The global threat spectrum continues to evolve, and we consistently face resurging and emerging threats that challenge our preparedness and response capacities and capabilities.

Global health and international security have been under siege because of the abilities of these threat agents to cause devastating epidemics by natural or intentional spread or decimate populations by weaponized synthetic compounds capable of incapacitating and killing hundreds within a matter of minutes to hours.

In the arena of more recent biological and chemical threats dwells an older infectious disease nemesis, the lethal Ebola viral hemorrhagic fever virus. In the world of chemical warfare agents lies the provocative, lesser known and deadly family of Russian nerve agents known as Novichokor “newcomer” compounds.

EBOLA – HISTORICAL PERSPECTIVE

The Ebola virus was discovered by scientists in 1976, and named after the Ebola River in Kinsasha, Zaire, where it emerged in both Zaire and Sudan. In the first outbreak, over 284 people were infected with a mortality rate of 53 percent.

The Ebola hemorrhagic fever virus belongs to the family of viruses known as Filoviridaewhich includes the Marburg hemorrhagic fever virus.

Viral hemorrhagic fevers are popular in the modern media. Movies and books of fictional apocalyptic epidemics involving graphic portrayals of lesions, extensive bruising, bleeding from mucous membranes, and high mortality rates abound and stir the imagination. The 1995 movie Outbreakfor example, depicts an Ebola-like illness that kills swiftly and that has mutated to become an airborne threat.

Richard Preston’s non-fiction book The Hot Zone and Tom Clancy’s Executive Orders are also popular works that have been read by many, including policy-makers and public health preparedness coordinators.

Ebola-like illnesses have also been portrayed on popular television shows like CSI and 24.

VHFs were weaponized by the former Soviet Union in the Biopreparat program, as well as the United States’ offensive biological weapons (BW) program.

Terrorist organizations, such as the Aum Shinrikyo cult in Japan, have attempted weaponize the Ebola virus, however, it was unsuccessful.

In his landmark book,  Biohazard, Dr. (Col.) Kantijan Abelikov, aka, Ken Alibek, the former Deputy Director of Biopreparat and defector, revealed a remarkable and ambitious project within the former Soviet BW program in which Ebola was genetically engineered and combined with smallpox (Variola major) which itself is highly communicable via airborne transmission as well pathogenic. This creates a chimeric virus capable of increased transmissability, enhanced pathogenicity and increased lethality.  It must be remembered that the VHFs are on the CDCs Select Agent list and are listed as Category ‘A’ bioterrorism agents.

While weaponizing the Ebola virus into a sustainable and effective warfare or bioterrorism agent is possible, it would not be an easy task considering the sophisticated  biotechnological expertise and the many variables and nuances of manufacturing a  viable and effective weaponized agent.

Taking into account that the Ebola virus is handled at the Biosafety 4 biocontainment level, it would be extremely difficult for a lone wolf or a non-sophisticated group to work with this “hot” and lethal pathogen.

In the U.S., the National Ebola Training and Education Centers (NETC) have a network in the US of three highly specialized training venues where health care personnel, first responders, public health personnel, and even hospital and clinic administrators can train as teams learn and drill on how to isolate, evaluate, triage and treat victims of Ebola hemorrhagic fever illness and other emerging infectious diseases (EIDs).

VHFs – CLINICAL AND PUBLIC HEALTH ASPECTS

The early symptoms include fever, headache, myalgia, diarrhea and vomiting, which are non-specific and may not indicate the highly serious lethal nature of the infection.

Unless epidemiologically associated with an going outbreak in a usually endemic area, the initial signs and symptoms can be associated with almost any viral syndrome, such as influenza. Easy bruising, small, pin-point hemorrhages of the mucosal membranes (petechiae), flushing of the face and chest and low blood pressure are some other clinical features of the disease.

The characteristic triad of features which are classic are hemorrhage, rash and severe sore throat which occur later as the disease irreversibly progresses and culminates in death from severe coagulopathy and multiple organ failure.

Ebola viral hemorrhagic fever is a zoonotic disease (transmitted to humans via wild animals) and spreads in the human population via human-to-human transmission. The disease affects humans, and nonhuman primates (monkeys, gorillas and chimpanzees), and is caused by one of five Ebola viruses.

While relatively rare, Ebola viral hemorrhagic fever disease (EVD) can cause 90-100 percent mortality rates among infected populations.

SITUATIONAL REPORT – 2018

As of 8 May 2018, the government of the Democratic Republic of the Congo (DRC) reported an outbreak of Ebola hemorrhagic fever, with two cases being initially confirmed by laboratory testing in the province of Bikoro, Equater Province situated on the shores of Lake Tumba, in the northwestern part of the country.

The last outbreak occurred in 2017 in the northern province of Bas Uele province. That outbreak was suppressed and contained by seamless integration of public health, medical resources and crisis management involving the World Health Organization (WHO), government officials and other stakeholders.

As of 26 May 2018, there have been 35 confirmed cases, 13 probable cases, 8 suspect cases and 25 deaths from the Ebola hemorrhagic fever illness.

The Ministry of Health, integrated with efforts from WHO, Medecins Sans Frontieres (MSF), UNICEF and other key partners have implemented a ring vaccination program, a similar approach used to eradicate smallpox. Healthcare workers, laboratory personnel, first responders and burial personnel on the front lines are the first to be vaccinated with an experimental, yet to be licensed rVSV -ZEBOV Ebola vaccine. The contacts of confirmed cases and the contacts of contacts are also offered vaccination.

The individuals being offered vaccination fall within the category of high-risk groups. The vaccine has demonstrated high efficacy during a major trial in 2015 in Guinea. Among the 5,837 people who received the vaccine in 2015, no EVD cases were recorded nine days or more post-inoculation.

The WHO and other public health and threat management authorities are maintaining very close surveillance on the evolving situation in the DRC and its surrounding environs.

As emergency planners, health care and public safety professionals we have an obligation to share in enhancing global health security and quickly responding as seamless and integrated international resources to contain and extinguish these deadly outbreaks.

NOVICHOK – THE NEW COMERS

We now focus our attention on a controversial group of synthetic nerve agents that allegedly possess several times the toxicity and lethality of both VX, and soman, (GD), two of the more toxic nerve agent compounds.

The Russian word Novichok, implies a “ newcomer “, a newbie, if you will.

Indeed, these series of military neurotoxicants or nerve agents were designed and developed by the former Soviet Union and Russia between 1971-1993, as a component of a Soviet program codenamed “Foliant” which was also responsible for the research and  development of other biochemical and chemical agents and methods related to the Soviet chemical and biochemical warfare scheme.

It is believed by various intelligence and scientific sources, that there are five (possibly more) variants of the Novichok adapted for military use.

NOVICHOK – HISTORICAL PERSPECTIVE

The Novichok initially became a chemical warfare buzzword in the 1990s, when a Soviet researcher, Vil Mirzayanov revealed that the Soviets had clandestinely designed and developed a newer and more potent nerve agent, allegedly several times more potent than both VX and soman. A microdrop of VX can kill an average size individual quickly, while soman in itself is a toxicological nightmare, as the antidote 2-PAM chloride or other oxime must be administered within a two minute window, lest “aging“ of the acetylcholinesterase enzyme and the soman form an irreversible bond where antidotal therapy would be ineffective.

Novichok agents supersede the toxicity and lethality of both VX and soman. These compounds are more difficult to identify and require much more organic chemistry and chemical engineering expertise than the more traditional chemical warfare agents. The precursors have not been banned and it enables purveyors and couriers of the requisite chemicals to facilitate delivery and reduces the potential for adverse health effects upon  transporters, chemical handlers and processing personnel.

The delivery systems for these chemical warfare agents (CWAS), and the agents themselves would allow for the mixing of precursor chemicals prior to use or during missile or projectile delivery (binary chemical weapons) .

Proudly, the Soviets claimed victory and fame for a vile and heinous family of agents capable of defeating personal protective and medical countermeasures and being profoundly more toxic than any synthetic neurotoxicant on the planet.

The Soviet Union had been developing these designer type of nerve agent analogues for quite some time, quietly though vehemently, disregarding international treaty and law prohibiting the proliferation and use of chemical warfare agents. The Soviets were convinced that these designer nerve agents would be able to circumvent the mandates and regulations of established chemical warfare agents and precursors, much like designer drugs would be able to defeat laws due to a miniscule change in chemical structure.

It is thought that the former Soviet Union/Russia developed smaller amounts, potentially enough to kill several hundreds of thousands of people.

The development and availability of these highly toxic agents created a tremendous rift among the Western nations, and presented multiple challenges for war planners and chemical defense assets.

Today, these lethal compounds continue to be thought of as the one of the deadliest substances available.

With the availability of advancements in both chemistry and chemical/process engineering, the design, development and production of these so-called “fourth-generation agents” is becoming a possibility in rogue-nation states and other actors seeking to obtain even less than pilot plant amounts of highly toxic agents for nefarious purposes.

New chemicals have been synthesized on rigid three-dimensional molecular skeletons, with the most promising being the normoboranes. Normoborane is a bicyclic crystalline hydrocarbon which has a geometry that will allow for a modular enhancement of the number of functional sites on a given molecule. Many normoborane derivatives, such as the mixture of chloroboranes known as the toxaphenes, are persistent and have considerable acute and chronic toxicity. These normoboranes have been considered as potential candidates for Novichok – like CWAs.

Novichok agents could be G-V analogues, combining the properties of both G-series and V-series nerve agents.

NOVICHOK – HEALTH EFFECTS/CLINICAL TREATMENT

Similarly to the G-series and V-series neurotoxicant warfare agents, Novichok agents cause a disruption of the nervous system functions by inhibiting the enzyme acetylcholinesterase, which catalyzes and breaks down the neurotransmitter acetylcholineat the neuronal synapse level. Excessive amounts of acetylcholine appear at the neuromuscular junction allowing for continued nerve impulses to overstimulate muscarinic (glandular) and nicotinic (muscular) receptors and create a cholinergic crisis involving a killer triad of physiological responses: bradycardia (slowed heart rate), bronchorhhea (excessive respiratory secretions), and bronchoconstriction (a tightening of the smooth musculature of the bronchi). There is also tetany and seizures involving the skeletal muscle system which leads to respiratory muscle twitching and fatiguability, as well as central apnea both which contribute to acute hypoxemic respiratory failure, cessation of breathing and death.

The treatments include administration of atropine to reverse the cholinergic crisis, oximes, such as pralidoxime (2-PAM chloride) the antidote which can disengage the nerve agent-acetylcholinesterase bond and allow acetylcholinesterase to regenerate to degrade the excessive acetylcholine and appropriate airway management and ventilatory support.

Of course, decontamination of victims is of paramount importance to reduce absorption of the agent and to serve as a protective countermeasure for personnel and facilities.

THE POISONING OF SERGEI V. SKRIPAL

On March 4,2018,in the quiet town of Salisbury, a former Russion KGB agent named Sergei V. Skripal and his daughter, Yulia, collapsed onto a bench and were both hospitalized in critical condition.

While there have been many suspicious and confirmed deaths of Russians on British soil involving non-conventional agents, it was disquieting for both MI-5 and MI-6 agents, intelligence analysts and operatives, as well other British authorities and emergency services to learn that a Novichok agent was used in an assassination attempt .

Chemical weapons experts agree on the possibility that Novichok agents were used in the past on Kremlin targets in Britain, but had escaped detection and misconstrued as death from natural causes.

What does this type of non-conventional assassination method actually mean for homeland defense and national security? What are the implications and consequences?

Whether it be from North Korea, and the agent is VX or ordered from Moscow and the agent is a Novichok compound or in the case of the murder of the former FSB operative turned dissident journalist, Alexander “Sasha” Litvienko, a rare radionuclide solubilized in his green tea, there are both political and strategic motives for these mini-terrorist actions.

These individual examples of attempted and successful assassinations utilizing non-conventional threat agents allow nation-states to suppress dissident activities, eliminate political rivalries and embarrassments, as well as demonstrate to the global community  that despite treaties and international laws, that they possess the ways and means to induce fear, uncertainty, panic and create mass murder and mayhem utilizing clandestine methods and unconventional weapons to achieve their objectives.

In summary, emerging infectious diseases, such as Ebola, have already challenged the Western world by cases requiring bio-containment, emergency transport and clinical treatment in the US. As we continue to achieve globalization via travel, commerce and industry, and as climate change and natural habitat destruction continue, EIDs will pose ever more serious health security and global public health challenges. The possibility that Ebola viral hemorrhagic fever, or other emerging pathogens will be weaponized and used  by rogue nation-states and sophisticated terrorist factions is real, and must be planned for.

The threat of chemical warfare and chemo-terrorism, as well as clandestine actions utilizing CWAs, such as the fourth generation/binary chemical weapons will increase and serve to challenge our resolve, our defenses and our perceptions of war, conflict and humanity as a whole.

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Frank G. Rando possesses over 30 years of real world experience as a public safety professional,clinician, educator ,emergency and crisis manager ,author and consultant in the areas of tactical ,disaster and operational medicine, weapons and tactics, law enforcement /criminal investigations ,counterterrorism, hazardous materials management and emergency response ,toxicology, environmental safety and health,and health care and public health emergency management .