1979 Sverdlovsk Human Anthrax Epidemic: Perspectives of Victims and Health Workers

Sverdlovsk, Russia, is located along the Iset River on the eastern slope of the mineral and petroleum-rich Ural Mountains about midway in the north-south trending mountain range. From Moscow by airplane Sverdlovsk is 2.5 hours and by Trans-Siberian Rail 1 day, 2 hours, and 20 minutes. The total distance between the two cities is 1,105 miles (1,778 kilometers).

About Sverdlovsk

Since the dissolution of the Soviet Union in 1991, Sverdlovsk has reverted to its pre-communist name of Yekaterinburg (also Ekaterinburg) although the Sverdlovsk appellation persists here and there. Sverdlovsk was named after Yakov Sverdlov, the son of a Jewish engraver who, as a Bolshevik, joined Vladimir Lenin in the coup to rule Russia in 1918. Lenin was grooming Sverdlov as the future Communist party leader, according to some observers, but Sverdlovsk died unexpectedly in March 1919 at age 33 years from pandemic influenza sweeping Europe and Asia. (1) Lenin’s regime renamed many Russian cities, including Yekaterinburg as Sverdlovsk in 1924, in the party’s posthumous mania for remembering Lenin who died of a stroke that same year. (2)

Tsar Peter the Great originally named the fledgling Yekaterinburg in the early 1700s after the Christian St. Catherine of Alexandria, Egypt, who lived during the fourth century A.D. She was learned in science and oratory and converted to Christianity as a young woman following a vision. She debated many highly-placed pagans who she persuaded to convert to Christianity, which invariably resulted in their martyrdom. Maximus also martyred St. Catherine by decapitation following torture at the wheel in 305 A.D. St. Catherine’s association with the wheel and Peter the Great’s own wife’s name, Catherine (after St. Catherine), convinced him to name the new Russian city Yekaterinburg, which was known for its abundant raw materials converted to cannons and other wheeled weaponry. (3)
Russian Orthodox Christianity is experiencing a resurgence in Yekaterinburg, as demonstrated by the building of the “Cathedral on the Blood” in 2000 over the exact spot where on July 18, 1918, Tsar Nicholas II, his family and their small retinue were executed by Lenin’s order in the cellar of the house of a successful local merchant, N.N. Ipatiev, which had been commandeered by the Bolsheviks for this purpose. (4) In 1977, Boris Yeltsin, born near Sverdlovsk and head of its Communist apparatus, received an order from the Kremlin to destroy the Ipatiev House.

Yeltsin obeyed, according to one source, and “the house was demolished overnight. By morning, every brick, including ones from the foundation, was taken to the city dump, and the site was paved with asphalt.” (5) Russian President Yeltsin oversaw the recovery of the remains of Tsar Nicholas and his family and buried them at Saint Peter and Paul Cathedral in St. Petersburg on July 18, 1998, 80 years to the day after their execution. In a speech at the funeral, he declared: “The burial is an act of humane justice, a symbol of unification in Russia and redemption of common guilt” and called for atonement for “one of the most shameful pages of our history.”(6)
Sverdlovsk’s Anthrax Epidemic

Boris Yeltsin also gave the go-ahead for a team of Americans led by Harvard geneticist Matthew Meselson to reassess in June 1992 the human anthrax outbreak that occurred in Sverdlovsk in 1979. Sverdlovsk had been closed off to the world during the outbreak (and since 1924) as rumors swirled about the origin of the human anthrax outbreak.  

The problem with the 1979 Sverdlovsk anthrax epidemic is that there are relatively few written records with which to reconstruct what happened. Soviet public health authorities have long attributed the outbreak to the ingestion of anthrax-tainted meat bought by Sverdlovsk residents on the black market near a ceramics factory in the southern part of the city. That the anthrax was inhaled from a leak in a military compound (#19) was finally confirmed in 1992 following the work of the American team.

In all, 96 people were hospitalized for anthrax during the Sverdlovsk outbreak of 1979, including cutaneous cases. Of these 96 hospitalized people, 6 were admitted to hospitals in Sverdlovsk on April 4, 1979. The peak of the epidemic occurred on April 10, 1979 when 10 patients were admitted. A graph prepared by the Soviets in 1988 includes both fatalities and survivors (see below). Of the 96 hospitalized patients, 64 died (a case fatality rate of 67%), according to Soviet records, thereby “tripling the USSR’s yearly average morbidity from anthrax and pushed its death rate off the chart.” (7-8)

Perspectives on the 1979 Anthrax Outbreak

I. Victims Perspective

1. Anna Komina (died age 54 years): Her son reported that she was a healthy worker in the ceramics factory who became ill with “faintness, dizziness, trouble with breathing” around April 4, 1979. She seemed to get better after that, but then, on April 8, 1979, she “completely collapsed.” (p. 86) “The first doctor who came to the house lacked intensive care equipment, so he called the emergency medical center…for an ambulance.” Two medics “worked for five hours to bring his mother’s blood pressure up to a level where it was safe to transport her to the local Hospital 20. The next day, she went into failure, as he put it, and within twenty-four hours, on April 9, 1979, she was dead.”

For five days, Komina’s body was held at the hospital while the family was given tetracycline pills by public health workers. On April 15, Anna’s coffin was buried in a special part of the cemetery named Sector 13. Later in April, Anna’s son received a three-injection vaccination series at the ceramics factory. He reported that around the May 1, 1979, firemen began hosing down buildings and trees right in his area, near the ceramics factory and put in some new asphalt roads in the area even though most of the area remains unpaved to this day. (p. 87)

2. Mikhail Fyodorovich Markov (died, age 47 years): His brother and sister-in-law say that his illness started on April 6, 1979, when he developed a cough. He went to the local clinic, where the doctor said that he might have the flu and instructed him to go to the neighborhood hospital if he felt worse later. Feeling a bit better, he went back to work in the ceramics factory, but, on the afternoon of April 9, 1979, he complained of feeling cold and was shivering. (p. 90) He was on the verge of collapse and went to bed when he began to develop a fever. Finally the family called an ambulance to transport him to Hospital 20. He died during the night and was buried in the special section in the cemetery. The family was prophylaxed with tetracycline and vaccinated in later April. They noted that firemen hosed down streets and buildings.

3. Aleksandra Chizhova (died, 50 years old): Her younger sister recalled that on April 10, 1979, Aleksandra she came home ill from work. The next day she complained of “feeling terribly sick” (p. 102) She was finally transported by ambulance to Hospital 24 where he died that night, April 12, 1979. She too was buried in the special place in the cemetery and her family was given tetracycline and vaccinated and their house disinfected by public health workers.

4.  Yuriyu Sysikov (died, 27 years old): His mother noted that he died on Saturday, May 12, 1979 (notably late in the anthrax epidemic) from classic anthrax, according to the autopsy report. He worked with his father in a construction company right next to the ceramics factory. On Friday, May 11, 1979, “he came home and I asked him, as usual, ‘Do you want to go for a sauna?’ But he said no. He was feeling sick. Saturday, at half-past eleven at night, his father had to call for an ambulance. He had lost consciousness,” recalled his mother. (p. 117) After the ambulance transported Sysikov directly to Hospital 40, the family did not see him again. When Guillemin asked whether Yuriyu had been vaccinated, his father replied no. The father had been vaccinated. The family had not received antibiotics. (p. 118)

5. Fagim Dayanov (died 43 years old): His widow recalled that he died late in the epidemic on May 10, 1979. He became ill on May 4, 1979 with a high temperature, the day after cleaning off a factory roof. He went to work anyway but later in the day asked to leave work because he was feeling sick. He stayed at home the next day, but on the morning of May 6, 1979 was taken by ambulance to Hospital 40, where he remained receiving intensive treatment until he died on May 10, 1979. His autopsy was performed the same day he died. Fagim was not vaccinated, according to his wife who was vaccinated. (p. 127)

6. Valeriy Poletaev (died, 38 years old): His next-door neighbor said of this ceramics factory worker that “it happened in one day. He lived alone and died at home [on April 12]. The ambulance came, they wrapped him in a blanket, and took him to the hospital.” (p. 128)

II. Local Health Care and Public Health Worker Perspectives

1. Dr. Yakov Klipnitzer was head of Hospital 20 and ill with nephritis on the weekend of April 7 and 8, 1979. “He was warned by one of his physicians that first one and then another patient had arrived and died suddenly,” writes Guillemin. “The same was happening at Hospital 24 and at Hospital I in nearby Leninskiy rayon. The heads of all these hospitals contacted each other. The next morning at 6 a.m., another patient was admitted to Hospital 20 and died quickly. Dr. Klipnitzer then called the health departments at the city and oblast levels to tell them that an unusually hazardous infection…had broken out. The Extraordinary Commission for Emergencies at the rayon level was immediately convened. It consisted of the executive chief of the rayon, chiefs of the local hospitals, the rayon head veterinarian, and the chief of the rayon SES [regional epidemiologist].” (p. 105) This commission decided to conduct a house-to-house survey in the area to ask after the health of the residents.

2. Dr. Nikolay Babich was the physician-epidemiologist in the Sverdlovsk area who was “a principal player in the public health response to the epidemic.” He described the epidemic this way: “People died in streetcars and in the lobbies of buildings. There was no time for an ambulance. Everything happened at once. Following regulations, the clinics trying to diagnose the illness notified Moscow.” (p. 46) He recalled that Dr. Vladimir Nikiforov arrived [from Moscow] the third or fourth day after the initial outbreak, before it was recognized as an anthrax epidemic. He thought that Nikiforov deserved great credit for saving at least some patients when a 100 percent fatality rate was expected. At first, the victims were taken to Hospitals 20 and 24, but after three to four days, Hospital 40 was devoted to the epidemic. Anyone with a temperature above 38 degree centigrade was sent there for screening, with special attention paid to pulmonary distress.” (p. 47)

3. Dr.  D.N. Ponomaryev, a physician-epidemiologist in the area, recalled that on April 2, 1979, “he received a telephone call from the city coroner, reporting that a man and a woman had died ‘as if by lightning.’” (Guillemin, p. 98) A few days earlier, he had been summoned to investigate an animal outbreak of anthrax south of Sverdlovsk in the countryside. Even as early as April 4, 1979, he said that he wondered, “Could this be [human] anthrax?” Two days later, on April 4th or 5th, he recalled that a pathologist confirmed that the deaths were due to anthrax. The two pathologists performing the autopsies, Drs. Faina Abramova and Lev Grinberg (see below), however, recall that the date of the first autopsy was April 10, 1979.

4. Drs. Lev Grinberg and Faina Abramova (Local Pathologists)

From the view of pathologist, Dr. Lev Grinberg, who performed autopsies on the victims with Dr. Faina Abramova, chief of pathology, “[o]n April 10 [1979], at one of the city’s smaller hospitals, Dr. Abramova and he took part in the autopsy of a young man. Abramova noted that, along with massive thoracic and gastrointestinal hemorrhaging, there was a distinctive pattern of bleeding in the brain. She remembered a photograph from an old medical textbook that associated anthrax with a circular ‘Cardinal’s cap’ of red hemorrhagic tissue and immediately made her guess.  Then she sent Grinberg by car to take samples of the brain and spleen for bacteriological analysis at the SES hazardous infection laboratory.

“By the end of the next day, April 11 [1979], her guess was confirmed: the disease was anthrax. By then the outbreak was reaching its peak. Screening, diagnosis, and treatment had already been set up at Hospital 40, which also became a center for autopsying. Abramova, who was no directing the autopsies, began, along with Grinberg, to investigate a series of ninety-six [96] bodies of people who died in April and May [1979] after being admitted to the hospital as possible anthrax cases. Of these, [42] were diagnosed at autopsy as having died of anthrax; the rest, as having died of other causes. Abramova and Grinberg did all but one of the autopsies themselves. There was a barrage of fatal cases at the peak of the epidemic, with fewer but still often multiple autopsies per day continuing over the subsequent month.” (p 51)

The official tally of anthrax deaths numbered 64. Grinberg told Guillemin that the “remaining [22] anthrax deaths must have occurred before April 10 [when all cases were centralized at Hospital 40] and been autopsied elsewhere.” (p. 52)

During the autopsies, Grinberg and Abramova “used no special protection except gauze face masks. They did, however, take the precaution of closing off the floor drains, and they tried not to spill blood. Afterward, buckets of chloramines were used to disinfect the autopsy room surfaces. At the height of the epidemic, they had to move quickly form one corpse to another, without rest and sometimes without time to clean equipment between autopsies,” according to Guillemin. “They sent tissue samples from each autopsy for bacteriologic confirmation and have the results to show us.” (p. 52)

Of the 42 cases, 39 had gastrointestinal lesions; 36 of these had lesions in the small intestine, and 30 had small multiple gastric (stomach) lesions. Of the 42 cases, only 9 had infection in the mesenteric lymph nodes, which Grinberg concluded meant that the gastrointestinal infection was secondary to inhalation anthrax. This was an extremely important finding in determining the source of the anthrax epidemic (tainted meat or inhaled spores from the local military bioweapons plant). (p. 53)

Of the 42 cases, all 42 cases show “massive infection in the chest area, with hemorrhagic thoracic lymph nodes and with hemorrhaging in the mediastinum (the area between the lungs). In most cases the inside surfaces of the lungs appeared to be without serious lesions, but in [11] cases there was a hemorrhagic lesion inside the lung.” Of the 42 cases, 21 “had cerebral hemorrhage, including [16] with definite Cardinal’s cap,” noted Guillemin (p. 53).

“Grinberg also noted that two or three victims had cutaneous anthrax, apparently at the sites of vaccinations. He remembers in particular one victim, a man who was vaccinated once on April 21 and died May1. Dr. Nikiforov believed that the vaccine inoculations were give too late to offer protection to anyone. Abramova and Grinberg think the vaccinations (three successive shots were prescribed) may have intensified existing infections.” (p. 53)

Grinberg and Abramova saved the gross organs preserved in 10% formalin, paraffin blocks of tissues, and glass slides of histological preparations, which were invaluable in proving the inhalational source theory of the anthrax outbreak.

5. Dr. Viktor Arenskiy, head of Sverdlovsk Medical Institute, was in 1979 a mid-level public health official during the outbreak who provided a detailed account of the first days of the outbreak. On April 7 or 8, 1979, he recalls that he was summoned to a high-level meeting about the epidemic. The earliest cases came from Hospital 20 and the autopsy of third case, which revealed massive internal hemorrhaging, sounded the alarm. At the meeting run by Dr. Babich (see above), attendees were asked for suggestions as to the etiologic agent causing the epidemic. Plague, smallpox, and anthrax were suggested. Cholera was ruled out by all.

At that point, whether the disease was contagious or not was not known. So a “military approach” was instituted in which Dr. Babich articulated three goals: 1) All sick adults and older children needed to be quarantined in the infectious disease ward of Hospital 40 (younger children and infants would go to Hospital 4, to the pediatric infectious diseases unit—none ever required hospitalization); 2) Medical personnel needed to take appropriate precautions when treating infected patients; and 3) Residents in neighborhoods producing sick patients needed to be canvassed for additional sick people and warned.

Dr. Arenskiy noted that the veterinarians battling an anthrax outbreak in livestock south of Sverdlovsk could not explain the appearance of anthrax in apparently well-fed cattle outside the city. (p. 114) To control the animal epizootic, Arenskiy recalled that napalm was used to burn the carcasses. (p. 115) He further noted that the military fell unusually silent within their compounds during the outbreak. Arenskiy believed that even in 1979, there were suspicions that the military “Compound 19” sitting on a bluff in Sverdlovsk was the source of the outbreak. (p. 114) Finally, he affirmed that many of the critical strategies for containing the outbreak were initiated at the local level before the head physicians from Moscow arrived in mid-April 1979.

6. General Hospital Medical Staff Reaction to Outbreak

How was the medical staff reacting to the outbreak? According to pathologist Dr. Grinberg “[f]rom the start…the medical staff was fearful about the epidemic. Was it contagious or not? Then Dr. Vladimir Nikiforov arrived on April 12 [1979] [from Moscow] and assured everyone that contagion was not a serious problem, although for the first week the staff was on antibiotics. Nikiforov demanded complete autopsies, which, out of fear and revulsion, not everyone wanted done. Ordinarily nearly all patients who died at the main hospital were autopsied, but this time the staff refused. Nikiforov, however, had his reasons and insisted. He thought it was important to determine which patients had really died oaf anthrax…In addition, as Abramova represented him, he had spent his whole life studying anthrax and realized how scientifically valuable autopsies might be in this case.” (p. 52)

Dr. Grinberg also noted that, at the beginning of the outbreak, medical staff speculated that the epidemic was plague and some physicians refused to go to work. Grinberg deliberately quarantined himself in the hospital to protect his family, as did other clinicians. In a few days, once it became clear the disease was non-contagious anthrax, he was no longer afraid. (p. 54)

Sources:

1. See also ““America’s Forgotten Pandemic: The Influenza of 1918” Book Review at: http://www.semp.us/securitas/2005sept-oct.html; accessed January 22, 2006.
2. “Yakov Sverdlov” at: http://www.spartacus.schoolnet.co.uk/RUSsverdlov.htm; accessed January 22, 2006.
3. “Catherine of Alexandria” at: http://www.catholic-forum.com/saints/saintc01.htm; accessed January 22, 2006.
4. “The Execution of Tsar Nicholas II, 1918” at: http://www.eyewitnesstohistory.com/nicholas.htm; accessed January 22, 2006.
5. “Boris Yeltsin” at: http://www.cs.indiana.edu/~dmiguse/Russian/bybio.html; accessed January 22, 2006.
6. David Walsh: “The old Russia and the new: Yeltsin buries the tsar” in World Socialist Web Site, July 21 1998; available at: http://www.wsws.org/history/1998/jul1998/tsar-j21.shtml; accessed January 22, 2006.
7. Jeanne Guillemin: “Anthrax: The Investigation of a Deadly Outbreak.” University of California Press, 1999, p. 27. See also: Jeanne Guillemin: “The 1979 anthrax epidemic in the USSR: Applied science and political controversy” (2000) available online at: http://www.aps-pub.com/proceedings/1461/102.pdf
8. Ibid, p. 34.