Each contained a shallow pool of liquid nitrogen in the bottom. One of them held the smallpox.
The freezers were chained to the wall with monstrous steel chains. Huggins shuffled up to the smallpox freezer, inserted the Smallpox Key into some sort of lock, and an alarm was disarmed, and the lock opened. There was a red panic b.u.t.ton on the wall near the smallpox freezer. When the researchers mushed around in their s.p.a.ce suits near the smallpox freezer, they worried that they would accidentally b.u.mp the b.u.t.ton and draw an armed response.
Huggins slid a terry-cloth mitt over his right s.p.a.ce-suit glove, and he lifted up the hinged circular lid of the freezer. He pushed it all the way up and back, and it clanged open. There was a whooshing sound, and a cloud of white nitrogen vapor billowed out of the top of the freezer, poured down its sides, and spread out across the floor, running around his legs. He could barely see the white cardboard boxes in the mist inside the freezer. He had about three minutes to get the vials he wanted before the pool of liquid nitrogen in the bottom of the freezer came to a boil and threw up a huge cloud of fog. The boxes were stacked one on top of another on steel racks.
He couldn"t see a thing. He reached into the fog and started feeling around. He counted down a certain number of boxes and slid a box out of a rack. He removed the lid of the box, which was still hidden from sight in the fog. The inside of the box was divided into a grid, and with his fingertips, he counted a certain number of columns across, then down a certain number of rows. He pulled five vials out of the grid. He wedged the vials into a plastic rack, lowered the lid of the freezer with a clang, and locked it.
The vials contained smallpox seeds. Each seed was a lump of frozen amplified smallpox soup the size of a pencil stub. Holding the rack of seeds in one hand, he returned the Smallpox Key to its hiding place. He then carried the seeds into another room, where he placed them in a tank full of water that was kept at 98.6 degrees Fahrenheit, the temperature of blood.
While John Huggins was warming the smallpox, the air-lock door opened, and Peter Jahrling stepped through to the hot side. He was wearing a Delta Protection s.p.a.ce suit-not a blue suit but a Day-Glo orange one of French design. The other scientists thought Jahrling looked hip-French couture in Level 4.
Jahrling shuffled over to Huggins: "How"s it going?"
"Ready in five minutes."
Jahrling"s heart was racing. He thought this was what a NASA launch must feel like. It seemed clear that if they failed, the WHO would not allow any more animal experiments with smallpox. And that could slow down the development of new drugs for smallpox for the foreseeable future.
He left Huggins with the smallpox and went down the hall to see what Hensley was doing in her lab. Jahrling shouted: "Are all your tubes labeled, Lisa? Are the tubes lined up in the right order? You want to be ready to go when John brings out the variola."
"Naw, I figured I"d wait till the last minute." She gave him a little grin.
He didn"t think it was funny. "You want to leave as little to chance as possible, Lisa."
"Uh-huh. Yes, sir." Give me a break, Dr. Jahrling, she thought. Huggins plucked the seed vials out of the water. The seeds had melted to a pink, milky liquid, which shimmered with faint opalescence, like mother-of-pearl. It was the same opalescence that appears in the pus of human victims of smallpox.
He held the vials in the light and tipped them gently, peering into the variola, checking to see if it had melted completely.
The strain was called the Harper. It was collected in 1951 from an infected American soldier whose name may have been Harper, and it had somehow ended up in the j.a.panese national collection of smallpox, under the control of Dr. Isao Arita, one of the leading eradicators. The Harper was delivered to the CDC after the Eradication. Researchers believed it was a very hot strain. John Huggins opened the vials and sucked the Harper from them with a pipette and dribbled the liquid into four syringes. As he loaded the syringes, he got a sweaty-palmed, nervous feeling. He was loading each syringe with a billion particles, maybe three hundred million cases of variola in one syringe, enough to toast North America. It was hot material, and it made his heart race. Huggins had handled amplified seed stock of variola before-indeed, he had grown these seeds in virus cultures in the MCL during the previous few days-but no matter how many times he handled liquid seed smallpox, he could never feel calm about it. You could just feel the explosive, infective power in those syringes. He had been vaccinated many times, but the slightest needle p.r.i.c.k from a syringe full of amplified Harper would be likely to blow through his vaccinations like a bullet through toilet paper. After he had loaded four syringes, he loaded an additional four vials with the Harper seed liquid. He put the vials and the syringes on a tray and carried them into the animal room, walking slowly, watching where his feet were going, and holding the tray as if it had an atomic bomb on it.
The monkey room was jammed with Army scientists and technicians wearing blue suits, waiting for the arrival of the Harper. They were hooked up to the air lines that coiled down from the ceiling. The monkeys were vocalizing, and eeks and calls sounded in the room. In the upper left cage of the first bank, a large male crab-eating macaque, Monkey C099, was watching the people. He was an alert animal, calmer and more inquisitive than the others.
Stockman and Martinez had taken note of the monkey. They had many years of experience with animals, and they were aware of differing "characters" among them. Monkey C099 had a pale muzzle with pinkish-white skin that was free of facial hair, which was unusual for a crab eater. It gave him a more human appearance than some of the other monkeys. He was a leader type, more confident of himself, and one of the largest males in the group. He had big, sharp, canine teeth. He was not a monkey to mess with.
Stockman freed some latches on Monkey C099"s cage and pulled a squeeze panel forward, which moved him toward the front of the cage. Stockman worked slowly and very gently, trying not to upset the monkey. While Stockman kept the monkey pressed against the front of the cage, Josh Shamblin took a syringe and gave the animal a shot of an anesthetic, Telazol, in the thigh.
They waited a few minutes. Monkey C099 settled down, and he almost went to sleep. Then Shamblin unlocked the bra.s.s padlock and lifted the animal out, holding it under the arms. He shuffled across the room, carrying the monkey in front of him.
Meanwhile, Huggins gave some vials of smallpox to Louise Pitt, who was in charge of the Monkey Cabinet. She loaded the liquid into a device that would make a mist inside the aerosol cabinet.
Shamblin handed the monkey to Pitt, and she placed him on a table inside the chamber, lying on his back.
Then Pitt gave the thumbs-up, and one of her team started a blower running. Harper smallpox was blown into the air around the monkey"s head. The monkey breathed one hundred million particles of Harper. The monkey yawned, exposing his fangs. He was loopy with the anesthetic.
The monkey was also due to get a load of smallpox straight into the bloodstream. Shamblin took an IV needle and inserted it into a vein in the monkey"s thigh. He attached a tube to it, and he took up one of the syringes full of Harper, uncapped it, and very carefully fitted the syringe into the tube. He injected the monkey with around one billion infective particles of Harper smallpox. There was a pause.
Josh Shamblin glanced around, catching people"s eyes to make sure that he had the attention of the room.
The roaring of air in people"s suits was too loud for speech. He was letting everyone know that he was about to pull the contaminated needle out of the animal.
Everyone stopped what they were doing and froze, and some people stepped backward. When he was sure the room was under control, Shamblin pulled the needle from the monkey"s thigh. The steel glinted, slick with monkey blood, and every human eye in the room watched it. It was perhaps the dirtiest needle in the history of variola"s entanglement with the human species. Without capping it-he wasn"t going to get his fingers anywhere near that b.l.o.o.d.y point-he took two steps across the room and dropped it in a biohazard container. The biohazard waste containers were cooked in autoclaves inside the Maximum Containment Lab, and only after they had been sterilized were they removed from Level 4.
Then they carried the big, sleepy, pale-faced monkey back to his cage, and they repeated the process three more times with three more monkeys.
The next day, they inoculated four more monkeys with a different strain of smallpox, the Dumbell 7124, which the researchers usually called the India strain. It had been collected in 1964 in Vellore, in southern India, by a British smallpox researcher named Keith Dumbell. Three years later, in Vopal, India, Soviet scientists collected the strain known as India-1, which became their strategic-weapon strain.
The Russian government has refused to share the India-1 strain with anyone, but Jahrling and his group believed that their India might be similar to the Russian India-1. They regarded it as the hottest smallpox that anyone outside Russia could obtain.
This test was different from Jahrling"s previous experiment, when his group had failed to infect monkeys with smallpox. They had used a lower dose then, and they had given the virus to the monkeys through the air. This time they also put it into the bloodstreams of the monkeys, and they used a higher dose. Jahrling felt that if a billion particles of smallpox didn"t give a monkey a disease of some sort, then nature would be telling us that variola was not going to go into any species except man.
They kept the monkeys under observation, wondering what would happen. The Harper and the India might start multiplying in the monkeys or it might not. If the monkeys became sick, no one knew what the disease would look like. It was impossible to say what variola would do.
Part Six - The Demon"s Eyes
Down
June 2, 2001
After the monkeys had been inoculated with two strains of smallpox at the CDC, Peter Jahrling and John Huggins flew back to Maryand. They left Lisa Hensley in charge of the experiment, a.s.sisted by Mark Martinez. They were supported by Jim Stockman and Josh Shamblin. The team members settled into a routine. They arrived at the CDC at seven o"clock in the morning and checked in through security.
Stockman and Shamblin would immediately put on blue suits and go into MCL West. The monkeys threw their bedding out of the cages every night. The bedding consisted of b.a.l.l.s of paper, which the monkeys seemingly enjoyed throwing around the lab. Stockman would clean up the paper and clean out the cages and give the monkeys their biscuits, a.s.sisted by Shamblin, who also readied things for blood tests of some animals. Down in the bas.e.m.e.nt corridor, Hensley and Martinez would sit at the desks with their laptop computers, catching up on e-mail, drinking coffee and c.o.ke.
It had become increasingly clear to Hensley that Peter Jahrling had pulled a fast one on her. She saw, now, that he had intended to put her in charge of the experiment, but he hadn"t told her so. She thought it was funny-Dr. Jahrling had been afraid she would refuse to work with smallpox if he asked her. In fact, she longed to get back to work with Ebola. She felt lonely in Atlanta. She missed Rob Tealle, but when she was in the throes of a big science project, she tended to put him in a different compartment of her life. Going into Level 4 with smallpox seemed to her a little like being an astronaut and going into orbit for months. The world fell away as you entered the air lock, and you focused on the work at hand. You lived with breathing equipment day after day, and you watched your hands every moment.
She was always the last to enter MCL West each morning, and she always checked the animals.
Eight of them had been exposed to smallpox, but there was no outward sign of illness in them.
Monkey C099 seemed gentler than the others. The scientists got into the habit of feeding him treats-marshmallows, cotton candy, and popcorn. This was nice for the monkey, and it didn"t affect the experiment. Holding a tuft of cotton candy, Stockman would go up to a cage, and a hand would whip out of the cage, almost faster than the eye could see, and the tuft would vanish in the monkey"s mouth.
Then the hand would reach from the cage again, as the monkey asked for more.
Each day, the scientists would give some of the monkeys a shot of anesthetic and stretch them out on a table in a room next door, to examine them, and Shamblin would extract blood samples. Mark Martinez would fill a series of Vacutainer tubes and hand them to Lisa Hensley, who labeled them and took them into her lab and ran dozens of tests on the blood, looking for any changes.
On Day Two of the experiment, Hensley detected the DNA of smallpox in, the blood of the monkeys. It had not been there before. This meant that the virus was almost certainly growing in the monkeys.
Hensley went home each night to her room at the hotel. If there was time, she jogged in a nearby park, or sat by the pool with other members of the team, who drank beers and unwound, or they would go out and get pizza. She usually didn"t drink alcohol during a Level 4 project. Frequently, she warmed a Healthy Choice dinner in her kitchenette, spread her papers and laptop out on the sofa, and worked on her Ebola project data, sometimes until late at night. When she had time, she would call Rob Tealle, or she would have a chat with her parents. She and Tealle had been wondering if they should get married.
They had been living together for quite some time, and Hensley felt a desire for a home life pulling on her.
Her twenties were pa.s.sing, and she wanted to have children someday. Her older sister had become a mother and was happy and fulfilled with her child. Hensley kept photographs of her little niece above her desk at USAMRIID.
JUNE 4th, 2001, was Day Four for the four monkeys that had been exposed to the Harper strain. It was Day Three for the monkeys that had been exposed to India. Lisa Hensley and Mark Martinez arrived early in the morning, put their laptops on the desks in the bas.e.m.e.nt, and started swapping the one phone jack to send e-mail. Jim Stockman put on a blue suit and went in to take care of the monkeys. A few minutes before eight o"clock, a telephone in the hallway rang, and Hensley answered it. It was Stockman, calling from MCL West.
He was shouting through his faceplate, "We"ve got two monkeys dead in here! Another one is going down!" She thought Stockman was joking. "Oh, yeah, like whatever," she blurted, but Stockman was a very serious man, and her heart went wham, and she could feel ma.s.sive amounts of adrenaline kicking in.
Monkeys down.
Martinez jumped up and began to move fast. He wanted to collect clinical samples from the dead monkeys, and hurried to put on his s.p.a.ce suit. As soon as he had left the locker room, Hensley followed him in.
Martinez went into the monkey room and looked through the plastic tent into the cages. There were two dead monkeys, hunched up, and they had spotty, starlike red spots all over their skin. He thought, Oh, my G.o.d. The monkeys were speckled-he could see tiny pinpoint hemorrhages all over their faces. The pinpoints were especially dense across the monkeys" eyelids, flanks, and insides of the thighs.
This was a flat rash, no pustules. The animals had flat hemorrhagic smallpox. My G.o.d, it was b.l.o.o.d.y.
The two dead monkeys were both in the India group. There had never been an animal known to be killed by any strain of smallpox. This was the first time anyone had seen variola amplified fatally in any species other than humans.
Feeling somewhat overwhelmed but extremely eager to find out what the India strain had done to the monkeys, Martinez got a pole and gently touched the dead monkeys. He wanted to make certain they were dead. A not-quite-dead monkey that is hot with India smallpox and has canine teeth would be an exceedingly dangerous animal. The touch of the pole revealed that the monkeys were stone dead.
One of them, a smaller male designated C171, was in rigor mortis.
Martinez was the team"s pathologist. He wanted to do posts on them fast-he wanted to see tissue. He examined the dead animals" eyes. They were normal-looking; there was no sign of blood, as there is in humans with b.l.o.o.d.y smallpox. He decided to do a necropsy-a postmortem exam-of the heavier male, Monkey C115. He carried the monkey into the necropsy room, laid it on a metal table, and a.s.sembled his tools. He closed the door behind him. Animal-use laws prohibit any necropsy or surgical procedure on an animal within the sight of other animals of the same species.
Lisa Hensley went straight to the necropsy room without stopping to see what was happening with any of the other monkeys. She wanted to get on the necropsy fast.
Martinez had already started by the time she arrived. The monkey was opened on the table; its abdominal cavity was wide, and it was puddled with free hemorrhages-the same thing that happens with human hemorrhagic smallpox. There were hemorrhagic spots all over the internal organs, especially the intestines.
Martinez lined up a row of plastic bins along the edge of the metal table, and he began filling them with samples of the monkey"s organs. He worked*very fast.
Hensley"s heart was pounding. There was an emergency telephone hanging on the wall near the monkey cages. She called Jahrling, reaching him just as he arrived at his office at USAMRIID.
Jahrling started shouting over the phone at her. She could barely hear his voice through her earplugs and the roar of air in her suit. He wanted her to call him from the MCL and report whatever she and Martinez saw, all through the day. He sounded hyper.
The monkey"s stomach was b.l.o.o.d.y, wrecked by the smallpox. The lungs were b.l.o.o.d.y and speckled by hemorrhage. The liver was necrotic-mostly dead. The virus had gone everywhere inside the monkey.
She was face-to-face with variola major for the first time in her life. Until she had seen this hemorrhagic monkey, she had had no idea how powerful the virus was, how truly frightening. It was scarier than Ebola, much scarier, because it was a virus that was superbly adapted to humans, and it spread in the air. Ebola spread only by direct contact, and it was not well adapted to humans. Here, variola would be coming straight into the air out of the animal"s body cavity.
"Lisa!" Martinez shouted.
He handed her a plastic bin containing a half-dollar-sized lump of dark meat.
"What the heck"s that?" she asked.
"Spleen."
The spleen was a mottled, cloudy, ultraswollen ball-and it was mostly dead. She picked up two scalpels, one in each hand, and bent over the sample in an awkward stance, holding her body back and away from the countertop, with her elbows out. This piece of spleen would contain several million human deaths" worth of variola. She cut delicate bits, mincing the tissue. This spleen is a moosh, she thought.
She worked quickly, because Martinez was in a flurry of cutting, and the samples were piling up fast. She stood at a little counter opposite the necropsy table. Occasionally, she unhooked her air hose and carried samples of blood or tissue into her lab and processed them, spinning the blood in a centrifuge, looking at it under a microscope, doing red-cell counts and white-cell counts. She was hurrying back and forth, her hands full of amplified India blood.
The day dragged on, and the first necropsy took hours, because what they saw in the monkey was new to science. Around noon, they considered taking a break. They wanted to get something to eat and go to the bathroom, but they also wanted to get moving on the second dead monkey, which was still lying in its cage. They decided to just keep going.
Meanwhile, word had been traveling fast around the CDC that monkeys were down in the MCL-down with variola. The emergency telephone on the wall of the monkey room rang steadily.
Hensley took the calls. People were calling from all over the CDC, and Jahrling and Huggins kept calling from Fort Detrick. Whatever their reservations might have been about Army people working with smallpox, the CDC people were getting excited, too. A CDC expert in Ebola named Pierre Rollin volunteered to help, and he arrived in MCL West with some compounds that could be used to prepare the tissues for viewing under an electron microscope.
In the cage on the upper left of the bank of cages in the monkey room, the inquisitive male with the light hair and unusual face, Monkey C099, was taking the scene in calmly. He seemed flushed.
Maybe he was going to go down, too. Another infected monkey was looking very sick and was sitting down. Most nonhuman primates do not like to sit down in the presence of humans and will get to their feet if a person is near them. But if a monkey is ill, he will sit down in the presence of a person. The sick monkey hugs its knees and watches people, and it won"t eat. A monkey never lies down in front of a human if it can possibly help it. If a monkey is very sick, it will lie down when people turn their backs, but if anyone looks at the monkey, it will sit up again.
The sick monkey was huddling and holding its knees, and there were starlike speckles on its eyelids. When Hensley turned her back, the monkey lay down in its cage.
Martinez was standing next to Hensley. He shouted, "It"s going to kill all of them fast. I"ll bet we"ll be out of here in two weeks."
"You wait and see," she shouted back. "I"ll bet there will be one survivor. And we"re going to be here for a long time, Mark."
They carried the second dead monkey into the necropsy room. Martinez was in good physical condition, but the strain of the necropsies was already starting to wear on him. He was a white-water kayaking instructor, yet doing pathology work in Level 4 with animals dying of hemorrhagic smallpox was pushing the envelope of his sense of physical control of his surroundings. The work was intense. Every move had to be right. You had to watch your hands, and you had to be superaware of who was around you and what they were doing.
Martinez found a chair, carried it into the necropsy room, and sat on it while he performed the second necropsy. He found that it helped him focus. Hensley had to keep running samples back into her lab, so she remained on her feet. Her back began to hurt, and she was freezing cold. It was the cutting posture that strained her back-bent over in that hunch, elbows out, body held back and away from the scalpel blades, while she took tiny slices of hot tissue. Something about the dry air inside the suit and the air-conditioning in the MCL was enough to practically give you hypothermia, even in summer in Atlanta.
Her boots were thin rubber, and she could feel the concrete of the floor through her socks.
They finished the second necropsy at three o"clock in the afternoon. "Let"s shower out after this,"
Hensley said, and Martinez nodded. But when they returned to the monkey room, they were shocked to find that the third monkey had already died. This monkey was the first to die of the Harper strain.
They forgot about taking a break and did the third necropsy. The work dragged on for hour after hour, and the sun began to set. There were no windows in the MCL to the outdoors, but a line of windows in the main room looked into a gla.s.sed atrium in Building 15. The light in the atrium went dark, as people went home from work. Martinez and Hensley had been in their s.p.a.ce suits since eight o"clock that morning. They hadn"t eaten anything, and they hadn"t been able to make a pit stop in the rest room.
The air in the suits was bone-dry, and they were dehydrated and thirsty.
At about eight o"clock at night, Martinez suddenly unhooked his air hose and signaled to Hensley that he was going to exit. She thought he was having trouble with his air supply. He ran out of the room, hurrying for the air lock. The trouble was with his bladder.
He stood in the chemical shower in the air lock in agony. The shower cycle was automatic and took nine minutes, and he couldn"t get out until it had finished. Then he ran through the gray zone, tearing off his suit, on his way to the bathroom.
The team returned to the hotel that night and sat around the swimming pool, feeling a little stunned. Businesspeople pa.s.sed by, talking about sales and deals; a man shot baskets on a little court near the pool; children yelled in the water. Life went on. The purpose of the work in the hot lab was to protect these people from variola, people who probably never thought about the disease and had little idea what it was.
Hensley went to her room and lay down flat on the floor and looked at the ceiling, trying to relieve the pain in her back. This was dramatic work that was going to get international attention. It might be published in some big journal like Science or Nature, and it was likely to upset the smallpox eradicators.
Harper JUNE 4-20, 2001.
Two days after the three monkeys died, Monkey C099, the handsome monkey, had tiny pimples spreading across his thighs, although he didn"t seem very sick. They anesthetized him, laid him down on the necropsy table, and inspected him. They opened his mouth and found several small pustules on his palate and inside his lips. They used a swab to take a sample of saliva from the back of his throat. They wanted to find out if the virus moved into the air from the back of the monkey"s mouth, as it seems to do in humans. They returned him to his cage, and he woke up shortly afterward. He seemed perkier than the very sick ones.
In the next few days, C099 developed cla.s.sical ordinary smallpox. It looked to Hensley and Martinez exactly like human smallpox, which meant that it could be a model of smallpox that the Food and Drug Administration might accept.
As the pustules enlarged and spread over the monkey"s face and hands and feet, the team saw that the pustules had dimples in them. This was a centrifugal smallpox rash, just like the ones humans get.
Martinez brought an underwater camera into the lab, and he photographed the monkey. He had to use a waterproof camera because in order to take it out of Level 4 he had to submerge it in a dunk tank full of Lysol for half an hour.
The pustules cl.u.s.tered thickly around the animal"s extremities, just as they did in people with smallpox. The scientists began to feel sorry for him. They named him Harper, after the strain he had received.
Harper had one hundred and fifty pustules; they counted them while he was unconscious on the table. Hensley found the cla.s.sic form of the disease more awful to look at than the b.l.o.o.d.y form, and this pale-faced monkey reminded her of a human child. She didn"t doubt that animal research was needed to save human lives-a prime example being research to find drugs that would be effective on HIV. The smallpox experiment had been reviewed and approved by the USAMRIID and CDC animal-use committees. Any animal that was clearly dying had to be sacrificed right away, and painlessly, so that its suffering would stop. But Harper was not dying. He was experiencing a form of agony that as the heritage of humanity, not of monkeys.
On the morning of June 7th, Harper was huddled in the back of his cage, visibly much sicker.