Alan Sipress - The Fatal Strain

The boy’s mother was stumped. So was his grandmother. The thirteen-year-old had been among the very first in southern Vietnam to succumb to this new disease. Yet there had been nothing noteworthy about his habits. The women told Uyeki they didn’t keep any poultry in their home. In fact there weren’t even farms in this suburban enclave of Ho Chi Minh City, the former southern capital still known by most of its denizens as Saigon.

Uyeki had followed the outbreak south, remaining just a week in Hanoi before decamping to Ho Chi Minh. He had tracked the virus to the boy’s home, determined to find the source of infection. “They had no idea what this kid did,” Uyeki said later. “Because, like a normal kid, aside from school, they’re playing. It’s not unusual for a parent or grandmother to have no idea what this kid does after school.” Uyeki could find no evidence of exposure to birds, much less sick ones. Nor was anyone else in the family ill. Could the virus now be lurking somewhere else? Perhaps in a new, undiscovered lair?

Sometimes, on disease investigations, fortune breaks your way. As Uyeki and his colleagues filed out of the family’s home, they were an odd sight, a band of strangers in masks. Quickly, curious neighbors started congregating. They showered the investigators with questions. Then Uyeki started doing the asking.

“Oh, yeah,” one neighbor piped up. “That kid, every day after school, he participates in cockfighting.”

Uyeki’s ears perked up. “Where?” he asked.

The neighbor led them down a narrow, paved street. After a couple of hundred yards, they came upon three or four woven baskets on the roadside, each containing a rooster. A little farther they found several more roosters and then a few more beyond that. This was the staging ground for the fights.

“We found out that this kid, along with other boys, every day after school he’d actually hold the cocks,” Uyeki later reported. “So that’s pretty good contact. If you’re holding the rooster, the rear end or the feathers are pretty close to your face. That is what we believed was his risk.” With this discovery, Uyeki had become the first to identify the threat posed by cockfighting, a popular pastime that over the coming years would be repeatedly implicated in bird flu deaths across Southeast Asia.

Other times fortune breaks against you. Days later, Uyeki and his Vietnamese colleagues pulled into a rural village in Tay Ninh province, about fifty miles northwest of Ho Chi Minh City, to investigate the case of a seventeen-year-old girl who had died of bird flu in a local hospital. They parked their van down the dirt road from her home. Chickens foraged in the dust. Pigs grazed on the roadside. Then, dressed in full protective gear, including baby blue disposable aprons and pants, masks, goggles, shower caps, gloves, and rubber shoe coverings, the team got out of the van and slowly approached the house.

But as they did, they discovered they weren’t the only strangers in town. A Vietnamese television crew had also turned up to interview the family. A crowd was forming.

The girl’s mother and grandmother were sitting in the doorway of their home, little more than a shack of bamboo and metal. They spotted the TV crew. They spotted the group of what could only have looked like space aliens. And the grandmother began to shriek. She was afraid. She was resentful of the intrusion at a time when the family was grieving.

But Uyeki wondered whether there was something more. He asked his translator what the old lady was saying. She was shouting over and over that her granddaughter had died of natural causes, insisting there was nothing untoward about the death. Uyeki suddenly realized the histrionics were meant for her neighbors. “She was trying to reassure them and also trying to deflect any potential stigma,” he concluded. The family was terrified of being ostracized if fellow villagers believed they were infectious or, even worse, cursed. The investigators retreated, deciding the family should be left alone.

As long as the cases were coming one at a time, WHO felt confident that a pandemic virus had not yet broken loose. Each isolated human case was a dead end for the pathogen. Then investigators began to hear about the wedding party.

In late December 2003, a family in the northern province of Thai Binh, a verdant, rice-growing region in the Red River delta, had gathered to prepare for a marriage. On January 3 the couple wed. Four days later, the thirty-one-year-old groom started having trouble breathing. He died in the intensive care unit barely a week after his nuptials. Next his twenty-eight-year-old bride and two younger sisters came down with a cough and fever. Though the wife soon recovered, the sisters were taken to Hanoi, where they were admitted to the tropical disease institute, a six-story cream-colored building on the bustling urban campus of Bach Mai Hospital. Both ultimately tested positive for bird flu.

Bach Mai was already associated with tragedy. In the waning days of 1972, U.S. B-52s had leveled the hospital during a withering aerial campaign against North Vietnam that came to be known as the Christmas bombing. At least thirty people inside Bach Mai were killed in an attack emblematic of the war’s excesses. After the conflict subsided, the hospital was slowly rebuilt, an inch at a time because of unexploded ordnance. Now, a generation later, Bach Mai again commanded the world’s uneasy attention.

Peter Horby went to visit the sisters the day after they were admitted. “They were well,” he recalled. They were walking around and taking the antiviral drug Tamiflu. But soon they started to deteriorate and within nine days were dead.

Horby set out for Thai Binh to learn more about the cluster of cases. “This was the first time we could investigate something like this,” he said. “Everyone was wondering whether it was human-to-human.” He interviewed the mother of the three victims. It was a tough conversation. She was distraught. He questioned neighbors. He tried to reconstruct the chain of events and scrutinized the timing of the cases to see whether everyone could have conceivably contracted the disease from the same, single source.

He learned that one sister had handled a duck while cooking. But she had not personally butchered the bird, considered a practice with a high risk of infection, and in any case the duck had seemed healthy. The bride and the other sister had no such exposure at all. There were no birds around their house or, for that matter, in their immediate neighborhood. They lived in town, not on a farm. But the sisters had cared for their ailing brother who, though never tested, almost certainly died from the disease. Horby deduced that the sisters had likely caught the virus directly from him.

Horby drove back to Hanoi and presented his report. The findings were explosive, especially because WHO had been reassuring the world’s media there was no reason to panic as long as there was no human-to-human transmission.

“We really have to be sure,” Brudon told the team members. “We must be really, absolutely sure.”

For several long evenings, they cloistered in the Hanoi command center scrubbing the evidence. The conclusion was clear. “The team was quite convinced after the careful epidemiological investigations done by some members of the team,” Brudon later wrote, “that we were in front of cases of H to H transmission.” She agreed to release the findings.

Almost instantly, Horby said, “the shit hit the fan.” The agency’s upper echelons had not seen the disclosure coming. The next day WHO’s director general, Dr. Lee Jong Wook, called Brudon. He was furious. He castigated her for endorsing what he thought an ill-considered statement. He said she had rattled the world for no reason.