Alan Sipress - The Fatal Strain

Finally, Ambassador Markus Cornaro, head of the European Commission’s delegation in Hanoi, warned that foreign donors to Vietnam were counting on the government’s full cooperation. How the government responded to the “offer of international support” would indicate the degree of trust and cooperation between Hanoi and the donors, Cornaro told him.

The words were diplomatic, the threat unmistakable.

Dung listened intently to his visitors. Then he listened to presentations from his own health officials outlining the lab findings in greater detail.

When everyone else had finished, Dung vowed that Vietnam was concerned for the welfare of the whole world, not just itself, and wished to be proactive, neither complacent nor hasty. And so, Dung said, he would propose inviting an international team of experts to work with Vietnamese scientists in checking the recent lab findings and exploring the wider threat. The team could come immediately, but on the condition that the lab findings remained secret until the review was done.

It seemed WHO had gotten its way. But when Troedsson reported back by telephone an hour later, Stohr and his colleagues in Geneva doubted Vietnam’s intentions. Hanoi hadn’t said anything about actually turning over the original lab samples for independent testing, and nothing less would do.

“It’s a trap,” warned one senior official in Geneva.

Troedsson didn’t want to dally. The deputy prime minister had offered full cooperation and Troedsson took him at his word. What Troedsson didn’t say was that some of his staff in Hanoi believed time was already up and the pandemic was under way.

“It’s urgent here,” he pressed. “We want to have a team here next week. Klaus, don’t let us down on this one.”

When the conference call was over, Stohr and his colleagues in Geneva were agitated. “We didn’t get the message across to Vietnam,” Stohr grumbled.

But could they afford to continue bickering with the Vietnamese?

“We have to get a team in there as fast as possible,” urged Tom Grein, the veteran investigator who helped coordinate the global response to Vietnam’s early outbreaks a year before. “Six hours on the ground, ask for the samples.” If Vietnam balks, Grein added, “WHO has to have the guts to pull the team out.”

That week, Yan Li, the Canadian scientist at the center of the storm, sent an e-mail to many of those who had participated in the secret conference call the previous Friday. He said he agreed with their criticisms of his Western blot study and wanted to explain why he had proceeded with this technique.

Li said it would have been difficult to analyze the serum samples using a more reliable test because the Vietnamese didn’t have the proper lab safeguards. “Therefore, it would be better for us to first use the Western blot method for initial testing and provide on-site training to Vietnamese scientists to use this technique in their regular laboratory,” he said. “But the prerequisite was that all, or at least those serum samples initially screened positive by Western blot, be sent back to us so we can further test them.” Li’s own lab in Winnipeg could perform the verifying tests.

After the initial tests came back positive, Li wrote that he had repeatedly told officials from NIHE and WHO that “these were very preliminary results” that could reflect contaminated samples and would have to be retested using a more established method. “It was clear to us,” he said, “that the Western blot method was only for initial screening and training but not for the final decision-making test.”

Dr. Frank Plummer, scientific director general of the National Microbiology Laboratory in Canada where Li worked, later provided me with a similar account of the Canadian collaboration with the Vietnamese, adding that the results of the Western blot tests were supposed to have remained private. “This interim information was neither meant for distribution nor for decision making,” Plummer said. He called it unfortunate that the information was shared with officials, prompting public health concerns.

To some at WHO, Li’s defense rang hollow. They’d heard something similar from the Canadians before, two years earlier, to be precise. That’s when a baffling respiratory outbreak had raced through a nursing home in the suburbs southeast of Vancouver, Canada, and Li’s lab had weighed in with an alarming and ultimately misleading diagnosis.

In the first week of July 2003, scores of elderly residents at the 144-bed Kinsmen Place Lodge in Surrey, British Columbia, started coming down with the sniffles. So did dozens more of the staff. By August about a hundred residents and at least forty-five staff members had developed what looked like a summer cold. Seven residents had died during that period, not an unusually high number for the home. But pneumonia was implicated in three of the deaths, and that was worrisome. Initial tests at several Canadian labs failed to identify the cause of the outbreak. Then, Plummer announced to the media that his scientists had discovered it was SARS.

The revelation rattled Canada. The country was still on edge after the global SARS epidemic earlier in the year. Toronto, Canada’s premier city, had experienced the largest outbreak outside Asia and 250 people had fallen sick. Forty-four had died. Li and his colleagues at the National Microbiology Lab had been deeply involved in researching that epidemic.

The new cases at Kinsmen Place Lodge certainly didn’t look like the same SARS. Most were mild and nearly everyone recovered. But Li’s lab was now reporting that its genetic analysis had revealed an almost perfect match with SARS. Separate tests conducted by the lab on samples from the nursing home had also found antibodies to the SARS Coronavirus . The virus could be returning in a new, unpredictable form. WHO urgently dispatched a SARS expert from Geneva to investigate.

In suburban Surrey, the six-story brick nursing home was placed under quarantine. Ill patients were put into isolation. A sign on the front door greeted visitors: STOP. RESPIRATORY OUTBREAK. STRONGLY RECOMMENDED YOU DO NOT ENTER THE BUILDING. For days, residents could only wave through the windows to relatives on the sidewalk below. At Surrey Memorial Hospital, nineteen health-care workers who had contact with a patient from the nursing home were restricted to home quarantine. Then another nursing home in western Canada reported a similar outbreak.

As time passed, however, tests at other labs, including CDC Atlanta, failed to turn up SARS in the samples. Instead they isolated another Coronavirus called OC43, known to cause common colds. Both WHO and Canadian officials ruled out a new SARS outbreak, and the quarantines were lifted. The misdiagnosis by the National Microbiology Lab was ultimately blamed on a combination of contaminated lab samples and overly sensitive tests that generated false positives. The lab’s reputation took a drubbing.

Li later told the Wall Street Journal that his lab’s results had only been preliminary and were faxed out to the public without his permission.

So as a crack team of investigators secretly set out for Hanoi in June 2005, they suspected that Li’s Western blot results on the samples from northern Vietnam were flawed also. That thought offered a measure of comfort. But there were still those disturbing results from the separate PCR tests conducted by the Vietnamese, and the Vietnamese had a good track record.

Maria Cheng was in China when she took the call asking her to head for Hanoi. Her colleagues in Geneva told her that something was going on in Vietnam but they weren’t sure what. They were more nervous than she’d ever seen them. “They were really scared about what was going on. They thought the pandemic was starting,” she recalled.