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Alex Lo

A three-year-old boy complains of a sore throat and stomach cramps, marking the start of one of Hong Kong's biggest health crises of modern times. But experts agree it might have been far, far worse if the outbreak had not been contained.

If bird flu had spread from Hong Kong, Lam Hoi-ka would have become H5N1's Patient Zero - the scientific name for the first known victim of a global pandemic.

Hoi-ka was admitted to Queen Elizabeth Hospital five days after he first fell ill in May 1997. His condition deteriorated rapidly, and on May 21 he died of multiple complications including pneumonia, liver and renal failure, and Reye's syndrome - a rare disorder causing brain inflammation.

From the start, doctors were puzzled by the unusual case, and a top specialist, Dr W.  L.  Lim of the government virus unit, was bought in.

Samples were taken from the boy's throat. By August, lab tests had revealed a stunning result: the H5N1 sub-type of the influenza A virus, previously known only to strike poultry, had jumped species and killed a human.

Hong Kong's policy makers all the way up to Chief Executive Tung Chee-hwa were staring at the prospect of a flu pandemic.

Hong Kong Flu killed 700,000 worldwide in 1968, while the Spanish Flu of 1918-19 killed between 20 and 40 million. Infectious disease experts around the world were now forced to contemplate the same terrifying prospect. Millions dead.

Dr Lim and several microbiologists from the Netherlands and the US decided to publish their findings and sound a global warning in a special notice posted in an October issue of the weekly international science journal, Nature.

'The identification of the H5N1 influenza A virus and its presently unknown pandemic potential should be the basis for an intensive monitoring [of] this virus by the international World Health Organisation influenza surveillance network,' it wrote.

From Hoi-ka's death in May to mid-January 1998, 17 more people were infected and five died. During this time, large numbers of poultry died in two waves of H5N1 attacks across New Territories farms in November and December. Up to that point, all human infections came from direct contact with the birds.

The government was faced with a dilemma. Would the virus evolve and be able to jump from human to human? Should the government kill all 1.3 million poultry and stop a third wave of chicken infection that may prove more dangerous to people? Or was it being too alarmist?

Legislator and infectious diseases expert Lo Wing-lok recalls the events of December 1997 and January 1998 and charts the worst-case scenario which he says had loomed all too large.

'We fail to halt the third wave of H5N1, the virus then hits both men and birds at the same time as Hong Kong enters the peak of the normal flu seasons in January and February, mutating and making itself more difficult to distinguish from normal flu,' he said.

'The H5N1 virus evolves the ability to jump from human to human by becoming air-borne. Then we have an epidemic.

'The MTRC, buses and other public transportation spread it quickly, within hours. Air transport spreads it within days. Spread around the world, you now have a pandemic, and millions will be killed.'

Although Hong Kong is stocked with anti-viral agents such as the drug amatidine, there would not be enough to distribute to 6.8 million SAR residents. Flu vaccines take months to develop and by then, H5N1 could have reached every corner of the world, Dr Lo said.

University of Hong Kong dean of science Frederick Leung Chi-ching says international procedures to contain an outbreak will be set in motion in such a case.

'You quarantine and isolate the patients, provide medicine where possible to healthy people, identify and eliminate the source of the outbreak,' Dr Leung said.

The H5N1 virus that crossed the species barrier in 1997 has not resurfaced. Since January 1998 there have been three outbreaks in Hong Kong and no new case of human infection. But scientists agree the threat of a global pandemic has not gone away.



Millions dead, Hong Kong in chaos. How close did we come to this nightmare bird-flu scenario?