Alan Sipress - The Fatal Strain

150 a country in transition:Jan Slingenbergh et al., “Ecological Sources of Zoonotic Diseases,” Revue scientifique et technique de l’Office International des Epizooties 23, no. 2 (2004): 467-84; Marius Gilbert et al., “Livestock Production Dynamics, Bird Migration Cycles, and the Emergence of Highly Pathogenic Avian Influenza in East and Southeast Asia,” paper presented at a conference of the Food and Agriculture Organization, Rome, May 30-31, 2006.

150 are concentrated around:Pierre Gerber et al., “Geographical Determinants and Environmental Implications of Livestock Production Intensification in Asia,” Bioresource Technology 96 (2005): 263-76; and Pierre Gerber et al., “Geographical Shifts of the Livestock Production: Land Use and Environmental Impact Implications,” paper presented at the conference “Structural Change in the Livestock Sector—Social, Health, and Environmental Implications for Policy Making,” Bangkok, Thailand, Jan. 27-29, 2004.

150 “Agricultural practices have become”:Slingenbergh, “Ecological Sources of Zoonotic Diseases.” On the role of ecological factors in the evolution of zoonotic pathogens, see also Stephanie J. Schrag and Pamela Wiener, “Emerging Infectious Disease: What Are the Relative Roles of Ecology and Evolution?” Trends in Ecology and Evolution 10, no. 8 (Aug. 1995): 319-24.

150 “virtual time bomb”:Les Sims and Claire Narrod, Understanding Avian Influenza (Rome: Food and Agriculture Organization, 2008), 2.

151 showed no symptoms:D. J. Hulse-Post et al., “Role of Domestic Ducks in the Propogation and Biological Evolution of Highly Pathogenic H5N1 Influenza Viruses in Asia,” PNAS 102, no. 30 (July 26, 2005): 10682-87.

151 tested flocks of free-range ducks:Thaweesak Songserm et al., “Domestic Ducks and H5N1 Influenza Epidemic, Thailand,” Emerging Infectious Diseases 12, no. 4 (Apr. 2006): 575-81.

151 Mekong River delta:On the role of ducks in Vietnam’s outbreaks, see Dirk U. Pfeiffer et al., “An Analysis of the Spatial and Temporal Patterns of Highly Pathogenic Avian Influenza Occurrence in Vietnam Using National Surveillance Data,” Veterinary Journal 174, no. 2 (Sept. 2007): 302-9.

151 outbreaks in the chicken population:Marius Gilbert et al., “Free-Grazing Ducks and Highly Pathogenic Avian Influenza, Thailand,” Emerging Infectious Diseases 12, no. 2 (Feb. 2006): 227-34. Further research, broadened to include Vietnam, provided additional confirmation of the link between avian influenza outbreaks on one hand and ducks and intensive rice cultivation on the other. Rice paddies were identified as the best predictor of outbreak locations. See Marius Gilbert et al., “Mapping H5N1 Highly Pathogenic Avian Influenza Risk in Southeast Asia,” PNAS 105, no. 12 (Mar. 25, 2008): 4769-74.

154 Thai government would bar:Thanawat Tiensin et al., “Geographic and Temporal Distribution of Highly Pathogenic Influenza A Virus (H5N1) in Thailand, 2004-2005: An Overview,” Avian Diseases 51 (2007): 182-88.

154 flu outbreaks unexpectedly erupted:See remarks by Dr. Hoang Van Nam, Department of Animal Health, Ministry of Agriculture and Rural Development, Vietnam, at the Technical Meeting on Highly Pathogenic Avian Influenza and Human H5N1 Infection, June 27-29, 2007, Rome; and UN Food and Agriculture Organization, “Ducks May Be Behind Unexpected HPAI Outbreaks,” press release, Avian influenza newsroom, June 7, 2007.

154 the fields of Kanchanaburi province:The episode is discussed in Thaweesak Songserm et al., “Domestic Ducks and H5N1 Influenza Epidemic, Thailand,” Emerging Infectious Diseases 12, no. 4 (Apr. 2006): 575-81.

154 a peasant named Bang-on Benphat:Rungrawee C. Pinyorat, “Thailand Confirms 13th Human Death from Bird Flu,” Associated Press, Oct. 20, 2005; and WHO, Situation in Thailand—Update 35, Oct. 20, 2005.

155 “Even insects can’t get in”:Even modern, all-enclosed poultry houses have been found to be vulnerable to disease. See, for example, J. Otte et al., “Industrial Livestock Production and Global Health Risks,” Pro-Poor Livestock Policy Initiative Research Report, UN Food and Agriculture Organization, Agriculture and Consumer Protection Department, Animal Production and Health Division, June 2007. All-enclosed houses are even vulnerable to insects that spread infection. See Kyoko Sawabe et al., “Detection and Isolation of Highly Pathogenic Avian Influenza A Viruses from Blow Flies Collected in the Vicinity of an Infected Poultry Farm in Kyoto, Japan, 2004,” American Journal of Tropical Medicine and Hygiene 75, no. 2 (2006): 327-32; and Birthe Hald et al., “Flies and Campylobacter Infection of Broiler Flocks,” Emerging Infectious Diseases 10, no. 8 (Aug. 2004): 1490-92. In some cases, the fans used for ventilating enclosed houses expel contaminated particles into the outside air, where they can infect other poultry houses and farms. See Christine Power, “The Source and Means of Spread of the Avian Influenza Virus in the Lower Fraser Valley of British Columbia During an Outbreak in the Winter of 2004: An Interim Report,” Canadian Food Inspection Agency, Animal Disease Surveillance Unit, Feb. 15, 2004; and T. A. Jones, C. A. Donnelly, and M. Stamp Dawkins, “Environmental and Management Factors Affecting the Welfare of Chickens on Commercial Farms in the United Kingdom and Demark Stocked at Five Densities,” Poultry Science 84 (2005): 1155-65.

This chapter draws on interviews with public health officials and other disease specialists in Hong Kong and Guangdong.

158 “strange contagious disease”: SARS: How a Global Epidemic Was Stopped (Manila: WHO Western Pacific Regional Office, 2006), 5.

158 detected in a Hong Kong family:The case is described in J. S. Malik Peiris et al., “Re-emergence of Fatal Human Influenza A Subtype H5N1 Disease,” Lancet 363, no. 9409 (Feb. 21, 2004): 617-19; and Bernice Wuethrich, “An Avian Flu Jumps to People,” Science 299, no. 5612 (Mar. 7, 2003): 1504.

161 a medical conference in Beijing:Ceci Connolly, “Four Months of Clues to Diagnosis,” Washington Post, June 23, 2003; and Donald J. McNeil Jr. with Lawrence K. Altman, “As SARS Outbreak Took Shape, Health Agency Took Fast Action,” New York Times, May 4, 2003.

161 “He talked about deaths”: Disclosure, Canadian Broadcasting Corp., Nov. 18, 2003, cited in “Documentary Says WHO Missed Chances to Contain SARS in China,” Canadian Press, Nov. 18, 2003.

161 “put two and two together”:Michael Specter, “Nature’s Bioterrorist: Is There Any Way to Prevent a Deadly Avian-Flu Pandemic?” New Yorker, Feb. 28, 2005.

163 precisely what it was:For a description of the Guangdong outbreak and analysis of the samples collected in Guangdong, see N. S. Zhong et al., “Epidemiology and Cause of Severe Acute Respiratory Syndrome (SARS) in Guangdong, People’s Republic of China, in February, 2003,” Lancet 362, no. 9393 (Oct. 25, 2003): 1353-58.

163 With the vials stashed in his satchel:A riveting account of this episode can be found in Karl Taro Greenfeld, China Syndrome (New York: HarperCollins, 2006), ch. 20.

165 “We tried to do our best”:Cheung Chi-fai, “Margaret Chan Breaks Down Twice at Hearing,” South China Morning Post, Jan. 14, 2004.