Alan Sipress - The Fatal Strain

“We thought there was no way Mr. Tuan could make it,” confided Dr. Nguyen Hong Ha, head of the ICU, as he stood just outside the doorway. “No patient who we’ve put on a mechanical ventilator has ever survived.”

Yet when I visited Tuan, the twenty-one-year-old had already cheated death. He no longer needed the machine to help him breathe. He could even stomach a little rice on his own.

The small, white-tiled hospital room was silent except for Tuan’s occasional dry cough and the muted sound of distant car horns wafting through the second-floor window. To his right was another cot. Not long ago, his teenage sister lay there beside him, burning with a fever of 105, gasping for air just like her brother. Now the cot was empty. Somehow, she too had eluded death. She had already returned to school in the village, where her classmates, much to her consternation, had nicknamed her Miss H5.

Some doctors on the wards claimed these two cases as a triumph for Vietnamese medicine. But flu specialists nervously monitoring the virus in the spring of 2005 knew better. This unexpected turn of events was no reason to celebrate. The survival of Tuan and that of his sister, ironically, were part of a deeply disturbing trend.

These two siblings, the young seaweed harvester and the mischievous schoolgirl, were at the epicenter of a renewed outbreak in northern Vietnam that signaled to some of the world’s leading virologists and field investigators that the virus had mutated. It wasn’t just the increasing number of cases. It was the pattern. They were coming in larger family clusters, and the overall mortality rate had dropped substantially in a matter of months, suggesting the virus was edging toward pandemic. It may seem counterintuitive, but an astronomically high kill rate can be bad strategy for a prospective epidemic. After all, a virus that swiftly dispatches most everyone it infects gives itself little chance to spread. The 1918 flu virus, by contrast, settled on a far more modest fatality rate, claiming fewer than 5 percent of those infected. Yet it was ultimately able to kill at least 50 million people and perhaps many more.

Over the following months of that spring, new laboratory findings would emerge from northern Vietnam that apparently explained the shifting pattern, confirming that the field observations were no coincidence. Hard science seemed to show that the virus had crossed another threshold. A year earlier, in 2004, this novel strain had demonstrated conclusively that it could pass from one person to another, though widespread transmission had still been elusive. Now, in 2005, that fateful barrier appeared to be falling. Some in the know even concluded that the pandemic had already broken loose. But disease specialists at WHO never publicly disclosed their fears. Instead, they sweated in private, secretly weighing whether to sound a global pandemic alert.

If they did so, the economic fallout could be tremendous. Though the blow would fall hardest on Vietnam, decimating tourism and trade, the whole region could suffer. Multinational companies might suspend their operations. Foreign governments might evacuate their nationals. Airlines might cancel routes, leaving countries isolated and visitors marooned. Stock markets would plunge. These reverberations would be felt worldwide. Yet the danger of waiting to sound the alarm might be catastrophic.

The quandary was compounded by gaps in the evidence. The scientific data were incomplete and contradictory in places. So the flu hunters were forced to make pivotal decisions with only a partial view of the truth. In battling this virus, science has time and again failed to provide the solid answers needed to decipher the pathogen and keep it in the box. Since the last flu pandemic in 1968, the revolutionary field of microbiology has indeed succeeded in breaking the genetic code of the microbes that menace us. But laboratory science has still failed to unlock the secrets of how this mercurial agent evolves and mutates, how it strikes its human prey and when.

This presents a different kind of challenge than those that stem from the Asian landscape. The limits of current science in understanding and disarming the disease are largely independent of the realities on the ground, whether there or elsewhere along the expanding frontier of viral spread.

Nor are scientific constraints the only ones. Both sides of the man-versus-microbes equation pose difficulties. On one side, global efforts to contain flu are hamstrung because WHO and other human health agencies focus on the people afflicted by the disease, at times to the exclusion of the animals that are the source. In addition, money is tight. The resources that frontline states need to identify, contain, and ultimately eradicate the disease among both people and livestock are running short. On the other side of the equation, the essence of the virus itself often eludes disease investigators, whether in the lab or the field.

So on a Friday afternoon in June 2005, WHO’s flu team secretly convened in the agency’s underground command center in Geneva, linked by a dedicated communications network with some of the world’s most elite medical specialists from Atlanta and London to Tokyo, Manila, and Canberra, and prepared to gamble.

Something odd was happening outside of Hanoi. Within a few weeks of one another, three separate clusters of bird flu cases had appeared in a single province southeast of the capital. One of the largest included Tuan and his sister, their grandfather, and a local nurse.

Thai Binh province, where Tuan grew up, is mostly a flat plain of lakes and emerald paddies, part of Vietnam’s rice basket. After Tuan had finished his schooling, he left Thai Binh to look for work in the seaport of Haiphong. Many in the West know Haiphong because of President Richard Nixon’s decision to mine its harbor during the Vietnam War. But today this port city at the mouth of the Red River Delta flourishes as northern Vietnam’s premier industrial center, and there Tuan found a job collecting seaweed for producing agar, a gelatin used in local cuisine.

In early February 2005, all Vietnam took a breather for the Tet holiday. Across the country, Vietnamese bought new clothes, cleaned, repaired, and even repainted their homes, and decorated them with small kumquat trees, pink peach blossoms, and yellow apricot blooms. They stocked up on banh chung, or pork cakes, and on candied fruit and other traditional delicacies. Then they invited the spirits of their ancestors to join them in marking the lunar New Year. Sons and daughters who had moved to the cities crammed trains and buses, streaming home to celebrate this extended festival with their relatives. Tuan joined this mass migration. He headed back to the remote village in Thai Binh he had left more than a year earlier and ambled down the dirt alley to his family home, a one-room brick dwelling with a cement floor built beside a creek. Just outside the front gate, ducks paddled in the murky water as they had since his childhood. On the opposing bank, a verdant field of tobacco stretched into the distance. For the reunion, his family bought a chicken in the local market and butchered it in the yard. Tuan’s fourteen-year-old sister, Nguyen Thi Ngoan, clasped the bird’s wings and legs. Tuan slit its throat. The chicken was likely infected. Soon the siblings were, too.

Tuan broke into a fever about four days later, his wizened father told me over a cup of tea. When I arrived, Nguyen Sy Nham, the family patriarch, was visibly exhausted. For weeks he had been commuting by bus to the Hanoi hospital seventy-five miles away, keeping vigil for hours at a time on a plastic stool at the foot of his son’s cot. Yet Nham offered me a carved wooden chair at his table, turned down the volume on the television, and, between puffs on his traditional dieu bat bowl pipe, softly shared his family’s ordeal.