Alan Sipress - The Fatal Strain

Cheng was a bright, young Canadian journalist who had written from Asia for several publications before WHO hired her in the middle of the SARS epidemic to help handle the flood of press calls. She impressed her seniors in Geneva and, after that crisis faded, stayed on, expanding her communications portfolio to include bird flu, polio, and other diseases, splitting her time between headquarters and the field. She was an old hand at flu by the middle of 2005. Yet she didn’t realize how serious the situation might be in Vietnam until Dr. Julie Hall, an influenza expert in WHO’s Beijing office, sat her down.

“If there is a pandemic and you get infected, you’re stuck there,” Hall told her. “Are you really going to do this?”

Cheng said yes.

The Beijing staff showed her how to properly wear a mask fitted to the contours of her face and sent her off.

“It was freaky,” she recounted.

The Vietnamese government had decided, after all, to cooperate with the special mission and provide the required lab samples. By coincidence, Prime Minister Phan Van Khai was due that same week to make the first trip ever to the United States by a top Vietnamese Communist leader, and this was no time to pick a fight. In an interview with the Washington Post on the eve of his trip, Khai signaled his government’s good intentions. “Due to the limited capacity and conditions in scientific research facilities, therefore, we are working closely with the international community,” he said. “A sample has been provided for international experts and foreign countries to carry out joint research.”

In Geneva, Margaret Chan was planning for the worst. Just days earlier, she had been brought in as WHO’s new director of communicable diseases and special representative for pandemic flu. She instructed Stohr to draw up a new list of experts who could advise the director general, Dr. Lee, about whether to sound a pandemic alert once the special team reported back. She recognized this would be as much a political determination as a scientific one.

“They should be from different backgrounds,” she told Stohr. “We need policymakers or advisors to ministries of health, not pure scientists.”

Chan was also concerned that news of the mission would leak. She called Hitoshi Oshitani in the regional office, and they agreed that the agency would say as little as necessary.

In Vietnam, Maria Cheng would have the unenviable task of trying to keep the press in the dark without actually lying to them. It would be hard to miss the foreign scientists that began descending on Hanoi on Monday, June 20. The elite team included Masato Tashiro, the chief virologist from Japan’s NIID; Angus Nicoll, an epidemiologist who was then head of communicable diseases for the British Health Protection Agency; and Oshitani. Also joining the mission was Nancy Cox, the CDC Atlanta’s influenza chief, who would finally get to make sure that the questionable lab findings were properly verified.

The mood in Hanoi was eerie. The team members were on edge. There was a sense, Cheng recalled, that something really bad could be happening.

They dropped their belongings at the Melia Hotel in downtown Hanoi and headed around the corner to the WHO office for a briefing with Hans Troedsson and Peter Horby. “They were convinced this was the beginning of a pandemic outbreak,” Cheng said. “Peter told me it was definitely happening. We just didn’t know how bad it was.” There was no doubt that the alert level would be raised. The only question, Horby told Cheng, was whether it would be hiked to level four, which signifies increased human transmission of the virus, or five, which means widespread transmission.

Horby said he had a high degree of confidence in the Vietnamese lab technicians. They were careful, and their results had always turned out to be right. That’s why he was so worried.

Wilina Lim and her assistant were the last to arrive. Oshitani had turned to Lim for help in retesting Vietnam’s worrisome samples. As the head of Hong Kong’s public health laboratories, she had been intimately familiar with H5N1 longer than nearly anyone else in her field, having identified some of the earliest cases in 1997. She had been reluctant at first to join the mission, asking instead that Vietnam ship the samples to Hong Kong, where she could do the analysis in her own lab. But the Vietnamese refused.

Lim had never been to NIHE. She had no idea what equipment they had or whether they knew how to use it properly. Even the slightest miscue could contaminate the samples, making gibberish of the results. Lim wasn’t taking any chances. She and her assistant started preparing everything they’d need to run the tests, and that meant everything. In one large cardboard box, they packed their own pipettes and pipette tips, their own primers, and even containers of water for testing. They packed their PCR machine, called a thermocycler, into another box. They also crammed a suitcase full with gloves, sanitary wipes, paper towels, and other assorted supplies. If the samples could not come out to Hong Kong, then Lim would recreate a miniature version of her own Hong Kong lab right inside NIHE.

While Lim was packing, the other team members were already in Hanoi at work, scrutinizing the lab techniques the Vietnamese had used, evaluating the test results in light of information from the field. The days started early, not long after dawn, and went until evening. The team members compared notes over late dinners, night after night, and then went to bed so they could begin anew. Everyone was stressed.

Lim caught an early morning flight to Hanoi on Thursday, June 23, and by midmorning was on the ground. She and Cox consulted on how best to run the new test and check the Vietnamese findings. Lim was anxious to set up her equipment and get started. But there was no room at NIHE. The institute was busy with its routine work. She had to wait. Finally, at 7:00 P.M., the lab staff cleared out, and Lim and her assistant began testing the first of thirty samples. They continued until midnight, then returned early the next morning, using their PCR machine to amplify genetic material in the samples. By that afternoon, they were seeing a clear pattern emerge.

Several colleagues were waiting anxiously in the WHO office when Lim returned with her findings.

Lim reported that her tests were coming back negative, every last one. There was no trace of genetic material from the virus. The patients sampled in Thai Binh had not been infected after all.

The earlier results had been flawed. The positives had all been false positives. The Vietnamese, it turns out, had been using a set of primers they’d been given by the Canadians, and these were detecting rogue bits of genetic material. The new tests using Lim’s primers had all come back clean.

In the office, the relief was tremendous, the swing of mood extreme.

Nicoll had been studying the field results when the pair reported back that there was no evidence the virus was becoming more infectious. He immediately put aside his papers. “What problem?” he suddenly thought. “It all goes away. It’s like water disappearing into sand. You think you have a cluster and you don’t.”

Horby, hugely comforted, packed up his belongings and left. Twenty minutes later he was bound for a previously scheduled vacation in Britain.

“We dodged a bullet there,” Cox said.

And with that, she and Nicoll decided to go shopping. Nicoll loaded up on souvenirs in the markets of Hanoi’s old city near St. Joseph’s, the city’s neo-Gothic cathedral. Cox bought an ao dai , the traditional, form-fitting Vietnamese gown with a high collar and slits up both sides. A day later, the pair headed north to the haunting waters of Halong Bay, one of Vietnam’s most popular tourist destinations, for a cruise amid its sculpted limestone islets.