The Demon in the Freezer (3 page)

Geisbert forgot about his doughnut and coffee. He went downstairs to some windows that look in on suite AA3, where John Ezzell was still working with the Daschle letter. Geisbert banged on the window and got his attention. Speaking through a port in the glass, he asked if he could have a bit of the powder to look at.

The Man in Room 151

EARLY 1970

ON THE LAST DAY
of December 1969, a man I will call Peter Los arrived at the airport in Düsseldorf, West Germany, on a flight from Pakistan. He had been ill with hepatitis in the Civil Hospital in Karachi and had been discharged, but he wasn’t feeling well. He was broke and had been holed up in a seedy hotel in a Karachi slum. His brother and father met him at the airport—his father was a supervisor in a slaughterhouse near the small city of Meschede, in the mountains of North-Rhine Westphalia, in northern Germany.

Peter Los was twenty years old, a former apprentice electrician with no job who had been journeying in pursuit of dreams that receded before him. He was tall and good-looking—thin now—with a square, chiseled face and dark, restless, rather guarded eyes under dark eyelashes. He had short, curly hair, and he wore faded jeans. He was traveling with a backpack, in which he’d tucked brushes, pencils, paper, and a set of watercolor paints, and he carried a folding easel.

Peter Los is alive today in Germany. The details of his character have been forgotten by the experts, but his case and its aftermath haunt them like the ruins of a fire.

Los had been living in a commune in the city of Bochum while he studied to be an electrician, but the members of the commune had split ideologically. Some favored a disciplined approach to communal living, while others, including Peter, favored the hippie ideals of the sixties. In August 1969—the month of the Woodstock music festival—eight members of the Bochum commune, including Peter, packed themselves into a Volkswagen bus and set off for Asia on an
Orientreise.
There were six men and two women on the bus, and they were apparently hoping to find a guru in the monasteries of the Himalayas, where they could meditate and seek a higher knowledge, and possibly also find good hashish. They drove the bus down through Yugoslavia to Istanbul, crossed Turkey, and went through Iraq and Iran, camping out under the stars or staying in the cheapest places. They rattled across Afghanistan on the world’s worst roads, and the Volkswagen bus made it over the Khyber Pass. They hung out in Pakistan, but things didn’t go as well as they had hoped, and they didn’t connect with a guru. The two women lost interest in the trip and went back to Germany, and toward December, three men in the group drove the Volkswagen into India and down the coast to Goa, to attend a hippie festival called the Christmas Paradise. Peter stayed behind in Karachi, and ended up languishing with hepatitis in the Civil Hospital.

An eastbound train took Peter and his father and brother out of Düsseldorf, and traveled through the industrial heart of northern Germany, past seas of warehouses and factories made of brown brick. It is unlikely that Peter would have had much to say to his father at this point. He would have lit a cigarette and looked out the window. The train arrived at the Ruhr River, and it followed the course of the river into the fir-clad mountains of the Sauerland, winding upstream under skies the color of carbon steel, until it reached Meschede.

Meschede is a cozy place, where people know one another. It nestles in a valley at the headwaters of the Ruhr, beside a lake. It had been snowing in Meschede, and the hills and mountains surrounding the city were cloaked in snowy firs. It was New Year’s Eve. Peter and his family celebrated the new decade, and he caught up with old friends and rested, recovering from his illness.

The weather was cloudy and dark, but in the second week of January the clouds broke away from the mountains, and clear air poured down from the north, bringing dry cold and blue skies. At the same time, influenza broke out in the town, and many people became sick with coughs and fevers. Around Friday, January 9th, Peter began to feel strange.

He was tired, achy, restless, and by the end of the day he was running a temperature. Then, on Saturday, his fever spiked upward, and he was very sick in the night. On Sunday morning, his family called an ambulance, and he was taken to the largest hospital in town, the St. Walberga Krankenhaus. He brought his art supplies and his cigarettes with him.

Dr. Dieter Enste examined Peter. He was recovering from his hepatitis, but perhaps he had typhoid fever, which is contagious, and which he could have caught in the hospital in Pakistan. They placed him in the isolation ward, in a private room, Room 151, and they started him on tetracycline.

The St. Walberga Hospital was staffed by the Sisters of Mercy, who served as nurses. The hospital was spare, simple, neat, and spotlessly clean. The isolation ward took up the entire first floor of the south wing, which was a semidetached building, three stories tall, covered with brown stucco, with a staircase that ran through the middle. The nuns told Peter to keep his door closed and not to leave his room for any reason.

He settled in on that Sunday morning and quickly began to feel better, and his fever almost went away. Even so, the nuns forbade him to leave the room, not even to use the bathroom, though it was directly across the hall. They made him use a bedpan, and they emptied it for him, and he washed himself at the sink in his room. The steam radiator under the window hissed and banged, and it made his room feel stuffy. He wanted a cigarette. He slid open one of the room’s casement windows just a crack, got out his cigarettes, and lit one. The nuns were not happy with that, and ordered him to keep his window closed.

That Sunday, a Benedictine priest named Father Kunibert made rounds through the hospital, offering holy communion to the sick. He was an older man, not strong on his legs, and he worked his way down through the building, so that he wouldn’t have to climb stairs. On the first floor at the end of the corridor, he put his head in Room 151 and asked the patient if he wished to receive communion. The young man was not interested. The medical report informs us that he “refused communion” and that “the priest was advised that his services were not desired.”

When the nuns weren’t looking, Peter continued to smoke, with his window open a crack. Cold air would pour in, filling the room with a brisk scent of the outdoors mixed with chirps of sparrows.

The tetracycline wasn’t working, so the doctors started him on chloramphenicol. He had a sense of creeping malaise, an anxious feeling that things weren’t right, that the drugs weren’t working on his typhoid. He was restless, couldn’t get comfortable, and he took out his colors and his brushes and began to paint. When he became tired of that, he sketched with a pencil. There wasn’t much to see out his window—a nursing sister in a white habit hurrying down a walkway, patches of snow, branches of bare beech trees crisscrossing a sky of cobalt blue.

MONDAY AND TUESDAY PASSED.
Every now and then a nun would come in and collect his bedpan. His throat was red, and he had a cough, which was getting worse. The back of his throat developed a raw feeling, and he sketched and painted. At night, he may have suffered from dreadful, hallucinatory dreams.

The inflamed area in his throat was no bigger than a postage stamp, but in a biological sense it was hotter than the surface of the sun. Particles of smallpox virus were streaming out of oozy spots in the back of his mouth and were mixing with his saliva. When he spoke or coughed, microscopic infective droplets were being released, forming an invisible cloud in the air around him. Viruses are the smallest forms of life. They are parasites that multiply inside the cells of their hosts, and they cannot multiply anywhere else. A virus is not strictly alive, but it is certainly not dead. It is described as a life-form. There was a cloud of amplified virus hanging in Room 151, and it was moving through the hospital. On Wednesday, January 14th, Peter’s face and forearms began to turn red.

Stripper

JANUARY 15, 1970

THE RED AREAS
spread into blotches across Peter Los’s face and arms, and within hours the blotches broke out into seas of tiny pimples. They were sharp feeling, not itchy, and by nightfall they covered his face, arms, hands, and feet. Pimples were rising out of the soles of his feet and on the palms of his hands, and they were coming up in his scalp and in his mouth, too. During the night, the pimples developed tiny, blistery heads, and the heads continued to grow larger. They were rising all over his body, at the same speed, like a field of barley sprouting after rain. They were beginning to hurt dreadfully, and they were enlarging into boils. They had a waxy, hard look, and they seemed unripe. His fever soared abruptly and began to rage. The rubbing of pajamas on his skin felt like a roasting fire. He was acutely conscious and very, very scared. The doctors didn’t know what was wrong with him.

By dawn on Thursday, January 15th, his body had become a mass of knob-like blisters. They were everywhere, all over, even on his private parts, but they were clustered most thickly on his face and extremities. This is known as the centrifugal rash of smallpox. It looks as if some force at the center of the body is driving the rash out toward the face, hands, and feet. The inside of his mouth and ear canals and sinuses had pustulated, and the lining of the rectum may also have pustulated, as it will do in severe cases. Yet his mind was clear. When he coughed or tried to move, it felt as if his skin were pulling off his body, that it would split or rupture. The blisters were hard and dry, and they didn’t leak. They were like ball bearings embedded in the skin, with a soft, velvety feel on the surface. Each pustule had a dimple in the center. They were pressurized with an opalescent pus.

The pustules began to touch one another, and finally they merged into confluent sheets that covered his body, like a cobblestone street. The skin was torn away from its underlayers across much of his body, and the pustules on his face combined into a bubbled mass filled with fluid, until the skin of his face essentially detached from its underlayers and became a bag surrounding the tissues of his head. His tongue, gums, and hard palate were studded with pustules, yet his mouth was dry, and he could barely swallow. The virus had stripped the skin off his body, both inside and out, and the pain would have seemed almost beyond the capacity of human nature to endure.

When the Sisters of Mercy opened the door of his room, a sweet, sickly, cloying odor drifted into the hallway. It was not like anything the medical staff at the hospital had ever encountered before. It was not a smell of decay, for his skin was sealed. The pus within the skin was throwing off gases that diffused out of his body. In those days, it was called the foetor of smallpox. Doctors today call it the odor of a cytokine storm.

Cytokines are messenger molecules that drift in the bloodstream. Cells in the immune system use them to signal to one another while the immune system mounts a response to an attack by an invader. In a cytokine storm, the signaling goes haywire, and the immune system becomes unbalanced and cracks up, like a network going down. The cytokine storm becomes chaotic, and it ends with a collapse of blood pressure, a heart attack, or a breathing arrest, along with a stench coming through the skin, like something nasty inside a paper bag. No one is certain what happens in the cytokine storm of smallpox. The virus is giving off unknown proteins that jam the immune system and trigger the storm, like jamming radar, which allows the virus to multiply unhindered.

In 1875, Dr. William Osler was the attending physician in the smallpox wards of the Montreal General Hospital. He called the agent that caused the sweet smell of smallpox a “virus,” which is the Latin word for poison. In Osler’s day, no one knew what a virus was, but Osler knew the smell of this one. When there were few or no pustules on the skin, he would sniff at a patient’s wrists and forehead, and he could smell the foetor of the virus, and it helped him nail down the diagnosis.

Around midday on Thursday, January 15th, five days after Peter Los had been admitted to the hospital, the doctors began to suspect that he had
die Pocken—
smallpox. Smallpox causes different forms of disease in the human body. Peter had classical ordinary smallpox.

The scientific name for smallpox is variola, a medieval Latin word that means “blotchy pimples.” The name was given to the disease around
A.D.
580 by Bishop Marius of Avenches, in the Vaud region of Switzerland. The English doctor Gilbertus Anglicus described the basic forms of smallpox disease in 1240. The virus is an exclusively human parasite. Smallpox virus can naturally infect only
Homo sapiens.
It comes in two natural subspecies, variola minor and variola major. Minor is a weak strain that was first identified by doctors in Jamaica in 1863, and is also called alastrim. While it causes people to pustulate, for some reason it rarely kills. Variola major kills around twenty to forty percent of infected humans who are not immune to it, depending on the circumstances of the outbreak and how virulent, or hot, the strain is. As a generality, doctors say that smallpox kills one out of three people.

Virus particles are also known as virions. Smallpox virions are very small. About one thousand of them would span the thickness of a human hair. It may be that you can catch smallpox if you inhale three to five infectious virions, or particles. No one knows the infectious dose of smallpox, but experts believe it is quite small.

Dieter Enste and the other doctors had not considered the idea that Peter Los might have smallpox because the young man had no rash for several days, and he had gotten a vaccination just before he had left Germany. He had gotten a second vaccination when he was in Turkey, but his vaccinations had not taken—he had not developed a scar on his arm, which meant that he had not become immune.

The St. Walberga doctors took a scalpel, cut a pustule on his skin, and drained a little of the opalescent pus onto a swab. They put it in a test tube, and a state official got in a Mercedes and drove the pus at a hundred and twenty miles an hour along the autobahn to a laboratory at the state health department in Düsseldorf.

Microscope

JANUARY 16, 1970

KARL HEINZ RICHTER
was a smallpox expert in the Düsseldorf office of the state health department, a medical doctor with a kindly face and a flop of hair on one side. He wore stylish metal-framed eyeglasses and a gray sweater under a jacket, which gave him a comfy but up-to-date look. Dr. Richter, along with a team of doctors and technicians, analyzed the pus taken from Peter Los’s skin. They put a little dried flake of the pus in an electron microscope—a tubelike instrument, six feet tall—which could magnify an image up to twenty-five thousand times. Then they took turns looking into the viewing hood; they would have to vote on the diagnosis.

Dr. Richter saw a vista of exploded human skin cells. Mixed in with the cellular debris were thousands of small, rounded bodies that looked like beer kegs. Some experts refer to them as bricks. The view in the microscope seemed vast, for magnified twenty-five thousand times, the flake of pus would have been an object nearly the size of a football field, and the little bricks in it lumps the size of raisins, and there could have been hundreds of thousands of them in the flake. These were virions of a poxvirus, and the vote was unanimous: this was smallpox.

The pox bricks had a crinkly, knobby surface, rather like a hand grenade—some experts call this feature the mulberry of pox. (A mulberry is a small fruit, the size of a thumbnail, which looks like a blackberry.) There are many species and families of poxviruses; smallpox is an orthopox, a poxvirus of animals. Poxviruses are among the largest and most complicated viruses in nature. A pox particle itself either makes or consists of around two hundred different kinds of protein, and many of the proteins are locked together into the particle like a Chinese puzzle. Pox scientists are slowly picking apart the structure of the mulberry of pox, but so far nobody has figured out the full design. Experts in pox find the pox virion mathematical in its structure and almost breathtakingly beautiful. At the center of the mulberry there is an odd shape that looks like a dumbbell, which scientists call the dumbbell core or the dogbone of pox. Inside the dumbbell, or dogbone, there is a clump of DNA, which is the long, twisted, ladderlike molecule that contains the genome of smallpox—the complete blueprint and operating software for variola. The steps of the ladder of DNA are the letters of the genetic code. The genome of smallpox has about 187,000 letters, which is one of the longest genomes of any virus. Smallpox uses a lot of this code to defeat the immune system of its human host. It has about two hundred genes (which make the virus’s two hundred proteins). By contrast, the AIDS virus, HIV, has only ten genes. In terms of the natural design of a virus, HIV has a simple design that works well. HIV is a bicycle, while smallpox is a Cadillac loaded with tail fins and every option in the book.

Poxviruses are one of the few kinds of viruses that are just large enough to be seen in the best optical microscopes (in which they look like fine grains of pepper). The infinitesimal palaces of biology extend far into the unseen. It is hard for the mind to grasp just how small is small in the microscopic universe of nature, but one way is to imagine a scale of nature built on the scale of the Woodstock music festival, which took place in a natural amphitheater at Max Yasgur’s farm in Bethel, New York. It held up to a half-million people. Seen from low orbit above the earth, the crowd of people at Yasgur’s farm would have looked something like this:

If a cell from the human body, in its natural size, were placed on this representation of the Woodstock festival, the cell would be an object about the size of a Volkswagen bus parked at the real festival. Bacterial cells are smaller than the cells of animals. If a single cell of
E.
coli
(the main type of bacteria that lives in the human gut) were placed on the Woodstock on this page, it would be an object the size of a smallish watermelon, perhaps sitting on the grass beside the Volkswagen bus. A spore of anthrax would be an orange. On that same scale, a particle of smallpox would be a mulberry. (The particles of the common cold are the smallest virus particles found in nature; a cold virus would be a marijuana seed under the seat of the Volkswagen bus parked at Woodstock.) Three to five mulberries of smallpox floating into the air out of the Woodstock dot on the page would be invisible to the eye and senses, yet they could start a global pandemic of smallpox.

AS DR. RICHTER
pondered the view in the microscope, he was not unprepared for the national emergency it implied. Three years earlier, he had laid out a plan for what would be done if smallpox broke out on his watch. Now it was happening. He lined up an older pox expert, Dr. Josef Posch, and they were joined by another colleague, Professor Helmut Ippen. They organized a quarantine at the hospital, they got vaccine ready, and they gathered biohazard equipment, which Richter had previously stockpiled. He also made a telephone call to the offices of the Smallpox Eradication Program at the World Health Organization (WHO) in Geneva, Switzerland, asking for help.

The WHO occupies a building constructed in the nineteen fifties on a hill above Geneva. It is surrounded by the flags of the world’s nations. In 1970, the Smallpox Eradication Program (SEP) was a relatively new effort at the WHO—it was inaugurated in 1966. The smallpox program operated out of a cluster of tiny cubicles on the sixth floor—the cubicles were exactly four feet wide, but they had a magnificent view southward across Lake Geneva toward Mont Blanc. Although the cubicles of the smallpox program were tiny and jammed together, the unit had a deserted feel, because at any given time more than half of the staff members were away, dealing with smallpox in various parts of the earth.

Dr. Richter ended up talking with an American doctor on the staff named Paul F. Wehrle, who spoke a little German. Dr. Wehrle (his name sounds like
whirly
) was a tall, thin, courtly epidemiologist with brown hair and green eyes who had a habit of wearing a jacket and tie with a white shirt when he went into the field, because he felt that a well-dressed doctor would inspire confidence in the midst of the shit terror of a smallpox outbreak. Wehrle now lives in quiet retirement with his wife in Pasadena. “I have unfortunately turned eighty,” he remarked to me, “but fortunately I have all of my hair, most of my teeth, and at least some of my brain.”

A single smallpox virus particle (virion) from a pustule in human skin. Negative contrast electron microscopy, magnified about 150,000 times, showing the “mulberry” structure of the proteins on the surface of the particle. The photograph was made in 1966 by Frederick A. Murphy, who could be described as the Ansel Adams of electron microscopy.

Diagram of a smallpox virus particle showing its surface and internal structure.Its dumbbell core (the dogbone) is visible; the dumbbell holds the genome of the virus, which consists of about 187,000 letters, or nucleotides, of DNA. (Both images courtesy of Frederick A. Murphy, School of Veterinary Medicine, University of California at Davis.)

When Dr. Richter told him what was going on in Meschede, Dr. Wehrle understood the picture only too well. The WHO rule was to keep smallpox patients
out
of hospitals, because they could spread the virus all too easily—hospitals are amplifiers of variola. Smallpox could essentially sack a hospital, infecting doctors and nurses and patients, and from there the virus would continue out into the community and beyond. The WHO recommended keeping smallpox patients at home under the care of vaccinated relatives. Since there was nothing a doctor could do for a patient with smallpox, it was just as well to keep the patient away from doctors.

Wehrle went down the hall to a double cubicle that was occupied by a tall, assertive medical doctor named Donald Ainslie Henderson. Everyone called Henderson “D.A.,” including his wife and children. D. A. Henderson was the head of the Smallpox Eradication Program. He was six feet two inches tall, with a seamed, rugged, blocky face, thick, straight, brown hair brushed on a side part, wide shoulders, big-knuckled hands, and a gravelly voice. Wehrle and Henderson discussed strategy, and Henderson made some telephone calls. The young man in the hospital at Meschede could start an outbreak across Europe. Henderson told Wehrle to go to Germany. Wehrle got a taxi to the airport, and that afternoon he was on a flight to Düsseldorf. Meanwhile, Henderson made arrangements to have one hundred thousand doses of smallpox vaccine shipped from Geneva to Germany immediately.

WHILE PAUL WEHRLE
was en route to Meschede, Dr. Richter and the German health authorities got Peter Los out of the St. Walberga Hospital—fast. The police closed off the hospital, and a squad of attendants dressed in plastic biohazard suits and with masks over their faces ran inside the building and wrapped Los in a plastic biocontainment bag that had breathing holes in it. He lay in agony inside the bag. The evac team rushed him out of the building on a gurney and loaded the bag into a biosafety ambulance, and with siren wailing and lights flashing, it took him thirty miles along winding roads to the Mary’s Heart Hospital in the small town of Wimbern. This hospital had a newly built isolation unit that was designed to handle extremely contagious patients. The Wimbern biocontainment unit was a one-story building with a flat roof, sitting in the middle of the woods. They placed Los on a silky-smooth plastic mat designed for burn victims, and he hovered on the edge of death. Construction crews began putting up a chain-link fence around the building.

That same day, Dr. Richter and Dr. Posch organized vaccinations for everyone at St. Walberga, patients and staff alike. They were given a special German vaccine that was scraped into their upper arms with a metal device called a rotary lancet, and then the doctors and their colleagues conducted interviews, trying to find out who had come into contact with Peter Los. Anyone who had seen Los’s face was assumed to have breathed smallpox particles. Twenty-two people were taken to the Wimbern hospital and put into quarantine. Everyone who had been in the south wing of St. Walberga but had not seen Los’s face was placed under quarantine inside the hospital, and they were ordered to remain there for eighteen days. Folding cots were brought in and set up in the bathrooms, where the medical staff slept. There wasn’t enough room to hold everyone, so the authorities took over a nearby youth hostel and several small hotels in the mountains and put people there, too. After a hospital worker escaped from quarantine and went home to his family, the authorities boarded up the doors of St. Walberga and nailed them shut, and stationed a police cordon around the hospital.

Paul Wehrle arrived in Meschede on the evening of January 16th, having traveled by train from Düsseldorf. He was met at the station by Richter and Posch. (Richter did the driving, since Posch had lost an arm in the Second World War.) They took Wehrle to a hotel, and they stayed up most of the night, planning a quarantine and vaccination campaign. The Germans wanted to vaccinate people with the special German vaccine, but Wehrle did not trust it. It was a killed vaccine that the German government had been using for many years, but the WHO doctors believed it didn’t give people much immunity. “The German vaccine had one small problem. It didn’t work,” Wehrle claims. “It was as close to worthless as a vaccine can be, only I couldn’t say that to the Germans and live, because they tended to be a bit protective of their vaccine.” He liked and respected the German experts and didn’t want to offend them, but he gently urged them to give everyone at the hospital a second vaccination with the WHO vaccine. It couldn’t hurt to have two vaccinations and might help, he said, and they agreed. He also persuaded them to use the WHO vaccine for the larger vaccination in Meschede.