Close Call

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 His own children, half way around the world, were safe now, too.