should have embarked on this task without any accurate estimate of its scale or duration,” the newspaper editorialized. “Equally astonishing is that it should have bungled matters so badly as to raise the possibility that other animals may have become infected.”
Yet even as the
Chan had accurately identified the source of the crisis. But had she found the solution?
Reporters asked Chan shortly after she announced the slaughter how she would know if it was a success. Chan told them it would have to put a complete stop to human cases. The normal incubation period for flu was a week. To be confident, Hong Kong would wait twice as long. If there were no more cases by the end of the second week of January, she would declare victory.
Just two days into the waiting period, Chan received a report of a new case, a three-year-old boy. “Son of a gun,” she thought. “What is going on?” Chan was scared. But when she reviewed the boy’s history with her staff, they concluded he had likely been infected just before the mass cull began. For two weeks the newspapers counted down the days and the population held its breath. On the final day, two new cases were announced. But these victims, too, had fallen ill before the slaughter.
There were to be no more. The final count stood at eighteen. Of those, six had died. Hong Kong would be the source of no new human infections, not that year and not for the next decade. The city had banished a killer.
Researchers later concluded a pandemic had been averted. This took an unprecedented effort that marshaled some of the world’s leading disease specialists and courageous investigators. It required exhausting lab work in Hong Kong and Atlanta, tapping some of the most sophisticated techniques then available to medical science.
Yet that alone was not enough. Hong Kong had aggressively pursued the pathogen from the instant city health officials learned of it. They took radical action to eradicate the virus though it was a gamble that carried a huge economic cost. The government acted with openness, even when hammered with criticism. As a result, humanity’s first brush with this novel strain would be its most successful. Over the following years, no other government would match this achievement, and the standard set by Chan and her colleagues would too often be honored in the breach.
Hong Kong’s success also lay partly in its nature, rare in Asia. As a small, mostly urban outpost, there were few agricultural interests to contest the imperatives of public health. Nor did most residents of Hong Kong live among livestock. Their main exposure to the virus, researchers later concluded, was at live markets. And though an age-old preference for fresh meat made these markets an integral part of Cantonese culture, the government overcame the inertia of tradition by restructuring them. When they reopened, Hong Kong barred the sale of live ducks and geese, believed to be the original source of the infection in chickens. Live chicken sales resumed, but all imported birds were screened for the virus before entering the markets.
But the virus would prove implacable. Even in Hong Kong, it would resurface in 2001, killing chickens in market after market. As a pre emptive strike, the government ordered a second mass slaughter of all poultry in the markets and imposed a mandatory rest day each month when they would be emptied, unsold poultry killed, and the stalls cleaned before restocking with new flocks. Undeterred, the virus struck yet again the following year. But over that period, it never again jumped to people.
Fukuda eventually would go on to become WHO’s global influenza chief. Yet he always remembered the Hong Kong investigation as the most rewarding in his life. He lauded Chan’s leadership as heroic. He had no way of knowing that nearly a decade later he would be reunited with her in fighting the virus as it spread to much more difficult terrain far beyond the horizon.
CHAPTER THREE
The Elephant and the Lotus Leaf
The operation, as Dr. Prasert Thongcharoen called his lonely campaign against a killer, started on a hungry stomach. After seventy years of life, he had developed an abiding fondness for farm-fresh eggs and looked forward to those occasions every few weeks when a pair of young friends would present him with dozens of the finest from their family homestead outside of Bangkok. So when they returned to the Thai capital empty-handed one warm December day in 2003, Prasert was disappointed. He also suspected something was terribly amiss.
A distinguished man with silver-and-black hair combed back off a high forehead and eyes keen behind thick aviator glasses, Prasert had accumulated countless honors and accolades during his pioneering career. He had been dean of the medical school at Bangkok’s Mahidol University, chief editor of the Thailand Medical Association’s journal, and a fellow of the Thai Royal Institute. He had also earned a reputation as something of a gourmet. He often cooked for the staff at Siriraj Hospital, where he continued to do research as an emeritus professor, preparing chicken-leg curry and other favorites in the small departmental kitchen. He experimented at home with new recipes, trying them out on his children. He was so passionate about fresh food that he once flew home from Hong Kong with a newly butchered goose in his hand luggage.
The doctor was partial to eggs sunny-side up for his breakfast and had been expecting a fresh batch as usual. Two of his longtime friends, the chief reporter at one of Thailand’s leading newspapers and his wife, had taken advantage of a national holiday marking the birthday of Thailand’s revered monarch, King Bhumibol Adulyadej, to escape Bangkok’s suffocating traffic and hectic pace. They had decamped to their farm about fifty miles to the east amid the mango orchards of Chachoengsao province. After a brief vacation, the couple returned to the capital and came to Prasert with apologies. “What happened?” he asked. The response astonished him: “There are no chickens, so there are no eggs. The farm is usually full of chickens. But the chickens all died. We don’t know why.”
The couple traditionally visited their farm twice a month and for years had been furnishing Prasert with six or seven dozen eggs on their return. This time they brought him only a riddle. It was a grim and disquieting puzzle that would become the focus of a personal crusade. Almost alone, he would press his kingdom’s leaders to admit that a plague was raging in the Thai countryside and threatening to leap beyond the borders. “I had no eggs to eat,” he later told me. “And so the operation began.”
Six years had passed since the novel strain of flu had crossed to people in Hong Kong in 1997, and the virus had been nearly invisible since then. In the interim, the only confirmed human cases in the world had come several months earlier in a Chinese family. At this moment in late 2003, though Asia was on the brink of an unprecedented outbreak in both birds and people, flu was on few minds. The virus, it seemed, had vanished, lulling much of the world into a naive confidence that the pandemic threat had passed.
This would become the pattern. Over the next few years, the H5N1 strain would repeatedly raise its head, surfacing in ever more countries and provoking grave public health warnings anew. Yet each time, the virus would stop short of epidemic and then retreat. Politicians would boast they’d cornered the bug. Media attention would fade. Much of the public would forget.
In 1997, H5N1 had been but one hurdle shy of pandemic, yet that recognition vanished in the silence that followed the Hong Kong outbreak. The virus was a subtype against which no one was immune. It had demonstrated it could infect people. Only the last of the three conditions for pandemic had remained unfulfilled: that the disease could be relayed along a human chain.
It would fall to Prasert to prove that once again, a novel strain was circulating across the landscape of East Asia. Soon after, he would also reveal that the virus had begun to strike his countrymen. And eventually, as the world watched anxiously to learn whether the virus could be passed from one person to another, Prasert would play a central role in confirming it could. Although Prasert held the title of WHO consultant, he waged this campaign mostly by himself. For while WHO’s flu specialists back in Geneva also suspected something was not right, they had
