Hong Kong, 1997

Young boy killed by H5N1

It all seemed to start with a three-year-old boy in Hong Kong with a sore throat and tummy ache.²⁴² On May 14, 1997, Lam Hoi-ka was admitted to Queen Elizabeth Hospital with a fever; a week later he was dead. The causes of death listed were acute respiratory failure, acute liver failure, acute kidney failure, and “disseminated intravascular coagulopathy.” Basically, on top of the multiple organ failure, his blood had curdled.²⁴³

The top specialist of the government virus unit was called in.²⁴⁴ Samples were taken from the boy’s throat. As far as anyone knew, human beings were susceptible to getting sick only from H1, H2, and H3 viruses. When the samples came back positive for influenza, but negative for all known human strains, Hong Kong’s chief virologist forwarded the mystery samples to the world’s top labs in London, Holland, and the CDC in Atlanta.²⁴⁵

The Dutch were the first to make the discovery. Virologist Jan de Jong received the sample and passed it to the lab of a colleague, Albert Osterhaus. That team found that the boy had been killed by an H5 virus, H5N1.²⁴⁶ The scientific world was stunned.

“We thought we knew the rules,” recalls the director of the Center for Public Health Preparedness at Columbia University, “and one of those rules was that H1, H2 and H3 cause flu in humans, not H5. This is like the clock striking 13.”²⁴⁷ H5 was supposed to cause disease only in birds, not in people.

Within two days, de Jong was on a plane to Hong Kong. “We had to act very, very quickly,” he recalls. “We realized this could be a pandemic situation.”²⁴⁸ Keiji Fukuda, chief of epidemiology in the CDC’s influenza branch, followed shortly behind. When Fukuda arrived in Hong Kong, he scoured through the dead boy’s medical charts. “As I went over his chart, the case became very un-abstract,” he said. It had been a hard death. The child had had to have a breathing tube inserted and was reportedly in great pain. Fukuda at the time was the father of two young children. “It drove home for me how much suffering there might be if this bug took off.”²⁴⁹

If H5N1 had spread from Hong Kong in 1997, Lam Hoi-ka would have been Patient Zero for a new global pandemic.²⁵⁰ Keiji Fukuda was asked in an interview years later what his first thought had been upon hearing the news that an H5 virus had killed a child. He said that he distinctly remembered hanging up the phone and thinking, “This is how it begins.”²⁵¹

What this first death showed, according to the director of Holland’s National Influenza Center, “was what everyone until then had thought impossible—that the virus could leap directly from birds to humans.”²⁵² “This had never happened before in history,” agreed the head of the University of Hong Kong’s Emerging Pathogens Group. “It was terrifying.” These statements were taken before the 1918 virus was resurrected in 2005.²⁵³ It had happened before in history, many scientists now believe, in 1918—and that makes it all the more terrifying.