Reportage

Playing It Extra Safe

Three safety airlocks, a separate power supply, walls of steel: in the middle of Hamburg, laboratory technicians research some of the world’s most dangerous pathogens under the strictest safety precautions. About working between Ebola and peracetic acid.

Text  Lena Schulte Photos Roman Pawlowski

There’s a very special dream that every employee in the high-security laboratory eventually has at some point. Elly says that once you’ve dreamed this one particular scenario, that’s when you know you’re really part of the team. The dream is actually a nightmare and it goes like this: it’s a workday like any other. You go through the three safety airlocks into the high-security laboratory. You do your research on the most dangerous pathogens on the planet. And, as always, you want to leave the lab after three hours because that’s the maximum limit you’re allowed to work at a time. So you head over to the airlocks, and as you are about to press the button for the shower of peracetic acid to disinfect yourself, you finally notice that you aren’t wearing the protective suit. You begin to panic.

“And the point is that you’re not panicking because you’ve been working with the Ebola virus without a protective suit,” Elly explains. “The problem is that you aren’t wearing the suit and you have to walk through the peracetic acid shower. And it’s caustic.” She laughs. “When your fear of everything else is greater than your fear of the virus, that’s when you’ve really ‘arrived’ at the lab.”

Lilly is 32 years old and has been working for five years as a biology lab technician in the high-­security laboratory at the Bernhard Nocht Institute for Tropical Medicine in Hamburg. For security reasons, her full name cannot be used here. The high-security laboratory in Hamburg is one of just four such labs in Germany that fulfill all the requirements for the highest security level, S4. It’s a lab that its employees affectionately call “The Submarine” because it’s a unit unto itself, a self-sufficient building within a building, completely separated from the rooms surrounding it, with its own supplies of power and fresh air—as required by international standards. A laboratory, about half the size of a tennis court, all of shining metal. Walls, tables, shelves, everything is made of stainless steel. The silver doors have round windows, like portholes. There are bright blue hoses dangling from the ceilings everywhere, delivering compressed air.

Highly infectious pathogens such as the Ebola, Lassa and Marburg viruses may be studied only in these types of laboratories. An infection with any of them can lead to life-threatening bleeding and organ failure in just days. These are some of the world’s most deadly viruses. The employees inside must trust that every protective measure works. And the population outside that no viruses escape. That the airlocks remain sealed and that everything is working properly.

“When your fear of everything else is greater than your fear of the virus, that’s when you’ve really ‘arrived.’”

Lilly

Two of the laboratory’s three rooms form traditional lab bays. These contain white incubators that keep the temperature for the dangerous viruses at a constant 37 degrees Celsius. The scientists carry out their experiments in the next room. They work on sterile workbenches, separated from the viruses by a glass pane and a flow of sterile air. There are monitors and microscopes on the tables. The researchers still use fax machines to send their notes to the office. They’re only allowed to take the papers out of the lab once a year when the entire facility is sterilized and serviced. Even normal waste must be decontaminated before it can be disposed of outside as laboratory waste. To keep the laboratory clean, its employees take turns as janitors because no cleaning staff are allowed to enter the lab.

Lab animals await their fate in the third room. Mostly regular laboratory mice, but also the Natal multimammate rat: a common African rodent that is known to harbor the Lassa virus. Elly checks in on the animals every morning. She also carries out experiments on them.

Before Lilly can enter the lab, she must put on her protective suit and pass through the three airlocks. The pressure drops behind each of the doors to prevent any contaminated air from escaping in the event of an emergency. Only twenty people have access to the laboratory. Just five at a time are allowed inside. The only way out is through a four-minute decontamination shower of peracetic acid and water, after which the protective suit is pathogen-free. Lilly is part of a team researching the Lassa virus. Lassa is widespread in West Africa and probably triggers an overreaction in the immune system. After flu-like symptoms, a continuous fever sets in. The liver and kidneys become enlarged, the skin breaks out in a rash. Because no effective therapy has yet been found, about one of every seven patients dies from the disease. The researchers are trying to find a treatment and also to understand exactly how the virus works.

The viruses being researched in the lab may sound exotic, yet it’s not impossible for them to crop up in Germany. The Marburg virus, for example, first appeared in 1967 in a lab technician in Marburg. When a number of people came down with high fevers and gastrointestinal problems and then died as a result, a state of emergency was declared for the entire town. The Lassa virus has also been repeatedly brought in to Germany. And August 2014 marked the date of the first patient to be treated for Ebola in Germany.

The high-security laboratory is located in the St. Pauli neighborhood in Hamburg, not far from the Reeperbahn red-light district. Where exactly the lab is located within the institute is a secret. Anyone who enters it is first reviewed by the secret service. That’s why we cannot print Elly’s full name nor photograph her. The risk is too high that someone might threaten her or infiltrate the laboratory to steal the viruses that she and her colleagues are researching.

To put on her protective suit, Elly first takes off her gray skirt and white sweater and puts on white trousers and a blue shirt. “It gets warm in the suit,” she says, “and if I’m going to sweat, then at least not in my own clothes.” Next, she clips a walkie-talkie onto the waistband of her trousers. The walkie-talkie has a fail-safe mechanism, similar to a dead man’s switch, that sounds an alarm if the device has been lying horizontally on the ground for some time. This gives the employees the assurance that they will receive immediate help if they should collapse or faint. The two supervisors who continuously observe their coworkers in the safety lab and maintain radio contact with them would be notified immediately. If necessary, they would begin an evacuation.

Lilly pulls orange gloves over her fingers, the first of three pairs that all employees must wear, one on top of the other. Then she secures her headset with a bandana. Now comes the suit. “It’s made of absolutely tear-resistant material,” she notes—made entirely of white PVC. “You could even walk through contaminated water in Chernobyl wearing this.” The protective suit is the life insurance for employees at the high-security lab. Elly trusts it to keep her safe. Filtered air flows into it through blue tubing. The air in the suits is at a higher pressure than the air in the lab, so that any escaped viruses would be pushed away. Once Elly has inflated her suit, she looks like an astronaut.

She slowly paces back and forth a few steps. Her gait is sluggish. In one hand she holds the blue tubing that supplies her with filtered air. As soon as she detaches it, her transparent face shield begins to fog up after a few minutes. Then her cheeks turn red as it gets warm. In the lab, the employees have established the rule that everyone must take a break after three hours. They can’t concentrate longer than that anyhow under such conditions.

Lilly can find some appeal in a few of the things that others might consider a burden. “Everything is different in the suit, particularly your senses,” she says. “Your sense of touch is different through the three pairs of gloves. You hear differently, with the constant hissing of the air supply, and there’s beeping now and then.” Elly must communicate in a different way, mostly through sign language. But most of all, she must be absolutely focused and alert at all times. The physical component of the lab work is often underestimated, she says. After her first times on the job, when she was much more tense, Elly would feel completely exhausted. It took a while before reality outside the lab felt normal again. She initially couldn’t listen to music for hours, but now she listens to all sorts of music even while inside the suit.

Because of all this, new employees must undergo a strict, multistage training program. Before anyone is allowed to work alone with a virus, they must have been inside the lab at least twenty times with a co-worker. “Everyone gets a very slow introduction,” Elly explains. “I always try to teach the new ones as much as possible outside the lab.” With the student she most recently trained, she had him put on the three sets of gloves in his regular office. That allowed him to experience the way that completely familiar items, like pipettes and syringes, felt through the layers of rubber. Elly finds it especially important to familiarize the newcomers with hazardous incidents. “There’s always a chance that all of a sudden an alarm goes off in the lab because the air pressure deviates too far from the target ­value­ because of a door that is closing too slowly,” she adds. “Or the tech department calls and says there’s a small problem with one of the decontamination showers and you should use the other one. That can be scary for someone who’s never experienced it.”

The innumerable repetitions, the slow internalization of movement sequences and the precise technical knowledge about the safety precautions gradually give the employees a feeling of control of their own day-to-day work. They develop trust in the protective measures and in their own abilities. Despite all of this, there’s always a residual risk. In 2009, a scientist at the Bernhard Nocht Institute in the high-security laboratory accidentally pricked herself with a needle through her protective gloves while working with the Ebola virus. She had just used the needle to infect mice with the virus. Residues of the deadly pathogen could have made their way into her bloodstream. She was immediately placed in an isolation ward and it would have been Germany’s first case of Ebola. It took days before she was declared virus-free and was able to leave the hospital.

You might think that safety standards like the ones here would be the rule and not the exception. Unfortunately, Elly experiences the exceptions once or twice a year. She and her team fly to Nigeria, usually between December and March, during the dry season, when the rats that carry the Lassa virus scurry back into human-made structures. There are frequent outbreaks of the virus around this time. It’s a rough four weeks. Lilly works twelve hours a day, seven days a week. In a hospital near the border with Benin, she helps diagnose cases of the ­Lassa virus with a portable minilab. Sometimes when she receives a sample she sees that the patient is a three-month-old newborn, sometimes she learns that the virus has wiped out an entire family.

She becomes thoughtful talking about it. “When you’re in Nigeria and you see patients, and you also see relatives and you hear their stories, that’s when it suddenly becomes clear what this disease ­actually is.” Lilly believes that everyone who works with these types of viruses should travel now and then to the areas where there are outbreaks so as not to forget the human cost. When there is an outbreak, the team from Hamburg needs 72 hours to get to the location with their mobile lab and start doing diagnostics. They travel without the lab if they’re conducting research projects: just this morning, a four-member team set off for Congo. Since the start of the Ebola epidemic there last summer, more than five hundred people have died.

Lilly says her work out in the field refreshes her respect for the virus. The familiar working methods of a controlled environment like the one in Hamburg don’t exist in Nigeria or in Congo. She naturally wears protective clothing when she’s working there and is meticulous about cleanliness, but the viruses are everywhere. Elly has come down with a cold twice on the plane back to Germany—the symptoms are similar to those of an infection with the Lassa virus. If she had also come down with a fever, she would have needed to get herself tested for the virus. Fortunately, that hasn’t been the case so far.