by Alan Sipress
The Chinese government was infuriated by the claim that the virus had spread from southern China to Qinghai. This made China the source of the global threat rather than an innocent victim of someone else’s birds. No sooner had the Nature article appeared online than China’s official Xinhua news agency fired back, quoting Jia Youling, the ministry’s animal-health director. No bird flu has broken out in southern China since the previous year, Jia claimed.
Government officials had been monitoring Guan’s research for more than a year. His genetic detective work was steadily unraveling their deceit. “They were very unhappy,” he recalled. “This is supposed to be a black box. Nobody is supposed to know what is going on. Now I’m opening the door and I have a strong case.”
The article about Qinghai was too much for the government. Jia went on the attack. He announced that Guan’s team had fabricated the data, saying the researchers had lied about taking samples at Qinghai. Soon after, Jia suggested that the team’s lab was so poorly equipped that the tests could have been contaminated and the results meaningless. He further alleged that the scientists had failed to apply for government approval to conduct their research and that the Joint Influenza Research Center at Shantou University Medical College, which Guan helped set up four years earlier, lacked adequate safeguards for doing the tests.
The government ordered the Shantou research center shuttered immediately. Virus samples were to be destroyed or turned over to the ministry’s official animal-flu lab in Harbin, one of only three institutes in China that would now be allowed to conduct this research. Jia later denied any political motive, saying the Shantou lab was one of four around the country that had been closed because it failed standard inspections. But to be sure Guan understood how severely they viewed his activities, agriculture officials accused him of the cardinal sin of disclosing state secrets.
“It was a lot of pressure,” Guan admitted, baring his still-fresh wounds. “Doing the science is simple. The big problem is that people try to stop you from writing.” As he recounted the incident, his voice rose an octave and he sputtered, almost spitting out his grievance as he struggled for the right words in English. “They tell me, ‘You’re a human doctor and this is an animal matter. Don’t interfere in my animal issue. It’s none of your business.’ ” He paused and caught his breath. Then, filling his lungs with the smoke of a freshly lit cigarette, he continued, “Working on this, I’m not sure how far I can go, how safely I can go. They kept saying I’m leaking state secrets.”
Yet Guan kept going, and his network kept collecting samples even after Shantou’s front doors were closed. That fall, his team published another piece of disturbing research. It documented a new wave of disease that had appeared in China’s poultry and had already spread elsewhere in the region. After sampling more than 53,000 birds at live poultry markets in six southern Chinese provinces, the scientists discovered that a new H5N1 subtype, which they labeled “Fujian-like” because of its similarity to an earlier isolate from Fujian province, had rapidly squeezed out its predecessors. In just a year, the rate of infection in China’s poultry had nearly tripled. This new wave of transmission had renewed poultry outbreaks in at least three Southeast Asian countries and sickened people not only in China but also in Thailand. The scientists said China’s massive campaign to vaccinate all its poultry was possibly to blame for stimulating the emergence of this resistant subtype.
The government responded by calling a press conference to belittle the findings and impugn Guan’s ethics. “The data cited in the article was unauthentic and the research methodology was not based on science,” Jia said. “In fact, there is no such thing as a new ‘Fujian-like’ virus variant at all. It is utterly groundless to assert that the outbreak of bird flu in Southeast Asian countries was caused by avian influenza in China and there would be a new outbreak wave in the world.”
A month later, Guan shut down his research network in mainland China and told his army of sample takers they would have to find other work. Over the previous eight years, Guan and his “thankless heroes” had sampled more than two hundred thousand birds. Many of the virus samples available to researchers and vaccine developers around the world had come from work done by Guan and his Hong Kong University colleague Malik Peiris. Time and again, they had alerted the world to crucial turns in the behavior of the virus.
But now he was switching off the radar, pulling the plug on the world’s early-warning system. “Let Dr. Jia Youling come and find a solution,” Guan told me in late 2007. “Let him clarify that I didn’t make a mistake or make up the data so I can recover my honor. Why should I sacrifice my honor?”
“Malik and I did a lot of work for the world,” he continued, his voice rising again. “Who continued on a weekly basis to do sampling for eight years? Anybody else? No. We are second to none in the world. What more can we do?”
PART THREE
CHAPTER NINE
The Secret Call
Nguyen Sy Tuan was conscious but could barely talk. His wasted frame was tucked beneath a white sheet on a metal hospital cot, arms spindly and useless by his sides. Never a husky man, he had lost more than a third of his weight since the virus set upon him nearly two months earlier. Tuan had withered to eighty-four pounds. His head was propped up slightly on a thin pillow. His face seemed frozen in horror, cheeks sunken and lips agape. His bulging eyes were fixed, staring for hours at the ceiling as if the young man was still haunted by a specter that the doctors had predicted would surely claim him. Never before had the specialists in the intensive care unit of Hanoi’s Bach Mai Hospital seen anyone survive such a massive attack.
“We thought there was no way Mr. Tuan could make it,” confided Dr. Nguyen Hong Ha, head of the ICU, as he stood just outside the doorway. “No patient who we’ve put on a mechanical ventilator has ever survived.”
Yet when I visited Tuan, the twenty-one-year-old had already cheated death. He no longer needed the machine to help him breathe. He could even stomach a little rice on his own.
The small, white-tiled hospital room was silent except for Tuan’s occasional dry cough and the muted sound of distant car horns wafting through the second-floor window. To his right was another cot. Not long ago, his teenage sister lay there beside him, burning with a fever of 105, gasping for air just like her brother. Now the cot was empty. Somehow, she too had eluded death. She had already returned to school in the village, where her classmates, much to her consternation, had nicknamed her Miss H5.
Some doctors on the wards claimed these two cases as a triumph for Vietnamese medicine. But flu specialists nervously monitoring the virus in the spring of 2005 knew better. This unexpected turn of events was no reason to celebrate. The survival of Tuan and that of his sister, ironically, were part of a deeply disturbing trend.
These two siblings, the young seaweed harvester and the mischievous schoolgirl, were at the epicenter of a renewed outbreak in northern Vietnam that signaled to some of the world’s leading virologists and field investigators that the virus had mutated. It wasn’t just the increasing number of cases. It was the pattern. They were coming in larger family clusters, and the overall mortality rate had dropped substantially in a matter of months, suggesting the virus was edging toward pandemic. It may seem counterintuitive, but an astronomically high kill rate can be bad strategy for a prospective epidemic. After all, a virus that swiftly dispatches most everyone it infects gives itself little chance to spread. The 1918 flu virus, by contrast, settled on a far more modest fatality rate, claiming fewer than 5 percent of those infected. Yet it was ultimately able to kill at least 50 million people and perhaps many more.
Over the following months of that spring, new laboratory findings would emerge from northern Vietnam that apparently explained the shifting pattern, confirming that the field observations were no coincidence. Hard science seemed to show that the virus had crossed another threshold. A year earlier, in 2004, this novel strain had demonstrated conclusively that it could pass from one pe
rson to another, though widespread transmission had still been elusive. Now, in 2005, that fateful barrier appeared to be falling. Some in the know even concluded that the pandemic had already broken loose. But disease specialists at WHO never publicly disclosed their fears. Instead, they sweated in private, secretly weighing whether to sound a global pandemic alert.
If they did so, the economic fallout could be tremendous. Though the blow would fall hardest on Vietnam, decimating tourism and trade, the whole region could suffer. Multinational companies might suspend their operations. Foreign governments might evacuate their nationals. Airlines might cancel routes, leaving countries isolated and visitors marooned. Stock markets would plunge. These reverberations would be felt worldwide. Yet the danger of waiting to sound the alarm might be catastrophic.
The quandary was compounded by gaps in the evidence. The scientific data were incomplete and contradictory in places. So the flu hunters were forced to make pivotal decisions with only a partial view of the truth. In battling this virus, science has time and again failed to provide the solid answers needed to decipher the pathogen and keep it in the box. Since the last flu pandemic in 1968, the revolutionary field of microbiology has indeed succeeded in breaking the genetic code of the microbes that menace us. But laboratory science has still failed to unlock the secrets of how this mercurial agent evolves and mutates, how it strikes its human prey and when.
This presents a different kind of challenge than those that stem from the Asian landscape. The limits of current science in understanding and disarming the disease are largely independent of the realities on the ground, whether there or elsewhere along the expanding frontier of viral spread.
Nor are scientific constraints the only ones. Both sides of the man-versus-microbes equation pose difficulties. On one side, global efforts to contain flu are hamstrung because WHO and other human health agencies focus on the people afflicted by the disease, at times to the exclusion of the animals that are the source. In addition, money is tight. The resources that frontline states need to identify, contain, and ultimately eradicate the disease among both people and livestock are running short. On the other side of the equation, the essence of the virus itself often eludes disease investigators, whether in the lab or the field.
So on a Friday afternoon in June 2005, WHO’s flu team secretly convened in the agency’s underground command center in Geneva, linked by a dedicated communications network with some of the world’s most elite medical specialists from Atlanta and London to Tokyo, Manila, and Canberra, and prepared to gamble.
Something odd was happening outside of Hanoi. Within a few weeks of one another, three separate clusters of bird flu cases had appeared in a single province southeast of the capital. One of the largest included Tuan and his sister, their grandfather, and a local nurse.
Thai Binh province, where Tuan grew up, is mostly a flat plain of lakes and emerald paddies, part of Vietnam’s rice basket. After Tuan had finished his schooling, he left Thai Binh to look for work in the seaport of Haiphong. Many in the West know Haiphong because of President Richard Nixon’s decision to mine its harbor during the Vietnam War. But today this port city at the mouth of the Red River Delta flourishes as northern Vietnam’s premier industrial center, and there Tuan found a job collecting seaweed for producing agar, a gelatin used in local cuisine.
In early February 2005, all Vietnam took a breather for the Tet holiday. Across the country, Vietnamese bought new clothes, cleaned, repaired, and even repainted their homes, and decorated them with small kumquat trees, pink peach blossoms, and yellow apricot blooms. They stocked up on banh chung, or pork cakes, and on candied fruit and other traditional delicacies. Then they invited the spirits of their ancestors to join them in marking the lunar New Year. Sons and daughters who had moved to the cities crammed trains and buses, streaming home to celebrate this extended festival with their relatives. Tuan joined this mass migration. He headed back to the remote village in Thai Binh he had left more than a year earlier and ambled down the dirt alley to his family home, a one-room brick dwelling with a cement floor built beside a creek. Just outside the front gate, ducks paddled in the murky water as they had since his childhood. On the opposing bank, a verdant field of tobacco stretched into the distance. For the reunion, his family bought a chicken in the local market and butchered it in the yard. Tuan’s fourteen-year-old sister, Nguyen Thi Ngoan, clasped the bird’s wings and legs. Tuan slit its throat. The chicken was likely infected. Soon the siblings were, too.
Tuan broke into a fever about four days later, his wizened father told me over a cup of tea. When I arrived, Nguyen Sy Nham, the family patriarch, was visibly exhausted. For weeks he had been commuting by bus to the Hanoi hospital seventy-five miles away, keeping vigil for hours at a time on a plastic stool at the foot of his son’s cot. Yet Nham offered me a carved wooden chair at his table, turned down the volume on the television, and, between puffs on his traditional dieu bat bowl pipe, softly shared his family’s ordeal.
Tuan’s fever had lasted for about two days and then subsided, his father recounted. Tuan took some aspirin, had a bath, and felt better. But the fever soon returned and spiked at 104 degrees. His head throbbed. His chest ached. He started coughing and had trouble breathing. A village medic was summoned, and Tuan was taken to the local health center, where X-rays showed a white smudge in his left lung. The center’s deputy director suspected it was severe pneumonia. Because bird flu had previously been identified in the area, Tuan was transferred to a larger hospital in the provincial capital after less than a day. There the doctors concluded he had indeed contracted bird flu and immediately rushed him to the tropical disease institute at Bach Mai Hospital.
By the time he made it to Hanoi, the X-rays showed the white smudge had clouded the entire lung. Soon it consumed the other one also. “Just from the morning to the evening and from one day to the next day, it spread very quickly,” recalled Dr. Nguyen Thi Tuong Van, deputy director of the Bach Mai Hospital ICU. The doctors gave him oxygen to ease his breathing, but it continued to grow more labored. After ten days they inserted a tube down Tuan’s throat and hooked him to a mechanical ventilator. The infection marched on, damaging his kidneys and liver. The pain was excruciating. “We thought it was very likely the bird flu would kill him. We were very pessimistic,” Van continued. “Then, when it seemed the situation couldn’t get much worse, it started to get better. Two weeks later, when he didn’t die, I thought maybe we could cure him.”
Tuan’s kid sister, Ngoan, helped care for him during the early days of his sickness. Researchers who later studied the genetic signature of the pathogen concluded that Ngoan may have caught the bug from her brother, noting that some genes in her virus were practically identical to his. By the time I met Ngoan at her home, she was fully recovered. A tall, somewhat gangly teen with a mane of black hair falling to the small of her back, she bubbled over with nervous energy. She told me she loved badminton, chess, and drawing. Her eyes were narrow, but in rascally moments or when feigning surprise, she’d open them wide, big and black. When her father hesitated in retelling the tale, she’d prod him with a playful slap on the leg or she’d interject with details of her own.
Ngoan said she fell ill several days after her brother. “I felt some pain in my legs and some chills,” she recounted. “I started coughing a little.” At the district health center, X-rays revealed her lungs were clear but a subsequent test came back positive for bird flu. She was quickly transferred to the Hanoi hospital, where her fever ascended to searing levels. “I felt so tired because I had so many injections and I couldn’t sleep much,” she recalled. Hospital staff moved her to the same room as her brother and the pair bantered as always to keep up their spirits, until Tuan could no longer speak. Ngoan’s older sister brought her a pad and a pen. Ngoan, who would always draw people when she was feeling down, sketched the doctors and nurses to ease her mind.
After four days, her fever broke. It returned to normal within two weeks. Barely a mo
nth after she got sick, she was back in school as something of a local celebrity.
Though the grandfather also contracted the virus, he objected that he had never felt sick and indeed had shown no symptoms. Vietnamese health officials happened across the old man’s infection while testing all the family members. To flu specialists, this was more evidence that the virus was experimenting with new, deceptive paths of infection. Though the man might not feel sick, he could possibly be contagious and, if so, how would anyone know to steer clear of him?
The nurse was the most disquieting case of all. Nguyen Duc Tinh was a tall, skinny twenty-six-year-old with an earnest manner and a whisper of a mustache. He was on duty at the local health center when Tuan was brought in. During the brief, overnight stay, Tinh took Tuan’s blood and temperature, gave him injections, and helped him walk. Within a week, Tinh had developed severe muscle aches, eye pain, and a high fever, symptoms of what he believed was ordinary flu. But when the fever subsided only to return two days later, he grew alarmed.
“Then I suspected I had bird flu,” he recalled, his brown eyes widening. “I was really, really afraid of dying.” But just two weeks after being reunited with Tuan in the Hanoi hospital, Tinh was discharged. “I had lost hope when the fever came a second time. When I returned to my hometown, I felt as if I were born again.”
Vietnamese officials were loath to admit he might have caught the disease by caring for Tuan. This could be an admission that a more dangerous strain was taking hold. They offered a raft of possible explanations for how Tinh got sick: He had sick chickens in his village. There were sick chickens at his girlfriend’s home. He’d eaten a sick chicken. He had eaten it at his girlfriend’s home.
