The Triangle of Doom - The Monster at Our Door: The Global Threat of Avian Flu - page 36

northern Georgia, for example, more than 1 billion chickens are slaughtered annually. Similarly, the rais-
ing of swine is increasingly centralized in huge operations, often adjacent to poultry farms and migratory
bird habitats. The superurbanization of the human population, in other words, has been paralleled by an
equally dense urbanization of its meat supply. (One swine megafarm in Milford Valley, Utah, reputedly
produces more sewage than the city of Los Angeles.) Might not one of these artificial Guangdongs be a
pandemic crucible as well? Could production density become a synonym for viral density?
The answer to these questions was revealed in March of 2003. While scientists were desperately trying
to figure out the identity of an atypical pneumonia in China, chickens were dying on a farm in the Gelder
Valley (Gelderland) of Holland. The Netherlands is the world's leading exporter of eggs and live chick-
ens, as well as a major producer of turkeys and geese; the hundreds of chicken farms in the Gelderland are
at the center of the highly rationalized, $2 billion-per-year Dutch poultry industry. Many of the farms also
keep pet flocks of ducks and swans. 140 With its intimate juxtaposition of wetlands, wild birds, poultry,
and high urban density, as well as its hub-like role in the European Union's global commerce, the Nether-
lands recapitulates many of the distinctive features of the Pearl River Delta; the March epidemic, in fact,
was later traced back to a farm whose free-range chickens were in contact with wild waterfowl in an ad-
jacent canal.
Although vigilant Dutch agricultural authorities quickly quarantined the movement of chickens and
temporarily halted poultry exports, the Highly Pathogenic Avian Influenza (HPAI) swept like wildfire
through the Gelderland. The virus was identified as an H7N7 strain more or less identical to a strain isol-
ated in mallards several years earlier. 141 By April, turkeys were dying in North Brabant, and the first HPAI
cases were reported in Meeuwen-Gruitrode in neighboring Belgium. Even more disturbingly, evidence of
the infection was discovered in pigs on several farms in the Gelderland, increasing the dangerous likeli-
hood of H7N7's reassortment with swine and human influenzas. (The pigs were promptly slaughtered.)
As European Union agricultural experts fretted over the potential for a pan-European epidemic, the Dutch
government came under immense domestic and foreign pressure to act more aggressively. The Hague de-
cided to exterminate all the poultry in the Gelderland and other infected areas and to dispose of thousands
of tons of virus-laden chicken manure. As thousands of unhappy farmers clamored in protest, crews of
poultry workers, aided by the Dutch army, began the epic slaughter of more than 30 million chickens, al-
most one-third of Holland's entire poultry population. 142
Although HPAI was an enormous threat to the poultry industry, there was little apprehension of any
public-health danger. A few years earlier, there had been a serious H7N7 outbreak among chickens in
Italy, but serological analysis found no evidence of any transmission to humans. Moreover, all the per-
sonnel involved in the Dutch cull wore protective clothing, including goggles and mouth-and-nose masks.
Even when a veterinarian who been involved in the early identification of the outbreak developed acute
conjunctivitis, experts expressed surprise but not alarm: in 1996, an English duck owner had developed
mild conjunctivitis after contact with a sick bird and there was an extraordinary case where an avian H7
had been transmitted to a human from a sick seal, but did not cause serious illness; H7N7 was also known
to be endemic in horses. The virus's modest talent for crossing species barriers had never been accom-
panied by corresponding virulence—on rare occasions the virus apparently could inflame cells around the
eye but it had shown no ability to replicate in the human respiratory tract or other tissues. 143
This benign view of H7N7, however, was quickly challenged by a chorus of complaints from poultry
workers with conjunctivitis, and in a few cases, reports of classical flu symptoms. Because some immig-
rant workers, now unemployed after the cull, had already returned to their native countries, there was
concern that they might seed new outbreaks. The prestigious Dutch National Institute of Public Health
and the Environment quickly dispatched an expert investigation team, under the leadership of Dr. Marion
Koopmans, to the Gelderland. A medical command center was established, and from 8 March nurses vis-