Alan Sipress - The Fatal Strain

Samaan had done the math. The victim had started feeling sick on New Year’s Day or perhaps a day earlier. The typical incubation period for the virus was believed to be three to five days. During that time, she had worked two shifts at the hospital, December 27 and 28. They were both overnighters. Samaan deduced that the woman would have been hungry when she came off duty at 7:00 A.M. and likely stopped at Kramat Jati, which was on the way home. In the hours just after dawn, the market would have been brimming with fresh produce and live poultry.

“She probably got a big dose of something and got sick,” Samaan surmised. She was back in the rear seat of the maroon minivan, and the van was again crawling through Jakarta streets, fighting Monday morning traffic. Samaan sensed she was getting close to her prey. The van passed pickup trucks stacked with plastic chicken cages, loose feathers stuck to the cruddy exterior, then pulled into a parking spot beside titanic sacks of chili peppers. Samaan got out, stepping carefully around the mud puddles, and plunged into the dim aisles of the market. Escorted by two colleagues from the Indonesian health ministry, she marched past the cassette stalls blaring the Indo-Arabic strains of working-class dangdut music, past jewelry shops heavy with gold bangles and necklaces, past stalls overflowing with dry goods, and then up the stairs to the second floor, where the thud! thud! of a meat cleaver welcomed her.

Samaan sloshed along tile floors slick with water, mud, and rivulets of blood. The footing was treacherous. On the chipped tile counters lay butchered chickens in a row. Their claws extended upward into the twilight of several naked lightbulbs. Toward the back, a few survivors clucked in dissent, their legs bound to makeshift wooden cages. Samaan kept her arms folded tightly in front of her, avoiding any contact.

“If she came here, could she buy the chicken here?” Samaan asked.

One of the health officials nodded.

“Her friends at the hospital said she really liked chicken feet,” Samaan continued. “Like that?” She pointed toward a small pile on the counter amid other odd bits and pieces of chicken. Several men were hacking plucked birds into pieces.

Samaan and her colleagues approached another butcher, a husky man in a skullcap. His feet were bare and his pants legs were rolled up to the knees. He was busy grasping birds with his bare hands and slitting their throats. The investigators asked whether the market had been checked for flu.

Swoosh went the knife. Blood freckled the man’s forearms.

He glanced up and assured them that local veterinary authorities tested the market once or twice a week.

“What did they find?” Samaan asked.

Swoosh went the knife.

“It’s disease-free,” he said curtly.

Samaan wasn’t convinced. Local food and health inspectors were notoriously lax when they weren’t outrightly corrupt. But she wasn’t going to linger any longer. She was reasonably confident she had stalked the infection to its source. She retreated through the maze and emerged into the sunlight.

There, she spied something that instantly made her amend her conclusions. Four peasant women were seated on the blacktop hawking chicken off wooden crates. Stacked behind them were round bamboo chicken cages, all empty. The birds had obviously been butchered right on the crowded sidewalk. Even if the market inside was free of infection, this informal commerce was less likely to be. She paused to look.

“She didn’t have to go all the way in there,” Samaan speculated, retracing the victim’s steps in her mind. “She could have bought the chicken right here. That might be more risky.”

Samaan reflected on the fateful morning, reasoning that the woman would have been weary after coming off her shift. She would have been eager to get home quickly. “That’s it,” Samaan thought. “She probably didn’t go inside. She would have bought it right here. There was plenty of potential for exposure.”

Samaan climbed back into the van.

“That’s my hypothesis,” she reported. “Can I prove it? It’s impossible.”

When I met the man who might save the world, he was making thirty-eight dollars a month. Ly Sovann was a physician in the Cambodian capital, Phnom Penh. He was full-faced with dark, playful eyes and sloping shoulders. He had a tendency to lecture, and when he did, he would stretch out his arms and gesture with open hands. But he was also quick to laugh, often at his own straits.

The first time I encountered him, Ly Sovann was planted behind an aging metal desk in a tiny room that passed for the headquarters of Cambodia’s disease surveillance bureau.

He was the director, responsible for spotting the stirrings of an epidemic in a country where the public health and veterinary systems were so impoverished that experts acknowledged at the time they were probably failing to detect most of the human cases and had no idea how rampant the virus was among poultry. He shared the twelve-by-ten-foot office with the rest of his ten-member team. The room was crammed with four other metal desks and tables, filing cabinets, shelves heavy with bound reports, and five boxes stuffed with the health ministry’s stockpile of protective gear, including gloves, goggles, masks, and aprons. There was only enough space for three people at a time, so his staff rotated through. They all shared one Internet line, which was just about the sole way they could follow the inexorable progress of the virus in neighboring countries, and Ly Sovann had secured that connection only after prevailing on the health minister to seek help from the prime minister’s office. Even at times of crisis, they could work only until 7:00 P.M. each night. That was when the power in the health ministry was shut off and Ly Sovann had to find his way down the stairs from the third floor and out of the darkened building by the faint glow of his mobile phone.

“We’ve had over thirty years of war,” Ly Sovann said as a small air conditioner sputtered and whined in the window behind him. “We need time to build up our system of public health. We try our best to build up the system for detecting avian flu in Cambodia. Five years ago, it was nothing. Now I have computers, paper, and stationery. It’s better.”

Still struggling to recover from decades of conflict and political instability, Cambodia’s government had only three dollars per person to spend on health care each year despite high rates of HIV/AIDS, tuberculosis, and infant and maternal mortality. The country lacked trained doctors, clinicians, laboratory facilities, referral wards, epidemiologists, and an overall health system tying them together. For a time, the government couldn’t even afford to produce radio spots warning about the risks of bird flu.

Out in the provinces, the health system was even more primitive than Ly Sovann’s operation. Local clinics couldn’t recognize cases of bird flu when the sick came in for treatment, raising the prospect that the virus would evolve into a more pernicious form and spread before anything could be done to stop it. This posed a danger not just for Cambodians but for those well beyond the country’s borders. “The chain is as strong as the weakest link,” warned Klaus Stohr when I first asked him in 2005 about his concerns over Cambodia and its destitute neighbor Laos. As the virus raced westward during the following year, WHO began raising a similar alarm over the threat posed by sub-Saharan Africa.

The situation would be less dire in some countries confronting the virus, but only by degree. Along the breadth of the battlefront, from Vietnam and Indonesia to Bangladesh, Egypt, and Nigeria, public-health and veterinary services have remained precariously short of the money needed to corner the disease in birds, detect and treat those people who contract the virus, and stem its onward spread.