

9. Q fever

You don’t need to be attacked with this disease to get it — you can actually contract it if you have livestock. eMedicineHealth explains goats, cattle, and sheep can carry the bacteria, and it’s extremely infectious. It results in a high fever and a cough, and in severe cases, you can die from complications.

Here’s where it gets scary — The Lancet says, because the disease is so infectious and easy to produce in large amounts, there’s a good possibility it could be used as an aerosolized warfare agent. It most likely wouldn’t cause many deaths on its own, but if left untreated, it can cause a lot of complications later on.

10. Brucellosis

Nowadays, there are other pathogens that would probably be more effective than brucellosis. But we can’t forget it was the first agent that was created as a weapon by the U.S, says the Southern Illinois University School of Medicine.

Cellular and Molecular Life Sciences explains it could still pose a threat because it’s easily contracted through the air. Also, its symptoms — body aches and fever — look like many other diseases, which makes it hard to diagnose without a blood test. Even with a proper diagnosis, multiple antibiotics may need to be used. It’s unlikely brucellosis would kill you

11. Melioidosis

Melioidosis is often associated with ganders, as both come from the same species of bacteria, says Medscape. This disease typically affects those who are in tropical climates, but it’s actually on the rise due to the increase in travel worldwide. Melioidosis is easy to contract — just inhaling the bacteria can lead to very serious illness, and Dycor suggests it can kill in as little as 48 hours. It’s also resistant to many antibiotics. If it were to be aerosolized and used as an agent, doctors would most likely have trouble treating everyone in time. The good news is this isn’t one that’s likely to be weaponized.

12. Typhus fever

Historically, we’ve seen the damage this illness can do — and it’s a good thing most of us don’t have to worry about it anymore. But, it’s possible we could see a reemergence of typhus in the form of biological warfare.

Typhus is incredibly infectious, which is how it managed to sweep over so many nations. Thankfully, you can’t pass it from person to person — MedicineNet.com explains infected fleas or lice spread the disease. But, depending on how densely populated your area is, this infection can travel pretty quickly. Biological weapons programs in Germany, Japan, and even the U.S. have looked into using typhus as a possible agent before, says GlobalSecurity.org.

13. Salmonella

Few of us actually consider what would happen if this common disease were to be used as a weapon. The Federation of American Scientists reports the Rajneeshee religious cult used salmonella to contaminate the salad bars at 10 restaurants in Oregon once. No one died from the event, but 751 people did get salmonella.

The good news is antibiotics can be administered to those with severe cases of this food poisoning. And you can’t get salmonella that easily — it has to be ingested. For this reason, using this disease as an agent would result in a lot of chaos, some sickness, and few deaths.

How would we respond today?

If a biological attack were to happen today, the CDC outlines how the situation would be handled. Their preparation efforts are mainly focused on what would happen if a highly contagious agent were to be spread through the air, as this type of situation could have the most devastating consequences.

There are five main focus areas based on preparation, detection, diagnoses, response, and communication. When it comes to preparation, local and state public health agencies need to have a plan in place in case an attack were to happen. They must have the necessary tools, support, and technical assistance to best treat patients. For detection, there are mechanisms to detect, evaluate, and report any strange activity that could mean bioterrorism, and clinical labs are provided to public health agencies for diagnosing diseases.

Protection for the future

Warfare in general is scary, and that’s without the disease factor. It’s pretty terrifying to think of what a biological attack would look like, but it’s not all bad. Thanks to technology and our advancements in medicine, our future protection is looking brighter than ever.

According to Dartmouth, vaccines and drugs are continually being studied in use against biological weaponry. There’s also plenty of research going into antibiotic resistance and how to engineer certain bacteria to be less resistant to available medications. In the near future, it’s likely we’ll see new vaccines that can protect against multiple diseases at once and new broad-spectrum antibiotics. Equipping local hospitals and public health agencies with the necessary tools while also keeping everyone calm is the best way to combat a bio warfare attack.