Alan Sipress - The Fatal Strain

From outside on the porch came the staccato of a youngster coughing. Samaan looked quizzically at her Indonesian colleagues. None of them were wearing any protection, no mask, no gloves. Samaan asked whether the boy might be infected. Unlikely, the Indonesians assured her. He had been coughing for weeks, long before the victim fell ill, and otherwise seemed healthy. As if to prove the point, the youngster suddenly appeared in the doorway on a bicycle. Besides, the Indonesians explained, he had already tested negative for the virus.

Samaan scribbled a few notes. Then she returned her attention to the victim’s mother.

“In the ten days before she became ill, did she go to any parks? Any farms?”

“Nothing,” the mother answered.

“A traditional market?”

“Yes, she went to a traditional market. A couple days beforehand, she bought us chicken.”

Samaan jotted down the details.

“Did she kill it herself?” Samaan continued, wondering whether the victim had been infected while butchering a sick or contaminated bird.

“It was already killed.”

“Feathers or no feathers?”

“It was already cut up and ready to cook.”

“When did she go to the market?”

The mother shrugged and turned toward a bushy-haired man sitting quietly in the far corner. It was the victim’s husband.

“I don’t know,” he said softly.

“Before New Year’s?”

“Yes, before New Year’s,” he confirmed.

Rising to her feet, Samaan asked to see the rest of the house. She entered a long room in the rear of the house. There was a refrigerator. She opened the door and peered inside. It was mostly empty. Next she went into the cluttered kitchen, where she instantly spotted a metal wire basket suspended about six feet off the ground. She pulled a pair of rubber gloves from her handbag and tugged them on. Then she craned her neck back, reached up, and gingerly unhooked the basket, placing it on a table. Inside were about a dozen brown eggs. She plucked them out one by one and scrutinized them, looking for traces of chicken droppings that could have contained the fatal dose. Nothing.

“Very clean,” she acknowledged. “No sign of feces.”

Samaan replaced the basket and snapped a picture of it with her digital camera.

The general lack of filth was becoming ever more disturbing, the absence of livestock unnerving. None of the neighbors seemed to have the wooden cages common in most Indonesian yards for raising chickens. In fact, except for a pair of black chickens lingering in a bush near the block captain’s home, there was practically no trace of poultry anywhere in the neighborhood.

“It’s perplexing and it makes me a bit worried,” Samaan confided to me. “She was a health-care worker. If there’s no sign of infection here…” Her voice trailed away.

Inside WHO, Tom Grein is a legend. His exploits as an epidemiologist are unsurpassed in his generation. He has ventured to some of the world’s most remote corners and confronted some of its most horrifying diseases. When bird flu initially exploded in Vietnam, he was among the first from WHO on the ground in January 2004. When the virus recorded its single largest cluster in the highlands of Sumatra in May 2006, again he was there. Yet Grein readily admits the limits of his calling. “Epidemiology never proves. It only highly suggests,” he put it to me. “As frustrating as that might be, not having a smoking gun itself is not failure.”

A lanky German with still, blue eyes, a strong chin, and closely cropped brown hair tinged with gray, Grein has a reserved, methodical manner. His colleagues say he can be dour when he’s stuck in Geneva and this demeanor has earned him the moniker Gray Cloud. Nothing makes him happier than when he gets to leave the office.

In 2005 he left and headed for southern Africa, responding to the deadliest outbreak of Marburg hemorrhagic fever ever recorded. He drove for ten hours from the Angolan capital, Luanda, into the country’s hilly interior, where he discovered villagers dying by the scores. Victims would develop a high fever, crippling headache, diarrhea, and vomiting. Then, as one of the most lethal pathogens of all turned its fury on the liver, spleen, and other organs, blood would often gush into the body’s cavities before emptying out through the nose, mouth, eyes, rectum, and other orifices. Barely one in ten survived. As if that weren’t daunting enough, Angola was just coming out of a twenty-seven-year civil war and remained unstable and violent. The landscape was still littered with land mines, the few concrete buildings scarred by gunfire. “There was a lot of hands-on work to do in a very difficult climate and very difficult environment,” Grein told me. “It took a long time to contain the outbreak.”

For nearly a month he and his team remained in the Angolan province of Uige. They went hut to hut carrying out inspections, working inside low, dark dwellings, the air thick with death. They disinfected bodies and buried those who had perished. Their protective suits, double gloves, and face shields were all that separated them from a similar fate. “There’s a perception that you’re putting yourself quite at risk. Though you take appropriate measures, the brain plays its games,” he admitted. All the time, he feared the disease would spin out of control. The international team would contain it in one place, believing they had broken the chain of transmission, and it would erupt somewhere else. They were never able to identify the original source.

Twice before, he had been dispatched to face down Marburg in Africa. He had investigated and ultimately helped control outbreaks in the Democratic Republic of Congo, formerly known as Zaire. In 1998 he had responded to a flare-up in southern Sudan of what health officials suspected was also hemorrhagic fever. Ebola, an equally cruel and contagious cousin of Marburg, had first been identified a decade earlier in an equatorial province of Sudan. Now that same pathogen was believed to have struck a quarter of the people in four isolated farming villages high in the savannah. Two Sudanese medical investigators who first reached the area had gotten ill, and one died. To get there, Grein and his entourage hiked from dawn until the middle of the night, fording four rivers along the way. “It was like Dr. Livingston with high grass left and right,” he recounted. “It was something out of an old movie with people in single file carrying things on the top of their heads.” The affliction turned out to be a particularly nasty respiratory tract infection. But not long after, he would confront Ebola itself in the Republic of Congo.

Then there was the time he was airlifted into the mountains of Afghanistan. Once again, hemorrhagic fever was suspected. An outbreak had pervaded three-quarters of the homes in a remote hamlet of northern Afghanistan, which was then controlled by the forces of the storied Tajik militia leader Ahmed Shah Masood. During the summer, it would take a week by mule to reach the village. But the disease broke out during the height of winter and the outpost was cut off by snow. Grein and a WHO colleague flew in by helicopter from the neighboring country of Tajikistan. They treated about twenty patients with antibiotics and collected specimens for further testing. The outbreak was ultimately blamed on an “influenza-like” respiratory infection.

I had known of Grein’s reputation long before I met him. When I finally caught up with him in Yogyakarta, a historic royal city on Indonesia’s Java island, he was exhausted. Six days earlier, a powerful earthquake had struck just south of the city, killing nearly six thousand people and displacing 1.5 million others. Now the neighboring Mount Merapi volcano was threatening to blow. Grein, who had coincidentally been in Indonesia for several weeks investigating the Sumatra bird flu cluster, was asked by WHO to extend his stay and set up a system for monitoring possible outbreaks of cholera and other disease in the quake’s aftermath. He had done the same a year earlier in the Indonesian province of Aceh after it was struck by the massive South Asian tsunami.