Table of Contents:

Foreword

Introduction

I. Storm Gathering

1. 1918

2. Master of Metamorphosis

3. H5N1

4. Playing Chicken

5. Worse Than 1918?

6. When, Not If

II. When Animal Viruses Attack

1. The Third Age

2. Man Made

3. Livestock Revolution

4. Tracing the Flight Path

5. One Flu Over the Chicken's Nest

6. Coming Home to Roost

7. Guarding the Henhouse

III. Pandemic Preparedness

1. Cooping Up Bird Flu

2. Race Against Time

3. Tamiflu

IV. Surviving the Pandemic

1. Don't Wing It

2. Our Health in Our Hands

3. Be Prepared

V. Preventing Future Pandemics

1. Tinderbox

2. Reining in the Pale Horse

Topics

References 1-3,199

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Hong Kong cull

The second human to die in Hong Kong was a 13-year-old girl with a headache. She soon started coughing blood as her lungs began hemorrhaging. The internal bleeding spread to her intestinal tract, and then her kidneys shut down.277 She fought for weeks on a ventilator before she died. “To me,” remarked Webster, “the startling thing about the second case is that there is a second case.” The experts still couldn’t believe that a virus supposed to be “strictly for the birds” was directly attacking human children.278

These initial cases started with typical flu symptoms—fever, headache, malaise, muscle aches, sore throat, cough, and a runny nose. They weren’t dying of a superimposed bacterial pneumonia, as one tends to see in seasonal influenza deaths of the elderly and infirm. H5N1 seemed to have gotten the immune system to do the dirty work.

Autopsies were performed on two of the first six victims, the 13-year-old girl in Hong Kong and a 25-year-old Filipino woman. Both died of multiple organ failure. Their lungs were filled with blood, their livers and kidneys clogged with dead tissue, and their brains swollen with fluid.279

In both cases, cytokine levels were found to be elevated. The virus evidently had tricked the body into unleashing cytokine storms, burning their livers, kidneys, and lungs in their immune systems’ not-so-friendly fire. Interestingly, viral cultures taken at autopsy from all their organs came up negative. It seems that in their bodies’ brutal counter-attack, their immune systems were able to triumph in a way and kill off the virus. Of course, in burning down the village in order to save it, the patients were killed off as well.280

Most of the 1997 victims had either bought chickens (or, in one case, chicken feet) or had shopped next door to a chicken merchant.281 Lam Hoi-ka may have been infected by baby birds in his preschool’s “feathered pet corner.”282 The strongest risk factor to shake out of the subsequent investigations was “either direct or indirect contact with commercial poultry.”283

Human-to-human transmission remained very limited. An infected banker, for example, didn’t pass the virus on to coworkers, but when a two-year-old boy had “played with and been hugged and kissed by his symptomatic 5-year old female cousin,” he joined her in the hospital three days later.284 Thankfully, they both recovered. The virus seemed only to be spread by close, rather than casual, contact. One of Lam Hoi-ka’s doctors came up positive for the virus, for example, but it is believed she had come in contact with his tears.285 The virus was still learning, but the scientific community was bent on putting an end to its education.

Realizing the disease was coming from chickens, leading scientists called for every chicken in the entire territory to be killed at once to stop any and all new human cases. “The infection was obviously tearing away at the inside of the birds,” Shortridge realized. “My reaction was: ‘This virus must not escape from Hong Kong.’”286 Biologically the plan made sense, but politically it was a tough sell. “It was absolutely terrifying.” Shortridge remembers. “You could feel the weight of the world pressing down on you.”287

The weight of world opinion may indeed have been what finally led to the government’s concession. Hong Kong had just been reunified with China, and with eyes focused on the fledgling power, it could not afford to be perceived as endangering the rest of the world.288 Amid mounting panic, Margaret F. C. Chan, who would go on to lead the investigation into SARS and become the World Health Organization’s influenza chief, ordered death sentences for more than a million birds.289

For four days, hundreds of Hong Kong’s government employees—many of them desk workers—engaged in the slaughter.290 Scuffles broke out with chicken vendors. Buddhist monks held a seven-day prayer chant for the souls of the birds.291

Overnight, new human infections ceased. The last human case in the 1997 Hong Kong outbreak was recognized the day before the slaughter commenced.292 In all, only 18 people got sick and only 6 people died. “I remember it as the most satisfying investigation of my life,” Fukuda said.293