| I--PERMAFROST
On September 24, 1918, three days after setting sail from
Norway's northern coast, the Forsete arrived in Longyearbyen, a
tiny mining town on one of the Norwegian islands north of the
Arctic Circle. It was the last ship of the year, before ice made
the Arctic fjords impassable, and it carried among its passengers
a number of fishermen and farmers going north for the winter to
earn extra money in Longyearbyen's coal mines. During the
voyage, however, the ship had been hit with an outbreak of flu.
Upon landing, many of the passengers had to be taken to the
local hospital, and over the next two weeks seven of them died.
They were buried side by side in the local cemetery, their
graves marked by six white crosses and one headstone:
Ole Kristoffersen
February 1, 1896-October 1, 1918
Magnus Gabrielsen
May 10, 1890-October 2, 1918
Hans Hansen
September 14, 1891-October 3, 1918
Tormod Albrigtsen
February 2, 1899-October 3, 1918
Johan Bjerk
July 3, 1892-October 4, 1918
William Henry Richardsen
April 7, 1893-October 4, 1918
Kristian Hansen
March 10, 1890-October 7, 1918
The Longyearbyen cemetery is at the base of a steep hill,
just beyond the town limits. If you look up from the cemetery, you
can see the gray wooden skeleton of the coal mine that used to
burrow into the side of the hill, and if you look to your left you can
see the icy fringes of a glacier. Farther down the mountain are a
shallow stream, a broad shale plain, and then, half a mile or so
across the valley, Longyearbyen itself: a small cluster of red-roofed,
brightly painted frame buildings. There are no trees, because
Longyearbyen is many miles above the tree line, and from almost
anywhere in the valley the cemetery is in plain view. Each grave
site is slightly elevated and surrounded by rocks, and there are
well-worn pathways among the rows of crosses. A chain-link fence
rings the periphery. When I was there in late August, the ground
had been warmed by the Arctic summer sun and was soft and spongy,
carpeted with orange and red and white lichen. In the last row
I found the miners' graves--seven deaths separated by six days.
It is possible to go to almost any cemetery in the world and
find a similar cluster of graves from the fall of 1918. Between
September and November of that year, as the First World War
came to an end, an extraordinarily lethal strain of influenza swept
the globe, killing between twenty million and forty million people.
More Americans died of the flu over the next few months than
were killed during the First World War, the Second World War, the
Korean War, and the Vietnam War combined. The Spanish flu, as it
came to be known, reached every continent and virtually every
country on the map, going wherever ships sailed or cars or trucks
or trains travelled, killing so many so quickly that some cities were
forced to convert streetcars into hearses, and others buried their
dead in mass graves, because they ran out of coffins. Of all those
millions of graves, though, the seven in Longyearbyen stand apart.
There, less than eight hundred miles from the North Pole, the
ground beneath the lichen is hard-frozen permafrost. The bodies of
the seven miners may well be intact, cryogenically preserved in
the tundra, and, if so, the flu virus they caught on board the
Forsete--the deadliest virus that the world has ever known--may
still be down there with them.
At the beginning of next month, a scientific team led by the
Canadian geographer Kirsty Duncan will fly to Longyearbyen and
set up a workstation in the church graveyard. The team will map
the site, and then scan it with ground-penetrating radar, passing
what looks like a small black vacuum cleaner over the tundra to
see how deep the bodies are buried. If the radar shows that they
are below the active layer of the permafrost--that is, below the
layer that thaws each summer--the team will return next fall with
enough medical equipment and gear to outfit a small morgue. The
site will be prepared with tarpaulins and duckboards. Pavement
breakers--electric jackhammers--will be used to break up the
tundra, and the chunks of earth will be scooped out with a shovel.
As the excavation gets close to the coffins, the diggers will don
biohazard spacesuits, and a dome or a tent will be erected over the
operation.
To minimize the possibility of infection, the bodies will be
left where they are, in their coffins, and autopsies will be
performed in the ground. If the clothes on the corpses are frozen
to the skin or tightly matted, someone on the team might run a
hair dryer over the material to loosen it up--but only briefly. "If
the bodies are thawed out and this material is taken out, it will
melt, and then there is always the chance of the spread of micro
droplets," Peter Lewin, one of the team members, told me. Lewin
is a pediatrician at Toronto's Hospital for Sick Children who doubles
as a medical archeologist, and he has earned international renown
for his pioneering cat scans of Egyptian mummies. (He helped
determine that Ramses V died of smallpox.) "Say you're doing an
autopsy"--he gestured to indicate a body spread out on the desk in
front of him--"if it melts, there may be a mucousy, secondary
blood product--some type of liquid exudation. The liquid seeping
out of that material may suddenly, by mistake, be aerosolized and
someone inhales it. You just don't want to take any chances."
From the ad-hoc morgue in the Longyearbyen cemetery, the
samples will be flown to a BSL-4 facility--4 is the highest level of
biological containment--either in England or at the United States
Army's infectious-disease research facility, at Fort Detrick,
Maryland. There's a small possibility that what scientists will find is
a live virus--a virus that, once thawed, could be as deadly and
infectious as it was in 1918. If they don't, the hope is that they'll
at least be able to recover the virus's genetic footprint--what
scientists call RNA residue. Samples of the virus will then be sent
to laboratories around the world. Its genetic code will be
sequenced and compared with every major sample of the flu virus
on file in the world's virological centers.
This task has a certain urgency. Scientists know that global
outbreaks of deadly influenza go back at least four hundred years,
and that there have been two more since 1918--the Asian flu, of
1957, which killed seventy thousand Americans, and the Hong
Kong flu, which killed thirty-three thousand during the winter of
1968-69. With luck, we'll be able to anticipate the next Spanish flu
before it does much damage. The problem is that we're not really
sure what to look for. No one kept a sample of the virus in 1918,
because the flu virus wasn't isolated until fifteen years later. And,
because influenza mutates so rapidly, there's almost nothing to be
learned about the peculiarities of the 1918 virus from looking at
the influenzas in circulation today. The only way to find out about
the 1918 virus is to find the 1918 virus.
"We've designed core-biopsy-removal equipment to take
core samples," Peter Lewin said. "You drill into the body, because
it's solid. It's a technique taken from forestry. You use what's
called a hole-saw tube." He drew a diagram on the back of a file
folder, outlining a long, hollow cylinder, with circular, screw like
grooves on its outside, a serrated edge on its tip, and a T-shaped
handle at its other end. "It's about nine inches long, about a
quarter inch in diameter," he went on, explaining that as the tube
is twisted into a body it will collect a long cross-sectional sample of
tissue. "We'll probably take four core samples of the lung"--he
pointed at the upper and lower chambers of his left and right
lung--"one of the brain, one of the trachea, perhaps two of the
bowel and liver."
Lewin was raised in Egypt, where his father was a British
military officer--two of Lewin's schoolmates were Adnan Khashoggi
and the future King Hussein--and he has the unflappable, genteel
air of a nineteenth-century colonial explorer. He ticked off the
details of the exhumation in Longyearbyen as if he were reciting a
grocery list. "We're doing some practice runs on frozen
material--basically, on frozen pigs--to see if this thing works. We
were initially going to use a drill. But the drill goes so fast that it
heats the tissue up, and, of course, we don't want that. So why not
just slowly twist it in?" He rotated his hand. "They use hole saws
on trees to get core samples of rings. They're very useful. But no
one has ever used them here. I mean"--he laughed--"how often
do you do core samples of frozen bodies?"
II--The Second Wave
The first known case of Spanish flu was reported on March 4,
1918, at Camp Funston, in Kansas. By April, it had spread to most
cities in America and had reached Europe, following the trail of the
hundreds of thousands of American soldiers who crossed the
Atlantic that spring for the closing offensives of the First World
War. The spring wave was serious but not disastrous, and by
midsummer it had subsided. A month or so later, however, the
Spanish flu resurfaced. It was the same virus in the sense that if
you'd got the flu in the spring you were resistant to it in the fall.
But somehow over the summer it had mutated. Now it was a killer.
The first case of the second wave was recorded on
August 22nd, in Brest, a major port for incoming American
troops. Within days, it appeared simultaneously in Boston and
Freetown, Sierra Leone, carried in the former case by
returning American soldiers and in the latter by H.M.S.
Mantua, a British navy ship. The virus crossed Europe in a
matter of weeks. It attacked Spain through Portugal, in the
west, and across the Pyrenees, in the north, lingering long
enough to be dubbed--erroneously, as it turned out--the
Spanish flu. Scandinavia was infected by England; Italy was
infected by France; and Sicily was infected by Italy. Allied
soldiers coming to the aid of anti-Bolshevik forces during the
Russian Revolution carried the flu to the White Sea area of
northwestern Russia. European and American ships brought
the flu to Iceland in mid-October, and American ships brought
the flu to New Zealand at around the same time. In India, the
virus came by sea and raced inland along the country's
railroad lines. As many as half of all those who died in the
pandemic died within India's borders. In America, an
estimated six hundred and seventy-five thousand people died.
In Philadelphia, seventy-six hundred people died within
fourteen days. Putrefying bodies were stacked up three and
four deep in the corridors of the city morgue, creating such a
stench that the morgue was forced to throw open its doors for
ventilation. In "America's Forgotten Pandemic" (1976), a
definitive history of the Spanish flu, the historian Alfred
Crosby offered this description of the flu's advance on Alaska:
On or about November 1 the virus reached the finest medium
for its propagation in Nome and vicinity, the city's Eskimo
village. Few Eskimos escaped infection. In a single eight-day
period 162 of them died. Some Eskimos, hounded by
superstitious horror, fled from cabin to cabin, infecting
increasing numbers with disease and panic. The temperature
fell below freezing, and when rescuers broke into cabins from
whose chimney came no sign of smoke, they found many,
sometimes whole families, who had been too sick to renew
their fires and who had frozen to death. When a number of
Eskimos were rounded up from their separate cabins and
placed in a single large building so they could be cared for
efficiently, several of them responded to what they apparently
perceived as incarceration in a death house by hanging
themselves.
This was not the flu as we normally think of it.
Typically, influenza infects the inner lining of the respiratory
tract, damaging the air-filled cells of the lungs known as
alveoli. Sometimes it brings on pneumonia. Usually it passes.
This was much worse. "If you autopsied some of the worst
cases, you'd find the lungs very red and very firm," said
Jeffery Taubenberger, a pathologist at the Armed Forces
Institute of Pathology, in Washington, D.C. "The lungs are
normally filled with air, so they are compressible. These
would be very heavy and very dense. It's the difference
between a dry sponge and a wet sponge. A normal piece of
lung would float in water because it was basically filled with
air. These would sink. Microscopically, you would see that the
alveoli would be filled with fluid, which made it impossible to
breathe. These people were drowning. There was so much
liquid in the air spaces of their lungs that patients would have
bloody fluid coming out of their noses. When they died, it
would often drench the bedsheets."
Without sufficient oxygen, patients would suffer from
cyanosis--a discoloration of the skin. "Two hours after
admission they have the mahogany spots over the cheek
bones," a physician wrote at the time, describing the
epidemic at Camp Devens, Massachusetts. "And in a few
hours you can begin to see the cyanosis extended from the
ears and spreading all over the face, until it is hard to
distinguish the colored man from the white." Nurses would
triage incoming flu patients by looking at the color of their
feet. Patients whose feet were black were considered as good
as dead.
Something else was strange about the 1918 strain, and
that was its choice of victim. Flu epidemics kill mostly at the
demographic fringes--the very old, whose immune systems
are the least robust, and the very young. Other adults do get
sick, but they rarely die. In 1918, however, the usual pattern
of mortality was reversed. The Longyearbyen seven, for
example, were all between the ages of nineteen and twenty-eight,
and that was by no means unusual. In the United States, men
between twenty-five and twenty-nine died of the Spanish flu at
several times the rate of men between seventy and seventy-four.
This wasn't just a deadly infectious disease. It was a deadly
infectious disease with the singular and terrifying quality of
being better at killing the young and healthy than the old and
the infirm.
III--Process of Elimination
Kirsty Duncan, the leader of the Longyearbyen
expedition, is a medical geographer and climatologist by
training, with dual appointments at the University of Windsor
and the University of Toronto. We met in her parents' house,
a bungalow in the Toronto suburb of Etobicoke, she on one
side of the family dining-room table, I on the other. Between
us were five overstuffed black binders, filled with the results
of four and a half years that Duncan had spent searching for
frozen flu victims. In the kitchen behind us, Duncan's mother
prepared lunch. Whenever the phone rang, or the banging
from the kitchen got too loud, or Duncan was coming to a
critical part of her story, she dropped her voice almost to
a whisper, so that I had to lean forward to hear what she
saying. She has large dark eyes and straight dark-brown hair
that runs so far down her back that once when she got up her
hair got caught in the chair. She's thirty, but she looks much
younger. When I first walked up to the house, I approached a
woman watering the flowers and said, "Professor Duncan?"
The woman replied, "Oh no. I'm her mother. Kirsty's inside."
Duncan's obsession with the Spanish flu began when
she read Crosby's book on the pandemic. "I was absolutely
fascinated--horrified, more than anything--that we didn't
know what caused this disease," she told me. "I said to my
husband, 'I'm going to find the cause of the Spanish flu.'" The
logical place to start, it seemed to her at the time, was
Alaska, so she wrote to the Alaska bureau of Vital Statistics
and had it ship her records from 1918. "I went through
thousands of death certificates, and I found all kinds of cases
of Spanish flu. The problem was trying to decipher where the
permafrost was." In 1951, the Army had led a secret
expedition to a grave site near Marks Air Force Base, in Nome,
to dig up 1918 corpses, but the mission--code-named Project
George--failed for that very reason: the bodies weren't in
permafrost, and they had melted and decomposed. After
Alaska, Duncan thought of Iceland. "But, of course, with all
that geothermal energy it's too warm," she said. "Then I had
a friend returning from Norway, and he mentioned
permafrost, and I became excited, because I knew flu had
been in Norway."
Duncan's focus was on the huge archipelago of islands, about
six hundred miles north of Norway, that is known as
Svalbard--and, in particular, on the town of Longyearbyen, a
settlement of just over a thousand people which has served
as Svalbard's major port for the better part of the century. "I
knew that people used to do coal mining in Svalbard," she
said. "I contacted the Norwegian Polar Institute. But they told
me I had a really difficult task ahead of me. There are no
medical records, because the hospital was bombed in the
Second World War; no church records, because the first
minister didn't come out until the nineteen-twenties; and no
government records, because Svalbard didn't officially
become part of Norway until 1925. They said there are these
diaries, though, that the coal company kept." Duncan called
the coal company, which referred her to a schoolteacher in
Longyearbyen. She called the schoolteacher. He found, in the
1918 entries, a record of the deaths of seven young miners
from Spanish flu. "So now I knew that there were seven
bodies, and that they were buried in the churchyard in
Longyearbyen," Duncan said. "I contacted the minister at the
church. I said I wanted to know if the graves were marked.
He said they were."
The bodies of the seven miners are not, in all likelihood,
perfectly preserved. Prolonged freezing desiccates soft tissue,
so the best Duncan's team can hope for is, essentially, natural
mummies. "In a frozen state, the fluids in the body simply
evaporate," Michael Zimmerman, an anthropologist at the
University of Pennsylvania and an expert on mummification,
explained to me. "The process is called sublimation. It's the
change from the solid state to a gaseous state without going
through a liquid state. If you put a tray of ice cubes in your
freezer and go back two weeks later, they're a lot smaller.
That's what we're talking about." Zimmerman estimated that
the Longyearbyen seven, if they had been properly buried,
would probably be down to about half their original weight,
and maybe even less, so that their skin would be stretched
tight over their bones, and every one of their ribs would be
showing, as if they had been deprived of food for an extended
period. "The eyes collapse, because there is a large fat pad
behind the eye that's mostly water, and when that dries the
eye falls back into the socket," he said. "Like everything else,
the lips will tend to retract, so the teeth will become more
prominent." Nonetheless, Zimmerman thought that a full
autopsy would still be possible. "I don't see a problem," he
went on, "especially given that these bodies were buried only
about eighty years ago. The tissues are probably still fairly
flexible. They're not like Egyptian mummies. Their tissues are
like old leather, like an ancient book, and unless you're
careful they'll crumble. Frozen bodies, since they don't
completely desiccate until they've been frozen for a thousand
years, are still flexible. You can get big pieces out pretty
easily." There is a catch, though. During the summer
months, the top layer of the permafrost thaws. In
Longyearbyen, that layer is between one and 1.2 metres
deep. If the miners were buried in that layer--if the
gravediggers in 1918 hadn't gone to the trouble of blasting or
pickaxing their way deep into the tundra--the bodies would
be dust and bone by now. "I contacted the Norwegian
authorities and asked what depth the bodies would have been
buried, and they said, 'Well, no one knows,'" Duncan went on.
"Back then, that was no man's land. But they assumed they
would have followed the practice of the time, which was about
two metres. The church minister believes they will be at two
metres."
This was more than simply a guess. In the permafrost,
anything buried in the active layer will, over time,
"float"--that is, be pushed up toward the surface by the
continual expansion and contraction of the ground. For that
reason, it's relatively common in the hills around
Longyearbyen to stumble across skeletons.
"If you go places where trappers are buried, you often
see the coffin, open on the ground," Kjell Mork, a
Longyearbyen high-school teacher who serves as the town's
unofficial historian, told me. Mork is the man who gave the
coal-company diaries to Duncan. He's a dead ringer for the
novelist Robertson Davies, and has in his house a polar-bear
pelt that takes up almost an entire wall. "I see it all the time.
Back in the sixteenth, seventeenth, and eighteenth centuries,
the trapping teams had only two or three people, so they
couldn't take the effort to bury the bodies deep enough. Up at
the northwest corner of the fjord, there used to be plenty of
them. But now there's a new ethic--to cover them up again. I
think the polar bears were going there." In the Longyearbyen
churchyard, however, nothing has ever floated. Next to one of
the crosses, just a few feet beyond the fence, I had seen a
pile of fairly sizable white bones, including what looked like a
human-size femur. But when I asked Mork about this he
shook his head. "I think that's just reindeer," he said. "They
come down the mountain to die."
Duncan's next big problem was to find out what had
happened to the bodies before they were buried. The flu
virus, after all, is notoriously unstable. It's an RNA virus, as
opposed to a DNA virus, and that means that instead of being
composed of double strands of genetic code it has just one
strand, and is much more vulnerable. The moment someone
dies, enzymes are released that begin breaking down these
nucleic acids and the genetic information they carry. A DNA
virus, like herpes or hepatitis, could probably last in a body
for a few days before being totally destroyed. But an RNA
virus, like flu, would last between twelve and twenty-four
hours at the most. The diaries kept by the manager of the
coal company show that the bodies of the Longyearbyen
seven were not buried until October 17th, ten days after the
last of them died. What happened in those ten days? Did the
bodies start to decompose before they were buried? Duncan
was told that orderlies at the Longyearbyen hospital would
have taken the bodies to an outdoor morgue while they
waited for the graves to be dug. For there still to be RNA
residue, the weather would have had to have been cold
enough in those first two weeks of October to keep the
RNA-dissolving enzymes at bay. She checked the weather records.
The average temperature in early October was minus five
degrees Celsius. Duncan had her bodies, and she knew where
to find them.
IV--Wax Museum
The Spanish-flu virus has been glimpsed just once, and
that was in a scrap of lung tissue found two years ago in the
National Tissue Repository, a division of the Armed Forces
Institute of Pathology. The repository is in an annex of the
Walter Reed Army Medical Center, in Maryland, just across
the District of Columbia line, in a windowless corrugated-steel
building behind a former elementary school. At the side are a
parking lot and a loading dock, and there is an ill-kempt lawn
out front. It looks like an industrial warehouse. Inside, there
are three rooms, the largest of which is filled with rows of tall
metal shelves, all stacked high with small brown cardboard
boxes. Inside each of those boxes are pieces of human tissue
about the size of a fingernail which have been preserved in
formaldehyde and encased in a block of transparent paraffin
wax. The repository holds more than two and a half million
samples--some pressed between glass slides, some in boxes,
some fully preserved organs--from autopsies on soldiers
dating back to before the First World War. It's the world's
largest library of death.
The supervisor of the repository is Al Riddick, a
powerfully built black man in his mid-forties with a bald head,
a gold chain, and glasses. When I toured the repository in late
summer, Riddick took me to the back of the main room and
pulled out a cardboard box from one of the shelves. Inside it
were seventeen wax blocks, measuring roughly an inch by an
inch by half an inch. "This is from a 1958 autopsy," he said.
He picked up one of the blocks, tilting it so that I could see a
speckled, bright-orange sliver of tissue embedded in the wax.
"That's a brain block right there," he said. Then he picked out
another block, this one encasing a dark-reddish pockmarked
rectangle that looked like a dried scab. "I would say that's
liver."
Next, we walked into an adjacent room, where the
Army keeps its collection of organs. On a lab bench was a
plastic Ziploc bag with a heavy-looking, linen-wrapped object
inside. "That's a large surgical case," Riddick said. "Could be a
breast. Could be a lung. It's big. Looks like a lung." He picked
it up in his hands, and began to knead the package delicately,
as one might check a mango for ripeness. "No, there's some
bone in there." He was as matter-of-fact as Peter Lewin had
been in describing how to use a hole saw on a frozen corpse. I
asked Riddick whether he was ever spooked, working in
roomfuls of human parts. He shook his head. "Son," he said.
"I'm a Vietnam vet. It's the people who move that bother
me."
In March of 1995, Jeffery Taubenberger, who heads the
institute's division of molecular pathology, called over to the
repository to see whether it had any tissue samples from
Spanish-flu victims. Taubenberger is not a "flu man,"
meaning that he is not one of the small circle of scientists
who have devoted their lives to influenza research. But he is
one of the world's experts in the arcane art of recovering
genetic information from preserved tissue samples, and it
occurred to him that he stood as good a chance of finding the
Spanish flu as the scientists looking for frozen bodies. The
archivists told Taubenberger that they had a hundred and
twenty autopsy samples of flu victims. Some, though, were
just microscopic slices of tissue between glass slides, and
they didn't give him enough material to work with.
Taubenberger wanted wax blocks, which reduced his choices
to seventy. Taubenberger and Ann Reid, a technician who
worked with him on the project, randomly selected the
medical records of thirty of those seventy cases. Of those, in
turn, they rejected all the soldiers whose disease had not
progressed rapidly, on the theory that those victims were less
likely to have had the virus in their lungs when they died.
That left them with seven cases. They were ready to begin.
Taubenberger and Reid started by taking lung samples
from all seven and slicing off a microscopically thin sliver from
the end of each block. "You take that slice and put it in a test
tube and get rid of the wax," Taubenberger explained. "And
you take that tissue and spin it really fast, so it all goes to the
bottom of the tube. You digest it in chemicals to chew up the
membranes and the proteins, you go through a series of
chemical purifications, and what you end up with is
something highly enriched with the RNA." Over an entire
year, Taubenberger, Reid, and other members of their team
worked to perfect a method of genetic analysis that could
isolate the right material and stretch the tiny pieces of tissue
they had as far as possible. Given the fragility of RNA, it was
not an easy task. No one had ever recovered RNA from a
sample so old. Early last year, they began testing the seven
samples. One turned up positive.
Taubenberger is wiry and intense, with thick dark-brown
hair and a patient, precise manner. He speaks in complete sentences
and strings them together in complete paragraphs, until he has
made even the most abstruse point crystal clear. I met him and Ann
Reid in his office at the institute, a squat, five-story concrete
bunker originally built as a nuclear shelter for President
Eisenhower. The building has no windows, only a battered concrete
doorway, and the walls inside are covered with tiles of a
disorienting government-issue yellow. Taubenberger, Reid, and I
sat in a circle, and the room was so small and cluttered that our
feet were nearly touching. "He was a twenty-one-year-old army
private," Taubenberger said. "We know he died in South Carolina,
at Fort Jackson. I believe he was from the state of New York. He
had no prior medical history. He got sick at the height of the
pandemic at Fort Jackson and had a fast downhill course. He
presented with massive pneumonia and died six days later,
on September 26th,at six-thirty in the morning. His autopsy
was performed around noon."
V--Viral Sex
One would think that, with the soldier's sample in
hand, many of the questions that surround the Spanish flu
could be answered. In a certain sense, that's true.
Taubenberger and Reid have so far decoded about fifteen per
cent of the genes in the soldier's virus, and their work has
made possible a few preliminary conclusions about the
Spanish flu. It had already been hypothesized, for example,
that the Spanish flu originated--at least, in part--with a bird,
probably a wild duck. Waterfowl are what virologists call the
"reservoir" for influenza. They carry most of the known
subtypes of influenza--without apparent ill effect--and
excrete them all in their feces, thereby spreading them
through land and water to the rest of the animal kingdom. All
animals that get the flu--horses, ferrets, seals, pigs, among
others--and human beings probably get it originally from
birds.
"At this time of the year in Canada, if you look at the
wild ducks that are about to migrate south before the winter,
around thirty per cent probably have the flu," I was told by
Robert Webster, a leading flu expert at St. Jude Children's
Research Hospital, in Memphis. "They're popping it out in the
water. If you sampled the lakes in Canada, you'd find all kinds
of avian influenza." At some point prior to the spring of 1918,
then, a flu-carrying duck must have shed feces while flying
over or nesting in some inhabited part of the world. If, in fact,
the pandemic started in the place where the first case was
reported--Camp Funston--the precipitating event was
probably somewhere in or around Kansas.
That bird virus probably didn't directly infect a human
being, though, because human beings generally can't catch
flu directly from birds. Viruses are particular in that way. A
virus infects and takes over a cell by latching onto what is
called a receptor, but--as far as we know--there isn't a
receptor for avian flu in human beings. So how did the 1918
virus get from ducks to people? One possibility, according to
Taubenberger's analysis, is through pigs--one of the genes he
studied looks like classic swine flu. This makes sense,
because pigs, uniquely, have both human and avian flu
receptors; they're the perfect bridge between species. So
perhaps the flu-contaminated duck feces dropped into a
barnyard, whereupon a pig became infected while nosing in
the dirt and passed the virus on to a farmer.
It's not quite as simple as that, though, since another of
the flu genes analyzed by Taubenberger looks very much as if
it came from human flu. This wasn't just bird flu passed on by
a pig, in other words. This could well have been bird, pig, and
human flu that somehow got mixed up together. The pig must
have already been infected with one flu when it picked up the
other: what it passed on to the farmer was a hybrid.
This is not as far-fetched as it sounds. A flu virus
consists of eight gene segments that are so loosely bundled
that they are like pieces of a jigsaw puzzle thrown together in
a bag. If a pig got infected with avian and human flu
simultaneously, the eight jigsaw pieces from the duck and the
eight jigsaw pieces from the human being would be thrown
together, and an entirely new puzzle could emerge.
Some scientists call this process of two viruses
combining "viral sex," which is an apt term, because, as in
human reproduction, offspring split the genetic inheritance of
mother and father. According to many influenza experts, this
flukish interaction of separate species is probably how almost
all the pandemic strains that periodically sweep the world first
arise. The Hong Kong flu, for example, consisted of seven
genes from an everyday human virus and one gene from a
duck that combined inside a pig to create a nasty new hybrid.
The Asian flu resulted from the same kind of reassortment.
Taubenberger couldn't tell from his sample, though,
what everyone really wants to know, which is what made the
Spanish flu so devastating. It is possible to look at the flu
strains that have proved deadly in domestic poultry and to
explain their lethality almost entirely by pointing to an
insertion mutation in one of the genes--a curious genetic
glitch that allows the virus to attack almost any cell. One idea
had been that the Spanish flu shared this same mutation. But
Taubenberger showed that this wasn't the case. The relevant
segment of the soldier's virus showed no such anomalies, and
that meant that the secret of the Spanish flu's lethality is
probably somewhere else. Perhaps it lies in one of the genes
that Taubenberger and Reid haven't looked at yet. Or perhaps
it's not one mutation at all, but several, all combining in some
subtle way.
"One thing to keep in mind is whether the virus that
Taubenberger has is just a precursor," Webster pointed out.
"We've only got one virus so far. It might have been early in
the pandemic's evolution. Have we yet looked at the nasty
bastard? We need more than one virus. One's not enough."
With an earlier or later sample, Taubenberger could see what
specific changes the virus made over the summer to become
a killer. Just as good would be to find a strain from another
part of the world which might have had a slightly different
evolution, so that Taubenberger could eliminate the
differences, and focus only on what the viruses had in
common. But finding that second virus has proved difficult,
since only the United States Army seems to have been so
assiduous in hanging on to autopsy samples from the First
World War. One famous pathology archive in Germany was
destroyed in the Second World War. A handful of samples
found in England have yet to turn up anything. Taubenberger
has put out feelers to Spain and Italy, and found nothing. I
asked him about Russia, since the Russians were also
pioneers in medical record-keeping, but at that he and Reid
burst out laughing. "There is an epidemiologist at the Centers
for Disease Control who is Russian, and I spent some time
talking to him about this when I was down there,"
Taubenberger said. At this point, he dropped his voice an
octave, imitating a thick Russian accent, and said, "October,
1918. Very bad time for Russia. Very bad time."
This spring, Taubenberger met Duncan at a conference
on the Spanish flu at the Centers for Disease Control, in
Atlanta, and agreed to join her team. His lab will analyze
whatever frozen samples she collects. The best hope for
another copy of the Spanish flu, a second copy that will help
make sense of the first, may well be lying in the permafrost
of Longyearbyen.
VI--Drift and Shift
Every year, early in the winter, the Food and Drug
Administration hosts what some call the Flu Meeting, to insure
that if the Spanish flu ever happened again we would not be
unprepared. This year, the meeting took place on January
30th in the Versailles Ballroom of the Holiday Inn in Bethesda,
Maryland, beginning at eight in the morning and ending at
four. At the front of the auditorium, twenty or so medical
experts sat behind a long table. Off to the side was a lectern,
where throughout the day officials from the Centers for
Disease Control and the World Health Organization gave
presentations. The audience was large--well over a
hundred--and included public-health officials from around the
world, and vaccine manufacturers eager to get guidance from
the government about what kinds of flu strains to put in the
upcoming fall flu shot. Video cameras recorded the
proceedings for those who couldn't attend. Of the dozens of
daylong conferences that the F.D.A. hosts every year, none
are as important.
The first two speakers at this year's meeting were from
the surveillance section of the C.D.C.'s flu division--the eyes
and ears of the flu world. Flu surveillance is critical because
the flu virus comes in so many shapes and varieties. All flu
viruses wear a kind of protective coat--an outer covering
made up of two proteins known as hemagglutinin (h) and
neuraminidase (n). That's how you can tell a flu virus under a
microscope. But there are at least fifteen varieties of h and
nine varieties of n, and any one of the former can combine
with any one of the latter to create a different virus family.
For the past twenty years, the world has been dominated by
two of these flu families--the descendants of the Hong Kong
flu of 1968 and the Russian flu of 1977--and every year each
of them spawns dozens of offspring: genetic variants that
result as individual viruses spread from person to person and
change to stay one step ahead of the human immune system.
Whenever a new offspring emerges, virologists say the virus
has "drifted." At the same time, there is always the possibility
that another avian strain will get mixed up with a human
strain inside a pig and an entirely new family will emerge. If
that were to happen, virologists would say the virus had
"shifted."
It's this constant drifting and shifting that makes the flu
so dangerous. If the flu stayed the same each year, you could
be vaccinated against it the way you can be vaccinated
against polio--for life. But, since the flu is always changing,
the World Health Organization has had to set up a far-flung
international surveillance network. Every day, in Moscow or
Berlin or Iowa City or some distant Chinese province, doctors
take nose and throat samples from flu sufferers, pack them in
plastic vials, and send them to laboratories to be tested. The
labs send isolates of the most interesting cases to the C.D.C.
or to one of three other national labs working with W.H.O., in
Tokyo, Melbourne, and London, for complete analysis, from
which virus family trees are constructed.
Every known subtype of h and n has been identified and
numbered, and every known strain has been labelled as well,
with the city or the place-name where it was first isolated. If
you got the flu last winter, for example, chances are you
came down with h3n2 A/Wuhan/359/95; that is, a virus with
No. 3 hemagglutinin, No. 2 neuraminidase, which was the
three-hundred-and-fifty-ninth sample isolated from the
Wuhan area of China in 1995. (The Wuhans were very big last
year.) If you got the flu two years ago, on the other hand,
chances are that you came down with something very similar
to h3n2 A/Johannesburg/33/94.
At the Flu Meeting, the C.D.C. presented a road map of
where the virus had travelled, and what forms it had taken
during the previous year. It's a fantastically detailed account,
in which the flu virus comes across as a malevolent
hitchhiker, stopping only to infect the locals before moving
on. "February, there was a ship outbreak, the U.S.S.Arkansas,
so severe that they brought the ship back into port," Helen
Regnery, the chief of the C.D.C.'s surveillance section, told
the meeting as she explained the travels of the h3n2 strain
throughout America last year. "The people on board the ship,
almost one hundred per cent, were ill, with varying degrees of
severity of illness." On an overhead projector was a list of all
the known offspring of the American h3n2 family, and
Regnery pointed to another strain. "The Alaska/02 was an
isolate in July. It is from a sporadic case and it has been
sequenced, and will be on the sequencing tree. Hawaii in July
had a nursing-home outbreak and increased activities....
Wisconsin, at a university, had an outbreak in September.
New York/43 is from an H.I.V.-positive patient in November."
New Jersey followed, and then Indiana and Texas.
Regnery's road map was intended to give the F.D.A.
and vaccine makers a guide to the upcoming flu season.
Vaccines consist, essentially, of a dose of virus that has been
chemically deactivated, so that it will stimulate the immune
system without causing disease. She was helping them to
decide what virus strain to use. But if you want to inoculate a
hundred million people you've got to grow enough virus to
make a hundred million flu shots, and that takes time. Drug
companies grow the virus in chicken eggs, injecting a
microscopic droplet of flu virus into the air sac above the
embryo and the yolk. There, in the nutrient-rich membrane of
the sac, the virus grows until, after two or three days, the
original droplet has become a tablespoonful. At that point, the
tops of the eggs are lopped off and the virus is suctioned out.
Mary Ritchey, an executive at Wyeth-Ayerst, one of the
nation's biggest flu-vaccine makers, told me that her
company might use a hundred and fifty thousand eggs at a
time, from which it might harvest two hundred and fifty
gallons of pure virus. To supply the entire country with
enough virus, vaccine makers have to do dozens of those
batches, totalling millions of eggs. Then they have to purify
the virus, test it, run it by the F.D.A., and then have it
packaged, labelled, and sent to clinics around the country--all
of which takes at least six months.
If the drug companies are going to have a flu shot
ready for the fall flu season, then, they have to be told what
strains to use by February or March. That means that the
W.H.O.'s international surveillance teams have to guess
what's going to happen in the fall based on what they have
seen the previous winter. There was a time, ten or twenty
years ago, when this process was notoriously inexact: a flu
shot might be prepared in the summer that offered only
marginal protection against the flu strains that surfaced the
following fall. With an improved surveillance system and more
sophisticated genetic analysis, though, that has now changed.
Every year, the C.D.C. gives itself a grade based on how
closely the guesses made at the Flu Meeting correlate with
the actual flu in the fall. For the last four years, those grades
have been perfect.
If something like the Spanish flu ever came back, this is
the system we are relying on to protect us. Right now,
virtually all the flu in the human population is either h1n1 or
h3n2, so the road map presented by the C.D.C. at the Flu
Meeting was almost entirely an account of genetic drift within
those two families. The minute that the C.D.C. or a W.H.O.
laboratory received a flu that didn't fall into the h1n1 or h3n2
families, it would sound the alarm. The surveillance system is
also specifically focussed on those parts of the world where flu
is prevalent and the inter-species movement that creates
pandemic strains is more likely to occur. That means China,
where there are as many ducks as people, and where pigs are
often raised on farms in close proximity to wild and domestic
poultry. China has been the source of the last two pandemics,
and most observers think it likely that the next will be from
there as well, possibly arising out of the marshy resting sites
for ducks both along the nation's eastern seaboard and inland
in an arc extending from Gansu Province to Guangxi, on the
southern coast. Over the past few years, the Centers for
Disease Control has funded ten flu laboratories in China. The
number of strains sent to the C.D.C. from China every year
has now reached two hundred, up from about a dozen several
years ago.
Perhaps more important, flu-watchers have a sense of when
to be on the lookout for new and vicious flu strains, because
any kind of major social upheaval can serve as a pandemic
breeding ground. This is probably what happened with the
Spanish flu: the 1918 virus was the result of a shift to h1n1.
But that alone doesn't explain its lethality. In the 1957
Asian-flu epidemic, h1n1 shifted to h2n2, and not nearly as many
people died. The difference was probably the First World War.
As the Amherst College biologist Paul Ewald argues in
his brilliant 1994 book, "Evolution of Infectious Diseases,"
under normal circumstances the mildest offspring of any flu
family will always triumph, because people who are infected
with the worst strains go home and go to bed, whereas people
infected with the mild strains go to work, ride the bus, and go
to the movies. You're much more likely, in other words, to
catch a mild virus than a nasty virus because you're more
likely to run into someone with a mild case of flu than with a
nasty case of flu. In 1918, Ewald says, these rules got
inverted by the war. The Spanish flu turned nasty in the late
summer in France. A mild strain of flu spreading from soldier
to soldier in the trenches stayed in the trenches because none
of the soldiers got so sick that they had to leave their posts. A
debilitating strain, though, resulted in a soldier's being
shipped out in a crowded troop transport, then moved to an
even more crowded hospital, where he had every opportunity
to infect others. Wars and refugee camps and urban
overcrowding give the worst flu strains a huge evolutionary
advantage. If there were ever again a civil war in China,
flu-watchers would be on full alert.
It doesn't take much, however, to see that our
pandemic preparedness is not foolproof. What if, for example,
the new strain emerges not in the spring but in midsummer?
How, under those circumstances, could a vaccine be made in
time for the fall, which is when--for reasons that are
unclear--any flu in temperate zones tends to strike in
earnest? And what if it didn't emerge from China, where there
is good surveillance, but from Africa, say, where neither the
C.D.C. nor any other W.H.O. center has the infrastructure to
monitor flu strains? Most troubling, though, is that knowing a
virus's type and source doesn't tell you nearly enough.
On May 10th of this year, for example, a three-year-old
boy from Hong Kong's New Territories came down with the
flu. He died on May 21st with what looked like an unusual and
severe case of viral pneumonia, compounded by Reye's
syndrome. A routine respiratory sample was taken from the
boy's body and analyzed at Hong Kong's Queen Mary Hospital.
It didn't seem to be either h1n1 or h3n2, though, and the
doctor, puzzled, forwarded the sample to the Centers for
Disease Control in early July, and also to other flu labs in the
Netherlands and London. "The doctor said she had a virus that
was reacting differently with the reagents," the C.D.C.'s Helen
Regnery told me. "This happens sometimes, and all viruses
that don't behave well are sent here right away. But at the
time the kind of reaction was such that we thought it might
be a human strain. Then we got another batch from Hong
Kong reacting the same way. Now it was a red flag: she'd
identified two others. She E-mailed me, asking if we could
confirm that particular isolate." This was on the first Friday in
August. The lab staff worked through the weekend. On
Monday, Regnery got a call from researchers at the flu lab in
the Netherlands. They had identified the boy's virus. It was a
pure avian flu, one that had never been seen in humans
before: h5n1. "He may have had direct contact with chickens
that were sick," Regnery said. "They had chickens at his
preschool. We found this out in a conference call the other
night. The epidemiologists we have over there tracked down
the day-care center, and they found some sick chickens."
When I visited the C.D.C. recently, Regnery and other senior
C.D.C. officials I spoke with were careful not to be alarmist
when they discussed the case. The two subsequent isolates
sent from Hong Kong turned out to be human flu, they told
me, and none of the other children at the preschool got sick.
Some members of the boy's family had mild respiratory
ailments immediately before his death, but none appeared to
have caught the same flu. A C.D.C. team of three
epidemiologists and a virologist recently returned from a
three-week trip to Hong Kong and mainland China to help the
local health authorities investigate and collect serum samples
to see if anyone else was exposed, but so far nothing has
come up. "For there to be a pandemic, there has to be a
strain to which all or most of the population has no immunity,
and that is capable of spreading from person to person,"
Nancy Arden, a senior epidemiologist at the C.D.C., told me.
"So far, this doesn't meet the second criterion."
Nonetheless, the situation was a little disturbing. Ducks
fly across virtually every continent in the world, dive-bombing
the landmass with flu virus. They pass it to chickens and
chickens come in close contact with humans every day--on
farms, in poultry markets, in chicken-processing plants. If
avian flu can't infect humans, of course, this is irrelevant. But
what if the Hong Kong case means that there may now be
strains of avian flu which can infect humans directly? Arden
said, "There's still a question of whether avian strains may be
evolving to the point where they can replicate in humans and
where a strain could be transmitted from bird to person. And,
once an avian virus gets into a mammal, it's possible that the
evolution would be speeded up. No one's so alarmed that
they're saying this is the start of the next pandemic. But it's
not something anyone would want to be complacent about."
Then, there's the type of flu the boy got. Avian h5 is
famous among virologists as the strain that passed to
domestic chickens in Pennsylvania in 1983, apparently from
wild ducks. Originally, it was harmless. But as it raced from
chicken to chicken in the giant commercial chicken
warehouses it underwent an unusual mutation. Instead of just
infecting the cells of the chicken's intestinal tract, the virus
became systemic--capable of infecting all the cells in a
chicken's body. The eyes of the chickens became swollen. The
chickens had difficulty breathing. They stopped laying eggs.
They became weak, and in some cases blood spots appeared
in their eyes and on their legs. Upon autopsy, it turned out
that they had been hemorrhaging throughout their bodies. In
a matter of months, seventeen million chickens died or had to
be destroyed. "It was chicken Ebola," the flu expert Robert
Webster told me. The little boy's h5 doesn't seem capable of
the same destruction in humans. But is there any other type
of h5 that would be? And, if there is, what genetic clues in the
virus would tip us off? This is the big unanswered question
behind our plans for the next pandemic, and it is also, of
course, the big unanswered question that drives the search
for the Spanish flu. What is it, specifically, that turns influenza
into a killer?
To get to Longyearbyen, you fly from Oslo for about an hour
and a half to Tromsø, a small town on Norway's northern
coast, and then for another ninety minutes over the
Norwegian Sea to the Longyearbyen airport. The second leg of
the trip retraces by air the route that the Forsete took
seventy-nine years ago. It is an extraordinary journey. First,
the choppy, frigid waters of the Norwegian Sea and then, out
of the Arctic mist, the forbidding mountains and glaciers of
Svalbard. Longyearbyen is at Svalbard's southernmost point,
huddled on the fringes of the island of Spitsbergen, a small
gray stain in a blanket of white. On a clear day, from the air,
it seems as if you could see the North Pole.
All this, of course, is what is so strange about the
Spanish flu--that after killing so many it must now be sought
out at the ends of the earth. Crosby, in the final chapter of his
book on the pandemic, wonders about the disappearance of
the pandemic from the American memory as well. In the
Readers' Guide to Periodical Literature, 1919-21, he reports,
there are thirteen inches of column space devoted to citations
of baseball stories, forty-seven inches devoted to Prohibition,
twenty inches devoted to Bolshevism, and eight inches
devoted to the flu. John Dos Passos, who crossed the Atlantic
on a troopship on which soldiers were dying of the Spanish flu
every day, has just one reference to the flu in his novel
"1919" and a brief mention of the pandemic in his
fictionalized war memoir, "Three Soldiers." The pandemic is
largely absent from the writing of Fitzgerald, Faulkner, and
Hemingway as well, all of whom witnessed its savagery at
first hand. "The average college graduate born since 1918
literally knows more about the Black Death of the fourteenth
century than the World War I pandemic," Crosby writes. He
offers a number of explanations for this. In the end, though,
he concludes that the virus's figurative disappearance is of a
piece with its literal disappearance, that we don't remember it
because we can't find it. The Longyearbyen expedition is, if
nothing else, an attempt to recover our memory of the
Spanish flu.
Kirsty Duncan made the trip to Svalbard for the first
time last spring. She had written to the governor of Svalbard
seven months before, who had, in turn, approached the
Norwegian medical-research community, the church in
Longyearbyen, the church council, the bishop, the town
council, and the victims' families and secured approval from
each. She flew to Norway in May. "I had been in
Longyearbyen about a day before I went to see the minister
of the church, and I was really concerned about meeting him,
because of what I was asking to do," she told me. "I
introduced myself, and I said, 'I hope in no way have I
offended you or the church,' and he said, 'No. This is exciting,
this is important work. It has to be done,' and I was so
relieved, and then he asked me if I had been to the cemetery,
and I said no, that I had no right to go there until I had
spoken to him, and he said, 'You go.'"
The cemetery is a ten-minute walk from the church,
along a gravel road that runs parallel to the mountain. You
walk away from the water and the docks, and toward the
glacier, and for the entire walk the cemetery is straight
ahead--a lonely stand of crosses climbing up the side of the
mountain. When Duncan talked about that walk from the
church to the graveyard, she looked away, her eyes misting
up and her voice catching with emotion. "It was May, and
everything was completely ice-covered. Completely white.
Longyearbyen is in a valley, and the cemetery is up on the
side of the valley floor. I knew that the seven graves I was
interested in were the last seven graves at the top of the
cemetery, and walking up there"--she stopped for a
moment--"walking up there was really hard. I was just one
year older than the oldest of them, and going to look at them
made me realize that they had just come of age. You think
about how they were just beginning their lives. And then you
see those crosses."
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