The Fatal Strain (26 page)

For many Eskimo villages of Alaska, the plague was even less forgiving. As winter was closing in, the final ship of the season, a vessel from Seattle called the
Victoria
, moored in the port of Nome on Alaska’s Seward Peninsula and deposited its lethal cargo. From there, sped by the wanderings of white missionaries, influenza advanced along the frozen tundra, penetrating the coast to the north. It killed every last Eskimo in the village of York, about 150 miles from Nome by dogsled. The inhabitants of nearby Wales, the westernmost point on the North American continent, joined in a funeral for a boy from York. Soon more than half those from Wales were also dead. At another outpost, Teller Lutheran Mission, disease erupted after a pair of visitors from Nome had joined a local church service. The first native fell sick two days later. Soon corpses stacked up inside the igloos. All but eight of the village’s eighty residents perished and were buried beneath the permafrost. One was a woman who ultimately helped crack the genetic code of the Spanish flu after researchers excavated her grave seventy-nine years later and retrieved a sample of infected lung tissue from her well-preserved body.

The global reach of pandemic flu is thus nothing new. But globalization is. And over the last generation, it has fundamentally recast the threat of infectious disease. As with SARS, the next flu pandemic will spread at the speed of jet aircraft, coursing along an ever-thickening web of international travel, each new thread reducing the time the virus must wait before breaching another frontier.

“As the first severe contagious disease of the twenty-first century, SARS exemplifies the ever-present threat of new emerging infectious diseases and the real potential for rapid dissemination made possible by the current volume and speed of air travel,” said Mark A. Gendreau, a senior attending physician at the Tufts School of Medicine, in testimony before the U.S. Congress. Margaret Chan was even blunter: “SARS was a wake-up call for all of us. It spread faster than we had predicted.” Within six months, it reached more than thirty countries on six continents.

More people are traveling more places than ever before. Though Hong Kong remains an exceptional crossroads, Yi Guan rightly suggests that the world increasingly resembles the ninth floor of the Metropole.

“Today you are in England, tomorrow in New York, and the third day you might be in Hong Kong,” Guan noted. Imagine how many people an infected traveler encounters along the way. “The case lands in London or New York or Hong Kong. Maybe ten thousand people have connecting flights in that airport within two hours. It spreads to the whole world. Globalization accelerates the transmission speed, maybe by a hundred times.”

A century ago, he continued, a novel flu strain could take more than a year to circle the world. “Now, currently, does it take one year? I don’t think so. Maybe one month,” he said.

Over history, each advance in transport and trade has sped disease on its way. The Black Death of the Middle Ages spread faster by merchant ship on the Mediterranean than by horseback on the Asian steppe. The last of three cholera epidemics in nineteenth-century America was the swiftest, exploiting the country’s new railroads. Even since 1968, the date of the last flu pandemic, change has been dramatic. Air traffic has increased about tenfold since then. Using data
on the volume of travelers at fifty-two major cities around the world, a team of American researchers projected how long it would take a flu pandemic to spread and compared it to the Hong Kong flu of 1968. They found that the same virus, if it had erupted in 2000, would have struck cities in the Northern Hemisphere nearly four months earlier. And while the Hong Kong flu required almost a year to sweep the globe, in 2000 the virus would have peaked in every one of the cities in half that time. A separate team of researchers in Britain, using a different statistical approach and more recent data, from 2002, concluded that in some cities in the Southern Hemisphere, the epidemic actually would have peaked a full year faster than it had in 1968.

An accelerating epidemic leaves public health officials little chance to top off their stockpile of antiviral drugs or distribute them. There’s less lead time to prepare measures meant to slow the inexorable advance of epidemic—for instance, isolation policies and school closings—or to make sure that strategic infrastructure and crisis manpower plans are in place. Most crucially, scientists expect it will take at least six months to develop a pandemic vaccine and far longer to make sure everyone gets it.

“All of technology cannot keep up,” Guan warned. “To manufacture a vaccine takes months. The transmission of disease is by the hour now.”

 

 

 

No matter how many ways Guan and his colleague Malik Peiris tried to find a flu virus in the specimens smuggled back from Guangzhou, they couldn’t. For that matter, they couldn’t isolate a virus of any sort at all. In the lab, they tried to grow the puzzling pathogen using chicken embryos, dog cells, monkey cells, and even human larynx and lung cells. Nothing. But each disappointment refined the search. Each time they failed to corner their quarry in the Guangzhou samples—for weeks, the only ones outside the hands of the Chinese government—the Hong Kong University team weeded out false pretenders, bringing the researchers that much closer to the golden moment of discovery.

When it came, it was Peiris who made it. His lab isolated a pathogen called
Coronavirus
in a new specimen taken at a Hong Kong
hospital from the dying brother-in-law of Liu Jianlun. Precisely one month after Dr. Liu had checked into the Metropole, Peiris sent an e-mail to a global network of laboratory scientists announcing that he had found the cause of the disease now named SARS.

The discovery was an unprecedented coup for WHO. Peiris was part of a virtual laboratory network that Klaus Stohr had assembled in mid-March 2003 for the SARS hunt. He had recruited eleven premier labs from nine countries for a rare collaborative effort, appealing to many of virology’s brightest and most competitive researchers to set aside their egos and their lust for scholarly publication. Instead they compared notes, speaking daily by teleconference to review their progress. Crucial findings were shared through a secure Web site. WHO also established parallel networks, so epidemiologists could analyze how SARS was spreading and clinicians could consult about how to treat it.

The overriding fear was that this killer could become endemic, like HIV-AIDS, before the world had time to diagnose the threat, contain its spread, and eradicate it. WHO rallied scores of disease specialists from inside the agency and out, dispatching them to East Asia. Keiji Fukuda, for one, spent eight weeks in mainland China and Hong Kong. It was what Fukuda saw in the wards of Prince of Wales Hospital that prompted WHO to sound its first global alert about this severe, unidentified pneumonia in mid-March 2003 and urge that patients be isolated. A second, stronger alert followed three days later after Mike Ryan, WHO’s global alert coordinator, was awakened with news that an infected physician had boarded an airplane in New York bound for Singapore. The man was bundled off the airplane during a stop in Frankfurt by German emergency medical staff in orange hazmat suits. Within hours, WHO had begun taking measures to curtail the international spread of SARS.

This was the agency at its best. “The quality, speed and effectiveness of the public health response to SARS brilliantly outshone past responses to international outbreaks of infectious disease, validating a decade’s worth of progress in global public health networking,” according to an assessment by the U.S. Institute of Medicine. “The
World Health Organization (WHO) deserves credit for initiating and coordinating much of this response.”

Yet even after the
Coronavirus
had been isolated and containment efforts put in place, the source of the disease remained a mystery. WHO investigators suspected a link to wild animals. Some of the earliest cases in Guangdong had been in restaurant employees who prepared exotic fare, often from small imported mammals, to sate southern China’s appetite for what locals called “wild flavor.” To choke off the epidemic, researchers would have to determine which creature was the culprit. Someone would have to literally stick a needle into the heart of an animal and a swab up its anus. Once again, the mission would fall to Guan.

In early May 2003, he crossed to the Chinese city of Shenzhen, just beyond the narrow river that serves as Hong Kong’s border with the mainland. Once a fishing village, Shenzhen had been designated a special economic zone in 1979 to attract foreign investment. The gold rush had transformed it into an audacious boomtown with a population rivaling New York’s and skyscrapers to rival Hong Kong’s. It had become China’s wealthiest and fastest-growing city and the quintessence of excess. In the city’s storied restaurants, the new rich spent hundreds, even thousands of dollars to dine on nearly any form of life they hankered after. At Dongmen Market, the hungry and the adventurous perused wire cages stacked high with writhing snakes, barking raccoon dogs, growling ferret badgers, turtles, hares, palm civets, hog badgers, house cats, scaled pangolins, rabbits, beavers, and the miniature Asian deer called muntjac.

By the time Guan set foot on the slick, bloody floors of the covered market, he had lost count of how many thousands of birds he’d sampled over the years, looking for flu. But he’d never collected specimens from the kind of grim menagerie that now confronted him. Many of these animals were carnivores with claws and fangs. The merchants, engaged in a shadowy yet highly lucrative trade, could be equally vicious. Guan had won prior permission from Shenzhen health officials for this expedition. At least that would keep the police off his back.

Dongmen Market was huge. It sprawled across an entire city block,
consuming the ground floor of a mammoth clothing-and-textile center. Stalls disappeared into the twilight of scattered fluorescent bulbs dangling from the metal ceiling. The odor was oppressive. “Where do I start?” Guan asked himself. He had applied his full deductive powers to the question even before he arrived. Whatever creature was the source of the virus, it had to be a mammal, he reasoned. That would explain why the microbe was so quick to become transmissible among humans, which of course are also mammals. So no turtles, snakes, or, for once, birds. The creature would also have to be fairly common. If it was too rare, the virus might have burned itself out before it had a chance to cross to people. Guan narrowed the list to eight species. He was especially interested in Himalayan palm civets, also known as masked civets because of the black and white stripes that run from forehead to nose and white circles around their eyes. About two feet long and ten pounds in weight, these catlike creatures have long been a popular Chinese delicacy.

He approached the traders. He explained that he and his team were looking to take a few samples from the animals: a throat swab, a rectal swab, and some blood. To get the blood, he would have to jab a needle into the heart of each beast. It would be too hard to find a vein through all the fur.

The dealers wanted no part of it. They were afraid Guan might kill or otherwise harm their lucrative creatures, perhaps somehow rob them of that raw bestial energy that made them so coveted by customers. But if Guan was willing to buy the animals, well, then they could do a deal.

Guan pulled a thick wad of Chinese banknotes from his pocket. He had thousands of dollars worth. Yes, he’d pay, he told them. But not full price. Here’s how it was going to be: He would give them one hundred yuan to sample an animal, about twelve dollars each. If the animal died within a day, the trader could notify Shenzhen’s disease-control officers and be compensated in full. The traders agreed and crowded around, eager for easy money.

There wasn’t enough space at each stall to take specimens, and it was too dark to see. In any case, Guan didn’t want to scare off anyone’s business. So once he made his selection, he had the merchants
lug the cages to the muddy alley outside. There, amid all the hustle, among the army of porters hauling crates of poultry and produce, exotic roots, mushrooms, and broad bushy vegetables, in between the handcarts, trolleys, and bicycles stacked with boxes, Guan spread a plastic tarp, put down his gear, and prepared to operate. He slipped on a white lab coat and mask. He donned thick protective gloves. The curious quickly crowded around. Guan and his colleagues asked the security guards to push them back. “There’s virus,” he warned.

Before they could begin, Guan’s team had to anesthetize each animal, pump it full of ketamine. That meant coaxing an often hostile creature out of its cage and plunging a needle into its flesh. “It’s very, very dangerous,” Guan advised. “They can bite you. The civet, his head can spin around 360 degrees and you never expect it. To catch it by its back, it’s too hard to do that.” Some beasts cowered, some lunged. So to restrain them, the researchers used a special tool fashioned from a long tube with a Y-shaped attachment that fit around the animal’s neck. With its head thus pinned down, Guan and his colleagues wrestled the critter to the ground and injected the anesthesia.

The subject soon went limp. Guan stuck a needle into its heart, filling a vial with blood. “My medical training helped me a lot,” he recalled. Next he inserted a swab into the animal’s throat and finally into its anus. Over the course of two days, he jabbed and swabbed twenty-five animals, including a half-dozen civets and assorted beavers, hog and ferret badgers, muntjacs, raccoon dogs, and domestic cats.

Back at the university lab, he quickly found the evidence he was looking for. He isolated the SARS
Coronavirus
in samples from the civets and one raccoon dog. These animals plus a ferret badger had antibodies that indicated they had been infected. There was no way to know whether these species were the ultimate origin of the pathogen or had caught it somewhere else. But it was now clear how the virus was spreading to people. The wild-game markets had to be shuttered.