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The CDC's Fukuda arrived in Hong Kong on Wednesday, Aug. 20. The next day he and a team of CDC investigators joined an intensive investigation already being conducted by the Hong Kong Department of Health. Working with health-department officers, Fukuda and his colleagues conducted scores of interviews and collected hundreds of blood samples, trying to figure out how the first victim, the three-year-old boy, could have contracted a virus that infects only birds.
The CDC took a hard look at the boy's preschool, in particular a corner of his classroom set aside as a kind of nature corner, with live chicks and ducklings. Fukuda knew that the birds had died before the boy got sick, but no one knew what killed them. The team swabbed the classroom floor to try to capture some of the virus, but found none. Although press reports suggested a close tie between the death of the classroom birds and the boy's illness, Fukuda says the source of the boy's infection is by no means certain. "It was unclear then," he says. "It is unclear now."
The CDC's investigation of the boy's illness lasted 2 1/2 weeks. By the time Fukuda left Hong Kong, his team had collected 2,000 blood samples. Antibodies indicating previous exposure to H5N1 were found in only nine samples, including one of the boy's classmates and one of his doctors. None of the nine recalled being ill. The fact that so few showed signs of exposure was concrete evidence that the virus was not particularly contagious.
For the moment, there appeared little reason to fear that this first case, however tragic, represented the start of a pandemic. Says Fukuda: "I left thinking, 'You know, this is probably some odd, sporadic thing.'"
He expected no more cases.
In another odd coincidence, that same August, as Fukuda investigated the new virus in Hong Kong, the quest to understand the 1918 epidemic suddenly gained momentum, with help from a surprising quarter. Out of the blue, Taubenberger got a letter from a retired San Francisco pathologist, Johan Hultin, who had read Taubenberger's paper in Science and saw at last an opportunity for which he had been waiting for nearly a half-century.
In 1951 Hultin took part in an expedition to Alaska to try to extract live virus from long-frozen victims of the 1918 flu in what is now Brevig Mission, Alaska. Now he was ready to try again. He knew from hard experience that no live virus had survived under the permafrost. But Taubenberger's paper convinced him that technology had advanced to the point where even a dead virus could be of immense value. The moment he saw the Science paper, he told himself, "There. This is it."
Hultin asked Taubenberger whether he would accept and analyze samples of lung tissue from frozen graves, if he, Hultin, went to Alaska to get them. "When are you planning to leave?" Taubenberger asked. He knew firsthand that such ventures take a lot of advance planning. "I can't go this week," Hultin told him. "But I can go next week." Taubenberger got really quiet. "I don't know what was going through his mind," Hultin says, chuckling. "He probably thought I was some kind of a nut."