The Fatal Strain

by Alan Sipress

  115 the Spanish flu’s victims: David M. Morens, Jeffrey K. Taubenberger, and Anthony S. Fauci, “Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness,” Journal of Infectious Diseases 198, no. 7 (Oct. 1, 2008): 962-70; Jonathan A. McCullers, “Planning for an Influenza Pandemic: Thinking Beyond the Virus,” Journal of Infectious Diseases 198, no. 7 (Oct. 1, 2008): 945-47; and John F. Brundage and G. Dennis Shanks, “Deaths from Bacterial Pneumonia During 1918-1919 Influenza Pandemic,” Emerging Infectious Diseases 14, no. 8 (Aug. 2008): 1193-99.

  115 80 percent of all prescription drugs: Michael T. Osterholm, “Unprepared for a Pandemic,” Foreign Affairs, Mar.-Apr. 2007.

  115 “interconnectedness of the global economy”: Ibid.

  116 would run short on everything: Michael T. Osterholm, “Preparing for the Next Pandemic,” Foreign Affairs, July-Aug. 2005.

  116 an unpublicized conference call: Personal notes of conference call, Jan. 15, 2004.

  116 an article for Science: Richard J. Webby and Robert G. Webster, “Are We Ready for Pandemic Influenza?” Science 302, no. 5650 (Nov. 28, 2003): 1519-22. Webster also raised concerns in 2003 in Robert G. Webster and Elizabeth Jane Walker, “Influenza,” American Scientist 91, no. 2 (Mar.-Apr. 2003): 122.

  116 “Klaus was very excited”: Interview with Dick Thompson.

  117 “Hitoshi suddenly came alive again”: Interview with Peter Cordingley.

  118 The cases continued to come: WHO: “Preliminary Clinical and Epidemiological Description of Influenza A (H5N1) in Vietnam,” Feb. 12, 2004; Tran Tinh Hien et al., “Avian Influenza A (H5N1) in 10 Patients in Vietnam,” NEJM 350, no. 12 (Mar. 18, 2004): 1179-88; and Pham Ngoc Dinh et al., “Risk Factors for Human Infection with Avian Influenza A H5N1, Vietnam 2004,” Emerging Infectious Diseases 12, no. 12 (Dec. 2006): 1841-47.

  118 Thailand finally stopped: For an overview of cases in both Thailand and Vietnam, see “Avian Influenza A (H5N1),” Weekly Epidemiological Record 79, no. 7 (Feb. 13, 2004): 65-76. On Thailand specifically, see “Cases of Influenza A (H5N1)—Thailand 2004,” Morbidity and Mortality Weekly Report 53, no. 5 (Feb. 13, 2004): 100-103; Darin Areechokchia et al., “Investigation of Avian Influenza (H5N1) Outbreak in Humans—Thailand, 2004,” Morbidity and Mortality Weekly Report 55, suppl. 1 (Apr. 28, 2006): 3-6; and Anucha Apisarnthanarak et al., “Atypical Avian Influenza (H5N1),” Emerging Infectious Diseases 10, no. 7 (July 2004): 1321-24.

  122 release the findings: WHO, “Avian Influenza A (H5N1)—Update 14: Two Additional Human Cases of H5N1 Infection Laboratory Confirmed in Vietnam, Investigation of a Family Cluster,” Feb. 1, 2004.

  123 “the ethics of researchers”: “Thaksin Challenges WHO Statement,” Nation (Thailand), Feb. 3, 2004.

  123 “temperatures were running high”: Nguyen Tran Hien, Jeremy Farrar, and Peter Horby, “Person-to-Person Transmission of Influenza A (H5N1),” Lancet 371, no. 9622 (Apr. 26, 2008): 1392-94.

  125 “think of it like a war”: Notes of WHO teleconference, Feb. 7, 2004.

  125 widespread in ducks: Y. Guan et al., “H5N1 Influenza: A Protean Pandemic Threat,” PNAS 101, no. 21 (May 25, 2004): 8156-61.

  125 permanent foothold in Asian poultry: K. S. Li et al., “Genesis of a Highly Pathogenic and Potentially Pandemic H5N1 Influenza Virus in Eastern Asia,” Nature 430 (July 8, 2004): 209-13.

  126 “no link could be established”: Internal WHO report, undated.

  126 “almost certainly H2H transmission”: E-mail, Nov. 6, 2004.

  127 more of the story: The cluster is also described in Kumnuan Ungchusak et al., “Probable Person-to-Person Transmission of Influenza A (H5N1),” NEJM 352, no. 4 (Jan. 27, 2005): 333-40; and “Excerpts of the Meeting of the Expert Panel on Avian Influenza,” Bangkok, Sept. 27, 2004.

  130 Thailand’s health ministry announced: “Avian Influenza Infection of Patients in Kamphaeng Phet,” press release, Ministry of Health, Thailand, Sept. 28, 2004.

  130 WHO released a statement: WHO, “Avian Influenza—Situation in Thailand,” Sept. 28, 2004.

  130 But even as they accepted: Likely cases of human transmission have occurred in at least a half-dozen countries, also including Indonesia, Cambodia, Pakistan, and China. On the last, for example, see Hua Wang et al., “Probable Limited Person-to-Person Transmission of Highly Pathogenic Avian Influenza A (H5N1) Virus in China,” Lancet 371, no. 9622 (April 26, 2008): 1427-34.

  Chapter Five: Livestock Revolution

  This chapter draws on interviews with dozens of villagers in Suphan Buri Province.

  133 another continent in the 1950s: Interview with local historian Samreong Reaungrit.

  134 chicken made its debut: For the history of the chicken industry in Thailand, see Christopher L. Delgado, Clare A. Narrod, and Marites M. Tiongco, Policy, Technical, and Environmental Determinants and Implications of the Scaling-Up of Livestock Production in Four Fast-Growing Developing Countries: A Synthesis, Final Research Report of Phase II, International Food Policy Research Institute, June 23, 2003, ch. 2.2; Christopher L. Delgado and Clare A. Narrod, Impact of Changing Market Forces and Policies on Structural Change in the Livestock Industries of Selected Fast-Growing Developing Countries, Final Research Report of Phase I, International Food Policy Research Institute, June 28, 2002, chapter 4.5; and Nipon Poapongsakorn et al., “Annex IV: Livestock Industrialization Project: Phase II—Policy, Technical, and Environmental Determinants and Implications of the Scaling-Up of Swine, Broiler, Layer and Milk Production in Thailand,” July 25, 2003, included in Delgado, Narrod, and Tiongco, Policy, Technical, and Environmental Determinants, 2003.

  134 doubled the average amount of chicken: Nipon Poapongsakorn et al., “Annex VIII: Livestock Industrialization, Trade and Social-Health-Environment Issues for the Thai Poultry, Dairy, and Swine Sector,” May 2002, included in Delgado and Narrod, Impact of Changing Market Forces, 2002.

  134 an even cheaper source of protein: Ibid.

  135 soaring demand for eggs: Thailand’s egg consumption doubled in a decade. Delgado, Narrod, and Tiongco, Policy, Technical, and Environmental Determinants, ch. 2.2.

  137 the first to fall sick: Jared Diamond, Guns, Germs, and Steel (New York: W. W. Norton, 1997), 92.

  137 afflicting their livestock: Ibid., 196-97.

  137 evolved from animal pathogens: Jared Diamond, “Evolution, Consequences and Future of Plant and Animal Domestication,” Nature 418 (Aug. 8, 2002): 700-707.

  137 about 60 percent also cause disease in animals: S. Cleaveland, M. K. Laurenson, and L. H. Taylor, “Diseases of Humans and Their Domestic Mammals: Pathogen Characteristics, Host Range and Risk of Emergence,” Philosophical Transactions of the Royal Society of London B: Biological Sciences 356, no. 1411 (July 29, 2001): 991-99.

  137 These microbes can hopscotch: Willam B. Karesh and Robert A. Cook, “The Human-Animal Link,” Foreign Affairs, July-Aug. 2005.

  137 An even higher proportion: L. H. Taylor, S. M. Latham, and M. E. Wool-house, “Risk Factors for Human Disease Emergence,” Philosophical Transactions of the Royal Society of London B: Biological Sciences 356, no. 1411 (July 29, 2001): 983-89.

  137 “Similar to the time”: “Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases” (Washington: National Academy of Sciences, 2005), 27.

  137 a mystery illness erupted: For an account, see Keith B. Richburg, “Malaysia Slow to Act on Virus,” Washington Post, Apr. 29, 1999.

  138 opening of trade routes: See, for example, William H. McNeill, Plagues and Peoples (New York: Anchor Books, 1998); Wu Lien-Teh et al., Plague: A Manual for Medical and Public Health Workers (Shanghai: National Quarantine Service, 1936); and John Kelly, The Great Mortality (New York: HarperCollins, 2005).

  138 “Pharoah’s rats”: Wu Lien-Teh et al., Plague. I learned of this reference in Kelly, Great Mortality.

  138 plague erupted in southern China: For a good account of the Yunnan outbreak and the subsequent spread of the
disease, see Carol Benedict, Bubonic Plague in Nineteenth-Century China (Stanford, CA: Stanford University Press, 1996).

  139 it ravaged Hong Kong: For accounts, see Benedict, Bubonic Plague; and Edward Marriott, The Plague Race: A Tale of Fear, Science and Heroism (New York: Picador, 2003).

  139 “Little wonder, then”: Marriott, Plague Race, 52.

  139 reported that patients suffered: James Cantlie, “The First Recorded Appearance of the Modern Influenza Epidemic,” British Medical Journal 2 (1891): 491.

  140 “epicenter” of all influenza viruses: Kennedy F. Shortridge and C. H. Stuart-Harris, “An Influenza Epicentre?” Lancet 2 no. 8302 (Oct. 9, 1982): 812-13; and Kennedy F. Shortridge, “Is China an Influenza Epicenter?” Chinese Medical Journal 110 no. 8 (1997): 637-41. More recently, researchers who studied the global spread of seasonal H3N2 flu strains between 2002 and 2007 have also suggested that the region of East and Southeast Asia is the annual source of the world’s seasonal flu viruses. See Colin A. Russell et al., “The Global Circulation of Seasonal Influenza A (H3N2) Viruses,” Science 320, no. 5874 (Apr. 18, 2008): 340-46.

  140 aquatic birds: Robert G. Webster et al., “Evolution and Ecology of Influenza A Viruses,” Microbiological Review 56, no. 1 (Mar. 1992): 152-79.

  140 actually been isolated earlier: A picture of the Chinese scientist who Shortridge says first isolated the 1957 Asian flu virus is shown in Kennedy F. Shortridge, “Influenza—a Continuing Detective Story,” Lancet 354 (1999): suppl. SIV 29.

  141 matter of greater dispute: For a broader examination of competing hypotheses, see Gina Kolata, Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused It (New York: Simon & Schuster, 1999), ch. 10.

  141 Haskell County, Kansas: John M. Barry, “The Site of the Origin of the 1918 Influenza Pandemic and Its Health Implications,” Journal of Translational Medicine 2 (Jan. 20, 2004): 3. Among the evidence cited by Barry against an Asian or European provenance is Edwin O. Jordan, Epidemic Influenza: A Survey (Chi cago: American Medical Association, 1927). Jordan concluded, “The primary origin of the 1918 pandemic cannot be traced with any degree of plausibility to any one of these localized outbreaks,” referring to India, China, Japan, France, Germany, or the military camps of the United States and Britain. Jordan himself could not pinpoint the origin.

  141 British army camp: J. S. Oxford, “The So-called Great Spanish Influenza Pandemic of 1918 May Have Originated in France in 1916,” Philosophical Transactions of the Royal Society of London B: Biological Sciences 356 (2001): 1857-59.

  141 a Chinese pedigree: Interviews and e-mail exchanges with Kennedy Shortridge. See also Kennedy F. Shortridge, “The 1918 ‘Spanish’ Flu: Pearls from Swine?” Nature Medicine 5, no. 4 (Apr. 1999): 384-85.

  141 medical accounts of an American missionary: W. W. Cadbury, “The 1918 Pandemic of Influenza in Canton,” China Medical Journal 34 (1920): 1-17.

  142 the Pearl River delta: Zhao Shidong et al., “Population, Consumption, and Land Use in the Pearl River Delta, Guangdong Province,” in National Academy of Sciences, Growing Populations, Changing Landscapes: Studies from India, China and the United States (Washington: National Academies Press, 2001).

  142 “greatest mass urbanization”: This description comes in his tale of another emerging disease to explode out of East Asia: SARS. Karl Taro Greenfeld, China Syndrome: The True Story of the 21st Century’s First Great Epidemic (New York: HarperCollins, 2006), 9.

  143 fastest growth on Earth: World Bank, World Development Report 1997 (Washington: International Bank for Reconstruction and Development, 1997), table 1.

  143 admiration for Bill Gates: Gates was rated seven times more popular than any sitting member of the Vietnamese Politburo in a survey for Tuoi Tre newspaper. The issue, released in Jan. 2001, was pulled from the newsstands by authorities.

  143 “The demand-driven Livestock Revolution”: Christopher Delgado et al., Livestock to 2020: The Next Food Revolution (Washington: International Food Policy Research Institute, 1999), 4. For a discussion of the “livestock revolution,” see also Christopher L. Delgado, Mark W. Rosegrant, and Siet Meijer, “Livestock to 2020: The Revolution Continues,” Jan. 11, 2001, paper presented at the annual meetings of the International Agricultural Trade Research Consortium in Auckland, New Zealand, Jan. 2001.

  144 doubled the average amount of meat: Henning Steinfeld and Pius Chilonda, “Old Players, New Players,” in Food and Agriculture Organization, Livestock Report 2006.

  144 surpassed that in developed ones: Ibid.

  144 China alone has accounted: Ibid.

  144 A large majority: Figures on China’s livestock production come from the Food and Agriculture Organization’s database FAOSTAT. For discussion of China’s demand for livestock products, see William P. Roenigk, “Keynote Address: World Poultry Consumption,” Poultry Science 78 (1999): 722-28; and Frank Fuller, Francis Tuan, and Eric Wailes, “Rising Demand for Meat: Who Will Feed China’s Hogs,” in Fred Gale, ed., China’s Food and Agriculture: Issues for the 21st Century, Agricultural Information Bulletin no. AIB-775, Economic Research Service, U.S. Department of Agriculture, Apr. 2002.

  144 Southeast Asia’s record: Figures on Southeast Asia’s livestock production come from the Food and Agriculture Organization’s database FAOSTAT.

  144 the Indonesian egg: D.K.S. Swastika et al., The Status and Prospect of Feed Crops in Indonesia, UN Centre for Alleviation of Poverty Through Secondary Crops’ Development in Asia and the Pacific, working paper, no. 81, p. 23.

  144 as meat prices dropped: “Managing the Livestock Revolution: Policy and Technology to Address the Negative Impacts of a Fast-Growing Sector,” World Bank, June 2005, p. 12.

  144 the record is more mixed: On possible negative effects on poverty, equality, food security, and the environment, see Cornelius de Haan et al., “Livestock Development: Implications for Rural Poverty, the Environment and Global Food Security,” World Bank, Nov. 2001; Hartwig de Haen et al., “The World Food Economy in the Twenty-first Century: Challenges for International Cooperation,” Development Policy Review 21, nos. 5-6 (Sept. 2003): 683-96; and Hans Wagner, “Protecting the Eenvironment from the Impact of the Growing Industrialization of Livestock Production in East Asia,” special presentation to UN Animal Production and Health Commission for Asia and the Pacific, 26th session, Sub ang, Malaysia, Aug. 2002. On possible positive effects, see Christopher L. Delgado, Mark Rosegrant, and Nikolas Wada, “Meating and Milking Global Demand: Stakes for Small-Scale Farmers in Developing Countries,” in A. G. Brown, ed., The Livestock Revolution: A Pathway from Poverty? (Canberra: ATSE Crawford Fund, 2003); and Christopher Delgado et al., Livestock to 2020: The Next Food Revolution (Washington: International Food Policy Research Institute, 1999). On equity benefits in Thailand, see Christopher, Narrod, and Tiongco, Policy, Technical, and Environmental Determinants, ch. 3.2.

  145 jutting into the fishpond: On the potential pandemic hazards associated with the mixed development of aquaculture and livestock production, see Christoph Scholtissek and Ernest Naylor, “Fish Farming and Influenza Pandemics,” Nature 331 (Jan. 21, 1988): 215.

  146 A single gram of bird feces: Christine Power, “The Source and Means of Spread of the Avian Influenza Virus in the Lower Fraser Valley of British Columbia During an Outbreak in the Winter of 2004: An Interim Report,” Canadian Food Inspection Agency, Animal Disease Surveillance Unit, Feb. 15, 1004.

  146 how to prevent epidemic contagion: See, for example, V. Martin, A. Forman, and J. Lubroth, Preparing for Highly Pathogenic Avian Influenza (Rome: Food and Agriculture Organization of the United Nations, 2006), ch. 5.

  148 There was a time: John Steele Gordon, “The Chicken Story,” American Heritage , Sept. 1996.

  148 nearly every four days: “Poultry Slaughter 2006 Annual Summary,” Agricultural Statistics Board, U.S. Department of Agriculture, Feb. 2007.

  149 But the watershed: Interview with Carol Cardona, Associate Veterinarian, University of California at
Davis School of Veterinary Medicine.

  149 safety measures to prevent disease: Interview with Cardona. In fairness, biosecurity remains imperfect. A study in Maryland found most poultry workers are given neither protective clothing nor facilities for on-site decontamination and hygiene. See Lance B. Price et al., “Neurologic Symptoms and Neuropathologic Antibodies in Poultry Workers Exposed to Campylobacter jejuni,” Journal of Occupational and Environmental Medicine 49, no. 7 (July 2007): 748-55.

  149 safeguard their investments: Interview with Goosen van den Bosch, head of technical services at Intervet.

  149 generous avenue to infection: On the dangers posed by intensive poultry farming, see J. Otte et al., “Industrial Livestock Production and Global Health Risks,” Pro-Poor Livestock Policy Initiative Research Report, UN Food and Agriculture Organization, June 2007.

  149 In the unnatural setting: B. Schmit, “Disease Prevention Crucial in Intensive Livestock Production,” Zootecnica International, July 1987, 49-51.

  149 Thai commercial farms: J. Otte et al., “Evidence-Based Policy for Controlling HPAI in Poultry: Bio-security Revisited,” Pro-Poor Livestock Policy Initiative Research Report, UN Food and Agriculture Organization, Dec. 20, 2006.

  149 lack of genetic diversity: “Managing the Livestock Revolution: Policy and Technology to Address the Negative Impacts of a Fast-Growing Sector,” World Bank, June 2005, p. 9.

  149 “Once an influenza virus invades”: R. G. Webster and D. J. Hulse, “Microbial Adaption and Change: Avian Influenza,” Rev. sci. tech. Off. int. Epiz., 2004, 23 (2), 453-65.

  150 a country in transition: Jan Slingenbergh et al., “Ecological Sources of Zoonotic Diseases,” Revue scientifique et technique de l’Office International des Epizooties 23, no. 2 (2004): 467-84; Marius Gilbert et al., “Livestock Production Dynamics, Bird Migration Cycles, and the Emergence of Highly Pathogenic Avian Influenza in East and Southeast Asia,” paper presented at a conference of the Food and Agriculture Organization, Rome, May 30-31, 2006.