The Fatal Strain (40 page)

The mood in Hanoi was eerie. The team members were on edge. There was a sense, Cheng recalled, that something really bad could be happening.

They dropped their belongings at the Melia Hotel in downtown Hanoi and headed around the corner to the WHO office for a briefing with Hans Troedsson and Peter Horby. “They were convinced this was the beginning of a pandemic outbreak,” Cheng said. “Peter told me it was definitely happening. We just didn’t know how bad it was.” There was no doubt that the alert level would be raised. The only question, Horby told Cheng, was whether it would be hiked to level four, which signifies increased human transmission of the virus, or five, which means widespread transmission.

Horby said he had a high degree of confidence in the Vietnamese lab technicians. They were careful, and their results had always turned out to be right. That’s why he was so worried.

Wilina Lim and her assistant were the last to arrive. Oshitani had turned to Lim for help in retesting Vietnam’s worrisome samples. As the head of Hong Kong’s public health laboratories, she had been intimately familiar with H5N1 longer than nearly anyone else in her field, having identified some of the earliest cases in 1997. She had been reluctant at first to join the mission, asking instead that Vietnam ship the samples to Hong Kong, where she could do the analysis in her own lab. But the Vietnamese refused.

Lim had never been to NIHE. She had no idea what equipment they had or whether they knew how to use it properly. Even the slightest miscue could contaminate the samples, making gibberish of the results. Lim wasn’t taking any chances. She and her assistant started preparing everything they’d need to run the tests, and that meant everything. In one large cardboard box, they packed their own pipettes and pipette tips, their own primers, and even containers of water for testing. They packed their PCR machine, called a thermocycler, into another box. They also crammed a suitcase full with gloves, sanitary wipes, paper towels, and other assorted supplies. If the samples could not come out to Hong Kong, then Lim would recreate a miniature version of her own Hong Kong lab right inside NIHE.

While Lim was packing, the other team members were already in Hanoi at work, scrutinizing the lab techniques the Vietnamese had used, evaluating the test results in light of information from the field. The days started early, not long after dawn, and went until evening. The team members compared notes over late dinners, night after night, and then went to bed so they could begin anew. Everyone was stressed.

Lim caught an early morning flight to Hanoi on Thursday, June 23, and by midmorning was on the ground. She and Cox consulted on how best to run the new test and check the Vietnamese findings. Lim was anxious to set up her equipment and get started. But there was no room at NIHE. The institute was busy with its routine work. She had to wait. Finally, at 7:00 P.M., the lab staff cleared out, and Lim and her assistant began testing the first of thirty samples. They continued until midnight, then returned early the next morning, using their PCR machine to amplify genetic material in the samples. By that afternoon, they were seeing a clear pattern emerge.

Several colleagues were waiting anxiously in the WHO office when Lim returned with her findings.

Lim reported that her tests were coming back negative, every last one. There was no trace of genetic material from the virus. The patients sampled in Thai Binh had not been infected after all.

The earlier results had been flawed. The positives had all been false positives. The Vietnamese, it turns out, had been using a set of primers they’d been given by the Canadians, and these were detecting rogue bits of genetic material. The new tests using Lim’s primers had all come back clean.

In the office, the relief was tremendous, the swing of mood extreme.

Nicoll had been studying the field results when the pair reported back that there was no evidence the virus was becoming more infectious. He immediately put aside his papers. “What problem?” he suddenly thought. “It all goes away. It’s like water disappearing into sand. You think you have a cluster and you don’t.”

Horby, hugely comforted, packed up his belongings and left. Twenty minutes later he was bound for a previously scheduled vacation in Britain.

“We dodged a bullet there,” Cox said.

And with that, she and Nicoll decided to go shopping. Nicoll loaded up on souvenirs in the markets of Hanoi’s old city near St. Joseph’s, the city’s neo-Gothic cathedral. Cox bought an
ao dai
, the traditional, form-fitting Vietnamese gown with a high collar and slits up both sides. A day later, the pair headed north to the haunting waters of Halong Bay, one of Vietnam’s most popular tourist destinations, for a cruise amid its sculpted limestone islets.

When officials from Geneva called Hanoi for an update, they were informed that Cox and Nicoll were on a boat and unavailable.

 

 

The scare would remain secret. The world would never be told how close WHO had come to putting it on a war footing. Just about the only hint provided by the agency came one day after the team departed Vietnam. Citing WHO, the French press agency reported that
an international team of virologists and epidemiologists had left the country after assessing that the threat posed by the bird flu virus was less than they’d suspected. Few other details were offered. “The most important thing,” Troedsson was quoted as saying, “is that we could rule out that there was an immediate, imminent pandemic.” It was meant to be reassuring. But his comments acknowledged more about the agency’s fears than officials ever had before.

CHAPTER TEN

Let’s Go Save the World

H
er maroon minivan had just edged into Friday morning traffic and already Gina Samaan was troubled. The case just didn’t make sense.

Seated in the backseat, Samaan flipped through the file yet again. This much was for sure. A twenty-nine-year-old Indonesian woman from the east side of Jakarta had died two days earlier. She had suffered from acute pneumonia. She had been ill for at least a week. The victim’s doctors suspected it was bird flu, and indeed her samples tested positive for the virus at a government laboratory.

The specimens also came back positive from another, secretive lab run by the U.S. Navy in downtown Jakarta. This was one of three overseas labs established by the navy to specialize in infectious diseases confronting U.S. forces on foreign terrain. Recently it had been forced to lower its public profile in Indonesia because of rising anti-Americanism fueled by the wars in Afghanistan and Iraq. Still, the lab continued to operate, perhaps ironically, right across from the city’s main prison, where Indonesia had jailed some of its most notorious terrorism suspects. The navy facility was more sophisticated than anything the Indonesians could muster, quietly supporting the government’s efforts to contain the spreading bird flu outbreak. If the lab confirmed the victim had died from the virus, it was sure to be so. But that scientific fact by itself revealed precious little about the case at hand.

Samaan’s van inched through the traffic. Outside, another equatorial morning had settled on the Indonesian capital, air so thick and languorous that breathing was a chore, the sky depressingly gray from the smog hugging Java’s swampy coast. Commuter buses muscled through some of the third world’s worst gridlock while motorbikes swarmed like mosquitoes. Though the van’s front and rear windows were emblazoned with the shield of the United Nations, few took notice of the vehicle or the young WHO investigator inside. Even fewer made way.

At twenty-nine, Samaan was the same age as the victim. Dark eyes earnest and intent behind rimless glasses, brown hair tied back with a pink hair band in a practical ponytail, Samaan pursed her lips as she continued to review the case. The local media were reporting that chickens in the victim’s neighborhood had recently fallen sick and died. But Samaan had access to test results on samples collected by the city’s veterinary department. These seemed to show that the local poultry were healthy. “That makes me a bit worried,” she admitted to me in a broad Australian accent. “Is there anything different here?” she wondered. “If so, what’s different?” If the source of infection wasn’t chickens, could it be another person? If so, it might mean the virus had mutated into a form more easily passed among humans.

That prospect seemed to grow over the following days as this influenza gumshoe followed a trail of clues leading unexpectedly into a neighboring province and then back again. In its own way, the stakes of her investigation were every bit as high as that of the special WHO mission dispatched to Hanoi seven months earlier to verify whether the virus was perilously mutating. Northern Vietnam had been a source of intense anxiety because of flawed test results that appeared to show that the novel strain had broken the pandemic code. But in the months before Samaan set out on this morning in January 2006, more people had died of the disease in Indonesia than anywhere else. And if a global epidemic were to erupt, there was no place more likely for it to start.

Samaan and the Indonesian health ministry had both agreed to let me accompany her on her investigation as long I respected the victim’s medical privacy by keeping her identity confidential. This afforded me
an intimate view, not only of the hunt but of the challenges and frustrations epidemiologists face as they try to run this killer to ground.

Samaan wasn’t taking any chances. She had stashed a bag with masks and plastic shoe coverings in the back of the van. In her bulky brown satchel of a handbag, buried beneath a cell phone, digital camera, and BlackBerry, she kept a small bottle of pink antiseptic hand lotion and a cheap thermometer. She had been taking her temperature twice a day since she had arrived in Jakarta eight months earlier, dispatched by WHO from the Australian health ministry. “It’s important to know your baseline,” she explained, adding that hers was a cool 97.5 degrees. She had also carefully considered her footwear, donning simple shoes with covered tops so her feet would be protected against any contamination on the ground. They had flat bottoms so they were less likely to get cruddy with dirt, chicken droppings, and other possible sources of infection. And because she was constantly removing her shoes according to Indonesian etiquette before entering someone’s home, she settled on a pair that was easy to slip on and off, so she didn’t have to bend down near the ground. After each outing, she washed them in the sink and, as a result, was going through a pair every few months.

Yet for all her preparations, Samaan wasn’t expecting what awaited her when we finally pulled up in the victim’s neighborhood. It was as if the whole community had turned out and was now sitting in rows of folding chairs on the block captain’s grassy front yard, anxiously anticipating an explanation for their tragedy. Samaan waded through the crowd along with her translator, a stocky Indonesian with thick sideburns, wispy beard, and crisp American accent acquired during a childhood in Pittsburgh, and a middle-aged woman in batik named Ibu Eni from the health ministry’s national lab. When they announced that blood samples were to be taken, dozens crowded around, offering their arms.

This was not the way things were done back home in Australia, where Samaan had recently graduated from an elite program in epidemiology at the Australian National University in Canberra. She would have preferred to proceed calmly, methodically. She would have wanted to interview the victim’s relatives and neighbors in their own
homes, carefully taking stock and observing them, noting their answers, calibrating their responses, piecing together the timeline, then drawing samples only from those who had immediate contact with the dead woman. Instead this was verging on chaos.

Ibu Eni took a seat behind a wooden school desk set out in the yard. She snapped on a pair of rubber gloves and began accepting one thrusting arm after another. After the first man had given blood, Samaan buttonholed the graying old-timer and tried to clarify the conflicting reports about sick poultry.

“Have there been any bird deaths in the
kampung
, or neighborhood?” she asked.

“Nothing,” he demurred. “Everything’s been ordinary.”

A second man in a black Mercedes cap interjected, correcting him, “Yes, there
were
two chicken deaths, about thirty meters away from the victim’s home.”

“How many were dead?” Samaan asked, confirming the number.

“There were two,” the second man repeated.

Then a third man, with a bushy mustache, stepped forward, weighing in, “Yes, there were two dead chickens a month ago.”

Samaan listened intently, producing a large, spiral notebook from her handbag and jotting down the details. “What were the symptoms?”

“It was all of a sudden. We didn’t see any symptoms,” answered the mustachioed neighbor.

“What made you think the birds were sick?” she pressed.

“My wife found them,” he answered. “My mother-in-law poured kerosene on them and burned them. I just cleaned up the remains.”