When it comes to readiness for bioterrorism or a disease outbreak, Utah is only halfway there, according to a national report that also gives the federal government a D-plus for post-9/11 emergency planning.

Utah scored in only five of 10 categories measured in the third annual Trust for America's Health report, "Ready or Not? Protecting the Public's Health from Disease, Disasters and Bioterrorism." States were rated on indicators such as ability to test for chemical and biological threat and ability of hospitals to care for an influx of patients in a mass emergency.

Delaware, South Carolina and Virginia scored the highest, earning eight of 10 points. Alabama, Alaska, Iowa and New Hampshire were lowest, each with two points.

Utah health officials say the state is in much better shape than it was when terrorism rushed to the forefront of planning following the attacks on the World Trade Center and the Pentagon on Sept. 11, 2001.

"We've come a long way. We had come quite a ways in preparation for the Olympics, but we've done a lot of things we had not even done for the Olympics," said Dr. Dick Melton, deputy director of the Utah Health Department.

Last year, Utah got a six out of 10, and "had they used the same criteria, we would probably have had an eight this year," said Health Department spokesman Cody Craynor.

But categories were changed and the report doesn't measure the other "dozens of areas" in which the state is making preparations, he added.

"It's hard to use this as a report card for us, because I don't think it is an effective measure of what we've done. Better is how we respond to crisis," he said, citing public health system action in the face of what seemed to be a smallpox scare and during mass immunization clinics, including an impromptu one at Clearfield's Job Corps.

Health officials feared a patient at Pioneer Valley Hospital had smallpox. The state lab determined within a couple of hours that it was severe chicken pox, Melton said. Without that capability, health officials would have had to assume it was smallpox, quarantine the patient and his contacts — and even close the emergency department until they had results from the Centers for Disease Control.

"Those are true measures, and I think we do a lot better than we could have four years ago. We've made many strides," Craynor said, adding there are also areas for improvement.

"Their criteria are 10 very bright line marks that do not represent the overall progress we've made, but only those 10 specific things," Melton said. "They are accurate but not a terribly good reflection of what we're doing."

Hospital-preparedness earned most of Utah's points. Utah has enough lab scientists to test for anthrax or plague in a suspected outbreak, and hospitals were deemed prepared to care for a surge of extra patients, including having needed extra medical equipment available, being able to immediately consult with infection-control experts and having a system to prioritize distribution of vaccines or antiviral medicines to hospital workers.