Pandemic flu, Ebola, Nipah virus. Emmie de Wit has held all of them in her hands (with three layers of gloves in between, of course).
She's a virologist working at the Rocky Mountain Laboratories in Hamilton, Montana. The 450-person facility, which is part of the National Institutes for Allergy and Infectious Diseases, is nestled in a town of 4,000. It's surrounded by mountains and national forests. Only one road passes through.
This is where de Wit, who is originally from the Netherlands, studies some of the world's nastiest pathogens. To do so, she often works in a Biosafety Level 4 lab, or BSL-4, built for research on "dangerous and exotic agents" that tend to be fatal and for which there is no treatment. It's a building within a building, layered like an onion so that if anything did escape, it wouldn't get very far.
We spoke to de Wit about her latest research and about what it's like to handle deadly things on the regular. The interview has been edited for clarity and length.
Could you run through a list of all the pathogens you've handled?
Influenza A viruses, seasonal flu, pandemic flu, avian flu and 1918 flu. Then there's Nipah virus, Ebola virus, PRRSv, which is a pig virus. Then there's MERS Coronavirus. That's probably about it. I might have missed one or two.
If you could spend all day every day working on one disease, what would it be?
Nipah virus is very interesting, I think, because it causes respiratory disease but also neurological disease. People who survive their Nipah virus infection can sometimes, ten years later, all of a sudden get sick again and either get very severe disease or die.
In a way, this makes Nipah scarier than Ebola. Imagine having Nipah and surviving. Every headache that you get after surviving Nipah, you have to wonder if that's the start of a whole new episode. So, that I think would probably be my number one choice — to try to see if we could figure out where was the virus for ten years in that person before they became sick again? And why are they getting sick now? Could we treat healthy people who survived infection with a drug so that the virus actually disappears?
Malaria is another favorite of yours right now?
It is right now. When we analyzed data from the Ebola outbreak in Liberia, we found that people that had the malaria parasites as well as Ebola were more likely to survive their Ebola infection.
What's your hypothesis on why that is?
Well, it could be one of two things. What seems to me the most likely is that if you're infected with these malaria parasites, your immune system is ramping up to fight the parasites. And so probably if you then get infected with Ebola, your immune system is already fighting something else and so it's easier to also fight the Ebola. On the other hand, there's also parts of the immune response when you have Ebola that actually kill you. So, it could also be that the malaria parasites suppress the bad part of the immune response. Hopefully we can figure that out.
What are you working on in the lab this week?
Ferrets with the 1918 influenza virus.
The big part — the animal experiment — has been done, the samples are in the freezer and now I'm processing them to get all the data.
It's really interesting. Every now and then, people that get seasonal influenza also get virus in the brain, and they get complications from that. That's fairly rare, but after the 1918 Spanish flu pandemic, there was this huge increase of a certain neurological disease, and Oliver Sacks had a few of those patients — like in the movie Awakenings — and he wrote a book about them. [Brain complications] have been linked to the 1918 pandemic, but we don't really know. Of course, when the 1918 pandemic happened, we hadn't discovered influenza virus yet.
This is a collaboration with a friend of mine, Debby van Riel, who's in the lab I used to be in, in Rotterdam in the Netherlands. Under Dutch law, they're not allowed to work with the 1918 influenza A virus — I don't understand why — so we do it here.
Debbie is really interested because she's shown that H5N1, the avian influenza that's causing a lot of problems in humans, can actually go to the brain also. And in seasonal flu, it's rare, but it happens.
So, we wanted to see what 1918 actually does. There's no way to go back and figure this out, other than in animal models.
So, you infected ferrets with the 1918 flu and then you want to see what happened to their bodies?
Yeah, and if they are infected, how much virus do they actually have, in which organs? How much virus do they shed? Are there antibodies in their blood? That sort of stuff.
What does the BSL-4 lab look like?
What you see from outside is a corridor. It sucks in the air from the building so that, if somehow there was a breach, the air from the BSL-4 would stay in that corridor and it wouldn't come into the rest of the building. Through the window, you can see the lab. It looks pretty much like any lab, but what's different is you see all these red hoses that are coming from the ceiling. When you're wearing a BSL-4 suit, that's where you hook up to air. As you move through the lab to a different spot, you unhook, move to where you want to be and grab another air hose.
How often to do you think about, um ...
Yeah, the worst case scenario?
Not too often.
It's all a matter of being trained extremely well to do this. Things can go wrong. Unexpected things happen, especially if you do animal work.
It's in your own best interest for your own peace of mind to follow all the rules. For some procedures, like if you're using needles, there always has to be a second person that can see what you're doing and assist you if something went wrong.
It's just a mindset of forcing yourself to stick to those procedures. And then, when you do and nothing goes wrong, then you know that if you get a cold, it can't be Nipah.
What does it feel like to wear a BSL-4 suit?
It probably looks worse than it is. You're a little bit slower when you walk, because the suit blows up with air. You get cold because of the air that's blowing in your face. You're wearing three pairs of gloves. That's something that people often have to get used to. And then you have to be very aware what you do.
For example, you always have to realize you want to keep the suit under positive pressure so that if you somehow got a hole in the suit, the air would flow out, so that no viruses could come into your suit. If you drop something on the floor, you have to make sure before you bend over that you're connected to air. Because if you bend over and you're not hooked up to air, you push all the air out of the suit, and then you're not under positive pressure anymore. It's fairly easy.
You can't eat or go to the bathroom, or drink water.
No, you can't. You learn that lesson pretty quickly. If you know you have to be in there for a long time, then you don't drink too much before you go in. But we have time limits. You can't be in a BSL-4 lab for more than 5 hours.
There is always someone in the building who knows exactly who is in the BSL 4 lab at any given time.
Do you like working in there?
Yeah, I really enjoy it, for a couple of reasons. It's different from what you do out here. You have to be very very focused. You can't do anything else other than what you're doing at that moment. It's kind of a nice mode to be in while you're working. And it's very quiet. Because you're on that air hose that blows air into your suit continuously, you can't talk to anyone unless you're wearing a radio. So, you're in your own little bubble doing your own thing.
And then on the way out, I don't know if you've ever experienced this, but at home you're in the shower and then something important pops into your head that you forgot. It's kinda nice to have that in the middle of the day when you come out of the BSL-4 and you're like, "Ah! I forgot to split my cells."
Every time you leave the BSL-4 lab you have to shower?
So, you see your colleagues with wet hair all the time?
Yes, and we all smell like the same shampoo. But then again, you don't have any smelly colleagues. So, there are lots of pluses to the BSL-4.
What about underwear?
Well I didn't want to talk about that because then we have to talk about underwear on NPR.
We have disposable underwear that you can wear under your scrubs. Apparently there's a story that the purchasing department didn't think we needed disposable underwear.
Because they were suggesting that real scientists would go commando?
See, this is why I didn't want to bring up the underwear. It leads to all kinds of questions. I won't say anything about the underwear until you turn the thing off.