Alan Sipress - The Fatal Strain

69 tremendous cytokine storms:See, for example, John C. Kash, et al., “Genomic Analysis of Increased Host Immune and Cell Death Responses Induced by 1918 Influenza Virus,” Nature 443 (Oct. 5, 2006): 578-81; Darwyn Kobasa et al., “Enhanced Virulence of Influenza A Viruses with the Hemagglutinin of the 1918 Pandemic Virus,” Nature 431, no. 7009 (Oct. 7, 2004): 703-7; and Darwyn Kobasa et al., “Aberrant Innate Immune Response in Lethal Infection of Ma caques with the 1918 Influenza Virus,” Nature 445 (Jan. 18, 2007): 319-23. A study in 2008 comparing the immune response to H5N1 and the 1918 virus in mice showed “considerable similarities” but found that the H5N1 strain actually elicited significantly higher levels of cytokines and macrophages. See Lucy A. Perrone et al., “H5N1 and 1918 Pandemic Influenza Virus Infection Results in Early and Excessive Infiltration of Macrophages and Neutrophils in the Lungs of Mice,” PLoS Pathogens 4, no. 8 (2008): e1000115.

69 “kissing cousin”:Remarks at Business Preparedness for Pandemic Influenza, Second Annual Summit, University of Minnesota Center for Infectious Disease Research and Policy, Feb. 5, 2007.

69 a wholly avian virus:Jeffrey K. Taubenberger et al., “Characterization of the 1918 Influenza Virus Polymerase Genes,” Nature 437 (Oct. 6, 2005): 889-93; and Terrence M. Tumpey et al., “Characterization of the Reconstructed 1918 Spanish Influenza Pandemic Virus,” Science 310, no. 5745 (Oct. 7, 2005): 77-80.

69 “a number of the same changes”:Jeffrey K. Taubenberger et al., “Characterization of the 1918 Influenza Virus Polymerase Genes,” Nature 437 (Oct. 6, 2005): 889-93.

69 more like the Spanish flu strain:For example, see James Stevens et al., “Structure and Receptor Specificity of the Hemagglutinin from an H5N1 Influenza Virus,” Science 312, no. 5772 (Apr. 21, 2006): 404-10.

69 A series of studies:H. Chen et al., “The Evolution of H5N1 Influenza Viruses in Ducks in Southern China,” PNAS 101, no. 28 (July 13, 2004): 10452-57; Taronna R. Maines et al., “Avian Influenza (H5N1) Viruses Isolated from Humans in Asia in 2004 Exhibit Increased Virulence in Mammals,” Journal of Virology 79, no. 18 (Sept. 2005): 11788-11800; Hui-Ling Yen et al., “Virulence May Determine the Necessary Duration and Dosage of Oseltamivir Treatment for Highly Pathogenic A/Vietnam/1203/04 Influenza Virus in Mice,” Journal of Infectious Diseases 192 (2005): 665-72; and Adrianus C. M. Boon et al., “Role of Terrestrial Wild Birds in Ecology of Influenza A Virus (H5N1),” Emerging Infectious Diseases 13, no. 11 (Nov. 2007): 1720-24.

69 “a process of rapid evolution”:“Mouse Studies of Oseltamivir Show Promise Against H5N1 Influenza Virus,” NIH News , July 18, 2005.

69 already become more ferocious:Carole R. Baskin et al., “Early and Sustained Innate Immune Response Defines Pathology and Death in Nonhuman Primates Infected by Highly Pathogenic Influenza Virus,” PNAS , Published online before print February 13, 2009, doi 10.1073/pnas.0813234106.

70 If the virus continued to develop:J. S. Malik Peiris, “H5N1 Pathogenesis in Humans: An Update,” Power Point presentation to the WHO working group, Sept. 21-22, 2006.

70 though later reported :WHO, “Influenza Research at the Human and Animal Interface: Report of a WHO Working Group,” Geneva, September 21-22, 2006.

70 62 million:Christopher J. L. Murray et al., “Estimation of Potential Global Pandemic Influenza Mortality on the Basis of Vital Registry Data from the 1918–1920 Pandemic: A Quantitative Analysis,” Lancet 368, no. 9554 (Dec. 23, 2006): 2211-18.

70 $3.13 trillion during the first year:The figures for severe, mild, and moderate pandemics are based on numbers included in Andrew Burns, Dominique van der Mensbrugghe, and Hans Timmer, “Evaluating the Economic Consequences of Avian Influenza,” updated in September 2008. An earlier version of this report, which had calculated the costs using a lower figure for global GDP, put the toll of a severe pandemic at $2.38 trillion. The study was originally published in a slightly different form in the World Bank’s June 2006 edition of Global Development Finance. For further discussion, see Milan Brahmbatt, “Economic Impacts of Avian Influenza Propagation,” speech at the First International Conference on Avian Influenza in Humans, June 29, 2006.

71 “It’s a possibility in this case”:Jane Moir, “Cousins of Child Victim in Flu Alert: Human Transmission Suspected,” South China Morning Post, Dec. 17, 1997.

71 “They live together at Grandma’s”:Edward A. Gargan, “Chicken-Borne Flu Virus Puts Hong Kong on Alert,” New York Times, Dec. 17, 1997.

71 “working at breakneck pace”:Jane Moir, “Cousins of Child Victim in Flu Alert: Human Transmission Suspected,” South China Morning Post, Dec. 17, 1997.

71 barely three hundred square feet:Rhonda Lam Wan, “Bird Flu Cousins’ Flat Behind Pile of Rubbish,” South China Morning Post, Dec. 19, 1997.

71 they were rebuffed:Ibid.

72 a city under siege:See, for example, the following accounts, all from the South China Morning Post: Rhonda Lam Wan and Billy Wong Wai-Yuk, “Doctors Scramble for Special Drug,” Dec. 13, 1997; Andrea Li and Alex Lo, “Fears Force Changes to Menus,” Dec. 16, 1997; Stella Lee, “18 Private Doctors to Join Bird Flu Probe,” Dec. 18, 1997; Rhonda Lam Wan, “Flood of Requests Prompts Promise of A-Strain Testing,” Dec. 20, 1997; and Ng Kang-Chung, “Rush for Bird Flu Tests As Seven More Suspected Victims Found,” Dec. 26, 1997.

73 Fukuda had never before missed:Patricia Guthrie, “Focus on Hong Kong Flu,” Atlanta Journal and Constitution, Dec. 25, 1997.

73 “will stop or spread”:“Hong Kong Tests Show Human-to-Human Transmission of Bird Flu Difficult,” Agence France Presse, Dec. 27, 1997.

73 “measures are sufficient”:Keith B. Richburg, “Hong Kong Killing All Chickens in Fight Against ‘Bird Flu’ Virus,” Washington Post, Dec. 29, 1997.

73 more bad news:For discussion of the poultry outbreaks in late December 1997, see L. D. Sims et al., “Avian Influenza in Hong Kong 1997-2002,” Avian Diseases 47, no. s3 (2003): 832-38; and Kennedy F. Shortridge, “Poultry and the Influenza H5N1 Outbreak in Hong Kong, 1997: Abridged Chronology and Virus Isolation,” Vaccine 17 (1999): s26-s29.

75 would kill every last chicken:For an overview of the 1997 poultry outbreaks and government response, see Kennedy F. Shortridge et al., “Interspecies Transmission of Influenza Viruses: H5N1 Virus and a Hong Kong SAR Perspective,” Veterinary Microbiology 74 (2000): 141-47.

75 The government pressed:Robin Ajello and Catherine Shepherd, “The Flu Fighters,” Asiaweek, Jan. 2008.

75 bloody chaos:Billy Wong Wai-Yuk, “Tears of Anger, Rivers of Blood,” South China Morning Post, Dec. 30, 1997; Stella Lee, “Slaughter Held Up by Inexperience,” South China Morning Post, Dec. 31, 1997; Keith B. Richburg, “Chicken Sightings Frighten Hong Kong, Washington Post, Jan. 3, 1998; and Keith B. Richburg, “Hong Kong Faulted on Handling of ‘Bird Flu’ Crisis, Washington Post, Jan. 4, 1998.