Alan Sipress - The Fatal Strain

Team members in Vietnam were stunned by Lee’s response. They were sure their hard work had uncovered a fateful twist in the evolution of a killer virus, and this was their reward? They concluded that Lee had buckled under pressure from some of WHO’s member countries, notably the Thais. With the virus also circulating in Thailand, that country’s government was sensitive about any suggestion that the strain could become epidemic, fearful of the toll this could take on the economy. Thai Prime Minister Thaksin publicly attacked WHO’s statement about human transmission, calling it bad science. “Normally, the ethics of researchers is such that if there is only a slight possibility of something happening, then they will discuss it among themselves. They will not say anything to the public to raise concern,” Thaksin told reporters, assuring them that “the possibility of human-to-human transmission is 0.00001 percent.”

In subsequent statements WHO adopted a far more reassuring tone, minimizing the significance of what the team in Vietnam had discovered. Three leading researchers based in Vietnam, including the director of its National Institute of Hygiene and Epidemiology, later cited the episode, recounting that “temperatures were running high, and any mention of person-to-person transmission of H5N1 was thought by some to be reckless.” They added, “An air of tension… surrounds this disease, particularly in the corridors of power within the international health and political communities.”

WHO would later clarify that “limited” human transmission was not a threat. The concern was “sustained” and “efficient” transmission. But the novel strain had now crossed another barrier. In 1997, it had demonstrated it could jump from animals to people. Back then, investigators in Hong Kong had also suspected that the virus could hop from person to person but never had conclusive proof. Now, nearly seven years later, it had shown convincingly that it could.

As reports of outbreaks among both people and birds continued to pile up, Vietnam resolved to take a terrible gamble. It would seek to exterminate the sickened flocks, the course recommended by international health specialists. But this would mean dispatching thousands of potentially susceptible peasants against an inscrutable enemy. They would fight the virus literally with their bare hands.

Inside the dimly lit coop of one farm outside Hanoi, workers chased the frenzied chickens, trying to pummel them with wooden rods. A bird bolted out the door into the sunlight and a woman lunged, snagging the errant fowl with her unprotected hands. She pounded it senseless, then stuffed its lifeless body into a sack with other casualties. Dozens of survivors scattered, dodging blows. Feathers flew. Droppings kicked up underfoot.

It was early February 2004, and I had arrived in Vietnam days earlier, anxious to see how authorities were tackling the budding epidemic. Poultry outbreaks had been reported across Ha Tay province, home to much of northern Vietnam’s chicken industry. As I approached the village of Phu Cat just south of the capital, an agriculture official in a blue uniform motioned for me to stop my car. He circled the vehicle, spraying the tires with disinfectant to ensure I was not tracking death into his community. Then, for my protection, another official handed me a 3M mask, surgical cap, rubber boots, and a white Kimberly-Clark jumpsuit and instructed me to put them on. He then joined me in the car and guided us into the village.

We pulled up at a two-story shed. Thousands of chickens on this farm had been marked for death because they might carry the virus. A pair of veterinary officials huddled in the driveway. They were clad in broad masks, caps, and thick goggles, as well as protective suits, gloves, and boots. The local government had dipped into its budget to finance protective outfits for officials but could not afford to buy them for the cullers—the very people on the front line. Upstairs on the second floor was the large, low-ceiling coop where farmworkers were running down their prey, stuffing the battered chicken bodies into sacks, and then heaving them out a window into the bed of a truck below. Most of those called to battle wore only cheap rain slickers and flimsy masks.

One young culler emerged from the shed, dirt and bloodstains speckling his sandaled feet. “I didn’t wear boots or gloves. I didn’t buy any,” he told me. Other farmworkers reported the same. “It’s very dangerous for the people, but we can’t buy everything we need to wear,” added a neighbor. “I’m afraid I’ll get infected from the chickens, but I have to do it because I can’t ask anyone else to do it for me.”

WHO officials were becoming alarmed. The workers in this nationwide slaughter were risking their lives. Even more ominously, they were giving the disease a prime opportunity to remake itself inside their bodies, potentially hatching a new strain easily passed among people.

Then, as springtime approached, the virus seemed to vanish abruptly from all of Asia. The outbreaks ceased like a fever breaking overnight. Most of the flu hunters headed home, still puzzled, but few believed they were gone for good.

“We need to think of it like a war,” urged Dutch scientist Dr. Albert Osterhaus in a conference call with WHO.

“We may have no choice than to live with the virus,” added Dr. Les Sims, who had been Hong Kong’s chief vet at the time of the 1997 outbreak. “I don’t believe we are going to get rid of this virus from the region even in the long term.”

Though flu specialists had anticipated the return of the novel strain, they were startled by its sudden reappearance in late June 2004. The virus had always surfaced in the cooler weather, and here they were still in the summer. Despite the unprecedented culling of more than 100 million birds in East Asia, the scourge reappeared on farms across Vietnam, eventually returning to Thailand, China, Cambodia, and Indonesia and spreading, for the first time, to Malaysia. New human cases popped up in Vietnam and Thailand. Researchers were reporting that the virus was widespread in ducks, moving into wild birds, and growing ever more lethal in lab animals. Another study concluded that the strain had gained a permanent foothold in Asian poultry.

In August 2004, Vietnam’s Tuoi Tre newspaper reported that a brother and sister in the southern province of Hau Giang had died under suspicious circumstances. The man, a nineteen-year old high-school student, had just taken his university entrance exam when he fell sick on July 23. Four days later he was admitted to the hospital with a fever, headache, and bloody cough and died after three more days. The local doctors diagnosed the case, apparently incorrectly, as septicemia or blood poisoning and never notified higher government authorities.

A day after he died, his twenty-five-year-old sister, a local teacher, began to complain of headaches, muscle pain, and difficulty breathing. She was dead within a week. A journalist for Tuoi Tre got wind of the cases and publicized them.

The hospital had already discarded samples from the brother, but lab technicians tested those from his sister and discovered she had bird flu. Health officials also reported that a third family member, a cousin, had also died recently but had never been tested.

Alerted, investigators came to the densely populated town deep in the luscious Mekong Delta, but they struggled to find the source of infection. Though the family raised ducks, chickens, and geese, the birds were all healthy. Investigators reported that “no link could be established with deceased or dying poultry.” But they did learn that the sister had initially cared for her ailing brother, possibly accounting for her infection. This revelation, coupled with the sequence of the cases, persuaded some at WHO that for at least the second time, the virus had hopped from one person to another.