Skripal Attack Scared U.K. Doctors: ‘We Were Expecting Them Not to Survive’

LONDON — Medical workers in Britain who treated former Russian spy Sergei V. Skripal and his daughter, Yulia, initially feared that they would be inundated with civilian casualties from a lethal, Soviet-developed nerve agent and that their colleagues had been exposed, they have told the BBC.

The accounts suggest that the British authorities were deeply apprehensive about the possibility of a larger health crisis in the hours after the Skripals were found unconscious on March 4, in what was initially believed to be an opioid overdose.

That evening, after hearing that Skripal had been a Russian spy, medical workers set aside that theory and began to catalog symptoms of poisoning by an organophosphate, or nerve agent.

“There was a real concern as to how big this could get,” Lorna Wilkinson, the nursing director at Salisbury District Hospital, said in an interview with the BBC Two program “Newsnight” that will be broadcast Tuesday. “Have we just gone from having two index patients having something that could become all-consuming and involve many casualties? Because we really didn’t know at that point.”

Dr. Stephen Jukes, a physician in the intensive care unit there, said that hospital workers had believed the Skripals would die.

“We were expecting them not to survive,” he said. “We would try all our therapies. We would ensure the best clinical care. But all the evidence was there that they would not survive.”

He told the BBC that the speed of the Skripals’ recovery was a surprise, and that he still found it difficult to explain. Both patients have been released from the hospital.

The interviews help flesh out the background of the Skripal case, which provoked a major diplomatic crisis between Britain and Russia. Within days, the British authorities accused Russia of using a military-grade nerve agent to poison the Skripals, but investigators have been tight-lipped for weeks about their progress, and no suspects have been named.

In the resulting vacuum, the Russian authorities have challenged Britain’s account with a raft of theories, among them that British intelligence poisoned the Skripals and that they were not poisoned at all. President Vladimir Putin of Russia has scoffed publicly at the British accusations, saying that if the Skripals had been exposed to a Russian nerve agent they would have died immediately. A video statement by Yulia Skripal, released last week, seemed intended to defuse that challenge.

In their BBC interviews, the medical workers said that they had taken immediate measures to protect the Skripals from brain damage, sedating them heavily to slow their metabolism. Over time, the sedation was decreased, and respiratory tubes were switched from the mouth to the trachea.

Once the patients regained consciousness, hospital workers tried to avoid telling them too much about what had happened, for fear of compromising the investigation, said the hospital’s medical director, Dr. Christine Blanshard. They also had to decide when the Skripals were healthy enough to be questioned by detectives.

“These are very difficult decisions,” Blanshard said. “On one hand, you want to provide reassurance to the patients that they are safe and they are being looked after, and on the other hand, you don’t want to give them information that might cause difficulties with subsequent police interviews.”

Doctors would have been able to apply lifesaving therapies as soon as it was clear that the Skripals had been exposed to a nerve agent, since the treatment is the same as for sarin or VX, according to a commentary published this month in the scientific journal Clinical Toxicology. The paper, titled “Novichok: A Murderous Nerve Agent Attack in the U.K.,” was written by J. Allister Vale, a professor of toxicology at the University of Birmingham, with Timothy C. Marrs and Robert L. Manyard. Nerve agents, which inhibit the enzyme acetylcholinesterase, can cause fatal respiratory paralysis within minutes if the exposure is severe, the paper said. It added, however, that “mild or moderately exposed individuals usually recover completely.” Symptoms can include abdominal pain, nausea, vomiting, diarrhea, tremors and convulsions.

The most important therapies are atropine, oximes and anticonvulsants. Atropine prevents the nose and lungs from producing too much fluid. Oximes reactivate acetylcholinesterase. Benzodiazepines are anticonvulsants and can reduce anxiety.

The paper says Detective Sgt. Nick Bailey, who was exposed to the nerve agent while “helping the Skripals,” was initially discharged from the hospital emergency room, but was readmitted after his condition deteriorated. He remained under treatment for 2 1/2 weeks.