Alan Sipress - The Fatal Strain

It’s not possible to credit the scores of scientists, public health experts, and medical specialists who agreed to be interviewed or offered me guidance. But I would be remiss if I didn’t single out the following for thanks. Michael Perdue, formerly of WHO in Geneva and now at the U.S. Biomedical Advanced Research and Development Authority in Washington, has been a great resource for me on the science of the virus. Michael Osterholm, director of the Center for Infectious Disease Research and Policy in Minneapolis, has steered me right when I’ve been stumped by questions about the evolution of the threat. I’m also smarter for the repeated insights of Malik Peiris in Hong Kong, one of the world’s premier researchers into respiratory viruses.

This book never would have been written at all without the intervention of three Post colleagues. David Maraniss encouraged me to embark on this project when I was still unsure whether to do so. Dana Milbank offered sage advice across a kitchen counter on how to frame the book, finally unlocking its potential. And Sandy Sugawara gave me the time to pursue the project even if the timing was inopportune. I’m beholden to all three.

I owe a major debt of gratitude to my very wise agent, Raphael Sagalyn. He immediately spotted the potential of this project, but for months kept pushing me to rethink and refine the conception until I got it right. Then he ran with it. At Viking Penguin, my editor Alessandra Lusardi has been a very sharp reader and elevated the writing by helping me bring the main themes to the fore while pruning back overgrowth in the storytelling.

In everything, I’m indebted to my parents for their love and gift of intellectual curiosity. Most of all, I’m grateful to Ellen, my partner in all things, for her understanding and encouragement. There’s no one else I’d rather travel to the ends of the world with.

2 All flu viruses in fact emanate:See, for instance, R. J. Webby and R. G. Webster, “Emergence of Influenza A Viruses,” Philosophical Transactions of the Royal Society of London B: Biological Sciences, 356, no. 1416 (Dec. 29, 2001): 1817-28.

6 a repeat of the Great Influenza:For a definitive account of the 1918 pandemic, see John M. Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (Viking Penguin: New York, 2004). See also Alfred W. Crosby, America’s Forgotten Pandemic: The Influenza of 1918, 2nd ed. (New York: Cambridge University Press, 2003).

6 at least 50 million lives:N. P. Johnson and J. Mueller, “Updating the Accounts: Global Mortality of the 1918-1920 ‘Spanish’ Influenza Pandemic,” Bulletin of the History of Medicine 76, no. 1 (Spring 2002): 105-15.

7 “accelerated number of near-misses”:Anita Manning, “New, Deadly Flu Pandemic ‘Inevitable,’ Experts Warn,” USA Today, Mar. 2, 2004.

7 theater of conflict that is Asia:Dr. Michael T. Osterholm of the University of Minnesota has called Asia “the genetic roulette table for H5N1 mutations.”

7 first documented global outbreak:C. W. Potter, “A History of Influenza,” Journal of Applied Microbiology 91 (2001): 572-79.

7 since the twelfth century:August Hirsch, Handbook of Geographical and Historical Pathology (London: New Sydenham Society, 1883).

This chapter draws on interviews with disease specialists from the World Health Organization and the U.S. Centers for Disease Control and Prevention, officials from the governments of Indonesia, North Sumatra province, and Karo district, and medical professionals and residents in North Sumatra province, as well as internal documents from WHO and the governments of Indonesia, North Sumatra, and Karo.

13 cruise ships in Alaska:An account of the investigation can be found in Timothy M. Uyeki et al., “Large Summertime Influenza A Outbreak Among Tourists in Alaska and the Yukon Territory,” Clinical Infectious Diseases 36 (2003): 1095-1102.

13 island nation of Madagascar:Accounts of the investigation into the outbreak can be found in “Influenza Outbreak—July-August 2002,” Morbidity and Mortality Weekly Report, 51, no. 45 (Nov. 15, 2002): 1016-18; and Weekly Epidemiological Record 2002, no. 46 (Nov. 15, 2002): 77, 381-88.

18 At Imperial College London:Neil M. Ferguson et al., “Strategies for Containing an Emerging Influenza Epidemic in Southeast Asia,” Nature 437 (Sept. 8, 2005): 209-14.

18 A separate team:Ira M. Longini Jr. et al., “Containing Pandemic Influenza at the Source,” Science 309, no. 5737 (Aug. 12, 2005): 1083-87.

19 “No attempt has ever been made”:“WHO Activities in Avian Influenza and Pandemic Influenza Activities, WHO, Jan.-Dec. 2006, 16. The approach was quickly embodied in WHO planning. See “WHO Pandemic Influenza Draft Protocol for Rapid Response and Containment,” updated draft, WHO, May 30, 2006.

19 WHO’s emergency containment plan:The strategy is described in the finalized WHO protocol. See WHO, “WHO Interim Protocol: Rapid Operations to Contain the Initial Emergence of Pandemic Influenza,” updated Oct. 2007.

20 “It will require excellent surveillance”:WHO, “WHO Activities in Avian Influenza and Pandemic Influenza Activities: January-December 2006,” p. 16.

25 by the time Puji was buried:A local account of the cases and grassroots response is “Report Regarding Bird Flu Disease in Karo Regency, from the Karo Regent Daulat Daniel Sinulingga to the Governor of North Sumatra in Medan, Kabanjahe,” May 31, 2006.

28 According to Batak lore:Interview with Juara Ginting, an anthropologist who grew up in Karo district and studied Batak belief and superstition at North Sumatra University before pursuing a master’s degree at Leiden University in the Netherlands.

29 beheaded a chicken:Margie Mason, “Officials Backtrack Bird Flu Cluster,” Associated Press, May 26, 2005.

29 scores of poultry traders:Jason Gale and Karima Anjani, “Indonesian Bird-Flu Victim Sought Witchdoctor, Shunned Hospital,” Bloomberg, May 26, 2005.

29 “significantly delayed”:WHO, “Avian Influenza Cluster, Karo, North Sumatra, May 2006, WHO Interim Report.”

30 “universally refused”:Ibid.

38 senior Indonesian officials:See, for instance, Health Minister Siti Fadilah Supari, quoted in Tubagus Arie Rukmantara, “Awareness and Prevention Key in Bird Flu Fight,” Jakarta Post, July 28, 2006.

38 “From the lessening of the tension”:Siti Fadilah Supari, It’s Time for the World to Change: In the Spirit of Dignity, Equity, and Transparency, Divine Hand Behind Avian Influenza (Jakarta: Sulaksana Watinsa Indonesia, 2008), 23.

38 Supari would continue:See, for example, “Minister Denies Bird Flu in RI Spreading by Human-to-Human Transmission,” Antara news agency, Sept. 3, 2007.

38 were quickly convinced:Georg Petersen, “Investigative Report of a Cluster of Human Avian Influenza Cases, North Sumatra, May 2006,” WHO.

39 “If he turns out to be positive”:Internal WHO communication from Jakarta, May 21, 2006.

39 “In response to the possibility”:Ibid.

40 tested positive for the virus:The specimens collected by Uyeki and his colleagues later showed that the virus had been aggressively mutating as it moved from son to father. See, for example, Santoso Soroeso, “Epidemiology and Clinical Features of Avian Influenza in Indonesia, Questions and Lessons Learnt,” presented at Australia-Indonesia Symposium in Science and Technology 2006, Sept. 13-14, 2006, Jakarta; and also Declan Butler, “Family Tragedy Spotlights Flu Mutations,” Nature 442 (July 13, 2006): 114-15. Initial analysis of the specimens at Hong Kong University also showed that Dowes’s sample had the same signature mutation as the sample from his son. This seemed to be further evidence that Dowes caught the virus from his son, marking the third generation of transmission. This finding was reported at the time by several media and cited by U.S. Secretary of Health and Human Services Michael O. Leavitt. See, for example, Department of Health and Human Services, Pandemic Planning Update II, a report from Secretary Michael O. Leavitt, June 29, 2006. But researchers familiar with the results later said the initial findings regarding a signature mutation were not as conclusive as at first thought. The case for third-generation spread still rests on the case histories of the Ginting family members and the timing of their illnesses.