Alan Sipress - The Fatal Strain

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.