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 person 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
