The worst of it was his hands. The pustules of variola had erupted there.

The hand is a symbol of humanity, part of what makes us humanthe hand that carved the Parthenon, painted the hands of G.o.d and Adam on the ceiling of the Sistine Chapel, and wrote King Lear was the only hand that had known smallpox. That same hand had now given the disease to a monkey.

The scientists were watching Jim Stockman, too. He was a serious man in his fifties who had worked with animals for his entire career and he was naturally gentle around animals. They felt that he might be having a difficult time watching Harper come down with smallpox. The monkey was getting dehydrated because he could hardly swallow. Stockman went to a drugstore and bought a bottle of grape-flavored Pedialyte-a fluid replacement that is often given to children who have diarrhea-hoping it would appeal to Harper. Hensley and Martinez prowled the breakfast bar at the hotel, picking over the fruit salad, taking red grapes, peaches, slices of mango and soft banana, tucking the fruit into foam coffee cups, and bringing it into MCL West to see if Harper would want any of it.

Stockman poured Pedialyte into a syringe that had a long plastic tube on it. The monkey took the liquid in his mouth. He seemed to trust the people in the s.p.a.ce suits. Shamblin and Stockman pulped up bits of fruit and put them on a tongue depressor and offered them to Harper. He couldn't chew, but he mouthed the mush and swallowed it. He had pustules on his haunches, and Mark Martinez got a soft pad and managed to slide it under the monkey, to help him sit more comfortably. They discovered that he liked the red grapes best of all, and Hensley would clean out all the grapes from the breakfast bar.

Stockman bought bags of marshmallows, and Harper managed to chew and swallow them.

Harper had gone semiconfluent across the face. He began to reach the stage of early crust, the most dangerous stage of human smallpox, when the cytokine storm goes out of control. Around June 10th, when the monkey had crusted, Stockman offered him a whole red grape. He reached out, took the grape, and put it in his mouth.

Harper began to seem a little better, and he developed a pa.s.sion for the grapes. If he noticed that someone had a cup of them, he would hold out both blistered hands and then stuff grapes into his cheek pouches until they bulged with grapes, saving them for later.

Lisa Hensley had been phoning Peter Jahrling every day, and the team e-mailed pictures of Harper's face to him. In late June, Jahrling brought some of the pictures to a meeting in Washington at the National Academy of Sciences, where he ran into D. A. Henderson. Members of the National Academy and leading experts on biological weapons were chatting and milling around a coffee machine.

Jahrling and Henderson's personal relationship had become tense and sour since Jahrling had begun to argue in favor of keeping smallpox.

Jahrling handed Henderson a color photograph of Harper. "Take a look at this, D.A." The pustules were all over the monkey's face, and they had dimples in them.

Henderson nodded and said something like, "Well, that looks just like smallpox." His point seemed to be that Jahrling didn't need to do experiments with smallpox when monkeypox looked so much like the real thing.

"Well, guess what, D.A.? It is smallpox."

According to Jahrling, Henderson shoved the photograph into Jahrling's stomach, turned on his heel, and walked away without a word. Henderson says that never happened.

June turned into July, and Atlanta simmered with heat. Hensley was perpetually chilled in her s.p.a.ce suit, and she welcomed the muggy weather when she walked out the doors of the MCL. She had no time for any kind of normal life. Go back to the hotel every evening.

Heat up a Healthy Choice dinner. Lie down on the floor. Call Rob. She was making herself less available to him and knew she was doing it, but the experiment was in white water. Harper had scabbed over, and his health had returned. They continued to feed him delicacies by hand, but they knew that he wouldn't permitted to live. The protocol of the experiment required the euthanasia of all animals, in order to gather more data on the effects of smallpox. And there was a biosafety rule that an animal infected with a level 4 pathogen could not be taken out of Level 4 alive. Smallpox could leave the facility with the animal. When the day came on which Harper had to be sacrificed, in late July, Jim Stockman announced that he had business to attend to in Maryland, and he would be flying home. Then it turned out that Josh Shamblin suddenly needed to fly home, too.

That night, each of the team members went into the monkey room, one by one, and paid visits to Harper. He had healed almost completely and had no scars. They left him heaps of marshmallows, peanuts, bunches of grapes, and a pear, more than he could eat. The next morning, Hensley and Martinez put Harper to sleep. They used an anesthetic that would cause no pain. The monkey had been anesthetized before, and he would not have found anything unusual about it this time.

Martinez placed Harper, unconscious, on the table and watched him go. He had to note the death formally. Hensley turned her face away.

Of the eight monkeys that were given the Harper or India strains, seven died, six of hemorrhagic smallpox, one of cla.s.sical pustular smallpox. Harper was the only survivor.

The team infected two more sets of monkeys. In round two, they infected six animals, five of which died. One of these monkeys got pustular smallpox and one of the others developed the brilliant red eyes of human black pox victims. In round three, the final round, they lowered the dose and infected nine monkeys, and none of them got sick at all.

Peter Jahrling felt that the experiements were successful. "We were able to put to rest the myth that smallpox infects no species but man,"

he said. "We were able to create a disease in the monkeys that approximates the course of the human disease. This means it will be useful for validating antiviral drugs and vaccines for the FDA." He said that the next step would be to challenge monkeys with smallpox and then try to cure them with the antiviral drug cidofovir.

I asked Jahrling about how he justified the suffering of the monkeys in the experiment. "My blood pressure would come down twenty points if we didn't have to work with variola in monkeys," he said. "It really bothers me. The thing is, you look into their eyes and you see they're intelligent. You go into a monkey room at night and you hear them vocalizing, and it sounds like people talking. It really gets to me. But a critical countermeasure to smallpox is going to be antiviral drugs, and the FDA requires testing the drugs on the authentic smallpox virus in an animal. Frankly, I myself could accept and live with an antiviral drug that we've tested in human tissues in vitro"-in test tubes-"and in, say, genetically engineered mice that have been given a humanlike immune system. But testing smallpox on a mouse that has a human immune system isn't going to be acceptable to the FDA anytime soon. Tens of monkeys are going to be sacrificed to this cause, but that is not the same thing as tens of millions of humans with smallpox, and I do believe that smallpox is a clear and present danger. But the truth is that I've been at the point where I really thought I couldn't do this anymore."

Lisa Hensley had experienced grief and sadness over Harper's death, in particular, but she regarded her feelings as a necessary consequence of her job as a public health researcher. "Each of us who does animal research has to weigh in our own conscience what we do," she said to me. "Around twenty percent of the population can't be vaccinated. They're immune compromised, or they have eczema, or they're pregnant women, or they're very young children. That's a large number of people who will have no protection if smallpox comes back. To me, it is not an acceptable loss."

WTC.

September 11, 2001 By the beginning of September, Hensley had been working with smallpox in a s.p.a.ce suit five to seven days a week, without a break, since the end of May. Her parents invited her and Rob Tealle to come with them on a vacation to the Outer Banks of North Carolina, and they accepted. She left Martinez to continue with the smallpox work, which was beginning to wind down.

On the eleventh of September, at 9:00 A.M., Stockman was feeding and checking the monkeys.

A CDC smallpox scientist named Inger Damon was taking care of some equipment in one of the rooms.

Sergeant Rafael Herrera was working in his suit, listening to music on a radio headset.

Mark Martinez was doing a necropsy of a monkey, and he noticed that Herrera had come into the room. Herrera's eyes were wide, and he mouthed something at Martinez, but Martinez didn't hear it, so Herrera got a piece of paper and wrote: "A plane crashed into the World Trade Center."

"Yeah?" Martinez shouted.

Herrera went out of the room, and Martinez resumed his work. A short while later, Herrera came back, and he wrote on the paper, "Another plane crashed into WTC."

Martinez had to keep working; he was in the middle of the necropsy.

Herrera was listening to developments on his radio headset. He wrote: "Pentagon," "Plane down in PA."

A window in the necropsy room looks out into a hallway. A woman appeared in the window, waving her arms and banging on the gla.s.s, and she held up a sign: YOU NEED TO EVACUATE.

A warning had come from high levels in Washington to the director of the CDC, Jeffrey Koplan, that the facility might be a target of a terrorist attack at any moment. It wasn't known in those early hours of September 11th who had carried out the attacks or what other attacks might come. Koplan had ordered an evacuation of all the buildings at the CDC.

Everyone at the CDC knew that the MCL was hot with variola. If it was broken open by the impact of an aircraft or the explosion of a bomb, the smallpox could conceivably escape.

As a lieutenant colonel, Mark Martinez was the ranking officer in charge. He unhooked his air hose and, thrashing in his s.p.a.ce suit, ran through the suite, getting everyone's attention, telling them to evacuate. The smallpox freezer was locked and chained, but there wasn't time to do anything about the dead monkey lying on the table.

Martinez ordered people to go into the decon air lock in groups of three. The shower has only two air hoses, so they shared the air. The decon shower filled with mist from the heat of their bodies.

Then a woman appeared in the Level 3 gray area and held a sign up to the air lock door: EMERGENCY PROCEDURES. It meant they had to crash their way out of the Maximum Containment Lab immediately. They wondered if a plane was heading for the building.

They stopped the shower and pulled the DELUGE handle. Many gallons of Lysol splashed over them, and they crashed out of the air lock and got out of the building.

Part Seven - The Anthrax Skulls

Henderson

Five days after the fall of the World Trade Center towers, on Sunday, September 16th, at four-thirty in the afternoon, D. A. Henderson was sitting in the den of his house in an easy chair by the j.a.panese garden, getting no peace from the view.

The telephone rang. It was Tommy Thompson, the Secretary of Health and Human Services, calling from HHS headquarters, on the south side of the Mall. "Can you come to a meeting in Washington?"

"When?"

"Tonight. Seven P.M. We're asking, What's next?" Thompson said. "We'd like you to be there."

Henderson told Nana where he was off to, and he got in his silver Volvo and drove to Washington. It was the end of his plans for retirement. He went to work in Thompson's office and eventually was appointed the director of the Office of Public Health Emergency Preparedness Response. He became, effectively, the bioterrorism czar in the government, with managerial control over an annual budget that grew to more than three billion dollars. He started getting up at five, taking an early train to Washington, and getting home late at night. He was seventy-three years old. He believed that it was only a matter of time before the bioterror attack that he had long expected finally occurred.

Henderson went to work for the federal government on a Sunday night. The next day or the day afterward-Monday or Tuesday, September 17th or 18th-someone visited a post office or mailbox somewhere around Trenton, New Jersey, and mailed letters full of dry, crumbly, granular anthrax to New York City: to the NBC anchor Tom Brokaw, to CBS, to ABC, and to the New York Post.

Into the Submarine OCTOBER 16, 2001 Peter Jahrling had been in near-daily contact with Lisa Hensley and the monkey team in Atlanta after September 11th, but by the middle of October, he became almost overwhelmed by the investigation of the anthrax attacks, the first large-scale bioterrorism event in the United States.

On the morning of the 16th, the day after it was delivered to USAMRIID, the powder in the letter mailed to Senator Daschle was being studied by John Ezzell, the civilian microbiologist who accepted it from the agents of the FBI's Hazardous Materials Response Unit. But Jahrling wanted Tom Geisbert to get the sample under an electron microscope, and that didn't seem to be happening fast enough. Jahrling met Ezzell in a hallway and said, in a loud voice, "G.o.dd.a.m.n it, John, we need to know if the powder is laced with smallpox."

Top Inst.i.tute scientists were yelling in the halls about an unknown terrorist bioweapon, and the staff rallied. A technician hurried into Ezzell's laboratory rooms and brought out two small test tubes of samples from the Daschle letter. One tube held a milky white liquid. This was from the field test done by the HMRU. The other tube contained a tiny heap of dry particles and a corner of paper cut off the Daschle envelope-the corner was about this size: L. The tubes were inside double plastic bags that were filled with disinfecting chemicals. The technician gave them to Geisbert, who took them into a Level 4 suite called the Submarine.

The Submarine is the hot morgue at USAMRIID. The main door of the Submarine is a ma.s.sive plate made of steel, with a lever. It looks like a pressure door on a submarine. Pathologists wearing s.p.a.ce suits have on one or two occasions used the Submarine for the dissection of the body of a person who was thought to have died of a hot agent, although the opportunity to do this kind of postmortem exam rarely arises. Geisbert suited up and went through the air lock into the Submarine, carrying the tubes of Daschle anthrax. He walked past the autopsy room to a small lab. He opened the tube of milky anthrax liquid and poured a droplet onto a slip of wax. Using tweezers, he placed a tiny copper grid on top of the droplet, and he waited a few minutes while the anthrax liquid dried to a crust on the grid. Then he put the grid in a test tube of chemicals, so that any live anthrax spores would be killed. He showered out of the suite, got dressed in civilian clothes, and brought the sample up to one of the scope rooms on the second floor, where he put the tiny grid into a holder and shoved it into one of the electron microscopes, a transmission scope, which is eight feet tall. The scope cost a quarter-million dollars.

Geisbert sat down at the eyepieces and focused.

The view was wall-to-wall anthrax spores. The spores were ovoids, rather like footb.a.l.l.s but with more softly rounded ends. The material seemed to be absolutely pure spores.

Anthrax is a parasite that has a natural life cycle in hoofed animals. An anthrax spore is a seed, a tiny, hard capsule that can sit dormant in dirt for years, until eventually it may be eaten by a sheep or a cow. When it comes into contact with lymph or blood, it cracks open and germinates, and turns into a rod-shaped cell. The rod becomes two rods, then four rods, then eight rods, and on to astronomical numbers, until the fluids in the host are saturated with anthrax cells. An anthrax cell (unlike a virus) is alive. It hums with energy, and it draws in nutrients from its environment. Using its own machinery, it makes copies of itself. A virus, on the other hand, uses the machinery and energy of its host cell to make copies of itself-it cannot live an independent existence outside the cells of its host.

The anthrax cells produce poisons that cause a breathing arrest in their host. Anthrax "wants" its host to drop dead. Anthrax-infected animals can go from apparent health to death with the celerity of a lightning strike. Some years ago, researchers in Zimbabwe found a dead hippopotamus standing upright on all four feet, killed by anthrax while it was walking. The hippo looked as if it had not even noticed it was dead.

The carca.s.s of the host rots and splits open, the anthrax cells sporulate, and a dark, putrid stain of fluids mixed with spores drains into the soil, where the spores dry out. Time pa.s.ses, and one day a spore is eaten by a grazing animal, and the cycle begins anew.

Geisbert turned a k.n.o.b and zoomed in. An anthrax spore is five times larger than a smallpox particle. He was looking for bricks of pox, so he was looking for little objects, searching spore by spore.

The task of finding a few particles of smallpox mixed into a million anthrax spores was like walking over a mile of stony gravel looking for a few diamonds in the rough. He saw no bricks of pox. But he noticed some sort of goop clinging to the spores. It made the spores look like fried eggs-the spores were the yolks, and the goop was the white. It was a kind of splatty stuff.

Geisbert twisted a k.n.o.b and turned up the power of the beam to get a more crisp image. As he did, he saw the goop begin to spread out of the spores. Those spores were sweating something.

The scope had a Polaroid camera, and Geisbert began snapping pictures. He suddenly realized his boss was leaning over his shoulder. "Pete, there's something weird going on with these spores." He stood up.

Jahrling sat down and looked.

"Watch," Geisbert said. He turned the power k.n.o.b, and there was a hum.

The spores began to ooze.

"Whoa," Jahrling muttered, hunched over the eyepieces. Something was boiling off the spores.

"This is clearly bad stuff," he said. This was not your mother's anthrax. The spores had something in them, an additive, perhaps. Could this material have come from a national bioweapons program? From Iraq? Did al-Qaeda have anthrax capability that was this good? Jahrling got up from the microscope.

"I'm going to bring this to the chain of command."

Carrying the Polaroids in the pocket of his gray suit, Jahrling walked across the parade ground of Fort Detrick to the offices of the Army's Medical Research and Materiel Command, which has authorty over USAMRIID. It was then headed by Major General John S. Parker, a chunky man with a calm, jovial disposition, wire-rimmed a.s.ses, and a shock of silver hair. General Parker is a heart surgeon.

Jahrling walked into his office without knocking. "You need to see this," he said, placing the pictures on the general's desk.

General Parker listened and then asked a few questions. "I want to look at it myself," he said.

Jahrling and the general hurried back across the parade ground. It was four o'clock in the afternoon, near the end of a hot, dry October day, and the East Coast of the United States was locked in a drought.

Catoctin Mountain looked dreamy and peaceful in the autumn haze. The sun was going down, and the flag in the middle of the parade ground cast a shadow toward the east over heatscorched gra.s.s.

Emergency Operations LATE AFTERNOON, OCTOBER 16, 2001.

General Parker and Peter Jahrling went by the office of the USAMRIID commander, Colonel Ed Eitzen, and then the three men went upstairs to the scope room, where Tom Geisbert was staring at the anthrax. Geisbert stood up nervously when the general entered and started to explain what he was doing.

"It's okay, I used to run an electron microscopy lab," Parker said.

Parker sat down at the scope and looked. Pure spores.

That was all he needed to see. He went out into the hallway and started issuing instructions to Eitzen and Jahrling in a rapid-fire way: We're going to put USAMRIID into emergency operations.

We're going to run this facility around the clock. He emphasized that the FBI would be using USAMRIID as the reference lab for forensic evidence from the bioterror event. FBI people would be working side by side in the labs with John Ezzell and other Army scientists. He was going to bring in microbiologists from other parts of his command to help with the work. Parker knew that Washington would be needing as much clear information as possible.

That morning, a postal worker named Leroy Richmond, who worked at the Brentwood mail-sorting facility in Northeast Washington, D.C., had called in sick. Richmond had a headache, a fever, and pain in his lower chest. He went to bed.

Later in the day, the Postmaster General of the United States John E. "Jack" Potter told his aides to ask CDC officials what should be done about postal workers "upstream" who might have handled the Daschle letter. Officials at the CDC answered that they felt there was o danger to any postal workers.

They had a reason for believing that. When they had learned that Robert Stevens and Ernes...o...b..anco had been exposed through the mail at the American Media offices in Boca Raton, the CDC investigators had taken swab samples in post offices around the area, and they had swabbed the noses of Florida postal workers. They had discovered anthrax spores in the Florida post offices, but no postal workers had become infected. There was no reason to think that postal workers in Washington were in danger.

Tom Geisbert couldn't keep his eyes off the weapon. He stared at it through the eyepieces of the electron microscope until he noticed that it was eight o'clock at night. He hadn't eaten or drunk a thing all day. He felt like having some breakfast, so he drove out for the double chocolate doughnut with a large coffee that he had been thinking of getting when he had arrived at work. He brought it back to the Inst.i.tute and continued to work until midnight. He and his wife, Joan, live in Shepherdstown, a long drive to the west. By the time he got home, it was one o'clock in the morning, and Joan was asleep.

That night, a postal worker at the Brentwood mail-sorting facility named Joseph P. Curseen, Jr., began to develop what he thought was the flu while working the night shift, near machines that sort mail.

He had a pain in his lower chest and a headache, so he decided to go home. That same evening, one of Curseen's coworkers, Thomas L. Morris, Jr., went bowling. He started to feel sick, and he went home and went to bed to get some rest.

OCTOBER 17, 2001.

Tom Geisbert couldn't sleep. He tossed and turned and looked at the clock: it was four in the morning. He couldn't free his mind of the view in the scope-endless fields of anthrax spores with an unknown substance dripping from them. He got up, took a shower, and left for work. He stopped to buy another double chocolate doughnut and a large coffee, then went to his lab to try to get more images of the anthrax.

At ten-thirty that morning, the House of Representatives was closed down after CDC people found anthrax spores in mail bins there. About two hundred Capitol Hill workers were told to start taking the antibiotic ciprofloxacin-Cipro. Major General John Parker went to the U.S. Senate, where he met with a caucus of the Senate leadership and their staff. He told them that he'd looked at the anthrax himself in the microscope and that it was essentially pure spores. He would later say, "The letter was a missile. The address was the coordinates of the missile, and the post office did a good job of making sure it got to ground zero."

A half mile away from the Senate, at the Health and Human Services headquarters, D. A.

Henderson had been working with Tommy Thompson's staff to get a stockpile of smallpox vaccine created on a crash basis.

There had been fast-paced meetings at the HHS on the subject of this stockpile. Henderson felt that the United States needed one ASAP. Thompson agreed and had just submitted a request to Congress for enough money to create three hundred million doses of smallpox vaccine-one dose for every citizen. The government hired a British-American vaccine company called Acambis PLC to make most of the doses. Acambis's main manufacturing plant is in Canton, Ma.s.sachusetts. Soldiers surrounded the plant and were stationed inside the American offices of Acambis, in Cambridge. It was thought that a terror attack on the United States with smallpox might be accompanied by an attack on the country's vaccine facilities or an attempt to a.s.sa.s.sinate Acambis personnel who knew how to make the vaccine. The move to surround the vaccine facility in Ma.s.sachusetts with military force was done rapidly, in secret, and under apparently cla.s.sified conditions.

Meanwhile, Daria Baldovin-Jahrling (she uses her maiden name with her husband's) had been getting telephone calls and visits from neighbors. The neighbors knew that Peter was a top government scientist involved with defenses against smallpox, and more than one of them quietly offered Daria money if she could get them some smallpox vaccine. "I don't even know if I can get any for ourselves," she answered them. "If I do, I can't take money for it, and I have to give it to my family first." She was very frightened. "If smallpox was going around Frederick," she said to Peter, "could you get any of the vaccine for the children?"

He told her that if there was a smallpox emergency, their children would get a jab of something in their arms; it might not be the licensed stuff, but it would work. He would make the vaccine himself in his lab if he had to. Yet he couldn't get his mind off the experiment by the Australians, when they had made a vaccine-resistant superpox of mice. What if the vaccine didn't work? He felt the pressure ratcheting up.

While General Parker was telling the Senate that the anthrax was pure and the HHS people were asking for money for a smallpox-vaccine stockpile, the FBI decided, sensibly, to get a second opinion on the Daschle anthrax. The HMRU dispatched a Huey to Fort Detrick. Not a few of the FBI's Hueys have bullet holes in them. The holes, which are covered with patches, are left over from combat in the Vietnam War. The FBI had gotten its Hueys used and cheap from the military.

The Huey touched down on a helipad across the street from USAMRIID. An agent went into the building and collected a cylindrical biohazard container called a hatbox. Inside the hatbox, inside multiple containers, was a small test tube of live, unsterilized Daschle anthrax.

The helicopter took off with the sample and thupped westward over Maryland. It touched down in West Jefferson, Ohio, near Columbus, at the Hazardous Materials Research Center of the Batelle Memorial Inst.i.tute, a nonprofit scientific research and consulting organization. Batelle scientists took the hatbox into a lab. They heated the anthrax powder in an autoclave to sterilize it, and they began looking at it under microscopes.

The spores were stuck together in lumps. They did not appear to be very dangerous in the air-the lumps were too large to float easily or go deep into human lungs. The Batelle a.n.a.lysts conveyed their findings to the head of the FBI Laboratory, Allyson Simons. Their tests showed that the anthrax was not nearly as refined or powerful as the Army people believed.