Novichok: what should I do if I think I've been exposed to nerve agent?

Counter-terror police say a couple left in a critical condition in Wiltshire were exposed to the same nerve agent as former Russian spy Sergei Skripal and his daughter Yulia earlier this year.

The couple, named locally as mother Dawn Sturgess and Charlie Rowley, were discovered in Amesbury, around eight miles from where the Skripals were poisoned with Novichok in March.

The incident comes four months after Mr Skripal, 67, and and his 33-year-old daughter were poisoned in a suspected Russian backed assassination attempt and will lead to fears that the public in Salisbury could still be at risk.

Mr Skripal, a former double agent, and his daughter, who had been visiting him from Moscow, spent two months in hospital. They were discharged in May and are at a secure location.

Novichok was identified as the compound used in the attack by experts at the science and Defence Science and Technology Laboratory at Porton Down. 

What is Novichok?

Novichok is not a single toxin but a family of  so called "fourth generation" nerve agents developed by the Russians in the 1970s and 1980s. In some forms, it is reported to be between five and eight times more toxic than earlier nerve agents, such as VX. 

What is Novichok

It can be stored as two less toxic chemical ingredients which, when mixed, react to produce the weaponised nerve agent. This makes it easier to transport and handle – an advantage for an assassin.

Michelle Carlin, senior lecturer in forensic and analytical chemistry at Northumbria University, said that it can be used in the form of an ultra-fine powder as well as as a liquid or vapour. 

It kills after being ingested or absorbed through the skin.

Is it the same batch that affected the Skripals?

Dr Carlin said it would be "unusual" if the couple had been affected by nerve agent from the same source as that used against the Skripals four months ago.

She said the new case was "surprising" and, while it is difficult to speculate over where the poison came from, it would be unexpected if it were from same source.

"It is difficult to speculate whether this is from the original source used in the Skripal case however, if it was from the same source, it is unusual that it has taken four months for someone to be affected by it," Dr Carlin said.

Novichok in Salisbury: How could this happen four months after Skripal attack?

What is the risk to the general public?

Professor Dame Sally Davies, chief medical officer for England, said the Skripal episode meant officials had a "well-established response" in place.

She said: "You do not need to seek advice from a health professional unless you are experiencing symptoms."

She also urged not to pick up any "unknown or already dangerous objects such as needles and syringes".

About | Novichok agent

What should I do if I visited these locations?

You should clean clothing and items you had with you while you were there.

Clothing that is dry-clean only should be put in two plastic bags (ie. a double layer), tied at the top and stored safely – PHE is reviewing the best way of cleaning these items and will publish information in due course.

Items such as phones and handbags should be cleaned with baby wipes. Jewellery, watches and glasses should be washed with warm water and detergent and then rinsed in clean cold water.

Amesbury poisoning

Should I destroy items of clothing?

Public Health England says this is not necessary but if you want to do this put them in two plastic bags, tie them at the top and dispose of  it in an outdoor bin in the normal way.

What effect does Novichok have on the body?

Novichok, like all nerve agents, disrupts the chemical signals between the nerves and the muscles which control vital organs, said Dr Carlin.

"This can lead to breathing difficulties, loss of control of bodily functions, increased salivation, convulsions, paralysis.”

Outward symptoms may include white eyes, convulsions, drooling and – in the worse cases – coma, respiratory failure and death.

Nerve agents can act within minutes but they can also take hours to take effect. Much depends on the exact toxin, the dose and the delivery method. 

What is the treatment for those exposed to Novichok?

Patients exposed to nerve agents are normally given the drug atropine, which reduces muscle spasms and the production of saliva. It needs to be given as soon after exposure as possible – ideally within minutes.

It is likely that atropine was used to treat the Skripals, said Alastair Hay, emeritus professor of environmental toxicology at the University of Leeds.

Doctors may also use a drug called pralidoxime, an antidote to organophosphate pesticides and chemicals.

Treatments for exposure to nerve agents

What are the long-term effects of exposure?

Little is known about this, although exposure is thought to lead to long-term harm. One of the Russian scientists who helped develop Novichok, Andrei Zheleznyakov, was accidentally exposed and, according to a book about the history of chemical weapons, War of Nerves by Jonathan Tucker, he suffered permanent ill health including hepatitis, epilepsy, severe depression and an inability to concentrate. He died five years after exposure.

The Moscow weapons lab that made the deadly Novichok nerve agent

Is there a wider risk from Novichok and other chemical and biological weapons in the UK?

The greatest risk comes from the fact that the taboo on the use of chemical weapons, which has held for much of the last 100 years, appears to be breaking down.

Politician's must bend every sinew to reestablish this red line, said Hamish De Bretton-Gordon, a former commanding officer of the UK Chemical, Biological, Radiological and Nuclear (CBRN) Regiment.

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