More Chernobyl Deaths Called ‘Unavoidable’ : But L.A. Doctor Says U.S.-Soviet Team May Save Many of Most Ill

An American physician said Thursday that more deaths of Chernobyl radiation victims are “unavoidable” despite the continuing efforts of a Soviet-American medical team.

Dr. Robert P. Gale, a UCLA bone marrow specialist, said 28 people with radiation illness are in the worst condition, adding, “We hope that a substantial number of these patients will survive.” Seven others already have died from the effects of radiation.

In addition, two people were killed in the initial explosion and fire at the reactor site in the Ukraine on April 26. A total of 299 people were hospitalized with “substantial” radiation doses, Soviet authorities have said.

Behind-the-Scenes View

Gale, at a press conference in Moscow, and a UCLA colleague interviewed in Los Angeles after his return from the Soviet Union provided a behind-the-scenes account of the last two weeks at the nine-story, brown-brick hospital in Moscow where the most critically irradiated Chernobyl victims were rushed.

It was, they said, “like a battlefield.”

“Every day, very urgent decisions had to be made--which patients to transplant (with bone marrow) and the order in which they should be done, and which ones not to transplant,” Dr. Paul I. Terasaki, an international authority on tissue typing, said in Los Angeles, shortly after returning from Moscow.

Gale arrived alone in Moscow on May 2, at the Soviets’ invitation. Terasaki and another UCLA physician, Richard Champlin, arrived two days later. The outside medical team also included Dr. Yair Reisner, an Israeli biophysicist.

Gale said Soviet physicians already had performed some bone marrow transplants and had diagnosed scores of patients before he arrived.

Terasaki said that when he arrived, he found that the Soviet tissue-typing laboratory was swamped with work. But he said he was able to show the Soviet team faster and more effective ways to type tissue, a procedure to match bone marrow compatibility between donor and recipient.

Terasaki said the Soviet doctors showed no resentment at the presence of the Americans. In fact, he said, they were “very friendly and appreciative.”

Although the Soviet and American doctors required interpreters, he said, they had “no problems” communicating with one another, because they both use the same scientific terminology.

Finding Donors a Problem

A major problem that confronted the physicians in the first frantic days was to find suitable bone marrow donors among relatives of the patients. In one case, according to Terasaki, a woman refused to donate her marrow to her brother even though they were a good match. Terasaki said the woman was reluctant to undergo general anesthesia and said her brother was “going to die anyway.”

Another major obstacle was that some of the victims’ white blood cells, which are used for tissue typing, had been destroyed by radiation. Therefore, it was not possible to select a compatible donor, according to Terasaki. In a few rare cases, physicians have been known to use fetal liver cells as substitutes for adult bone marrow.

Six Chernobyl victims received such fetal liver cells, Terasaki confirmed.

In human fetuses, it is the liver, rather than bone, where marrow is located. Marrow in fetal liver is believed to be useful because it contains the types of cells needed by the recipient but not the type that could cause rejection. Destruction of bone marrow leads to serious internal bleeding problems and lethal infections.

Still another problem, Terasaki said, was in determining how much radiation each patient had received, and therefore which one was most likely to die first.

Unusally Capable

Yet, Terasaki said, the dozen Soviet physicians seemed unusually capable at estimating dosage simply by studying a patient’s symptoms.

“The Soviets seemed to be well organized at doing that, perhaps because they had had previous experiences,” the UCLA scientist said. Terasaki said the Soviet doctors made no mention of any prior radiation accident from which they may have gained such experience.

Together, the doctors performed 19 transplants, Gale told a news conference.

In Isolation Rooms

For these patients, the next few weeks are critical because they will be vulnerable to bleeding and infections until the new bone marrow has begun to generate enough protective cells. Terasaki said such patients are in isolation rooms to protect them from bacteria and viruses.

Sixteen of the seriously irradiated were not given transplants, either because they were not needed or because they were too badly injured to benefit from such treatment, Gale said. Many of the 16 had inhaled or swallowed radioactive particles, which required the doctors, nurses and other personnel attending the patients to wear protective clothing to shield themselves from radiation emanating from the patients.

These patients presented extra treatment problems because of the damage caused by the radioactive particles to the lining of the lungs and gastrointestinal tract, Gale said.

The slim, soft-spoken Gale said he met earlier Thursday at the Kremlin with Soviet leader Mikhail S. Gorbachev, who personally thanked him for his assistance to Chernobyl victims. American industrialist Armand Hammer, who arranged for the UCLA team to come to Moscow, was also present.

Taught New Lessons

Gale told reporters that Chernobyl had taught some new lessons in medical treatment of radiation victims and sparked more Soviet-American cooperation in this field.

The Soviet Union, he said, has agreed to become a member of an international bone marrow registry, and their physicians have agreed to join with American doctors to write a report on their Chernobyl experience.

One medical lesson, Gale said, was the importance of taking blood samples from radiation victims immediately so the samples could be frozen to preserve any white cells that have survived, allowing tissue typing to be done.

Too Soon to Tell

Gale carefully avoided controversy in his remarks to the press, saying that it is too soon to tell how many persons might suffer long-term consequences from radioactivity from the April 26 accident.

But he asserted that it is “extraordinarily unlikely” that anyone far from the power plant would suffer the same kind of acute radiation sickness as the 299 patients who have been hospitalized.

No country alone can cope with a nuclear disaster, Gale said, indicating the necessity of international cooperation by medical and scientific specialists.

At the press conference, Andrei Vorobyev, a member of the Soviet Academy of Medical Science who worked with Gale, said no one in the town of Chernobyl, about 10 miles from the reactor, was suffering from radiation sickness except workers who were in the plant at the time it exploded.

Other Town Checked

Vorobyev added that clothing and thyroid glands of a group from the town of Pripyat, closer to the nuclear plant, were checked as well. The sample showed that Pripyat residents received only half the dose of radiation that was dangerous, he said.

The 35 worst-off cases, the doctors said, included firefighters, doctors and other workers who were in the plant when the reactor blew up at 1:23 a.m. on April 26. But Vorobyev said not all the 299 patients had been working in the station itself.

Meanwhile, the plant and relief workers there, equipped with face masks to prevent inhalation of radioactive particles, were shown for the first time on Vremya, the main evening television news show. The film showed armored personnel carriers, used to transport disaster teams at minimum risk of radiation exposure, racing through the streets.

Reporters for Tass, the official news agency, also were allowed into the plant for the first time since the accident. They said there were 50 workers on shift duty to monitor three shut-down reactors. The reporters were told that radiation levels at the power station were only one-fourth of the levels measured three days ago.

William J. Eaton reported from Moscow and Harry Nelson from Los Angeles.