Iraqis. After inspecting the equipment carefully, they saw no reason to ask Iraq to stop production at the plant. An older American weapons inspector, a man well beyond the age of retirement who in his day had been a leading scientist in the United States Army's biologicalweapons (B.W.) program, visited Al Hakam as a member of an UNSCOM team. He was mighty impressed. He said, 'They've got a helluva good B.W. plant here at Al Hakam. How can I prove it? I've just got a feeling, that's all.' He could not prove it, and he was frankly doubted by most U.N. experts, although he was one of the very few people in the entire UNSCOM organization who actually had hands-on professional experience as a biological weaponeer. Iraq, meanwhile, was making hundreds of thousands of gallons of brown liquid concentrate in this plant.
In 1995, one of the heads of Iraq's biological-weapons program, Babrak Kamal, suddenly defected and ended up in Jordan. Various intelligence agencies rushed to debrief Kamal, and Kamal talked. Fearing that he was telling everything about their bioweapons program, and in an effort to placate the United Nations Security Council, Iraqi officials suddenly disclosed that Al Hakam was, in fact, an anthrax weapons plant. The brown liquid was anthrax. UNscoM inspectors had been wrong about Al Hakam. The old Army scientist had been right. In June 1996, after a year of bureaucratic hesitation - during part of which time Iraq was allowed to continue operating the plant - the United Nations finally blew up Al Hakam with dynamite. Al Hakam is now eleven square miles of level ground. The many tons of anthrax that the plant produced have never been found. Unlike many bioweapons, anthrax can be stored indefinitely.
There was another revelation, this one more unpleasant. In the wave of panic following Kamal's defection,
Iraq also suddenly confessed that a French-built animalvaccine plant called Al Manal had been turned into a weapons facility dedicated to toxins and virus weapons. Al Manal is a modern Level 3 biocontainment virology complex situated in the southern outskirts of Baghdad. The Iraqis said that this plant had been used for an earlyphase genetic engineering program in virus-weapons research, and then, during the Gulf War, had been used to make large quantities of botulinum toxin - botulism, or bot tox, as military people call it. Bot tox is one of the most powerful toxins known. An amount of bot tox the size of the dot over this i would be enough to easily kill ten people. Bot tox is a nerve agent. It is one hundred thousand times more toxic than Sarin, the nerve gas that the Aum Shinrikyo sect released in the Tokyo subway. Iraq confessed to having made approximately nine thousand cubic yards of weapons-grade bot tox at the French-built plant at Al Manal. The bot tox had been concentrated twenty times over. In theory it was more than enough bioweapon to kill every person on earth a thousand times over. In a practical military sense it was enough to eliminate all human life from Kuwait.
The bioproduction lines at Al Manal had been built in 1980 by a French vaccine company called Institut Merieux, which is headquartered in Lyons. Merieux is owned by the pharmaceutical giant Rhone-Poulenc. Merieux was paid a great deal of money by the Iraqi government to build production lines at Al Manal that were ready for operation, and to train the staff in the use of the equipment. The purpose of the plant was to make vaccines for protecting animals from foot-and-mouth disease, which is caused by a virus. The plant was wildly expensive. Some experts claim that an effective animalvaccine plant could have been built at a tenth of the cost. However, Iraq had plenty of money to spend. The Iraqis needed a Volkswagen. Merieux sold them a tank.
At the time that Merieux was involved in Al Manal, Iraq was involved in a bitter war with Iran. This was the Iran-Iraq War (1980-88), during which,'in 1984, Iraq initiated the use of chemical weapons. In 1985, while Iraq was known to be using chemical weapons, French advisers from Merieux were working at Al Manal, training the Iraqi staff in how to make virus vaccines. To make a virus vaccine, you use bioreactors to grow strains of viruses. You can use the same equipment and manufacturing processes to make hot weaponized viruses. If the plant is equipped with high Level 3 biocontainment, virus weapons can be produced without too much difficulty or danger to the staff.
United Nations inspectors discovered that the buildings at Al Manal are made of bomb-resistant concrete, strengthened with large amounts of steel bar. The hardening goes deep inside the buildings. Al Manal has a kind of double-shell construction in which some of the inner biocontainment zones are themselves reinforced with steel. Did Merieux engineers notice that they were building the production fines in a 'hardened' facility? Did they speculate that Iraq might view the place as a potential military facility? Much of the production equipment at Al Manal came from European biotechnology and pharmaceutical companies: from France, Spain, Germany, and Switzerland. What did these companies know or guess? The chance that the public will ever find out is essentially zero.
Until 1990, five years after the French advisers left, Al Manal was apparently used for making animal vaccines, and it had a staff of civilian scientists. In the fall of 1990, however, when the Gulf War was imminent, a military staff suddenly took over the operation of Al Manal. The plant was then almost instantly converted to a bioweapons facility. All of the plant's production equipment was used for making bot tox, and the Iraqis ran double
production lines. In a short time the plant was pumping out bot tox. Iraqi production scientists had no problems making the toxin. They knew exactly how to do it. They had obtained their strain of botulism through the mail from the United States. They had ordered it from the American Type Culture Collection, a nonprofit organization in Rockville, Maryland, that supplies microorganisms to industry and science. The seed strain cost Iraq thirty-five dollars.
One UNSCOM inspector who is an attentive observer of French behavior in Iraq sums up his view of Institut Mérieux's motives this way: 'The reality is that people just don't realize what can be done [with bioproduction equipment]. To Merieux at the time, their involvement with Al Manal was a successful commercial venture. Hey, if they can sell an extra ten fermenter tanks, open another bottle of champagne! It's the act of commerce that's important, and what happens afterward is someone else's responsibility.'
Al Manal has become the responsibility of the United Nations. As of this writing, the plant is standing, but much of its equipment has been destroyed. The buildings and infrastructure, including the bomb-hardened Level 3 biocontainment zones, have not been destroyed by the U.N. Al Manal is in excellent condition. The decisionmaking process in the United Nations is so flawed that an admitted virus and toxin weapons biocontainment facility can't be dismantled.
Inspectors have noticed that the Iraqis seem to be switching to small, portable bioreactors that roll around on wheels. The Al Manal bioweapons plant could go hot in a matter of days. All it needs is some more equipment. In the meantime, not a single drop of the nine thousand cubic yards of bot tox made at Al Manal has been found.
In fact, it is said that no Western intelligence agency has ever recovered a sample of a weapons-production
strain of any Iraqi biological weapon. The U.N. inspectors have found empty biological bomb casings in Iraq, and they have obtained video footage taken by lraqi scientists of bioweapons tests conducted in desert areas - biological bombs going off, hot agents being sprayed into the air, a jet doing a line laydown. It is clear from the footage and the bomb designs that the Iraqis know what they are doing. It is just that the U.N. people haven't found the heart of any Iraqi bioweapons system, the life form itself.
In the years following the Gulf War, the biologicalweapons inspection process in Iraq continued to go forward, but it left important questions unanswered. The U.N. teams continued to monitor and search Iraq, but some of the individual team members began describing their efforts as a charade, or as just another job, for which at least they were getting some hazard pay. Other individuals on the teams were known to have taken personal risks to uncover information. There were indications that the Iraqi bioweapons program was very much alive, and was focusing more and more on viruses, on genet
ic engineering, and on miniaturization of the research and production processes - using tiny bioreactors that can be hidden in small rooms.
The French UNSCOM inspectors and officials always seemed to be at the center of conflicts with other UNscoM teams. It was quite clear that the French were no longer interested in discovering any more biological-weapons installations in Iraq. Some of the other inspectors would say, privately, that the senior French UNSCOM inspectors appeared to be acting on direct orders from their government to stop finding things in Iraq. The French government seemed confused. Most of the French political leaders were middle-aged men, relatively uneducated in advanced biology, and unable to grasp the seriousness of biological weaponry. French leaders seemed unable to conceive of the idea that the proliferation of biological
weapons in the Middle East might be a direct threat to the safety of the French people. This was a situation that, to be sure, the French people knew nothing about. When a bomb goes off in a trash can in Paris and kills a dozen people, it is a problem. If the bomb were to contain a military virus, the problem might be uncontrollable.
But commercial interests are important in France, as they are everywhere. Not so long ago, Iraq had been a customer and friend of France. Iraq might be a customer and friend again. It is important to have good relations with one's customers and friends. Money makes friends. Money makes the world go around.
A Cast of the Net NEW YORK CITY, FRIDAY, APRIL 24
Alice Austen had a freshly printed fist of the hospitals in the New York City area, with telephone numbers, on her desk. She began calling the hospitals, one by one. She would get an E.R. house-staff doctor and ask him or her a few simple questions. The conversation didn't take long. 'Have you had any emergency cases recently where the patient was in violent terminal seizure?' she would ask. 'We're looking for previously healthy people who suddenly develop seizures that may end in death. These patients may have discoloration of the iris of the eye. There may be a very strong muscular rigidity. The spine bends backward in the shape of a C.'
The reactions she got from the doctors were all over the map. One doctor thought she must be a paranoid schizophrenic. He refused to talk to her unless she could prove that she was really a C.D.C. doctor. Another doctor, a woman, told her that she had been seeing a lot of strep A flesh-eating bacteria - 'cases of people's faces melting off, and arms and legs. These are mostly homeless people. Who knows where they're getting their infections.'
'Are you seeing seizures with any of these patients?' 'No. Not like you're describing.'
After hours of this, she had come up with nothing. It was looking like a dead end.
Then she had a breakthrough. The third case.
She called the St George Hospital on Staten Island. It was a small hospital in an outlying borough of New York City. She reached an emergency-room physician named Tom d'Angelo.
'Yes,' he said. 'I think I've seen this.' 'Can you describe it?'
'It was a woman named - what was her name? - let me get the patient records, hold on.'
'Okay,' d'Angelo continued, with a sound of papers being shuffled. 'Her name was Penelope Zecker. She died here in the E.R. on Tuesday.'
'Who was the attending?' Austen asked.
'I was. I signed the death certificate. Apparently she had been having dizzy spells. She had a history of hypertension. She was on blood-pressure meds. Age fiftythree. Smoker. Someone called 911 - it was her mother. Penny was living with her mother. She was having a seizure. The E.M.T. got her here. She had a cardiopulmonary arrest and we couldn't resuscitate. With her history of hypertension, we figured she must be having an intracranial bleed or an infarct. I think it was a brain bleed. Her pupils were blown - dilated and fixed. She was cooked.'
'Did you do a brain scan?'
'No. We couldn't get her stabilized. She had this dramatic agonal seizure. Her spine bent all the way back and froze. It was really impressive. It scared the nurses. It scared me. I've never seen anything quite like it. Her face twisted up, it changed shape, really. She rolled off the gurney and landed on the floor. Her legs straightened out. Her head went way back. There was incredible muscular tension in the spine. She starting biting the air. The nurses were afraid of being bitten, actually. She bit down on her tongue and almost severed it. Also, it
appeared that she had bitten off several of the fingers of her right hand.'
'My God. When did she do that?'
'Before she was admitted. The elderly mother was - well - incoherent. A patient biting off her own fingers. I've never seen that before.'
'Was there an autopsy?' 'No.'
'Why not, in a case like that?'
He paused. 'This is a for-profit hospital,' he said. 'What do you mean?' she said.
'An autopsy? At a for-profit hospital? Who's going to pay for it? The H.M.O.s sure as hell won't pay for an autopsy. We try to avoid autopsies.'
'You try to avoid knowing what happened to a patient, Dr d'Angelo?'
'I'm not going to argue that, Dr Austen. We didn't do an autopsy, okay?'
'I wish I could have looked at her brain tissue. Do you have samples?'
'Bloods and spinal and some lab tests. We don't have tissue samples because we didn't do an autopsy, as I told you.'
'Can you get me the results by tomorrow?' 'Absolutely. I'm glad to help.'
'What did you put on the death certificate?' 'Cerebral vascular accident. Brain stroke.' There was a pause. 'You think this is something infectious?'
'I'm not sure what it is. What's the mother's address and phone number?'
Cells
With a pencil, Austen marked another X on her map, this one at the St George Hospital on Staten Island. Now there were three points of death:
1. Times Square. April 16. Harmonica Man. The index case.
2. St George Hospital, Staten Island. April 21. Penelope Zecker.
3. East Seventy-ninth Street. April 22. Kate Moran. There was still no obvious connection among them. What had they come into contact with? How were these people connected in a biological sense? The term stealth virus came into her mind, but she pushed it out.
She called Walter Mellis. 'Walt, I've found a third possible case.' She described it to him. 'But I think I'm missing something important. There's a pattern that I'm not seeing.'
'What do your instincts say?'
'It's something I've seen, Walt. It's a visual clue. It's staring me in the face and I don't see it.'
By now, the samples of Kate Moran's tissue would have been processed and prepared for viewing in a microscope. Austen went to the O.C.M.E. histology lab and
collected a set of glass slides. There was no microscope in her office, so she took the slides to Glenn Dudley's office. 'So how are things going, Dr Austen? Have you solved the mystery yet?' He was dressed in a scrub suit, sitting at a word processor. He had just finished his day's autopsies, and he was writing up his reports. She noticed that he looked tired. His usually perfect hair was mussed, his face was sallow.
She described the Zecker case.
'Interesting,' he said. 'I've got some lab results for the Moran girl.' He pulled out a report. 'She had high uric acid in the bloodstream.' He gave the readings. 'She had a mildly elevated white-blood-cell count in the spinal fluid.'
'Any toxins?' she asked.
'If we'd found any toxins in her blood I would have told you,' he said. He turned away and blew his nose on a laboratory Kimwipe and hurled it into the wastebasket with a gesture of annoyance. Then they sat down, facing each other across the doubleheaded microscope. Dudley chose the slides to look at. First they looked at slices of the girl's liver and lung. Everything seemed normal. Then they looked at slides of vaginal tissue. Austen found an area of what looked to be a blister, and she examined the cells there. Some of them appeared to have angular shadows or crystalline objects in their centers, but she wasn't sure.
Austen wanted to look at brain cells. 'Yeah, well, the brain was a bitch to prepare after you chopped it
up, Doctor,' Dudley said.
Even so, they searched through fields of Kate Moran's brain cells. Once again, some of the cells - in the nuclei - contained the lumpy shapes.
'Let's look at some kidney,' Austen said. She was thinking about the golden streaks in Kate's kidneys. Together they studied a slide showing tissue of the
kidney. The damage was clearly caused by uric acid. Austen saw needlelike shapes.
'Yeah,' Dudley said. 'These are uric acid deposits. This kid had very high uric acid.' The finding was consistent with the blood work. She had been undergoing some kind of kidney failure when she died.
'I'd like to get some of this tissue in an electron microscope,' Austen said to him. 'Get a better image of the objects in the cell nucleus.' An electron microscope uses a beam of electrons to make highly magnified images of the interior structure of cells. It can make an image of virus particles.
'Why don't you just take some stuff back to Atlanta?' he said.
'I will. But I want to follow up on a couple of things here in the city.'
Houston Street
By now, Austen was sure this was an outbreak. The shapes inside the cells were part of the disease. Mental alarms were going off. Back in her office, she stared at the map for a while, pondering what to do. She noticed that her hands were sweaty. The day had practically gone. She opened up the case files and pored over them, looking for details. She was sure there was a detail she'd missed. Harmonica Man was the index case. She had to look more closely at that, although the O.C.M.E. had not been able to establish where he even lived, much less his real name.
There was a knock on the door. It was Ben Kly. 'How are you doing, Dr Austen? I was just checking in on you. You don't look too good.'
'I'm okay. How are you doing, Ben?' 'Do you think this thing is real?'
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