Sarin Gas Attacks in Syria: What if it happened in the US?

By Surili Sutaria Patel, Senior Specialist, Environmental Health, APHL 

“It is the worst use of chemical weapons on civilians in the 21^st century,” said United Nation’s Secretary-General Ban Ki-Moon.

On the cool night of August 21st, residents of Ghouta, a suburb of the Syrian city of Damascus, were abruptly awakened by an explosion. In a region ravaged by civil war, explosions were unfortunately common; this particular explosion, however, was different.

An artillery rocket containing sarin gas had been released in the night, as the temperature dropped right before dawn. The cold, now-toxic air in Ghouta did not rise. Instead, the heavy gas circulated close to the ground and pervaded the lower levels of buildings where families rested for the night.

Almost immediately, many felt an onslaught of troubling symptoms: shortness of breath, disorientation, irritated eyes, blurred vision, nausea and vomiting. Many dropped into unconsciousness and over 1,400 people died, including 400 children, who would have been getting ready to go to school a few hours later.

Sarin is a volatile, man-made nerve agent used as a chemical weapon. First developed in Germany as a pesticide in 1938, sarin is a very toxic and fast acting gas. It is difficult to detect as it is a clear, colorless, tasteless and odorless vapor. Sarin enters the body through the eyes, skin, lungs or eating contaminated food. Instantly after exposure to the gaseous form and a few minutes after exposure to the liquid form the toxic effects of this chemical will present in humans. Sarin is a deadly chemical yet it is short-lived in the environment, presenting a very serious public health threat.

Given the symptoms (and the assumption that chemical weapons had been used), the UN stepped in to officially determine the cause of illness & death. They assembled an investigative team of scientists from Finland, Germany, Sweden and Switzerland to examine both environmental and clinical samples (blood, hair and urine).

A total of 30 environmental samples were collected from two impact sites and analyzed by two laboratories. Concurrently, a clinical investigation advanced: in addition to conducting medical examinations, 34 victims were selected to provide blood and urine samples for further investigation. Nearly 85% of the blood samples tested positive for sarin. The investigative team reported back with great confidence that the chemical weapon used was in fact, sarin.

The world mourned for these innocent people, so devastated by such an atrocious crime. The large-scale use of such weapons against civilians led to increased international attention on chemical weapons of mass destruction: their possession, storage, destruction, and use. Not only did the global community call for Syria to disclose and destroy their chemical weapons, but many countries examined their own system for responding to such an attack.

While it is painful to think of, what if this reprehensible act of terrorism had taken place on US soil? Americans are protected by the CDC-funded Laboratory Response Network (LRN) which maintains an integrated network of laboratories that can respond quickly to acts of biological or chemical terrorism, as well as all the other wonderful first responders that skillfully approach such a scene.   The Laboratory Response Network for Chemical Threats (LRN-C), comprises 54 public health laboratories at the local, state, and territorial levels, and has protocols similar to the UN investigative team: from the systematic method used to select individuals for clinical testing to the chain of custody protocols practiced when collecting and shipping the samples to the appropriate laboratories. LRN-C operates as a network of laboratories designated Level 1, 2 or 3 laboratory capabilities.

• Level 3 laboratories work with hospitals and first responders for clinical specimen collection, storage and shipment.
• Level 2 laboratories employ chemists trained to detect various toxic chemical agents, including nerve agents such as sarin.
• Level 1 laboratories use high-throughput analysis to serve as surge-capacity laboratories for CDC, in case CDC is overwhelmed by the number of samples. These labs also have the capability to test even more chemicals than the Level 2 laboratories.

The LRN, with funding and assistance from CDC, serves as a global, national, state and local asset. Its staff remains crucial to any chemical response in the United States and even abroad.

While we hope for that day where the potential for such atrocities no longer exists, we recognize the need to remain vigilant and prepared. Most importantly, our hearts and thoughts remain with the people of Ghouta, and Syria at large.