Bird flu out of mind but still a threat

On the Trail of Avian Flu
and the Coming Pandemic

By Alan Sipress

Viking. 386 pp $27.95

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Reviewed by Huntly Collins

For most Americans, the threat of avian flu - "bird flu," in the vernacular - is likely a distant memory.

The highly pathogenic virus, which came to public attention in 1997 with the first human cases identified in Hong Kong, swept through the poultry industry in Southeast Asia and eventually spread to birds around the world.

But H5N1, as scientists call the virus, never gained much of a toehold in humans, mainly because it isn't easily transmitted from one person to another. Since 2003, there have been fewer than 470 confirmed human cases of bird flu and just 282 confirmed deaths, most of them in Indonesia.

For these reasons, it would be easy to relegate Alan Sipress' book about bird flu, The Fatal Strain, to the back shelves. But that would be a mistake.

Even though the threat of bird flu has receded, as has the more recent threat of swine flu, Sipress has written an important book that offers insights about how the world might better prepare for what he and most flu experts regard as the inevitable - another flu pandemic with the potential to kill millions of people around the world.

Sipress, now the economics editor at the Washington Post and a former reporter at The Philadelphia Inquirer, began covering bird flu when he was a foreign correspondent for the Post, based in Southeast Asia. His book greatly expands on his reporting, weaving together the complex and riveting story of how the virus spread from one country to another; how governments were slow and, in come cases, unwilling to combat it; and how gutsy health officials at the World Health Organization and elsewhere stepped in, time and again, to avert a global catastrophe.

Although the virus was initially transmitted from birds to people, Sipress documents that the virus almost certainly was spread from person-to-person in clusters of cases in different countries. His poignant account of some of the men, women and children who died from bird flu underscores its danger. Of those who became infected, more than half died.

Although Sipress is not a scientist, he does a workmanlike job of explaining the science accurately and in lay terms. He clearly explains how, as an RNA virus, flu virus rapidly mutates, raising the probability of new strains to which humans have no defenses. He tells his story largely through the eyes of the men and women who were on the front lines fighting the virus, most of them scientists unknown to the public, although they played a pivotal role in stopping the spread of avian flu in human populations.

Sipress' biggest contribution, however, is to take us deep inside the cultures of various countries in Southeast Asia and to show us how certain traditional practices facilitate the spread of bird flu and inhibit public health officials from fighting it. We meet a witch doctor in Indonesia who claims to cure the virus with black magic. We witness a cockfight in Thailand, where feathers and blood go flying. In Cambodia, we come to understand how the Buddhist ritual of freeing birds from cages - a symbol of giving life and following in the footsteps of the Buddha - may disseminate a deadly virus. And all over Southeast Asia, we see how the "wet markets," where live animals are sold and butchered, raise the prospect of animal-to-human transmission of potentially dangerous microbes.

While it's easy for Westerners to condemn such practices, Sipress helps us understand just how important they are in the life of local communities. He is also sympathetic to the enormous economic cost borne by farmers and governments when entire flocks of birds have to be killed in order to stop an epidemic in its tracks.

On the other hand, Sipress has little sympathy for government stonewalling when it comes to outbreaks of bird flu or other dangerous infectious diseases such as SARS. In one country after another, he documents the failure of government leaders to acknowledge that an epidemic was under way for fear of the impact on trade and tourism. He writes: "Not a single one of these frontline countries - China, Indonesia, Thailand, and Vietnam - had adopted the most powerful disease-fighting weapons: truth and transparency."

In places, Sipress overstates his case by larding his analysis with hyperbole. (Once a pandemic begins, he writes, there would be no way to know "how many hospitals and governments could stumble under its siege.") He also tends to anthropomorphize the virus, which is described variously as "sinister," and "savage" as it "smuggles itself" or "pursues its prey deep into the body." Actually, the virus is just doing what viruses do, which is using the genetic machinery of human cells to reproduce itself.

Overall, however, Sipress' book is an important - and highly readable - contribution to our understanding of the all-too-human mistakes that make pandemics possible and, if he is right, inevitable.