Panic in Level 4: Cannibals, Killer Viruses, and Other Journeys to the Edge of Science - Hardcover

Richard Preston is the bestselling author of The Hot Zone, The Demon in the Freezer, The Wild Trees, and the novel The Cobra Event. A writer for The New Yorker since 1985, Preston is the only nondoctor to have received the Centers for Disease Control’s Champion of Prevention Award. He also holds an award from the American Institute of Physics. Preston lives outside of New York City.
www.richardpreston.net

PANIC IN LEVEL 4 by Richard Preston

INTRODUCTION- Adventures in Nonfiction Writing

Oliver Heaviside, the English mathematician and physicist, once
said, “In order to know soup, it is not necessary to climb into a pot and
be boiled.” Unfortunately, this statement is not true for journalists. As
a writer of what’s called “literary nonfiction” or “creative nonfiction”–
narrative that is said to read like a novel but is factually verifiable–
it has often been my practice to climb into the soup. Getting
boiled with your characters is a good way to get to know them, but it
has occasionally led me into frightening situations.

Some years ago, while I was researching The Hot Zone, a book that
focuses on the Ebola virus, I may have had a meeting with an unknown
strain of Ebola. (A virus is an exceedingly small life-form, an infectious
parasite that replicates inside living cells, using the cell’s own machinery
to make more copies of itself.)

Ebola has now been classified into seven different known types.
Though it has been studied for more than thirty years, Ebola is one of
the least-understood viruses in nature. Scientists have been understandably
reluctant to study Ebola too closely because it has on occasion
killed those who tried to do so. The virus was first was noticed in
1976, when it surfaced in Yambuku, Zaire (now the Democratic Republic
of Congo), near the Ebola River, where it sacked a Catholic
mission hospital, killing most of the medical staff along with a number
of patients and people the patients had came into contact with. Ebola
spreads from one person to the next by direct contact with blood or secretions,
including sweat. There is no evidence that it can spread
among humans through the air, although there is some evidence that
it may spread among monkeys this way. As a parasite, Ebola carries on
its life cycle in some unidentified type of animal–Ebola’s natural
host–that lives in certain unidentified habitats in equatorial Africa.
Occasionally Ebola comes into contact with a person, and the virus
makes what is known as a trans-species jump from its host into the
human species.

When Ebola gets inside a human host, it causes the person’s immune
system to vanish, and the person dies with hemorrhages coming
from the body’s orifices. The most lethal strains of Ebola have been
known to kill up to 95 percent of people who become infected with it.
Ebola causes people to vomit masses of black blood with a distinctive
“coffee grounds” appearance. Victims can have a bright red nosebleed,
or epistaxis; it won’t stop. A spotty, bumpy rash spreads over the body,
while small, starlike hemorrhages appear beneath the skin. An Ebola
patient can have blood standing in droplets on the eyelids and running
from the tear ducts down the face. Blood can flow from the nose,
mouth, vagina, rectum. The testicles can become infected with Ebola
and can swell up or be destroyed. Victims display signs of psychosis.
They can develop endless hiccups. Rarely, in particularly severe cases of
Ebola, the linings of the intestines and rectum may come off. Those
membranes may be expelled through the anus in raglike pieces called
casts, or the intestinal lining can emerge in the form of a sleeve, like a
sock. When an Ebola patient expels a sleeve, it is known as throwing a
tubular cast.

Some of the action in The Hot Zone takes place at Fort Detrick, an
Army base in the rolling country along the eastern flank of the Appalachian
Mountains in Maryland, an hour’s drive northwest of Washington,
D.C. The Army’s Level 4 virus laboratories at Fort Detrick are
clustered inside a large, nearly windowless building that sits near the
eastern perimeter of the base. This building is the headquarters of the
United States Army Medical Research Institute of Infectious Diseases,
or USAMRIID–a facility that Army people often simply refer to as “the
Institute.” While I was visiting USAMRIID, or the Institute, to interview
various experts in Ebola, I began asking officials at the base for per-
mission to put on a biohazard space suit and enter one of the Army’s
Biosafety Level 4 virus laboratories. I wanted to get a firsthand look at
researchers handling Ebola. More than that, I wanted to know what it
feels like to wear a biohazard space suit and be face-to-face with a real
Level 4 virus, so that I could get a sense of my characters’ feelings and
experiences, and could describe them with convincing precision.
(Many nonfiction writers refer to their characters as “subjects,” but I
prefer to think of them as dramatis personae in a true story.)

Biosafety Level 4, also called BL-4 or Level 4, is the highest and
tightest level of biosecurity in a laboratory. Laboratories rated at
Biosafety Level 4 are the repositories of viruses called hot agents–
lethal viruses for which there is no vaccine or effective cure. Level 4
labs are sealed off from the outside world. People who go inside a
Level 4 lab are required to wear a biohazard space suit, a pressurized
whole-body suit, like an astronaut’s, made of soft, flexible plastic, typically
blue. Army researchers sometimes refer to the space suit as a
“blue suit” because of its color. A soft, flexible helmet that completely
surrounds the head is joined to the suit, and the helmet has a clear,
flexible plastic faceplate in it; the suit also has an independent air supply.
The air supply prevents you from breathing the air inside the lab,
which could be contaminated with a hot agent. Ebola virus is classified
as a Level 4 hot agent, one of the most dangerous known, and it has
the potential to be used as a biological weapon. The scientists at
USAMRIID (it’s pronounced “you-SAM-rid”) conduct research into
vaccines and drugs that could be used to protect the population of the
United States against a terrorist or military attack with a biological
weapon, including Ebola virus. This is medical research, peaceful in nature.

The Level 4 labs inside the Institute consist of groups of interconnected
rooms. Each group of rooms is known as a hot suite or a hot
zone. Each suite is sealed off from the outside world and is accessible
only through an air lock. The air lock has heavy, stainless steel doors.
Inside the air lock there is a chemical decontamination shower, also
known as a “decon” shower. The purpose of the decon shower is to
sterilize the outer surface of the space suits of researchers who are leaving
a hot zone, to prevent a hot agent from getting a ride to the out side world.
Chest freezers inside the Army’s hot zones are filled with
collections of microvials (tiny plastic test tubes the size of a pencil stub)
that contain frozen or freeze-dried samples of many different strains of
lethal viruses.

The freezers are kept at 95 degrees below zero Fahrenheit. They
are said to be hot. They are hot in a biological sense: they contain
frozen samples of lethal viruses that are held in suspended animation in
the extreme cold. The virus collections stored in USAMRIID’s hot freezers
are said to include strains of Bolivian hemorrhagic fever virus, Guanarito
virus, Junín virus, dengue hemorrhagic fever, Venezuelan equine
encephalitis (VEE), Japanese encephalitis virus (JEV), Hendra virus,
Nipah virus, Lassa virus, and the seven known types of Ebola. (These
viruses’ effects on humans vary. Guanarito, Junín, and Lassa, for example,
cause hemorrhaging from the body’s orifices, like Ebola. VEE and
JEV infect the brain and spinal cord, causing coma or death. Nipah is a
brain virus from Malaysia that can trigger a literal meltdown of the
brain. The brain of a Nipah victim can be semiliquefied as the virus consumes
it, and can pour out of the skull during an autopsy.) The hot
freezers also may contain (although the Army doesn’t say much about
this) an assortment of Level 4 Unknown viruses, or X viruses. The Unknown
X viruses appear to be lethal in humans, but little is known
about them. They’ve never been fully studied or classified. They may include
something known as the Linköping Samples, which may or may
not harbor an unidentified type of Ebola. The X viruses are presumed
to be potentially lethal, so they are kept in Level 4 for safety.

We know that Ebola virus was one of the more powerful
bioweapons in the arsenal of the old Soviet Union. In the years before
the Soviet Union broke up, in 1991, bioweaponeers had reportedly
been experimenting with aerosol Ebola–powdered, weaponized
Ebola that could be dispersed through the air, over a city, for example.
The Soviet weaponized Ebola was apparently stable enough that it
could drift for distances in the air and still infect people through the
lungs when they breathed a few particles of it. This is why the U.S.
Army was studying it: the Army researchers were trying to come up
with a vaccine or a drug treatment for Ebola, in case of a terrorist or
military attack on the United States with Ebola.

As a natural disease, Ebola virus does not seem to be able to pass
from person to person through the air, though. In each of the natural
Ebola outbreaks, the disease seems to burn itself out, and Ebola fades
away and is lost in the backdrop of nature, until, once again, by chance,
it finds its way into a human host.

One day I was interviewing the commander of Fort Detrick. We
were getting toward the end of the interview, and I decided to ask one
last question. “I’d like to try to convey to readers what it really feels like
to be face-to-face with Ebol...