virus, which spread readily through face-to-face contact, especially in crowded or intimate circumstances. Days after assisting Ang with her examination of Mok, the registrar boarded a plane. He flew to an infectious-disease conference in New York, twenty hours’ worth of air travel from Singapore, and was there when he began feeling sick. Before embarking to come home, via Frankfurt, he phoned a colleague in Singapore and mentioned that he was ill. The colleague alerted Singaporean authorities, who alerted WHO, who alerted German officials, who met the plane when it landed in Frankfurt and took the doctor away into quarantine. He spent almost three weeks in a Frankfurt hospital, along with his wife and his mother-in-law, who by then were sick too. One crewmember from the plane, but only one, had also been infected. Unlike the cardiology resident who assisted the intubation, though, these patients in Frankfurt all survived.
Back in Singapore, health officials and government authorities cooperated to stanch further transmission. They enacted firm measures that reached far beyond the hospitals—such as enforced quarantine of possible cases, jail time and fines for quarantine breakers, closure of a large public market, school closures, daily temperature checks for cab drivers—and the outbreak was brought to an end. Singapore is an atypical city, firmly governed and orderly (that’s putting it politely), therefore especially capable of dealing with an atypical pneumonia, even one so menacing as this. On May 20, 2003, eleven people were taken to court and fined $300 each for spitting.
By the middle of July, when the last SARS patient left Tan Tock Seng Hospital, more than two hundred cases had been recognized. Thirty-three of those people died, among whom were Esther Mok’s father, her pastor, her mother, and her uncle, in that order of demise. Esther herself survived.
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Dead or recovered, they had all been infected—but infected with what?
As the disease spread internationally, scientists on three continents worked in their laboratories with samples of tissue, blood, mucus, feces, and other vital, unsavory materials taken from one patient or another, trying to isolate and identify a causal agent. The very name coined during that early period, SARS, reflects the fact that this thing was known only by its effects, its impacts, like the footprints of a large, invisible beast. Ebola is a virus. Hendra is a virus. Nipah is a virus. SARS is a syndrome.
The search for the SARS pathogen proceeded urgently in those laboratories, but it was hampered by some confusing signals and false leads. For starters, the symptoms looked a little bit too much like influenza—or, more precisely, like influenza at its worst. One form of influenza at its worst is the so-called bird flu, caused by a virus designated as H5N1, with which Hong Kong in particular had had fearful experience just half a dozen years earlier, when eighteen people became infected by spillovers from domestic poultry. Eighteen doesn’t sound like a large number of patients; the fearful aspect was that six of those eighteen died. Health authorities had responded quickly, ordering the closure of live poultry markets and the destruction of every chicken in Hong Kong—amounting to 1.5 million doomed, squawking birds—followed by a seven-week hiatus for decontamination. This draconian response, combined with the fact that H5N1 didn’t transmit well from human to human, only from bird to human, had succeeded in ending the 1997 Hong Kong outbreak. But in February 2003, just when alarming rumors about “a strange contagious disease” began to emerge by email and text message from Guangdong, avian flu struck again in Hong Kong. It was entirely distinct from the SARS outbreak, but that couldn’t easily be seen at the time.
The flu killed a thirty-three-year-old man and sickened (but didn’t kill) his eight-year-old son. It probably also killed the man’s seven-year-old daughter, who had died two weeks earlier of a pneumonia-like illness during a family visit to Fujian, the Chinese province just northeast of Guangdong. Possibly the little girl had consorted too closely with Chinese chickens; her brother had definitely done that, according to his own later testimony. Samples of nasal mucus from both the father and the son showed positive for H5N1, which seemed to suggest that the wider flurry of case reports from Guangdong might likewise pertain to avian flu. So the scientists tested their SARS samples for H5N1. But that was a false lead.
Another wrong notion was that SARS might be caused by some form of chlamydia, a diverse group of bacteria that includes two kinds associated with respiratory disease in humans (as