March 13, 2003
Pok Fu Lam, Hong Kong, China
1,144 Infected, 127 Dead
MALIK PEIRIS COULD HEAR HIS SON’S XBOX FROM WHERE HE SAT IN the living room. He still had an old turntable on which he could play vinyl albums to drown out the bleeps and bursts of the video game, but he hadn’t been in the mood for music in what seemed like months. His schedule had become a blur of lab work punctuated by teleconferences and the briefest snatches of sleep. Despite repeated attempts to culture something from his samples, he had failed, and was now finding himself despondent and, for the first time, questioning his own abilities as a virologist. They had gone through the forty-eight samples Guan Yi had brought down from Guangdong, and had yet to come up with a causative agent.
What was it they weren’t seeing? Peiris agreed with his colleagues on the WHO Laboratory Network that this was not influenza, but that was a little like saying a person wasn’t Bolivian. There were still tens of thousands of possible viral agents, and that was only if you were counting those species already familiar to man. Ecologists estimate that there are about thirty million different species of animals on earth. If you assume that each is host to at least one species of virus (and probably dozens), that makes at least thirty million species of virus, any one of which could conceivably find a route by which to infect humans. Of the 4,000 identified species of virus, about 150 were known to infect humans, and it was those on which the WHO Laboratory Network was now concentrating.
Peiris stood up, slipped his loafers on, and walked out the door. He was so distracted he forgot to say good-bye to his wife. Downstairs, he started up his BMW and paused for a moment to let a slightly queasy feeling pass over him. He had been feverish for a few days already and was now regretting not having gotten a flu shot. It was hypocritical of him to urge the shots upon his family and friends while he himself, who worked in a laboratory crawling with influenza, couldn’t be bothered to walk down the hall and roll up his sleeve. Now, perhaps, it was too late.
When he arrived at work, he stopped in to see K. H. Chan, his laboratory partner and fellow University of Hong Kong microbiologist. They talked about the new samples that had arrived, both picked up as part of the Heightened Pneumonia Surveillance Network. Chan was reluctant to continue employing the same cell lines; those had so far proved fruitless, and he wondered about the possibility of testing with others.
“What else do we have?” Peiris asked.
Chan mentioned a kidney cell line from fetal rhesus monkeys, most commonly used for hepatitis A tests. (Because of the large amount of shellfish consumed there, Hong Kong has frequent hepatitis outbreaks.) Malik knew this was an unlikely cell line in which to grow a respiratory virus and said he would think about it.
When he arrived in his office and took his seat behind his desk, he received a call from K. Y. Yuen, from the University of Hong Kong’s microbiology department.
“Let’s try some new cell lines,” Yuen suggested.
They had a tremendous advantage over virtually every other lab in the network because of the samples Guan Yi had smuggled down. For political and legal reasons, they could not publicly say that they had these samples, nor could they explain why they had decided to use new cell lines. But at the same time as other labs in the world were getting their first batches of samples, the University of Hong Kong team was already working on their fiftieth attempt at isolating the virus.
Peiris agreed that it was time to try some new cell lines. Dominic Tsang, an epidemiologist at Queen Mary Hospital, who was well connected with Wilson Yee, a physician at Kwong Wah Hospital, had written to Peiris a few days earlier telling him, “Dr. Yee is seriously considering the option of an open-lung biopsy to obtain tissue for our investigation. Pending patient’s family’s consent, such procedure would proceed and lung tissue would be delivered to your laboratories for processing.” Peiris and his colleagues had just received these fresh samples from Kwong Wah Hospital. The patient was the brother-in-law of the late Dr. Liu Jianlun, the nephrologist who had come down from China and checked in to Hong Kong’s Metropole Hotel. The brother-in-law had also passed away from the disease; the virus had to be there.
Guan Yi was back in Guangdong, working with Zhong Nanshan on setting up a virology lab in the Guangzhou Institute of Respiratory Diseases. Peiris didn’t bother to tell Guan Yi about these new samples, or the decision to introduce them to new cell lines. After all, Peiris was the chief of human research in the Pandemic Preparedness group, while Guan Yi ran the animal side. At this point, Peiris felt, the disease was a matter for his lab and not Guan Yi’s.