KUWAIT CITY, KUWAIT - DECEMBER 13: Czech soldiers in chemical protection suits take part in a chemical attack response drill conducted at the U.S. Embassy by civil defense authorities and troops from the United States, Germany, and Czech Republic December 13, 2002 in Kuwait City, Kuwait. The exercise, dubbed 'Event Horizon,' was staged to test the coordinated emergency response to a mock attack on the U.S. Embassy in Kuwait by terrorists using deadly sarin nerve gas.
What are nerve agents like Novichok and how do they kill?
01:34 - Source: CNN

Story highlights

Novichok is a "weaponized organophosphate," a category of pesticides

Symptoms include blurred vision, sweating, nausea, respiratory arrest, loss of memory and consciousness

CNN  — 

What should a medical professional do when faced with a patient poisoned by a nerve agent?

That question became relevant to doctors in Amesbury, England, on Saturday when a couple came into contact with a Soviet-era nerve agent. And it was relevant earlier this year when the same agent – Novichok – nearly killed a former Russian double agent and his daughter.

The latest victims, Charlie Rowley, 45, and Dawn Sturgess, 44, occupy critical care hospital beds at Salisbury District Hospital, where Sergei Skripal and his daughter Yulia were treated in March, according to a statement issued Thursday by UK Home Secretary Sajid Javid.

“Our strong working assumption is that the couple came into contact with the nerve agent in a different location to the sites which have been part of the original clean-up operation,” Javid said. He also said all areas decontaminated after the Skripal poisoning are safe and pose “no significant risk” to the public.

Dr. Peter R. Chai of the Division of Medical Toxicology in the Department of Emergency Medicine at Brigham and Women’s Hospital in Boston, described Novichok as a “weaponized organophosphate,” a category of pesticides commonly used in agriculture.

The weaponized nerve agents commonly called Novichok, VX and sarin “mostly possess the same chemical structure backbone of other organophosphate pesticides,” Chai said. “But they’ve been modified to make them potent.”

In a word, deadly.

The cure itself is also far from pleasant.

Yulia Skripal, who spent 20 days in a coma after being poisoned by Novichok, described the treatment as “invasive, painful and depressing. Our recovery has been slow and extremely painful.”

Chai’s research paper on these chemical compounds – “novichok” means “newcomer” in Russian – and potential therapies was published last week.

‘A sense of fear’

Andrei Zheleznyakov, a Russian military researcher, is the first person known to be exposed to one of the Novichok nerve agents. In 1987, while working on a secret Soviet chemical weapons initiative, he was exposed to the chemical compound when his fume hood malfunctioned.

“Circles appeared before my eyes: red and orange. A ringing in my ears. I caught my breath. And a sense of fear: like something was about to happen. I sat down on a chair and told the guys, ‘It’s got me,’ ” Zheleznyakov said, as quoted by Chai.

Zheleznyakov survived the exposure but developed difficulties concentrating and became withdrawn, according to his colleague Vil Mirzayanov, who described the incident and the Soviet chemical weapons program in his memoir, “State Secrets: An Insider’s Chronicle of the Russian Chemical Weapons Program.”

Though more is known today about these nerve agents, most doctors have little direct experience with them. Generally, nerve agents are colorless and odorless, though they may smell fruity, chocolatey or even like moth balls if impure.

When treating a patient who has been exposed to Novichok, there are three major steps, Chai said.

“Number one, you’ve got to recognize this has happened to somebody. You cannot treat it if you don’t think about it,” he said. Recognition is the “cornerstone,” he said, because “the most common symptoms people first develop are blurred vision, sweatiness and nausea. And, if you think about it, those are actually pretty nonspecific.”