Not in My Back Yard -- And Not in Yours

Hundreds of people in Vietnam, Hong Kong and mainland China, many of them hospital workers, have come down with a mysterious respiratory illness that has killed at least six people and left most of the others with severe breathing difficulties..., officials of the World Health Organization said yesterday.

Yesterday was March 14, 2003, and that was how New York Times readers learned of the mysterious and extremely lethal virus originating in China that caused severe acute respiratory syndrome and within weeks would infect nearly 8,000 people in 37 countries. The number of victims in that first and only SARS outbreak was small by global pandemic standards thanks to rapid action by public health officials, and within a few months it was over. But the fraction of those who died -- nearly 10 percent -- marked this as a notably virulent pathogen, and the virus often killed the young and strong as well as the frail.

We dodged that first bullet.

But SARS lives on worldwide, in laboratories where it is being studied and from which, despite their high biological security level, it already has escaped more than once through infected lab workers. If we suffer another SARS epidemic, many scientists believe it will emerge from a laboratory escape, not from the wild.

What could be a worse setting for such an escape than a densely populated urban area where a lab researcher might become infected with this virus or another viral or bacterial disease that is both deadly and highly contagious, transmitted by casual contact, a cough or a hand brushing a contaminated surface?

Someplace like the high Bio Security Level 3 or highest Level 4 labs in the Roxbury section of Boston, which Boston University has been trying to get approved for seven years in order to establish a National Emerging Infectious Disease Laboratory to study such killers.

If not SARS, imagine it to be the far deadlier 1918 pandemic flu virus that killed an estimated 40 million people worldwide during World War I -- far more than died in the war. Or the deadly avian H5N1, whose infections were transmitted via poultry to 442 people but caused a truly alarming 262 deaths by 2010. Luckily, human to human transmission has been rare, but experiments at the University of Wisconsin to see if H5N1 can become contagious in humans may change that.

You may well feel safe, believing that rigorous risk analyses would precede any such pathogen research, and they would demonstrate beyond any reasonable doubt that no such deadly scenario could play out in your neighborhood. But to the contrary, BU and the National Institutes of Health have carried out two risk analyses demonstrating only that several highly contrived lab accidents would not spawn deadly epidemics.

First, BU-hired experts analyzed what would happen in Roxbury, the largely African-American neighborhood where the national laboratory would operate, if a small amount of anthrax were spilled and an infectious aerosol developed. Problem: anthrax is not contagious, so would not escape the laboratory to infect others. A superior court judge threw that one out.

Next, an NIH risk analysis considered scenarios in which one lab worker becomes infected with ebola, sabia, monkeypox or Rift Valley fever, all of which are indeed deadly and contagious. Problem: they are only mildly contagious, thus would infect only those in intimate contact with the lab worker, and symptoms show up very rapidly and obviously, so those infected could be quickly and completely isolated. SARS, in contrast, is quite contagious. A National Research Council committee appointed by the National Academy of Sciences found the NIH analysis "was not sound and credible, did not adequately identify and thoroughly develop worst-case scenarios, and did not contain the appropriate level of information to compare the risks associated with alternative locations."

The third attempt at showing Roxbury will be a perfectly safe place to study the world's deadliest pathogens is now underway. But results so far are as deceptive as in the earlier attempts at rationalization of an already-determined location. A consulting firm hired for this third analysis claims a secondary infection of SARS from a lab researcher to someone outside would occur once in 10,000 years in a worst-case scenario, and likely only once in over a million years. How are such long odds plausible? The consultants looked at only two scenarios, a centrifuge accident and a massive earthquake that would level the laboratory. They did not look at the risk of a SARS-infected lab worker, unaware he was infected, transmitting the infection to someone outside the laboratory -- by far the most likely scenario, which already played out precisely in a SARS escape in China that killed the mother of a lab observer and many hospital workers treating infected lab workers.

SARS is not the only deadly pathogen to escape its supposedly escape-proof security. Dozens of U.S. cases have been reported over the years with one major difference from the Chinese. So far, in this country, only lab workers have fallen victim.

The message could not be clearer. Investigations of such deadly pathogens should be conducted only in highest-security BSL-4 labs, tucked away in remote locations where any accident can be quickly contained.

Lynn C. Klotz and Edward J. Sylvester are authors of Breeding Bio Insecurity: How U.S. Biodefense Is Exporting Fear, Globalizing Risk, and Making Us All Less Secure, University of Chicago Press, 2009.

A more detailed analysis of the BU lab issues by Lynn Klotz appeared in Gene Watch entitled "SARS In The City."