Chernobyl

I recently watched the highly rated HBO miniseries “Chernobyl, “a dramatization of the 1986 nuclear power plant disaster. I found the show engaging. Each episode brought the audience in, and although most of us knew something about the events surrounding the catastrophe, the viewer felt absorbed and tense throughout most of it. Job well done.

I was impressed with the realistic settings. Most of the series was filmed in the Baltic state of Lithuania, a decision that made perfect sense. Filming permits are much easier to get there than Russia. Additionally, having been occupied by the USSR, Lithuania has many of the same unattractive block-like building structures the Soviets are known for. It so happens that I recently took a trip to Russia and the Baltic region (see my previous blog), including Lithuania, and saw some of those on my trip.

Lithuania is also home to the Ignalina nuclear power station, a now decommissioned RBMK reactor, Chernobyl’s “sister” power plant and a near doppelganger of the Chernobyl reactor. The Ignalina power station is so similar to Chernobyl, in fact, that the European Union required it to be closed as a condition for Lithuania to join the EU. Interestingly, today, Lithuania is one of the most avid supporters of renewable energy in the EU.

I imagine that in addition to using the Ignalina reactor as the site of much of the action in the miniseries (with the help of special effects), the gripping scenes of the Chernobyl control room were filmed in the control room of the Ignalina reactor. The result was a very realistic re-enactment of events. So realistic, I felt like I was part of the action.

That said, there were some inaccuracies (surprise, surprise). I understand why instead of showing all the scientists that helped the lead scientist, Valery Legasov, the writers invented a female physicist (Ulana Khomyuk) to act in their stead. Showing the whole team would have been a distraction. However, some of the other information was inaccurate for unclear reasons (at least, unclear to me).

A major misrepresentation involved the danger posed to the public by the unprotected firefighters and nuclear power plant workers. Although they were exposed to dangerous levels of ionizing radiation and some radioactive materials had been deposited on them, these workers didn’t actually ingest any of the nasty stuff. Once these victims were hosed off, they were not radioactive themselves, and therefore were not a danger to others (not even to the unborn fetus of the firefighter’s wife). This is in contrast to the 1987 incident in Goiania, Brazil, involving radioactive cesium taken from a radiotherapy capsule left behind by a medical facility. The cesium glowed, and people found it fascinating. Some individuals ingested it and needed to be shielded to prevent exposure of others. Their urine was treated with resins to decrease the volume of radioactive waste. Twenty people required medical treatment, and four died.

At Chernobyl, in addition to radioactive iodine (half-life 8 days), radioactive strontium (half-life 29 years), radioactive cesium (half-life 30 years), and many other radionuclides were released into the air. Iodine tablets are effective in protecting against radioactive iodine only. Iodine is normally taken up by the thyroid to make thyroid hormone. When radioactive iodine is present, it, too is concentrated in the thyroid, significantly increasing the risk of thyroid malignancies in the future, unless it is flushed out by an abundance of non-radioactive iodine. To be effective in countering exposure to radioactive iodine, iodine tablets must be given within 12 -18 hours of exposure. In the case of the Chernobyl incident, the government dispensed iodine several days after the accident to some of those who were exposed. Members of the public, not knowing about proper dosing, bought iodine pills and overdosed their children, many of whom needed medical attention for bleeding ulcers from the excess iodine.

One more thing about the veracity of the miniseries: the makeup of some of the victims was a bit over the top. One guy looked nothing short of slimy. I’m not sure what that was about.

I found it interesting that Boris Shcherbina, the vice chair of the Council of Ministers who oversaw the Chernobyl investigation and cleanup, was described as being a former shoe salesman. While I couldn’t verify that, I found it plausible from what I know of Soviet bureaucracy, in which positions were granted in accordance to people’s loyalty to the party, rather than competence. That general lack of expertise goes a long way in explaining the failure of the Soviet Union’s economy, and periods of mass starvation.

Acute radiation exposure has fairly predictable effects, depending on the dose. At the time of the Chernobyl incident, it was known that below a certain exposure, victims were likely to suffer skin and gastrointestinal damage, but recover. At a higher range of doses, they would often die of bone marrow failure. At still higher levels, exposure was one hundred percent lethal, from damage to skin, gastrointestinal system, lungs, bone marrow, and central nervous system.

Bone marrow failure stops the formation of blood elements, including red cells which carry oxygen, white cells which defend against disease, and platelets which are needed for blood to clot. Without a functioning bone marrow, death ensues as the blood cells die off without being replenished.

I remember an American doctor, Peter Gale, going to the USSR after learning about Chernobyl to help with bone marrow transplants, the only hope of survival for patients with exposure to radiation at levels sufficient to destroy bone marrow. At the time, bone marrow transplantation was a much newer technique, not nearly as successful as it is today (although it is still far from one hundred per cent successful). In all, Dr. Gale and his team performed thirteen bone marrow transplants.

In retrospect, it appears that transplantation mainly served as a bridge from the time of bone marrow failure in victims with moderate radiation exposure, to bone marrow recovery from the few progenitor cells that remained. Once the marrow recovered, the transplanted marrow was rejected. Two people who received transplants and survived never had recovery of their own bone marrow, their bone marrow likely having been completely destroyed by their exposure. Others who received bone marrow transplants had higher levels of exposure, and died of other complications.

Gale and his team learned much about the effects of radiation poisoning on bone marrow and how to treat it. What wasn’t made public until years later was the team’s use of a new medication from the Swiss pharmaceutical company Sandoz (later merged with Ciba-Geigy to form Novartis). The medication, intended to help damaged marrow recover quickly, had been tested on animals but not yet tried on people. In a Bondian move, Gale arranged for a Swiss businessman to carry the medication to Sheremetyevo airport near Moscow in his checked luggage. Someone in baggage handling removed it before the businessman claimed his luggage, and the pharmaceutical was delivered to Gale. This scheme gave the businessman complete deniability if apprehended.

Gale and a soviet physician injected themselves with the drug, using ten times the dose recommended for humans. While Gale was essentially unfazed by the medication, his soviet counterpart soon developed severe chest pain and was hospitalized for a presumed heart attack that night. It was later determined that his heart was fine, but the marrow in his breastbone had expanded so much in response to the medication, he suffered excruciating pain in the chest area. The medication was subsequently given to Chernobyl victims, and likely contributed to the recovery of some with moderate radiation exposure by “kick-starting” the small amount of marrow progenitors that remained. Versions of this medication are routinely used today when bone marrow needs to be stimulated, such as after chemotherapy and after some bone marrow transplantations. In this country, the most commonly used is probably Neupogen made by Amgen. One known side effect is bone pain.

The long-term consequences of Chernobyl will never be known. Probably due to a combination of poor record-keeping and secrecy, the number of deaths from the effects of exposure is not available.

Despite changes in leadership, the Russians don’t seem to have changed much. The August 2019 Nyonoksa accident involving a nuclear-powered cruise missile released radioactive substances into the air. This was admitted only because Norway detected increased radioactive iodine. Although that was not conclusive on its own, as increased radioactive iodine is generally detected several times a year, the Russians stopped their own nuclear monitoring, reporting communication and network issues. Later it was ascertained that radioactive strontium, barium and lanthanum were also released.

Following this mishap, doctors treating the patients at one hospital were not informed of the radiation risks, medical staff treating the victims were told to sign nondisclosure agreements, and it was reported that the hospital records of the patients involved were deleted. One of the treating physicians was said to be contaminated by radioactive cesium. Seven people are reported to have died from the explosion.

As the explosion took place shortly before my Baltic trip, which included a stop in St. Petersburg, I considered bringing iodine pills with me “just in case.” However, as it appeared there was no increase in radiation detected that far from the explosion, and whatever would have travelled there would have cleared by the time of my visit, I ultimately decided against it.

About ten years ago, in the course of my work as a pathologist, I received a bone marrow sample from a young woman. I diagnosed her with an uncommon type of leukemia, one with a poor prognosis. I later learned that as a child, she had been in Chernobyl (or Pripyat) during the nuclear accident. She was treated, and her leukemic cells decreased, but she was far from cured. Despite that, she wanted to go back to Russia to visit family. She did that, but upon return, her leukemic cells were out of control, filling her marrow. Despite treatment, she died shortly thereafter. Was she a Chernobyl fatality? We’ll never know for sure, but I’d say there’s a good chance.