Alan Sipress - The Fatal Strain

When officials from Geneva called Hanoi for an update, they were informed that Cox and Nicoll were on a boat and unavailable.

The scare would remain secret. The world would never be told how close WHO had come to putting it on a war footing. Just about the only hint provided by the agency came one day after the team departed Vietnam. Citing WHO, the French press agency reported that an international team of virologists and epidemiologists had left the country after assessing that the threat posed by the bird flu virus was less than they’d suspected. Few other details were offered. “The most important thing,” Troedsson was quoted as saying, “is that we could rule out that there was an immediate, imminent pandemic.” It was meant to be reassuring. But his comments acknowledged more about the agency’s fears than officials ever had before.

Her maroon minivan had just edged into Friday morning traffic and already Gina Samaan was troubled. The case just didn’t make sense.

Seated in the backseat, Samaan flipped through the file yet again. This much was for sure. A twenty-nine-year-old Indonesian woman from the east side of Jakarta had died two days earlier. She had suffered from acute pneumonia. She had been ill for at least a week. The victim’s doctors suspected it was bird flu, and indeed her samples tested positive for the virus at a government laboratory.

The specimens also came back positive from another, secretive lab run by the U.S. Navy in downtown Jakarta. This was one of three overseas labs established by the navy to specialize in infectious diseases confronting U.S. forces on foreign terrain. Recently it had been forced to lower its public profile in Indonesia because of rising anti-Americanism fueled by the wars in Afghanistan and Iraq. Still, the lab continued to operate, perhaps ironically, right across from the city’s main prison, where Indonesia had jailed some of its most notorious terrorism suspects. The navy facility was more sophisticated than anything the Indonesians could muster, quietly supporting the government’s efforts to contain the spreading bird flu outbreak. If the lab confirmed the victim had died from the virus, it was sure to be so. But that scientific fact by itself revealed precious little about the case at hand.

Samaan’s van inched through the traffic. Outside, another equatorial morning had settled on the Indonesian capital, air so thick and languorous that breathing was a chore, the sky depressingly gray from the smog hugging Java’s swampy coast. Commuter buses muscled through some of the third world’s worst gridlock while motorbikes swarmed like mosquitoes. Though the van’s front and rear windows were emblazoned with the shield of the United Nations, few took notice of the vehicle or the young WHO investigator inside. Even fewer made way.

At twenty-nine, Samaan was the same age as the victim. Dark eyes earnest and intent behind rimless glasses, brown hair tied back with a pink hair band in a practical ponytail, Samaan pursed her lips as she continued to review the case. The local media were reporting that chickens in the victim’s neighborhood had recently fallen sick and died. But Samaan had access to test results on samples collected by the city’s veterinary department. These seemed to show that the local poultry were healthy. “That makes me a bit worried,” she admitted to me in a broad Australian accent. “Is there anything different here?” she wondered. “If so, what’s different?” If the source of infection wasn’t chickens, could it be another person? If so, it might mean the virus had mutated into a form more easily passed among humans.

That prospect seemed to grow over the following days as this influenza gumshoe followed a trail of clues leading unexpectedly into a neighboring province and then back again. In its own way, the stakes of her investigation were every bit as high as that of the special WHO mission dispatched to Hanoi seven months earlier to verify whether the virus was perilously mutating. Northern Vietnam had been a source of intense anxiety because of flawed test results that appeared to show that the novel strain had broken the pandemic code. But in the months before Samaan set out on this morning in January 2006, more people had died of the disease in Indonesia than anywhere else. And if a global epidemic were to erupt, there was no place more likely for it to start.

Samaan and the Indonesian health ministry had both agreed to let me accompany her on her investigation as long I respected the victim’s medical privacy by keeping her identity confidential. This afforded me an intimate view, not only of the hunt but of the challenges and frustrations epidemiologists face as they try to run this killer to ground.

Samaan wasn’t taking any chances. She had stashed a bag with masks and plastic shoe coverings in the back of the van. In her bulky brown satchel of a handbag, buried beneath a cell phone, digital camera, and BlackBerry, she kept a small bottle of pink antiseptic hand lotion and a cheap thermometer. She had been taking her temperature twice a day since she had arrived in Jakarta eight months earlier, dispatched by WHO from the Australian health ministry. “It’s important to know your baseline,” she explained, adding that hers was a cool 97.5 degrees. She had also carefully considered her footwear, donning simple shoes with covered tops so her feet would be protected against any contamination on the ground. They had flat bottoms so they were less likely to get cruddy with dirt, chicken droppings, and other possible sources of infection. And because she was constantly removing her shoes according to Indonesian etiquette before entering someone’s home, she settled on a pair that was easy to slip on and off, so she didn’t have to bend down near the ground. After each outing, she washed them in the sink and, as a result, was going through a pair every few months.

Yet for all her preparations, Samaan wasn’t expecting what awaited her when we finally pulled up in the victim’s neighborhood. It was as if the whole community had turned out and was now sitting in rows of folding chairs on the block captain’s grassy front yard, anxiously anticipating an explanation for their tragedy. Samaan waded through the crowd along with her translator, a stocky Indonesian with thick sideburns, wispy beard, and crisp American accent acquired during a childhood in Pittsburgh, and a middle-aged woman in batik named Ibu Eni from the health ministry’s national lab. When they announced that blood samples were to be taken, dozens crowded around, offering their arms.

This was not the way things were done back home in Australia, where Samaan had recently graduated from an elite program in epidemiology at the Australian National University in Canberra. She would have preferred to proceed calmly, methodically. She would have wanted to interview the victim’s relatives and neighbors in their own homes, carefully taking stock and observing them, noting their answers, calibrating their responses, piecing together the timeline, then drawing samples only from those who had immediate contact with the dead woman. Instead this was verging on chaos.

Ibu Eni took a seat behind a wooden school desk set out in the yard. She snapped on a pair of rubber gloves and began accepting one thrusting arm after another. After the first man had given blood, Samaan buttonholed the graying old-timer and tried to clarify the conflicting reports about sick poultry.

“Have there been any bird deaths in the kampung , or neighborhood?” she asked.

“Nothing,” he demurred. “Everything’s been ordinary.”

A second man in a black Mercedes cap interjected, correcting him, “Yes, there were two chicken deaths, about thirty meters away from the victim’s home.”