Medusa

CHAPTER 2

ANHUI PROVINCE, PEOPLE’S REPUBLIC OF CHINA

THE HELICOPTER DARTED IN FROM NOWHERE AND CIRCLED above the village like a noisy dragonfly. Dr. Song Lee looked up from the bandage she was applying to a cut on the young boy’s arm and watched as the helicopter hovered and then started its vertical descent to a field at the edge of the settlement.

The doctor gave the boy a pat on the head and accepted her payment of half a dozen fresh eggs from his grateful parents. She had treated the wound with soap, hot water, and an herbal poultice, and it was healing nicely. With little in the way of medicine and equipment, the young doctor did the best she could with what she had.

Dr. Lee brought the eggs into the hut and then joined the noisy throng rushing to the field. Excited villagers, including many who had never seen an aircraft up close, completely surrounded the helicopter. Lee saw the government markings on the fuselage and wondered who from the Ministry of Health would be coming to her remote village.

The helicopter door opened and a short, portly man wearing a business suit and tie stepped out. He took one look at the chattering crowd of villagers and an expression of terror crossed his broad face. He would have retreated into the helicopter if Lee had not eased her way through the mob to greet him.

“Good afternoon, Dr. Huang,” she called out in a strong enough voice to be heard above the babble. “This is quite the surprise.”

The man cast a wary eye over the crowd. “I hadn’t expected such a large reception.”

Dr. Lee laughed. “Don’t worry, Doctor. Most of these people are related to me.” She pointed to a couple whose weathered brown faces were wreathed in smiles. “Those are my parents. As you can see, they’re quite harmless.”

She took Dr. Huang by the hand and led him through the swarm of onlookers. The villagers started to follow, but she waved them off and gently explained that she wished to speak to the gentleman alone.

Back at her hut, she offered her visitor the battered folding chair she sat in to treat patients. Huang mopped the sweat off his bald pate with a handkerchief and scraped the mud from his polished leather shoes. She boiled water for tea on a camp stove and poured a cup for her visitor. Huang took a tentative sip, as if he were unsure it was sanitary.

Lee sat down in the patched-up old dining-room chair that the patients used. “How do you like my open-air treatment room? I see my more modest patients inside the hut. Farm animals, I treat on their own territory.”

“This is a far cry from Harvard Medical School,” Huang said, gazing in fascination at the hut, with its walls of mud and thatched roof.

“This is a far cry from anywhere,” Lee said. “There are some advantages. My patients pay me in vegetables and eggs, so I never go hungry. The traffic is not as bad as in Harvard Square, but it’s next to impossible to find a good caramel caffe latte.”

Huang and Lee had met years before at a mixer for Asian students and faculty at Harvard University. He was a visiting professor from China’s National Laboratory of Medical Molecular Biology. She was finishing her graduate studies in virology. The young woman’s quick wit and intelligence had impressed Huang immediately, and they had continued their friendship after returning to China, where he had risen to a high position in the ministry.

“It has been a long time since we talked. You must be wondering why I’m here,” Huang said.

Dr. Lee liked and respected Huang, but he had been among a number of highly placed colleagues who were conspicuously absent when she needed someone to speak out on her behalf.

“Not at all,” Lee said with a note of haughtiness. “I expect that you are probably carrying the apology of the authorities for their heavy-handed treatment of me.”

“The state will never admit that it is wrong, Dr. Lee, but you have no idea how many times I have regretted not standing up in your defense.”

“I understand the government’s tendency to blame everyone but itself, Dr. Huang, but you have no idea how many times I have regretted that my colleagues failed to come to my defense.”

Huang wrung his hands.

“I don’t blame you,” he said. “My silence was a clear act of cowardice. I cannot speak for my colleagues. I can only offer my most humble apologies for not defending you in public. At the same time, I did work behind the scenes to keep you out of jail.”

Dr. Lee resisted the temptation to show the doctor the harsh conditions in the impoverished village. He would soon learn that a jail didn’t need bars. She decided that it would be unfair to pick on Huang. Nothing he could have done would have changed the outcome.

She forced a smile.

“Your apology is accepted, Dr. Huang. I am truly pleased to see you. Since you do not bear the thanks of a grateful nation for my service, what are you doing here?”

“I come as the bearer of bad news, I’m afraid.” Although they were alone, he lowered his voice. “It has returned,” he said in a near whisper.

Lee felt an icy coldness in the pit of her stomach.

“Where?” she asked.

“To the north of here.” He rattled off the name of a remote province.

“Have there been any other outbreaks?”

“None so far. It is an isolated area, thank goodness.”

“Have you isolated the virus to confirm its identity?”

He nodded. “It’s a coronavirus, as before.”

“When was it first detected? And have you found its source?”

“About three weeks ago. No source yet. The government immediately isolated the victims and quarantined the villages to prevent its spread. They are taking no chances this time. We are working with the World Health Organization and the U.S. Centers for Disease Control.”

“That’s quite different from the last response.”

“Our government learned its lesson,” Huang said. “Their secrecy regarding the SARS epidemic damaged China’s reputation as an emerging world power. Our leaders know that secrecy is not an option this time.”

The Chinese government had come under international fire because it kept the first SARS epidemic secret from the world, causing a delay and slowing treatment that could have prevented a number of deaths. Song Lee was working as a teaching physician in a Beijing hospital when the epidemic broke out. She suspected it was serious and assembled the facts to make her case. When she urged her superiors to take action, they warned her to stay silent. But the World Health Organization’s outbreak-alert system issued a global warning. Travel came to a halt and quarantines were enforced. An international lab network isolated a virus never before found in humans. The disease was called SARS, short for severe acute respiratory syndrome.

The virus spread to more than two dozen countries on several continents, infecting more than eight thousand people. Almost a thousand died, and a pandemic of worldwide proportions was narrowly averted. The Chinese government imprisoned the doctor who had told the world that the cases were being under-reported and that patients were being driven around in ambulances to keep them away from the World Health Organization. Others who had tried to expose the cover-up also became targets. One of them was Dr. Song Lee.

“Secrecy wasn’t an option then, either,” she reminded Huang, making no attempt to keep the heat out of her voice. “You still haven’t told me what this has to do with me.”

“We are assembling a research team and want you to be on it,” Huang said.

Lee’s anger spilled out.

“What can I do?” she asked. “I am simply a country doctor who treats life-threatening diseases with herbs and voodoo.”

“I implore you to put your personal feelings aside,” Huang said. “You were one of the first to detect the SARS epidemic. We need you in Beijing. Your combined expertise in virology and epidemiology will be invaluable in developing a response.” Huang folded his hands together as if in prayer. “I will get down on my knees to beg, if you wish.”

She gazed at his anguished face. Huang was brilliant. She could not expect him to be valiant as well. Softening her voice, she said, “It won’t be necessary to beg, Dr. Huang. I will do what I can.”

His round face lit up.

“Mark my words,” he said, “you won’t be sorry for your decision.”

“I know I won’t,” Lee said, “especially after you meet my conditions.”

“What do you mean?” Huang asked in a guarded tone.

“I want enough medical supplies to take care of this village for six months . . . No, make that a year, and expand it to encompass the villages around this one.”

“Done,” Huang said.

“I have established a network of midwives, but they need a trained professional to oversee them. I want a family-practice physician flown in here this week to take over my practice.”

“Done,” Huang repeated.

Lee chided herself for not demanding more.

“How soon do you need me?” she asked.

“Now,” Huang said. “The helicopter is waiting for you. I would like you to speak at a symposium in Beijing”

She did a quick mental inventory. The hut was on loan. Her belongings could fit into a small valise. She would have to inform only the village elders and bid her aged parents and her patients a quick good-bye. Standing, she extended her hand to seal the bargain.

“Done,” she said.

THREE DAYS LATER, Dr. Lee stood on a podium behind a lectern at the Ministry of Health in Beijing, steeling herself to address more than two hundred experts from around the world. The woman on the podium bore no resemblance to the country doctor who had delivered babies and piglets by candlelight. She wore a pin-striped business suit over a blouse of Chinese-flag red, a rose silk scarf encircling her neck. A touch of makeup had lightened the amber complexion that had been darkened by outdoor life. She was grateful that no one could see her callous palms.

Soon after she had arrived in Beijing, Lee had gone on a shopping spree, courtesy of the People’s Republic of China. At the first shop, she tossed her cotton jacket and slacks in the trash. With each subsequent purchase, in some of Beijing’s most fashionable boutiques, she redeemed a bit of her lost self-respect.

Song Lee was in her mid-thirties, but she looked younger. She was slender, with small hips and breasts, and long legs. While her figure was adequate but unremarkable, it was her face that inevitably turned heads for a second look. Long dark lashes shaded alert, questing eyes, and full lips alternated between a friendly smile and a slight, more serious pucker when she was deep in thought. Working in the country, she had tied her long jet-black hair in a loose ponytail and tucked it under a cap that may have belonged to a foot soldier on Mao’s Long March. But now it was styled and cut short.

Since arriving in Beijing, Lee had attended a dizzying schedule of briefings and had been impressed at the swift reaction to the latest outbreak. In contrast to the slow response several years before, hundreds of investigators and support staff had been mobilized around the world.

China was taking the leading role in the fight against the outbreak and had invited experts to Beijing to demonstrate its robust reaction. The speedy response had revealed a silver lining to a serious situation: everyone she talked to seemed confident that basic health practices could contain the SARS outbreak while researchers continued to look for the source and develop a diagnostic test and an appropriate vaccine.

But while the mood was upbeat, Dr. Lee was unable to share their confidence. She was worried that no source of the virus had been found. The civets that had carried the original SARS strain had been wiped out, so maybe the virus had jumped to another host-dogs, chickens, insects-who knew? Also, the Chinese government’s uncharacteristic transparency bothered her as well. Bitter experience had taught her that the authorities did not easily give up their secrets. Even so, she might have dismissed these qualms had not the government refused to let her visit the province that had been infected. Too dangerous, she was told, the province was under the strictest quarantine possible.

Dr. Lee had set her suspicions aside for now to focus on the daunting prospect of appearing before an audience of sharp-minded experts. Her heart thumped madly in her chest. She was nervous about speaking in public after spending years among people whose greatest concern was the rice yield. The computer programs now available to chart an epidemic not only baffled her, she was unsure of her own expertise as well. She felt like a Stone Age holdover thawed from a glacier after ten thousand years.

On the other hand, practicing medicine at its most basic level had given her a gut instinct that was more valuable than all the charts and tables in the world. Her intuition was telling her that it was too early to celebrate. As a virologist, she had respect for how fast a virus could adapt to change. As an epidemiologist, she knew from painful experience how an outbreak could quickly get out of control. But maybe she was just gun-shy. She had gone over the statistics Huang had given her, and the epidemic seemed to be on the road to being contained.

Dr. Lee cleared her throat and looked out at the audience. Some of the people waiting for her to speak were aware of and possibly responsible for her exile, but she swallowed her bitterness.

“To paraphrase the American writer Mark Twain, rumors of my professional demise have been greatly exaggerated,” she said with a straight face.

She let the ripple of laughter roll over her.

“I must admit, I come to you humbled,” she continued. “Since I established my rural practice, great strides have been made in the world of epidemiology. I am impressed at the way the nations of the world have come together to fight this new outbreak. I am proud of the role my country has taken in leading the effort.”

She smiled at the applause. She was learning to play the game. Those wanting angry denunciations of past policy would be disappointed.

“At the same time, I must warn against complacency. Any epidemic contains the seeds of a pandemic. These pandemics have come to us in the past, and human beings have always come out the worse for it.”

She talked about the great plagues in history, starting with the first recorded pandemic that struck Athens during its war with Sparta. The Roman pandemic of 251 A.D. had killed five thousand people a day, the Constantinople epidemic of 452 ten thousand a day. Around twenty-five million died in Europe of the Black Death during the 1340s, and forty to fifty million worldwide in the great influenza epidemic of 1918. She repeated her warning against complacency, and repeated how pleased she was at the multinational response to the current epidemic.

Dr. Lee was stunned at the applause that her presentation received. Her acceptance back into the medical community after years of exile was unexpected, and she was overcome with emotion. She left the stage, but instead of returning to her seat she strode to the exit. Tears welled in her eyes, and she needed to compose herself. She walked along the corridor, not sure where she was going.

Someone called her name. It was Dr. Huang, hurrying to catch up to her.

“That was a fine presentation,” he said, breathless from the chase.

“Thank you, Dr. Huang. I’ll return to the auditorium in a few minutes. It was quite an emotional experience for me, as you can imagine. But it was reassuring to hear that a worldwide pandemic is unlikely.”

“On the contrary, Dr. Lee, a pandemic is a certainty. And it will kill millions before it runs out of victims.”

Song Lee glanced at the door to the auditorium. “That’s not what I heard in there. Everyone seemed quite optimistic that this epidemic can be contained.”

“That’s because the speakers don’t know all the facts.”

“What are the facts, Dr. Huang? Why is this SARS epidemic any different from the last?”

“There is something I must tell you . . . this business about SARS . . . well, it’s a fraud.”

Lee glared at Huang.

“What are you saying?”

“The epidemic we are concerned about is caused by another pathogen, a variation of the influenza virus.”

“Why didn’t you tell me this? Why did you let me blather on about SARS?”

“It pained me to do so, but the presentation was intended as a smoke screen to hide the fact that the pathogen we are dealing with is much more dangerous than SARS.”

“The experts speaking in the auditorium may beg to differ . . .”

“That’s because we have been feeding them misleading information. When they have asked for specimens of the strain to help with their research, we have given them the old SARS virus. We are trying to prevent a panic.”

She felt a dryness in her mouth.

“What is this new pathogen?”

“It is a mutated form of the old influenza strain. It spreads faster, and the mortality rate is much higher. Death comes more quickly and more often. It’s incredibly adaptable.”

Dr. Lee stared in disbelief. “Hasn’t this country learned its lesson about secrecy?”

“We have learned it very well,” Dr. Huang said. “China is working with the United States. We and the Americans have agreed to keep the existence of this new pathogen a secret for now.”

“We saw before that delay in releasing information costs lives,” Lee said.

“We also saw forced quarantine,” Huang said. “Hospitals shuttered, travel and commerce interrupted, people attacked in Chinatowns around the world. We can’t tell the truth now. There’s no way to stop this pathogen until we’ve developed a vaccine.”

“You’re sure of this?”

“Don’t take my word for it. The Americans have far more sophisticated computers. They have created models suggesting we can temporarily contain pockets of the disease, but it will eventually break out and we will have a worldwide pandemic.”

“Why didn’t you tell me all this back in the province?” Lee asked.

“I was afraid you might still think I had betrayed you before and wouldn’t believe me,” Huang said.

“Why should I believe you now?”

“Because I am telling the truth . . . I swear it.”

Dr. Lee was confused and angry, but there was no doubt in her mind that Dr. Huang was being forthright.

“You mentioned a vaccine,” she said.

“A number of labs are working on it,” he said. “The most promising drug is being developed in the U.S. at the Bonefish Key lab in Florida. They believe a substance derived from ocean biomedicine will produce a vaccine that will stop this pathogen.”

“You are saying that one lab has the only viable preventative?” Lee almost laughed at the absurdity despite the direness of the situation.

The auditorium doors opened, and people were starting to spill into the corridor. Huang lowered his voice.

“It’s still in development,” he said, “but, yes, our hopes are high. It might go even faster if you were there as the representative from the People’s Republic.”

“The government wants me to go to Bonefish Key?” she said.

“It seems that I have been ‘rehabilitated.’ I’m willing to do anything I can. But you are putting everything on this one vaccine. What if it doesn’t work?”

A haunted look came to Huang’s eyes, and his voice dropped to a whisper.

“Then only divine intervention can help us.”