February 5, 2003
Pok Fu Lam Garden, Hong Kong, China
357 Infected, 35 Dead
GUAN YI, ONE OF THE VIROLOGISTS WHO LED THE EXPEDITION THAT investigated migratory bird deaths on Ah Chau Island, smoked constantly, sometimes lighting one cigarette from the butt of his last. He frequently switched brands, going from Mild Sevens to Winstons to Pandas and then back again to Japanese cigarettes. Sometimes, when I visited, he would give me a pack of whatever he was smoking. “Take them, try these,” he would say, offering up a Chinese brand I had never heard of. “They’re from Yunnan, but not so bad.” And he would light our cigarettes, and we would smoke and talk about respiratory diseases.
One afternoon, as he was sitting watching his large-screen TV—the news networks at that point seemed to be covering nothing else but the countdown to war—he received a call from one of his colleagues across the border, a doctor at a respiratory disease clinic in Guangdong. There was something very bad going on, this doctor was telling him. They were getting flooded with patients who were presenting symptoms of severe respiratory tract infection, high fever, myalgia, headache.
“We have no idea what this is,” the doctor told him, “but we are frightened. My colleagues have been falling ill. And these patients are dying.”
Guan Yi, who views the whole world as a potential petri dish for influenza, was sure that this had to be some sort of mutant influenza. He ran through the checklist. Winter. Southern China. High threshold of human-animal interaction. “Can you send me samples?” he asked.
Of course not, the doctor replied. That could get him arrested, or worse, for exporting state secrets in the form of respiratory swabs. He could never get his department heads to go along with that.
Guan Yi, who had returned home to eat lunch, finished his last sip of tea, snuffed out his cigarette, and slipped on a beige vinyl windbreaker. He lived on the eleventh floor of an apartment block on Primrose Hill, near the University of Hong Kong microbiogy department at Queen Mary Hospital, just a few miles from Malik Peiris. Unlike Peiris’s complex, which was a more typical expat’s flat—spacious rooms, generous balconies, ample parking—this was a far less capacious accommodation for Guan Yi, his wife, and their son. Their block of flats was typical of the housing developments in which Chinese families tended to live—four apartments to a floor, four rooms in each apartment, each room barely big enough for a single bed. There was a Wellcome supermarket on the ground floor and a 7-Eleven next door.
As soon as he hit the street, he hailed a taxi. Sliding in, he buckled his seat belt, as he always did. (Not a driver himself, he was dubious about the safety of internal-combustion transport.) Arriving back on campus, he walked down to the basement of Queen Mary Hospital’s micobiology unit, where K. Y. Yuen, the head of the University of Hong Kong microbiogy department, was sitting in his makeshift office. (Yuen’s formal office was in the university’s microbiology department, but he found it more convenient to keep a cluttered office here, near the hospital labs and research assistants.)
His slouching posture in a white lab coat over a cardigan sweater belied his role as one of Hong Kong’s most knowledgeable infectious-and respiratory-disease experts. He spoke in a soft voice, almost a mumble, that forced you to lean in to hear him. It seemed he had been having the same informal conversations with colleagues across the border as Guan Yi. “When you have young, immuno-healthy adults dying of pneumonia, you have to worry about what is going on,” he would later tell me. “You have two differential diagnoses: a mutated H5N1 or a mutated H3N2 or H3N1 or an adenovirus.” (He was referring to several types of zoonotic, or species-jumping, influenzas and a common respiratory virus.)
The son of a dental assistant, Yuen had grown up in Hong Kong’s impoverished western district when that area of Hong Kong was even more ragged and squalid than it is today. When he was a boy, he shared a two-room apartment with his parents and three brothers, and they had been among the luckier families. Some families shared their flats with four other families—twenty or thirty people in three or four tiny rooms. Many of these flats lacked running water or electricity, and much of a family’s life—cooking, laundry, bathing—was communal. Diseases had burned through Hong Kong’s poor neighborhoods when Yuen was a boy—the cholera epidemic of 1963, the Chinese flu of 1968—and many of his neighbors had been stricken, and a few had perished, in those outbreaks. Yuen had seen firsthand how a densely populated area could amplify a disease. When he graduated from the University of Hong Kong’s medical school and interned in the United States, at the Fred Hutchinson Cancer Research Center, he decided to dedicate his career to keeping Hong Kong safe from infectious diseases. His fierce commitment to Hong Kong was similar to that of a soldier defending his own village—only, in Yuen’s case, the enemies were microbial rather than martial.
When Yuen heard about the unexplained pneumonia cases across the border, he thought first about the epidemics he had witnessed as a boy. Then he recalled studying the 1894 bubonic plague epidemic, which had reduced Hong Kong’s population by a third. At the time, the Yersinia pestis bacteria, the causative microbe, was unknown, making appearances of bubonic and pneumonic plague seem like mysterious cosmic calamities. “Bubonic plague,” wrote Edward Marriott in The Plague Race, his account of the 1894 outbreak, “exploding out of China, had torn through the island colony and now the houses lay shuttered and boarded-up, the only movement through the narrow alleyways the slow shuffle of soldiers, doctors, scientists.” That global meltdown is today viewed as the start of the Third Plague Pandemic, which would infect much of the old and new worlds, causing a notable outbreak in California in 1900. We are now living through the Fourth Pandemic, which most recently, in 1994, killed hundreds in Surat, India. With the advent of modern antibiotics, if treated early enough, the disease is usually not fatal. But in Hong Kong in 1894, infection by plague was still tantamount to a death sentence, and those who suffered disproportionately were the Chinese underclass. The main hospitals, the European Government Civil Hospital and the Chinese community’s Tung Wah, were quickly filled to capacity. The colonial government pressed into service a battered hulk, the Hygeia, to serve as a floating hospital moored three hundred yards off the Admiralty waterfront. This “hospital,” vowed James Lawson, superintendent of the Government Civil Hospital, would be designated specifically for infected Chinese. The Hygeia, a mastless, dark, slit-windowed vessel drifting ominously offshore, quickly became the object of intense speculation as hundreds of supposedly plague-stricken Chinese were sent to her, never to return. (In one case, a healthy pregnant woman was mistakenly sent to the death ship.) The ship, the Chinese said, was really a laboratory where the most awful experiments were conducted. One popular rumor swirling through the cantons and narrow alleyways was that the English were perfecting a cure for the plague by removing children’s livers and using the restorative powers of these internal organs as a remedy for sick colonials. Chinese parents began withdrawing their children from school before they could be kidnapped by English soldiers for this purpose. Many English could and did flee, as did the Japanese, French, and others of the colonial class. Chinese fled back to China, carrying the disease into the hinterlands. Other Chinese stayed and died by the tens of thousands.
Several of the world’s foremost scientists, notably Japanese bacteriologist Shibasaburo Kitasato and Pasteur Institute–trained French-Swiss scientist Alexandre Yersin, converged on Hong Kong. They engaged in a race to isolate the agent, with Yersin emerging as the more successful microbe hunter after Kitasato hastily published a paper in which he claimed to have found the causative bacteria and that it was not the same as that responsible for bubonic plague. Yersin would not only correctly isolate the bacterium—hence its Latin name of Yersina pestis—but would also be the first to cure a plague victim with serum taken from a convalescent patient.
That had been the first great race for a microbe undertaken in Hong Kong. One hundred years later, K. Y. Yuen worried that perhaps they were on the verge of yet another microbe hunt. Any new agent, he realized, especially a mutated influenza virus, could do similar damage in the crowded, fetid alleyways of Kowloon or in his native western district.
“So what’s going on across the border?” Yuen asked Guan Yi.