THE THIN WHITE LINE: the history of a future avian influenza pandemic

Chapter 2: State of Emergency

The most dangerous place on Earth

    Five days earlier, Dr. Sally Wei, staff scientist for the Viral Diseases Division of the National Microbiology Laboratory, prepared to enter the Biosafety-Level 4 lab, one of the most dangerous places on Earth, home to the world’s deadliest germs and viruses.
    Canada has a robust influenza surveillance system comprised of a network of laboratories that pass on unusual influenza strains and other viruses for identification to the NML at the Canadian Science Center for Human and Animal Health in Winnipeg. These laboratories routinely identify the agent in thousands of clinical samples every flu season, such as throat and nasal swabs collected from flu patients, and thereby determine the most prominent strains currently circulating in Canada. This information is then used to determine the country’s annual immunization strategy.
    If the laboratories run into something they don’t recognize, they tag it as a suspect novel virus and send tissue samples for testing. The NML is a significant Canadian achievement——one of the world’s select group of 15 facilities that have Biosafety-Level 4 containment facilities necessary for handling extremely hot viruses.
    Level 1 labs handle bugs unlikely to cause disease in healthy humans. Level 2 labs handle bugs that are generally not transmitted through the air. Level 3 labs handle serious and/or life-threatening bugs that can be transmitted through the air. Level 4 labs handle those bugs that can cause disease for which there is no treatment or vaccine. These labs are structurally isolated from other buildings, completely sealed, with their own air.
    H5N1 is considered a Biosafety-Level 3+ pathogen.

    On October 20, a Calgary laboratory conducted immunofluorescence on nasal swab specimens and baseline serum samples taken from John Warren after he was brought into Mountain View General Hospital.     Immunofluorescence involves attaching a fluorescent compound to an antibody. Viral antigens that react to the antibody can then be visually observed under a microscope by lighting the sample with UV radiation; you can see the location and relative amount of any protein for which there is an antibody present.     Immunofluorescence for viral influenza antigens conducted on Warren’s nasopharyngeal aspirates was positive; the man had Type A influenza.
    Since it didn’t match any normal flu bugs then circulating, tissue samples were shipped overnight to NML, where staff scientists could isolate the virus and work up an antigenic and genetic characterization.
    The light flashed green. Wei could now enter the entry-change room.
    Inside, she shed her clothes and jewelry, including her engagement ring, until she wore nothing that she wasn’t born with. She stored these personal items in a locker. Putting on simple long-sleeved scrubs, she approached the next door leading into the Biosafety-Level 4 lab and typed her security code into the access control, which beeped its acceptance and unlocked the door.
    Wei now entered the suit room. Dr. Kyle Ambrose, who had gone through before her, was already putting on his spacesuit. He greeted her by calling her “Wei Wei,” her nickname among the scientists working for the Viral Diseases Division. Before putting her own suit on, she blew it up with air and tested it for leaks. Then she put on her inner gloves, taped the cuffs securely, and stepped into her own suit. They helped each other with the zippers, stepping gingerly, scanning each others’ suits for gaps or tears.
    The principle behind the biohazard suit is to isolate a human being from the surrounding atmosphere and thereby protect him or her from exposure to potentially deadly germs in the air. This is partly accomplished by continually pumping fresh air into the suit; if the suit tears, positive air pressure will blow particles outside of the suit and not into it. In Biosafety-Level 4, they store the world’s deadliest bugs for study.
    If a person in the suit inhales a hot agent, or cuts him or herself with a scalpel, or even if a particle touches exposed skin, a lethal infection could result.

Staff scientist at Canada’s National Microbiology Laboratory in Winnipeg showers in his “spacesuit” before leaving the facility’s Biosafety-Level 4 lab. NML worked tirelessly to isolate the virus, confirm its infectiousness, provide a pure sample and get started on a vaccine.(13)

    Opening an airlock, Wei and Ambrose retrieved four containers. These looked like ordinary small picnic coolers, but were marked with biohazard symbols. Air flowed toward them——negative air pressure ensuring that any stray bugs were pushed inside the facility instead of being allowed to accidentally escape. Inside the containers, tissue samples in test tubes, neatly packed in dry ice, awaited their attention, each marked with the laboratory and specimen number, location and date of collection, patient’s age, extent of influenza activity and, if relevant, travel history. Due to the epidemic in the Far East and the WHO declaring a Phase 6 Pandemic——sustained human-to-human transmission of a novel virus——several days earlier, the Health Canada brass had ordered that characterization of all unknown influenza viruses be given priority over other research.
    Holding the containers, they shuffled toward the next sealed submarine door and stepped through, pausing for a decontamination sequence that included a chemical shower before proceeding through the final door and into the lab.
    The entire process had taken 13 minutes.
    Their suits featured a yellow coil that connected to an air supply in the laboratory. They hooked their hoses to this supply. Instantly, air roared inside their helmets and defogged their faceplates. From here on out, it would be difficult to communicate.
    Wei opened the containers and began inspecting the vials. Two of the samples had been taken from people who had been to China within the last 10 days. They would keep an eye on these two. She signaled this to Ambrose, who prepared the samples for testing. His eyes darted nervously, always on the lookout for sharp objects.
    She held up a vial and wondered if it contained a new form of life unleashed on the world. The seeds of pandemic.