Panic in the Gray Zone
JANUARY 12, 2000
HENSLEY WAS WORKING ALONE in her blue suit in hot suite AA4, near the center of the Institute. It was about three o’clock in the afternoon. She had been working with soups of Ebola for many hours. She wasn’t feeling well: she had a cold and was a little achy, as if she might have a slight fever. She had probably caught a virus, but she was in the middle of an experiment, and she couldn’t abandon it just because she felt sick. She would lose her data if she went home.
She was holding a pair of blunt children’s scissors with her rubber space-suit gloves. (Sharp scissors are forbidden in Level 4.) She was trying to open a bottle by prying on a tab with the scissors. Suddenly, they slipped, and the tip of the scissors jammed into the middle finger of her right glove. She felt a stab of pain near her fingernail.
She held her space-suit glove in front of her faceplate. What had just happened? Had she cut the glove? The yellow rubber was wet, and as she turned the glove in the light, she couldn’t tell if there was a cut in the rubber or not.
Inside her space-suit gloves, she was wearing latex surgical gloves, for an extra layer of protection. Wriggling her arm, she pulled her hand out of the space-suit sleeve and up inside her space suit—the way Dr. Hatfill did when he ate a snack inside his suit—and inspected the latex glove at close range, inches from her eyes.
The rubber was translucent. Beneath it, she saw blood oozing out of her finger, moving along the fingernail. A red spot under the rubber was spreading along the cuticle. It hurt.
It is believed that a single particle of Ebola virus introduced into the bloodstream is fatal.
Hensley felt a sudden rise of fear, which turned into a little bit of panic. What was the last thing I touched with my hand? What was I doing? What were the scissors touching? Was there any soup on the scissors? The mind goes sticky in a moment of fear. She blanked. She couldn’t remember what she had been doing with her hands. There was nobody to ask.
She began to talk to herself silently: Quit panicking and calm down. Did I make holes in both gloves? Or did I just crush my cuticle? She stuffed her arm back down into the sleeve of the space suit and wiggled her fingers into the outer glove.
Time to get out of here.
She opened the decon-shower air-lock door, stepped into the air lock, closed the door, and latched it. She pulled the shower chain, and a spray of chemicals hissed down over her space suit. While she was taking the chemical shower, she realized that she did seem to have a low-grade fever. Oh, this is great, she thought. I already don’t feel well, and now they’re going to take my temperature and then lock me up. She racked her brain trying to remember what she had been doing with her hand. Her glove had been slippery and wet . . . wet with detergent. Some detergents kill Ebola particles. So if there had been Ebola on her glove, maybe the detergent neutralized it. The shower stopped, and she opened the exit door and went out into a Level 3 staging area and pulled off her space suit.
The staging area is a gray room—in between the hot side and the cold side. It has lots of equipment in it, and along one wall there is a row of hooks that hold blue suits belonging to all the scientists who work in the suite. A laboratory technician, Joan Geisbert, was working in the gray area. Geisbert is a slender, quiet woman with dark, wavy hair, dark eyes, and a serious, intelligent manner. She is married to Tom Geisbert, Hensley’s boss. Joan Geisbert is an expert in Level 4 laboratory work, with many years of experience. Hensley trusted her, but she thought she’d better not say anything.
This is no big deal, she told herself. She pulled off her surgical glove and washed her hands with disinfectant soap.
She needed to know if there was a hole in her inner latex glove. That was a serious question. If there was a hole in the glove and there was bleeding on her hand, then there was a chance the scissors had cut her skin. The tip of the scissors could have been contaminated with Ebola virus. Washing her hands would do no good if a particle or two of Ebola had made it into her bloodstream.
Joan Geisbert was puttering with something, not paying any attention to her.
The way to test a surgical glove for a hole is to hold it under a faucet and fill it with water, like a water balloon. If there’s a hole, a thread of water will squirt out. Hensley went to a sink, filled her glove with water, and held it up to see. There was nothing, no leaks . . . but when she squeezed the glove, drops of water oozed out of a hole in the finger.
Okay. She had cut her finger in the presence of Ebola Zaire.
“Hey, Joan? I think I screwed up.”
“Let me see.” Joan Geisbert came over to the sink and inspected her finger and the hole in the glove while Hensley told her what had happened. Geisbert glanced at her with a look of alarm.
Oh my gosh, Hensley thought.
“Get dressed and report to Ward 200. I’ll call Tom and have him meet you there.”
Ward 200 contains a Level 4 biocontainment hospital suite known as the Slammer. Someone who has been exposed to a hot agent can live there for weeks in isolation, and if they become sick they are tended by nurses and doctors wearing space suits.
Hensley took a water shower, got dressed in civilian clothes, and reported to Ward 200. By the time she arrived, Tom Geisbert was waiting for her. He was flushed and nervous. Peter Jahrling had been paged, and he had broken away from a meeting in Washington and was driving back to the Institute as fast as he could. The ward started to swarm with medical doctors, Army officers, nurses, soldiers, and lab techs. An accident investigation team formed up and examined the cut on her finger. They wanted to know what she had been doing with her hands just before she had cut her glove. They took her temperature and discovered she had a fever. She explained that she thought it was just a cold. They stuck needles in her arm and drew out many tubes of blood. She was too nervous to sit on the exam table, so she leaned against it, and then she couldn’t stop pacing around the room.
Tom Geisbert took an Army major named John Nerges aside. “Can you stay with her?” he said. “Talk to her and keep her mind off it.” John Nerges is a large, kindly man, and he was concerned about Hensley, but he joked around and kept up a patter with her.
Meanwhile, the investigation team took her latex glove into another room and studied the hole. They measured the distance between the hole and the location of her cut. Maybe the scissors had not made the hole. They held a meeting out of her hearing. She paced up and down the hallway, with Major Nerges at her side. “Can I get you a soda or anything?” he asked.
“Yes, please.”
She could see the Slammer every time she passed the doorway. There was a bed with a bio-isolation tent around it, and a dummy lying on the bed. Teams of soldiers at USAMRIID used the dummy to practice handling a contagious patient. Major Nerges came back with a Diet Pepsi. “It’s no big deal,” he said. She popped the can and noticed that a soldier had walked into the Slammer and had opened the bio-isolation tent.
He picked up the dummy carried it away on his shoulder.
Hensley turned to Major Nerges. “If it’s no big deal, why is he taking the dummy away?”
Major Nerges walked over to the grunt and swatted him lightly across the back of the head. “You idiot, she’s standing right there,” he growled.
AFTER INTERVIEWING HER for two hours, and studying the glove and her hand, the accident investigators came to the conclusion that there was a low probability that Lisa Hensley had been infected with Ebola virus. Her glove had been wet with detergent, and they felt it would most likely have killed any virus particles. She was free to go home and get some rest. However, she would need to report to an Army doctor twice a day for the next three weeks.
She wasn’t sure her mother should know about this. She went to a telephone near the Slammer and dialed her parents’ house in Chapel Hill. Unfortunately, her mother answered.
“Hi, Mom. I need to talk with Dad about science.”
In a moment, her father came to the phone, and Lisa told h
im what had happened.
He spent a long time calming her down. “Let’s not tell your mother. I’ll call you every day.” He was worried about her, but he said, “I think you need to suck it up and get back in there and finish your experiment.”
“I know. I know I do.”
Otherwise, she might never go back.
At six o’clock, after most people had gone home, she returned to the locker room in suite AA4, put on surgical scrubs and her space suit, and faced the steel door that led inward to Biosafety Level 4. It was a matter of turning the handle and pulling the door open. That was not difficult. The staging room was quiet, empty, with only the sound of her breath running inside her faceplate, which was starting to fog up. Through her visor she saw the red, spiky biohazard symbol on the steel door. Suck it up and turn the handle.
Peter Jahrling arrived at the Institute and went looking for Lisa Hensley. He didn’t find her in her cubicle, so he went to Tom Geisbert’s office: “Jesus, Tom, she’ll never want to go back to the lab. Was she crying? Where is she?”
“She went into AA4, Pete.”
“You’re kidding.”
The door was heavy, and it swung open slowly. She latched it behind her and stepped through the air lock to the hot side.
Up in Geisbert’s office, Jahrling was saying, “Would you and Joan mind giving her the talk?”
“What talk, Pete?”
“The one I don’t want to give her. About not sharing body fluids with anyone during the incubation period of Ebola.”
An hour later, Hensley emerged from the hot suite, chilled and shivery, feeling a little feverish and perhaps a little trembly, but she had finished the experiment.
Joan and Tom Geisbert were waiting for her on the cold side. They invited her out to dinner at a Mexican restaurant, where they bought her some dinner and two beers. The beers helped. Tom and Joan looked at each other, and Tom said to Lisa, “I’m supposed to give you the talk about not sharing body fluids with anyone for a while.”
“Yeah?”
“That was the talk.”
“You mean when I kiss a guy, no swappin’ spit?”
Tom turned red, and Joan burst out laughing.
She assured them it wasn’t an issue right then. In fact, Hensley did have a date lined up that night, a first date with a man she didn’t know very well. Finally, she phoned him and asked if he wouldn’t mind putting off the date, since she had just had a potential exposure to Ebola virus.
He was very understanding.
She drove back to her apartment, which seemed freezing cold, and so she placed a space heater on the floor by her grandmother’s couch, turned it on, lay down on the couch, and wrapped herself in a blanket. Her cat, Addy, curled up with her. Then she began calling her closest friends, and she stayed up late that night on the couch talking with them. She slept for a while, and awoke from a turmoil of blue-suit nightmares. She was boiling hot, her throat was parched, she had a fever. . . . Where am I?—and there was Addy, purring at her side.
HENSLEY CONTINUED her work with Ebola virus, somewhat oblivious to the heated arguments between smallpox experts about whether variola should live or die. The smallpox virus was a relic of the past to her, a virus with a seventies feel, like an album by Debbie Boone. She was more interested in trans-species jumps of viruses that were emerging right now.
She also had her mind on children: what was a woman scientist on a fast track supposed to do about children? She started playing volleyball in a league and met a man named Rob Tealle, who became her significant other. He was a builder and general contractor who worked around Frederick—a smart man, but not a scientist. Hensley packed her grandmother’s couch into a U-Haul trailer and moved to an apartment in Frederick. She and Tealle became very close. It was the biggest relief in the world to go home after a day in a blue suit and talk about normal things with a normal guy.
A Failure in Atlanta
SPRING 2000
AFTER THE WHO committee opened a three-year window in which live smallpox could be worked on, Peter Jahrling and John Huggins put together a plan to try to infect monkeys with the virus. The Food and Drug Administration has long insisted that new drugs for a human disease be tested in humans before they are licensed for use. This is not possible in the case of smallpox. Since smallpox has been eradicated, no one is infected with it, and you can’t (legally) infect people with a lethal disease just to study them. So the FDA was in a bind over smallpox. It published a draft of a new rule, the Animal Efficacy Rule, which says that for an exotic threat such as smallpox, the FDA would license a new drug or vaccine if it could be tested in two different animals that had the disease, and if the disease resembled the human disease—if there was an animal model of the disease.
Peter Jahrling wanted to get an animal model of smallpox that they could test drugs on and that the FDA would accept. Since there is no smallpox at USAMRIID, Jahrling assembled a research team and flew them to Atlanta. He got permission from CDC officials to bring the smallpox freezer out from its hiding place and allow his team to take out the smallpox, warm it up, and try to infect monkeys with it. Jahrling decided to infect the monkeys by having them breathe smallpox in the air, to mimic the way it spreads among humans.
The USAMRIID scientists built a portable aerosol chamber that they called the Monkey Cabinet. It is a huge device made of plastic and steel, and it has wheels, so it rolls. They trucked the Monkey Cabinet and a number of monkeys down to Atlanta and installed them in the CDC’s Maximum Containment Lab. Jahrling and Huggins exposed the monkeys to around two million human infectious doses of smallpox. Then Jahrling went back to Fort Detrick to attend to other business, while John Huggins remained in Atlanta, monitoring the monkeys. A few days after they’d breathed enough smallpox to take out a city, some of the monkeys got a flush across their chests, and a couple of them developed a few pimples. After a day or so, the monkeys recovered.
As the experiment was winding down, Jahrling began to feel desperate. He was afraid that D. A. Henderson would label this experiment a failure and would say “I told you so” and that it confirmed the widely held belief that animals could never be successfully infected with human smallpox. The clock was ticking. A year had passed since the WHO had extended the deadline for destroying the smallpox virus, and Jahrling needed data that looked at least vaguely promising, or the WHO might not allow him to do another experiment.
He needed someone to fly down to Atlanta, take some blood from the monkeys, and do a quick study of it right there. Maybe that would show something. He asked Joan Geisbert, but her son was graduating from high school in Frederick, and she was going to be there no matter what. Lisa Hensley could probably run the tests, but she was wrapped up in Ebola research and pretty clearly did not want to be involved with smallpox. He asked her anyway.
“Yeah, I’ll do it, sir,” she said.
Jahrling began to wonder about this. If Hensley went down to Atlanta and started working with smallpox, what would happen if she enjoyed it? What if people at the CDC were impressed with her? He told Tom Geisbert, confidentially, that he was afraid the CDC people might try to poach her. USAMRIID and the CDC had a history of strained relations. Jahrling told Hensley that he would accompany her to Atlanta.
She was annoyed, and when she was annoyed she tended to rely on Tom Geisbert for advice. She dropped by his office and asked, “Does he think I need a baby-sitter in Atlanta?” Geisbert explained Jahrling’s worry about CDC poaching.
Jahrling and Hensley flew to Atlanta at the beginning of May 2000. They sat next to each other on the government-budget AirTran flight, and Hensley was uncomfortable, not to say tongue-tied. At the CDC, they put on blue suits and entered the Maximum Containment Lab. Hensley worked all day taking blood samples from monkeys that had breathed ten million human doses of smallpox and seemed fine.
Three days later, Hensley was back at Fort Detrick with the raw data from her tests. A month later, Jahrling flew to Geneva and presented Hensley’
s data to the Ad Hoc Committee on Orthopoxvirus. He argued that the data was “suggestive,” which meant that the experiment had bombed. D. A. Henderson argued that Jahrling would never be able to infect monkeys with smallpox, that it just wasn’t going to work. Jahrling pleaded for another chance, and the committee agreed to let him try again—in another year.
Then, out of nowhere, came a discovery that shook the smallpox experts to their cores.
Nuclear Pox
SEPTEMBER 2–3, 2000
A FEW MONTHS after the failure of his monkey-model experiment, on a hot Saturday in early September 2000, Peter Jahrling flew to Montpellier, France, for the thirteenth International Poxvirus Symposium. It was held at Le Corum, a modern conference center in the middle of town. The place was jammed with more than six hundred poxvirus experts from around the world, many of them milling in the lobbies and chain-smoking cigarettes. On Sunday afternoon, Jahrling wandered around a lobby where scientists were showing poster papers.
A poster paper is much like the reports that children give in school. It’s usually about an experiment that doesn’t warrant a full presentation. A scientist makes up a poster that summarizes the experiment, hangs it up and stands next to it, and answers questions.
There were fifty or sixty poster papers hanging on bulletin boards. Jahrling bumped into Richard Moyer, an American poxvirus expert who is the chairman of the Department of Molecular Genetics at the University of Florida in Gainesville. There was a lot of noise and cigarette smoke, and they wanted to talk, so they found a poster that nobody was looking at. Jahrling and Moyer placed themselves to one side, so they wouldn’t disturb the scientist standing next to the poster, and they chatted about some of the things they’d been learning. Moyer glanced over at the poster. He stopped talking.
The Demon in the Freezer Page 13
