Alan Sipress - The Fatal Strain

He ascended the escalator. At the top were the immigration counters. Guan liked to tell himself it was all one country, Hong Kong and the mainland. That was, after all, the official Chinese government line. And by that logic, he wasn’t smuggling the samples abroad. But in many practical ways, China still treated its border with Hong Kong as an international frontier. Guan showed his passport to the blue-uniformed immigration officer, who waved him through. When he reached customs and saw the X-ray machine, he momentarily considered looking for another way around. Then he thought better. “If you try to avoid that,” he told himself, “there will be more trouble.” He placed his satchel on the belt. Seconds passed before it reappeared on the far side. The white-uniformed customs officer didn’t say a word. Guan retrieved his bag and continued toward the waiting room.

There were families with large suitcases, and businessmen returning home after a day trip to their factories and suppliers. They were already queuing up when the train was announced. Guan joined the line. An immigration officer was conducting a final passport inspection. “The quieter you are, the safer you are,” Guan reminded himself. Usually he was a dervish of activity, a fast-walking, fast-talking impresario of scientific notions who pressed his theories, passions, and grievances on listeners in a shotgun spray of sentences, a chronically restless soul who found it nearly impossible to remain seated or stand still unless, of course, he was smoking a cigarette out an open window. Yet in his plain gray suit, inexpensive haircut, and large, silver-framed aviator glasses, he could melt into the undifferentiated mass of commuters if he could just feign the right air of indifference.

“The more you keep quiet,” he repeated to himself, “the safer you are.” The immigration officer asked for Guan’s passport. He flicked his cigarette to the floor and produced the document from his jacket with an affected look of weary annoyance. The officer returned the passport and moved on.

Finally the line moved. The passengers filed downstairs to the red tile railway platform and onto the train. Guan claimed his seat. He placed the satchel carefully on the overhead rack. Then he took out his cell phone and called his lab. “Are you ready?” he asked. “The samples are on their way.”

But as they were analyzed over the coming days, the samples stumped Guan and his fellow researchers. The virus wasn’t H5N1. It wasn’t flu at all. It would later be identified as SARS, and that was fortunate. Because in the age of globalization, flu would have been much worse.

Half a year after the SARS epidemic had subsided and life had returned to Hong Kong’s deserted streets, the city’s legislative council would conduct an inquiry in January 2004 into the government’s handling of the crisis. The outbreak had killed 299 people in Hong Kong alone. Nearly six times that number had been infected. Amid stinging criticism, Hong Kong’s secretary of health, welfare, and food and the chairman of the hospital authority would lose their jobs.

Margaret Chan, the city’s health director who had so ably steered Hong Kong through the bird flu outbreaks of 1997, had also skippered its emergency response to SARS. As she testified before the legislative council, she broke into tears. “We tried to do our best,” she assured the members before being overcome by emotion, forcing them to briefly suspend the hearing. During her testimony, Chan told the council she had tried several times in early 2003 to confirm the press reports of an epidemic brewing in neighboring Guangdong province. On February 11, 2003, the very day that Guan was making his clandestine run to the Guangzhou institute, Chan and one of her departmental consultants had repeatedly phoned health officials in Guangdong about the rumors. No one answered their calls. “Usually, with other infectious diseases, there was no problem with communication,” she testified. She added that a Guangdong official later told her “there was a legal requirement for infectious diseases at that time, that infectious diseases were classified as state secrets. That is why they cannot share the information.”

The council went on to censure Chan, who by that time had resigned from the health department for a post at WHO in Geneva. She was faulted in part for leaving Hong Kong vulnerable “in that she did not attach sufficient importance to ‘soft intelligence’ on the [acute pneumonia] epidemic in Guangdong.” The report suggested she could have dispatched a team to the mainland to investigate.

Ultimately, it was a doctor named Liu Jianlun who had brought the disease to Hong Kong’s attention. Liu was a retired kidney specialist from southern China. At age sixty-four, he still worked part-time in an outpatient clinic at a hospital in Guangzhou. It was this hospital that first treated one of the earliest victims, a forty-four-year-old seafood seller from the suburbs who came in January 30, 2003, with a severe cough and fever. This patient stayed only two days before being transferred to another hospital. But in that remarkably brief time, he infected at least ninety-six other people, including ninety health-care workers.

Liu himself started feeling sick two weeks later. He worried that he had contracted whatever horrible illness was besieging his hospital. But his chest X-rays looked clear. So he dosed himself with antibiotics and set out with his wife on a three-hour bus ride for a nephew’s wedding in Hong Kong. When they arrived, he felt well enough to go shopping and enjoy a long lunch with relatives. Late that afternoon, on February 21, Liu and his wife checked in to their room on the ninth floor of the Metropole, a three-star hotel in Kowloon with a large swimming pool on the roof and a karaoke bar in the basement. Their room was what marketers call cozy, with two single beds and a pale olive carpet. From the window of room 911, they could see a Shell service station, an Esso service station, a YMCA guesthouse, and beyond, one of the most congested quarters in all Hong Kong.

Long before the term globalization was coined, Hong Kong was the definition. As a colonial entrepôt, it evolved into a bridge between Occident and Orient, a global financial center, and one of the world’s busiest ports. The ninth floor of the Metropole was true to form. Staying on the floor that same evening were also three women from Singapore, including a former flight attendant on a shopping excursion, four Canadians, among them an elderly woman from Toronto visiting her son, a British couple on the way to their native Philippines, a young German tourist headed for a two-week vacation in Australia, and three Americans, including, right across from 911, a Chinese-American garment merchandiser bound for Hanoi to meet his denim suppliers. Sometime in the course of that evening or early the next morning, before Liu checked out of the hotel with a searing headache and dragged himself five blocks to a hospital, he managed to infect all thirteen of those neighbors. Three others at the Metropole also caught the virus. Based on intensive sampling, health investigators later theorized that Liu, upon returning to the ninth floor from dinner, had thrown up on the teal-colored carpet outside the polished, wood-trimmed doors of the elevator. Someone, perhaps his wife, cleaned up the mess. An invisible mist of infectious particles wafted along the corridor.

Liu would become Hong Kong’s first case. Before he died, he told the doctors and nurses caring for him about the disease raging in his own hospital.

The Singaporean hotel guests returned home, where they were all hospitalized, and one, the woman on the shopping spree, in turn sparked an outbreak that sickened at least 195 people in her own country. The doctor who treated the initial Singaporean case later flew to New York for a medical conference and on the way infected a Singapore Airlines flight attendant.