beavers, hog and ferret badgers, muntjacs, raccoon dogs, and domestic cats.
Back at the university lab, he quickly found the evidence he was looking for. He isolated the SARS
Based on Guan’s research, WHO urged China to close them down. This time, at least for a while, China listened. New infections ceased.
On July 5, 2003, the world officially defeated what Shigeru Omi, WHO’s regional director for East Asia, later called “the first emerging disease of the age of globalization.” The agency reported that the SARS epidemic was over. The last chain of transmission had been severed in Taiwan, with no new cases detected there since mid-June. The global death toll had been kept below eight hundred.
This epidemic had been contained, first and foremost, through the successful isolation of those infected. Some countries, like Vietnam and Singapore, had tackled it more aggressively than others, adopting measures like temperature screening for airplane passengers and hospital visitors, isolation rooms at airports, designated wards for suspected cases, and rapid tracing of those who’d been exposed. But in the end, the key everywhere was preempting the virus before it could infect again.
Had the pathogen been a novel strain of flu, the strategy would have failed.
Pandemic would have followed, potentially with millions of deaths, and not because of any human miscue. The difference is wired into the biology of these two viruses.
On many scores, there is an uncanny resemblance between influenza and SARS. They are both cruel respiratory afflictions that originate in animals and cross to the humans who prey on them. Like SARS, flu has often if not always emerged out of southern China, where live markets have proven central in amplifying and spreading the disease. Yet flu is far more sinister.
Flu, for starters, is a more nimble virus that spreads with an ease unmatched by other respiratory diseases. “Flu replicates far more efficiently in humans than SARS,” Guan reminded me. “After adapting to humans, SARS can spread quite quickly. But if compared to flu, it is still quite slow.”
In analyzing outbreaks, researchers focus on what they call the basic reproductive number. That figure represents how many other people are typically infected by each sick person. Obviously, the higher the number, the more infectious the disease. An early study of SARS concluded that its reproductive number was lower than that for other respiratory viruses. Researchers said this accounted for why SARS could be contained. Later research compared SARS and flu and found that the transmissibility of flu, as represented by its reproductive number, might be three times greater or more.
SARS was also a soft target because its victims became contagious only after developing a fever and other symptoms. An analysis of SARS patients in Hong Kong found the amount of virus in their nose and throat remained low for the first five days after they started feeling sick, only peaking on the tenth day. When researchers looked at the actual pattern of cases, they reached a similar conclusion that people were rarely contagious in the first few days after they came down with symptoms. Typically it took almost a week or more. For public health authorities, this pattern was a blessing. It gave them ample chance to identify and isolate victims before they disseminated the virus further.
“It is difficult to escape the conclusion that the world was very lucky this time,” wrote a team of researchers from Britain and Hong Kong, adding that an anticipated flu pandemic by contrast could have a “devastating impact.”
With flu, people may be contagious even before they develop symptoms. One analysis estimated that between 30 and 50 percent of those infected with a novel flu strain would catch it from someone who wasn’t yet ostensibly sick. The true figures will depend on the specifics of the strain. But still, in a brewing flu epidemic, there may be no sure-fire way to determine who is contagious and isolate them. Even those infected might be ignorant of their fateful role in spreading the plague until it’s too late.
“Once adapted to human-to-human transmission, influenza is highly transmissible, both in the late incubation period as well as early in the disease. Therefore, its spread may not be amenable to interruption with the same public health measures used to contain SARS,” wrote Peiris and Guan in the cautious language of scholarly publication.
In person, Guan was more succinct: “From a single spark, you can burn up the world.”
I visited Guan several times in the years after SARS. When I last met him at his university office, he was agitated as usual. It was flu, not SARS, that was keeping him up late at night.
“I can see what many people cannot see,” he told me. He had always been a bit of a Jeremiah. “For me as a scientist, my record and reputation are fully acceptable to the scientific community. So why do I keep working so hard?”
He paused and reached across the table to pour me a cup of traditional Oolong tea from a white ceramic pot.
He resumed. “The flu virus is not easy to track down. I am building up information so I can know where and how a pandemic might happen. I want to tell the world we can create a different future.” He was on his pulpit, urging humanity to prepare for the inevitable mutation of the virus and adopt economic and political reforms that would stem its spread. These should include restructuring farms, markets, and trade and improving how disease is monitored. Most important, he preached, was candor in disclosing outbreaks when they occur. “If not, who will be the losers? The whole globe.”
Guan shifted on the edge of his chair and told me he envied Al Gore. As a former U.S. vice president, Gore could find the financing to make his film
“We are all sitting at the same table,” he continued. “We share the same benefits, share the tea. Globalization is good for promoting civilization. But if you’re part of globalization, you need to take responsibility. If not, it will damage not only one country but many, many countries.”
Guan himself had come to epitomize the age of globalization. From Jiangxi, where he grew up reading in the courtyard with chickens for companions, this country boy had worked his way to Tennessee to study with the dean of all influenza researchers and then found a perch at Hong Kong’s most exclusive university. There, he was quickly promoted to professor, awarded his own laboratory, and installed in a corner office on the fifth floor of the Faculty of Medicine with a spectacular hillside view of the western approaches to Victoria Harbor and Lantau Island beyond. When he breaks for a cigarette, he stares out the floor-to-ceiling picture windows, watching the procession of freighters and the setting sun burning into the mist. He travels the world, lecturing and consulting. Shortly before my last visit to see him, he had flown to my home city of Washington for a meeting with U.S. health officials, sending me a message by BlackBerry when his airplane landed but departing again before we could meet. Just three days after he’d set out from Hong Kong, he was home again. “Fifty hours in transit,” he told me afterward, somewhat bemused. The pace had left him little time for Jiangxi. Though he sent money home to support his brothers and sisters, he could only spare five days a year for his aging, melancholy mother. “I’m so sorry, mother,” he told her. “For 360 days a year I belong to the world.”
This globalized age offers untold firepower for fighting disease. It was via the Internet, for example, that some of the earliest rumors about SARS in southern China found their way to WHO, and the intense scrutiny of global media made it untenable for Beijing to keep the secret indefinitely. The agency’s virtual lab network wired together the world’s leading scientists as never before. Public health officials, even in poor, far-flung corners of the world like Mongolia and Vietnam, were quick to learn how to recognize, treat, and contain the disease with guidance from foreign reinforcements.
Yet for all the advances of this era, someone still has to grab the bird and swab its underside. There is no substitute for the grunt work of influenza field research.
Guan had continued to expand the sampling program that he launched with the lab at Shantou University Medical College. By 2005 he had about eighty people working for him, quietly collecting specimens every week from poultry and wild birds in seven provinces of southern China and Hong Kong. He had tapped into an old-boy network that dated as far back as Jiangxi, locally recruiting what he called his band of heroes. “They’re very brave,” he said.
