Surviving the bio-apocalypse: Sarin gas

You just binge-watched Amazon Prime’s new series, Jack Ryan (spoiler alert), or you’ve been following the Novichok debacle in the UK. Or perhaps you’ve heard that President Trump is “strengthening America’s biodefense” … and you’re terrified. In this multi-article series, you’ll get a breakdown of what you should know and do in the event of a biological or chemical terrorist attack.

Why have I heard of Sarin gas before?

Sarin has been discussed (and even used) in many TV shows and movies, most recently in Jack Ryan and Homeland. Unfortunately, it has also been in the headlines because of mass chemical attacks in Syria. It was also used to carry out attacks in Iraq (in 1988) and in Japan (in two separate episodes in the mid-90s).

What’s the likelihood of a Sarin attack?

First, a brief history. Sarin was first produced as a pesticide by German scientists right before World War II, then ordered into mass production by Hitler as a possible weapon against Allied forces. Thankfully, he never actually used it.

During the Cold War, both the U.S. and Russia (among others) produced and maintained stockpiles. In 1993, the Chemical Weapons Convention banned chemical weapons and ordered them destroyed. Although most countries have complied, this treaty has yet to be signed by Egypt, North Korea, and South Sudan.

As of 2016, ninety percent of the world’s known stockpile of chemical weapons had been “verifiably destroyed,” including in Iraq and Syria. Some of the largest stockpiles of Sarin belonged to Russia, which “verifiably destroyed” the last of its chemical weapons in 2017, and the U.S., which plans to destroy its final stockpiles by 2023. Other countries suspected to have Sarin include North Korea, which has an estimated 5,000 tons of chemical weapons, and Syria, as evidenced by their recent attacks.

In modern times, an attack would likely come from a hidden stockpile of Sarin rather than someone synthesizing it from scratch, since it’s really difficult to obtain and safely combine the chemical ingredients.

What would a Sarin attack look like?

Sarin can be liquid or gas. It has no taste, smell, or color. It is a nerve agent, meaning it continuously over-activates part of your nervous system – in this case, the part that controls “rest and digest functions.” You’ll know you’ve been exposed because you and everyone else in the area will start to experience runny nose, watery eyes, chest tightness, difficulty breathing, nausea, and drooling. Shortly after that, you’ll lose control over bodily functions, like defecation and urination. The final symptoms include twitching and muscle spasms, which ultimately causes death by suffocation. All within about ten minutes. (Of note, exposure to pesticides in general can cause similar symptoms, since they all belong to the class of chemicals known as organophosphates.)

What should I do if exposed to Sarin?

Leave the area as fast as possible! If you’re in an enclosed area and can’t leave, try to get to higher ground since Sarin is heavier than air and will concentrate in lower-lying areas.

Immediately pull off your clothes (ideally, without pulling them over your face). Then wash your skin with soap and water.

The antidotes are medications known as pralidoxime and atropine, which are available at essentially all hospitals and in many ambulances.

Madeleine Hopson, M.P.H.

Madeleine Hopson is a fourth-year medical student at Columbia University Vagelos College of Physicians & Surgeons. She graduated from Columbia University Mailman School of Public Health with an M.P.H in Environmental Health Sciences and Molecular Epidemiology.

Christopher Kelly, M.D., M.S.

Christopher Rehbeck Kelly, M.D., M.S., is a cardiologist at North Carolina Heart and Vascular and UNC Rex Hospital in Raleigh, North Carolina.

Marc Eisenberg, M.D., F.A.C.C.

Marc Sabin Eisenberg, M.D., F.A.C.C., is an associate professor of medicine at Columbia University Medical Center and an attending cardiologist at NewYork-Presbyterian Hospital.