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Perhaps the boy had never been infected at all. So Fukuda and his team traced the precise route of the specimen. They went to Queen Elizabeth Hospital, the primary referral hospital on Hong Kong’s Kowloon peninsula, to see the intensive care unit where the boy had been treated. They checked to make sure that hospital staff had followed proper sampling procedures, and they examined the equipment. They asked whether any other patients had a similar respiratory disease and could have been the source of the virus. They asked about the health and habits of the staff. Perhaps some nurse had tracked the virus in. The team also visited the health department’s lab at Queen Mary Hospital on Hong Kong island, reviewing how the tests were conducted. They explored whether the virus might have been inadvertently introduced by technicians working at a veterinary lab in the adjacent building. After nearly a week of investigating, there was still no evidence of contamination anywhere.
    But the conclusive proof came in the lab. The team conducted an analysis using antibodies that would find the virus and cling to it. The antibodies were tagged with fluorescent stain so they could be identified under a microscope. When these were added to a sample from the dead boy’s windpipe, they attached to the inside of the human cells in
the specimen. The antibodies did not simply float on top. This meant the virus had truly infected the boy’s cells and was not an accidental visitor.
    The cruel progression of the boy’s disease also seemed to confirm he’d been struck by a form of viral pneumonia arising from influenza. As Fukuda pored over the medical records, he learned that Hoi-ka was initially taken to a doctor after coming down with a high fever, sore throat, and dry cough. The doctor prescribed aspirin and antibiotics and sent him home. But the condition worsened. The boy didn’t seem to be thinking right or acting right. He was oddly irritable. He wasn’t his usual alert self. The doctor couldn’t put his finger on what was wrong. So he admitted Hoi-ka to a small private hospital. A day later, he was moved to the intensive care unit at Queen Elizabeth Hospital and put on a respirator, but to no avail. The boy was losing consciousness. His lungs were failing. Five days later, he was dead.
    Fukuda read the records and thought, “Wow. This is really bad. No matter what they could have done, they weren’t going to prevent him from dying.” Fukuda was struck by the relentless advance of the disease. “It was clear from the time the child got in. He started getting sicker and sicker and sicker and then he died. You don’t expect to see that in young healthy children.” It reminded Fukuda of the healthy young men he had seen in San Francisco in the 1980s struck down almost overnight by AIDS.
    It also made him think of his daughters. He couldn’t keep his mind off them. He wasn’t frightened, not yet. There was just one case. But he felt so sad. How awful for parents to lose a child out of the blue to such a mysterious intruder. “This,” he thought, “is just like a visitation from outer space.”
     
     
    Hoi-ka’s young lungs had been ravaged. The final diagnosis gave the cause of death as pneumonia and acute respiratory distress syndrome, in other words a severe inflammation of the lungs that culminated in their wholesale destruction. But the virus didn’t stop there. The boy suffered kidney failure, and his blood was poisoned, unable to clot
normally. His liver and kidneys also showed evidence of Reye’s syndrome, a separate, potentially fatal disease that can occur when aspirin is taken to treat viral disease.
    This was indeed flu. But it wasn’t the flu most people know. Sure, ordinary seasonal flu can put you on your back with a fever, a cough that keeps you up at night, and aches that rack your bones. But in the vast majority of cases, these symptoms pass in just a few days. This new strain meant far more than a runny