Today, as the Washington Post tells this story. It has the feel of a single-source anecdote, of being “too good to check.” It is neat, compact, no one is mentioned by name, and there’s a moral to the story: ready-made for narrative-addicted Posties.
But it is what happened, says the Post, to a Russian infectious-diseases lab tech.
The Russian Mishap as told by the Post
She was an ordinary lab technician with an uncommonly dangerous assignment: drawing blood from Ebola-infected animals in a secret military laboratory. When she cut herself at work one day, she decided to keep quiet, fearing she’d be in trouble. Then the illness struck.
“By the time she turned to a doctor for help, it was too late,” one of her overseers, a former bioweapons scientist, said of the accident years afterward. The woman died quickly and was buried, according to one account, in a “sack filled with calcium hypochlorite,” or powdered bleach.
The 1996 incident might have been forgotten except for the pathogen involved — a highly lethal strain of Ebola virus — and where the incident occurred: inside a restricted Russian military lab that was once part of the Soviet Union’s biological weapons program. Years ago, the same facility in the Moscow suburb of Sergiev Posad cultivated microbes for use as tools of war. Today, much of what goes on in the lab remains unknown.
via Ebola crisis rekindles concerns about secret research in Russian military labs – The Washington Post.
In fact, there is a case of a Russian researcher dying of laboratory-acquired ebola — in 2004. Here’s Judith Miller at the New York Times. University of Minnesota Center for Infectious Disease Research and Policy in 2004. However, the unfortunate Russian researcher in 2004 was in Novosibirsk at the Vector (formerly Biopreparat) facility, not near Moscow.
Now, we’re familiar through work with a similar mishap in the United States, with a somewhat better outcome, that happened about the same time.
The American Mishap
On February 11, 2004, a scientist was injecting a test treatment into laboratory animals (mice) deliberately infected with a mouse-adapted strain of Ebola Zaire, at the US Army Medical Research Institute for Infectious Diseases in order to study the disease. She inadvertently stuck herself with the needle. It went right through her bio-safety suit glove and her surgical glove into the soft muscle of her hand. (She was trying to inject the sample into the mouse’s belly, whilst holding the mouse in her hand). She was in a Bio Safety Level-4 containment lab at the time, the strictest and most inconvenient of medical precautions.
The accident and its aftermath has been written up by Kortepeter et al. in the Journal of Emerging Infectious Diseases in 2008. Here’s their description of the accident:
The person had been following standard procedure, holding the mice while injecting them intraperitoneally with an immune globulin preparation. While the person was injecting the fifth mouse with a hypodermic syringe that had been used on previous mice, the animal kicked the syringe, causing the needle to pierce the person’s left-hand gloves, resulting in a small laceration. The virologist immediately squeezed the site to force the extravasation of blood. After decontamination of the blue suit in the chemical shower, the injured site was irrigated with 1 liter of sterile water and then scrubbed with povidone-iodine for 10 minutes.
In terms of exposure risk, the needle was presumed to be contaminated with virus-laden blood, although it was suspected that low levels of virus were present on the needle. The animals had not yet manifested signs of infection, and much contamination may have been removed mechanically when the needle pierced the gloves. The local decontamination of the site also reduced potential for infection.
BSL-4 is used for pathogens which are highly contagious, lethal, and for which there are no suitable vaccines or therapies. The most common BSL-4 agents are hemorrhagic fevers, including filoviruses like ebola, Marburg, and Lassa; and CCHF. (We’re probably forgetting a few). Many of the nastiest nasties like Yersinia pestis (plague), yellow fever, Rickettsia spp., are BSL-3 because there exists an approved or experimental vaccine or treatment for them in humans.
BSL-4 implies, among other things:
- Hermetically-sealed rooms with highly-engineered HVAC systems to control any air interchange; HEPA filters catch even the tiniest viral particles. The BSL-4 facility is physically isolated from non-BSL-4 buildings or areas. Operations are conducted in accordance with a detailed procedures manual.
- Permanent underpressure (so air would never flow out if the seal leaked or was breached; a truly leak-proof seal is a near impossibility, but it can be approached asymptotically).
- At a minimum shower-in, shower-out through an airlock.
- Minimum number of people allowed in. All personnel must have (extensive) BSL-4 general and facility-specific training.
- Everyone inside must wear a positive pressure personnel suit. Every individual’s suit has a segregated air supply.
- No clothes from outside go in, no clothes from inside come out.
- Anything that does come out, comes out through sterilization measures, usually an autoclave.
- Even inside the BSL-4 containment, work with BSL-4 pathogens takes place under hoods or (preferably) in cabinets.
These are international rules and we’d assume the Russians follow them also.
Anyway, she thought the plunger didn’t move, but instantly reported the accident, and took basic first-aid measures. And things started to happen. Because an ebola patient is not infectious for 24 hours, she was allowed to go home and pack for a month away from home. (Home wasn’t very far, because the same facility where she worked hosted her quarantine area). Then she came back to USAMRIID, and walked through the round stainless-steel vault door of RIID’s “Patient Isolation Suite,” or, as everybody called it, The Slammer. There she would stay for 21 days.
If she lived that long.
They made it as comfortable as possible for her. She had a computer and TV, and could stay in touch and read the news — including reports on her own health in the local paper — on the internet. She had a VCR (yeah, not DVD) with a bunch of old movies.
There were basically three possibilities: (a), she hadn’t been infected; (b), she had, and would soon be dead of the disease; or (c), she had been infected, but would be one of the minority that beat the disease. The postdoctoral researcher was young, but adult, and healthy, which helped. And all the skills of all of RIID and its many peer organizations and cooperating scientists were galvanized into action.
An Experimental Hail-Mary Pass
In addition to the other precautions, RIID scientists and their industry and academic peers took a look at whether any experimental therapy might work. A small company in Corvallis, Oregon, AVI BioPharma (formerly AntiVirals, Inc). had been working for years on a concept called Morpholino Oligomers (called PMOs sometimes, abbreviating a longer name), which interposes a synthetic therapeutic molecule — the PMO — between the patient’s cell’s nucleic acids and the single-stranded RNA virus causing the disease. (Viruses use the infected organism’s cellular mechanisms to reproduce themselves). At the time it was a highly experimental therapy, unproven not just for ebola in humans, but for any disease in humans, any primate, or even any laboratory animal.
Because viruses need living cells to reproduce, the scientists at AVI were big believers in direct-to-animal testing, using rodents, ferrets and non-human primates. But with just 21 days max, if Researcher X had been infected, there would be no time for testing. Worse, given the state of technology of 2004, it took about 8 days to make the morpholino in potentially-therapeutic quantities, but it took several days to sequence a pathogen’s genome, and the gene sequence of the infectious virus strain was necessary to start morpholino development! Here, the researchers caught a break: since RIID was working with a known ebola strain, they had a good sequence in-house. The gene sequence of the virus was blasted through the internet to AVI, and morpholino production started. In a very short time, a tiny vial of potentially life-saving — but completely untested — ebola therapeutic morpholino was on a jet from Oregon to Maryland.
It was eight days after the researcher’s lab accident.
A Lucky Break
Medicines are tightly controlled in the various nations of the world. The US has an early-20th-century food-and-drug-act with many subsequent amendments, one that tends to strangle real medical research — like morpholino research — while giving legal cover to bogus nostrums and snake-oils (all the stuff that advertises on radio; it’s all crap). But giving an experimental molecule that hasn’t even been given to a mouse to a human is strengstens verboten. Still, if Researcher X had broken with ebola, they’d have given it to her. But the researcher got a lucky break. She never tested positive for the virus, never developed systems, and walked out of the Patient Containment Suite for the last time on 3 March 2004, 21 days after entering.
If she had broken with ebola, perhaps morpholino research would be further along today. But perhaps she’d be dead; there is that, and we wouldn’t wish her dead to advance science.
Science will still get there.
How Science is Getting There Today
Most of the players have moved on. The top guy in RIID’s program then went over to DHS’s expensive, duplicative, and troubled biodefense program. AVI BioPharma has become Cambridge, Massachusetts -based Sarepta, which continues morpholino research and recently reported successful non-human primate trials for a morpholino therapeutic for Marburg virus. Like ebola, Marburg is a Cat A bioterrorism threat agent, and Sarepta’s research has taken place in collaboration with USAMRIID.
One thing has changed. A 2011 rebuild of several buildings at USAMRIID eliminated the Slammer. RIID is hard up for space, and the Patient Isolation Suite hadn’t been used since 2004. The 2004 incident described here was its first use since 1985; from 1972 when the Slammer opened to 1985, 20 other patients were considered and 17 were admitted, some of which for diseases later downgraded to BSL-2 or -3 pathogens. None of them broke with the disease; it seems like every case was an exercise of due caution. The managers of RIID concluded that any future BSL-4 patients, including suspected ebola exposures, could be adequately contained in local hospitals. The duplicative new DHS BSL-4 facility at Ft Detrick (NBACC), and a triplicative planned new facility (NBAF), an exercise in Nebraska Avenue empire-building which DHS is extremely defensive about, also do not contain any facility for isolating infected researchers.