Pandemic Surprise - The Monster at Our Door: The Global Threat of Avian Flu - page 30

The first Metropole case to attract WHO attention was a Chinese-American businessman who became
desperately ill in Hanoi. Local hospital staff, petrified by the possibility that it was a case of avian flu,
asked the local WHO representative, Dr. Carlo Urbani, to oversee the patient. The Italian doctor aler-
ted the WHO Regional Office for the Western Pacific on 28 February that the mystery disease was now
a traveler, and there were soon outbreaks in several other countries. On 1 March, with several patients
already hospitalized in Hong Kong, a female flight attendant (the first of several Metropole victims) was
admitted to a Singapore hospital with acute respiratory distress. A few days later, an elderly Canadian
who had stayed in the Metropole died in Toronto, and five members of her family were soon hospitalized.
Meanwhile, in a pattern that confirmed rumors from Guangdong, hospital workers who had been exposed
to the Metropole patients in Hong Kong and Hanoi developed symptoms; the French Hospital in Hanoi
was forced to close. Next, the Chinese-American businessman died, followed by the son of the elderly
Toronto woman. By mid-March, scores of medical personnel in Hanoi and Hong Kong were in intensive
care, and Ontario officials had to seal off Scarborough Grace Hospital. Dr. Urbani developed the disease
and was evacuated from Hanoi to a hospital in Thailand, where he died on 29 March. By this time, some
frightened hospital staff in China, Canada, and Vietnam refused to treat patients diagnosed with the enig-
matic, deadly illness.
Was it avian influenza? The pathogen was still unidentified on 15 March when the WHO labeled the
disease after its symptoms: Severe Acute Respiratory Syndrome or SARS. On that same day, a young
Singaporean physician, returning from a medical conference in New York, was hospitalized during a stop-
over in Frankfurt along with his pregnant wife and mother-in-law. The doctor had treated the steward-
ess in Singapore: another superspreader, she would ultimately be the source of almost one hundred other
cases. Although WHO finally issued a warning to the airline industry, it came too late to prevent other
infected passengers from subsequently carrying SARS to Beijing and Taiwan. At the end of March, both
Hong Kong and Toronto authorities were pressed to take more drastic action. Hong Kong officials closed
schools and put more than 1,080 residents under quarantine, while in Toronto, another hospital was closed
off and thousands of hospital workers and others in contact with SARS cases were asked to quarantine
themselves at home.
In Hong Kong the epidemic assumed nightmarish proportions in the Amoy Gardens housing complex
in Kowloon. Tower Block E was thirty-three stories high with eight apartments on each floor; the virus
was first brought to the building in mid-March by a resident's brother, who had recently undergone dia-
lysis at the SARS-infected Prince of Wales Hospital. He was suffering badly from diarrhea and used his
brother's toilet. Within a few days, an extraordinary 321 residents of Block E and adjoining buildings de-
veloped SARS. The mode of transmission remains a mystery. Although some experts insist that the conta-
gion had to be airborne (perhaps as residents shared elevators), Department of Health officials concluded
that SARS was disseminated, at least in part, through faulty plumbing that brought residents “into contact
with small droplets containing viruses from the contaminated sewage.” The Amoy Gardens incident was
particularly troubling because it demonstrated that in conditions of extreme urban density—such as those
found in high-rise housing, hospitals, and slums—viral transmission might be potently amplified by faulty
ventilation and sewage systems, or, worse, by those systems' absence. 118
Meanwhile, SARS had become a test of China's international credibility, with Health Minister Zhang
Wenkang continuing to antagonize the world public-health community with his perfunctory and reliably
inaccurate reports on the epidemic. Since early February, WHO experts had urgently wanted to visit
Guangdong to investigate conditions there, but the Health Ministry obstructed the mission until the begin-
ning of April—by then, SARS has set Beijing ablaze as well. China's “official secrets” law had prevented
Guangdong officials from briefing other local health authorities about the disease, so when the first cases
appeared in Beijing in early March, local doctors were clueless. When the WHO team flew to Beijing,