Pandemic Surprise - The Monster at Our Door: The Global Threat of Avian Flu - page 29

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Pandemic Surprise
Humankind has had a lucky escape. 114
Robin Weiss and Angela McLean
Shortly before the isolation of the new avian-to-human H5N1 in Hong Kong in 2003, the WHO office in
Beijing received an email warning that a “strange contagious disease” had killed more than one hundred
people in Guangdong in a single week. Medical workers and foodhandlers were said to be especially af-
fected. In the provincial capital of Guangzhou (Canton), panicked residents were buying up surgical masks
and antibiotics as well as white vinegar, a traditional folk treatment for respiratory illness. Over the next
few days, Chinese public-health officials grudgingly acknowledged that five people had died from “atypic-
al pneumonia”; the outbreak had started in Foshan the previous November, had infected about 300 people,
but was now “under control.” The Chinese were admitting, in effect, that they had concealed the epidemic
from the WHO, but were now urging the world “not to worry”—they emphasized that the victims had all
tested negative for influenza. But provincial and national authorities gave conflicting accounts of the likely
pathogen: Guangdong blamed the bacterium Mycoplasma pneumoniae, while Beijing insisted that it was
actually Chlamydia. To further erode credibility, “a spokesman for the Guangdong health department told
reporters that all further information would be disseminated by the party propaganda unit.” 115 Although
these prohibitions did not stop the Internet from gushing rumors, authorities also threatened that “any phys-
ician or journalist who reported on the disease would risk being persecuted for leaking state secrets.” 116
Veteran influenza researchers were highly skeptical of the official Chinese account. With avian influ-
enza again killing birds in Hong Kong, it was logical to suspect that the mysterious pneumonia was, in fact,
the beginning of the long-dreaded pandemic. The reports from Guangdong, moreover, were soon followed
by the identification of the two, possibly three, human H5N1 cases: could this be just a coincidence? Cir-
cumstantial evidence supported the worst-case scenario. It also followed that if the disease were in Hong
Kong, south China's portal to the world, the virus might escape on the first available plane.
As investigators later reconstructed the itinerary, this is exactly what happened in the third week of
February. A doctor from Guangzhou who had been attending victims of the pneumonia, arrived in Hong
Kong on 21 February for a family wedding. Already ill, he checked into a room on the ninth floor of the
Metropole Hotel, where by some unidentified mechanism, he managed to transmit his virus to sixteen oth-
er guests on the same floor—in the parlance of epidemiology, the doctor was a “superspreader.” As the
infected hotel guests, including airline crew members, traveled onward to other destinations, they quickly
transformed the Guangdong outbreak into an embryonic global pandemic. The CDC would later construct
a flowchart of cases that originated from the Metropole Hotel: 195 in Hong Kong, 71 in Singapore, 58 in
Vietnam, 29 in Canada, and 1 each in Ireland and the United States. As WHO Global Outbreak Alert and
Response scientists later marveled, “A global outbreak was thus seeded from a single person on a single
day on a single floor of a Hong Kong hotel.” 117