February 10, 2003
World Health Organization Headquarters, Dongzhimenwai, Beijing, China
393 Infected, 40 Dead
“WE TRY TO TAKE SERIOUSLY EVERY REPORT OF AN OUTBREAK,” DR. Henk Bekedam, the head of the World Health Organization mission in Beijing, would tell me later. “But this is China. Do you know how many rumors you hear of influenza or plague or even anthrax? In a country this big, there is no way to follow up on each individual piece of gossip.”
Perhaps the main task of the World Health Organization’s Global Outbreak Alert and Response Network (GOARN), based in Geneva, was to sort through the dozen or so credible rumors received every day. Each morning at 9:00 A.M., WHO epidemiologists Mike Ryan and Tim Gruen would go through and discard most of them, forwarding a few to the appropriate officials. On February 5, they forwarded a report on the outbreak of possible avian flu in Guangdong to Klaus Stöhr, the head of the WHO Global Influenza Surveillance Network. The report came in the form of an e-mail from the son of a former WHO staffer who was currently teaching English in Guangdong. The young man reported that there was some sort of new disease in Guangdong and that folks down there seemed “pretty spooked.” What concerned WHO officials was that this report seemed to concur with speculation that some sort of influenza outbreak was afoot. Still, the officials could confer only through back channels with their Chinese counterparts.
By Monday, February 10, a report had hit ProMed, the Harvard-based infectious disease surveillance website dedicated to tracking potential outbreaks and read by health care specialists and public health officials around the world. “Have you heard of an epidemic in Guangdong?” asked an e-mail sent in by Dr. Stephen O. Cunnion, a retired captain in the U.S. Navy Medical Corps. He forwarded a note passed along to him by a colleague. It read, “An acquaintance of mine…reports that the hospitals [in Guangdong] have been closed and people are dying.”
ProMed tends to deal in frightening and very real disease outbreaks. Swine fever, classical (Brazil), hantavirus pulmonary syndrome (USA), anthrax, human and livestock (China)—these are typical headings in the daily ProMed digest. A posting there meant that doctors, scientists, nurses, and journalists from Harvard to Hong Kong were turning their attention to Guangdong. For the WHO’s Hitoshi Oshitani, based in the group’s western Pacific regional office in Manila, the posting meant a flood of inquiries. As the head of Communicable Disease Surveillance and Response throughout Asia, he knew that if this was coming from Guangdong, then the greatest likelihood was influenza.
“What’s going on?” he asked Alan Schnur, the country coordinator for the Communicable Disease Surveillance and Response Department and effectively the second in command of the WHO’s China mission. “We should get a team down there.”
Schnur, always cautious by nature, advised that they wait for the Chinese government to respond and provide more information. Later that day, WHO officials in Beijing would have even more reason to be alarmed. A posting to the Chinese website Boxon.com read, “non-official sources have confirmed the panic in Guangdong province. In the last two weeks, hundreds of people in Guangzhou and Zhongshan have been infected by strange decease [sic].” A doctor from Renai Hospital, in Guangzhou, reported on the website that according to a confidential Public Security Bureau fax, “280 people have died…the disease has been confirmed to be very infectious, many doctors are affected.”
That same day, Hitoshi Oshitani in Manila received an e-mail from a parasitologist named Carlo Urbani, based in Hanoi, Vietnam. He said he had heard from the French embassy in Hanoi that they had had reports from their consulate in Guangzhou that there was an outbreak of a severe respiratory ailment and that many had already died. “Everyone suspected influenza,” Oshitani would tell me later. “I thought immediately that this was a new influenza.” If this was influenza, then the fact that there were already hundreds of cases being reported and hospitals closing down was alarming. A standard A-type influenza would not ravage Chinese hospitals, certainly not in Guangdong, one of the most sophisticated provinces in China. Oshitani had visited those hospitals, and he knew the doctors. They were very good, perhaps among the most experienced in the world at dealing with respiratory ailments. If this really was influenza and it was burning through hospital wards, then it had to be avian flu. He knew about the H5N1 outbreaks in Penfold Park, in Hong Kong, and about Malik Peiris’s and Guan Yi’s investigations into that outbreak. What if this were a shape-shifted avian influenza subtype that had achieved efficient human-to-human transmission? That would mean that he was now receiving reports of the front end of a global pandemic that could…
The first journalist to call Hitoshi Oshitani was Mary Anne Benitez of the South China Morning Post. “What is it?” she asked.
“Whatever it is,” Oshitani could only reply, “it’s bad news.”