Frontline World

Hong Kong - Chasing the Virus, June 2003

Related Features THE STORY
Synopsis of "Chasing the Virus"

Tracing Disease Outbreaks

On the Trail of a Killer

Scientists spell out their approach to SARS

International Health Organizations, Search for a Quick Cure, Economic Fallout




Interview With Renata Simone: On the Trail of a Killer
In late April 2003, FRONTLINE/World reporter/producer Renata Simone crossed paths in New York with noted HIV/AIDS researcher David Ho. He'd just returned from Taiwan and was planning a trip to Hong Kong to conduct research on SARS. He invited Simone along. Simone tells Web editor Douglas Foster, in an interview conducted just as she came out of a 10-day quarantine (she'd contracted a simple cold, not SARS, as it turned out), that the invitation just seemed too good an opportunity to pass up.

Reporter/producer Renata Simone, Hong Kong harbor

Reporter/producer Renata Simone, Hong Kong harbor.
How had you gotten to know David Ho?

I've been following AIDS since 1985, and he's one of the leading researchers. I'm doing a six-part television history of the epidemic that starts back in Africa and continues right up to the present. My choice for the science advisor was David Ho, because he's so brilliant and he's accessible too. He'd invited me to a meeting in New York about AIDS in China.

It was at that meeting that he came up to me and said, "I have to tell you something. Let's talk." He took me over to the side and said, "You won't believe where I was yesterday -- Taiwan." The Taiwanese called on him because they were desperate for advice about SARS. He said there's a real detective story there, and he started to tell me about the spread of the virus. He said that he was going back the following week to test an idea for a treatment. I said right away, without even thinking, "Can we follow you?"

Who would have thought that a background in AIDS research would be the right preparation for attacking the SARS problem?

Exactly. The minute the virus was sequenced, and they realized what kind of virus SARS was, the researchers realized that it was similar enough to HIV -- in the surface proteins, in the way it attaches to its target cells -- that they might be able to use a similar strategy to fight it. So a light bulb went off as soon as the Canadians were able to generate the whole genetic sequence.

Tsang Kam On, resident of the Amoy Gardens apartment complex

Simone with Tsang Kam On (r.), resident of the Amoy Gardens apartment complex.
When did it dawn on you that you might be putting yourself at risk to do the story?

In the beginning, I thought, "Gee, I've reported on health issues, I've been in hospitals, I've been around microbes, how hard can it be?" Then when the lawyer for WGBH came down and started talking to me about liability and long-term disability insurance, that was when the facts of SARS hit me emotionally. SARS has long-term consequences -- it's not pneumonia, it's a very serious illness. That's when I felt frightened. Actually the editorial team sat around with the lawyer in the office and discouraged me from going. So we decided that we wouldn't do the piece and we went home.

The decision not to go was based on the risk?

Right. I went home, and the next morning I just woke up -- it was one of those things where your eyes pop open and you have that rare complete thought in the morning. And I just said, "It's a mistake, we have to go, I have to do this." I thought that if I clicked onto the AP Wire and found out that the tests that David was going to do had worked -- and I could have been in the room when it happened, but didn't go out of fear. The regret would be so hard. I (went) back in and lobbied everybody on that Monday and left the next day. So we had the experience of setting up an international shoot in about 48 hours. We just did it. We traveled light, a couple of bags and the little camera.

What was it like to arrive in Hong Kong?

It felt very strange. I had never been to Hong Kong before, so I didn't have anything in my own experience to compare it to. The airport was absolutely empty except maybe for four or five people in a long, long hallway with 30 gates. That was truly eerie.

The streets were empty too?

Reporter/producer Renata Simone at Amoy Gardens

Reporter/producer Renata Simone at Amoy Gardens.
At rush hour there were a few taxicabs and some buses, but there was really no other traffic. The restaurants were empty. We were there for six days, and it was so easy to move around, but also unreal. We shot most of the story of the science in the laboratory and then it was time to go out to do the Hong Kong epidemiology -- you know, how did the disease spread, where did it go, what was the detective story?

What were the steps in unraveling the mystery?

We went to ground zero in Hong Kong -- the Amoy Gardens apartment complex where more than 320 people became infected and 42 died. I looked around and noticed the exposed sewage pipes on the outside of the building. In the end, the detectives on this case, the epidemiologists, figured out that it was airborne sewage that had carried the virus.

Airborne sewage?

The world learned from that apartment complex that the SARS virus can survive in feces. So one person came into one building and was sick. When the sewage from his apartment went outside of the building, through leaky and cracked PVC pipes, the virus leaked into the air. Once airborne, it can get carried by wind and survive on surfaces for up to three days.

So you were standing there looking at this open sewage -- and you understand at that point that the spread of SARS doesn't require contact between people?

What unnerved me most was that I could faintly smell the sewage. I had my mask on, but I was also really frightened.

How did you deal with the fear?

The way a still photographer puts distance between the subject and himself with the lens. You're doing a job. What I had to do was follow the story and not dishonor the people who were living there by exaggerating things. I just thought of it in a common-sense way. I'm concerned, I'm protecting myself, but I also need to be respectful to the people who live here.

What was the attitude of the people in that complex toward you?

There were diametrically opposite reactions. I didn't see much in between. People would either come up to us and volunteer things or they would literally jump when they saw the camera and go walking in the opposite direction. One man invited us into his apartment. He said, "Do you want to see how it worked? I'll show you."

What did he show you?

He showed me the bathroom. There are two open drains -- one in the floor and one in the shower, of course. What happened was that the effluent from the toilet, before it went into the sewage pipes on the outside of the complex, was running through pipes in the floor of the apartment. Little virus particles were becoming aerosolized, as the public health people say, and coming out of the drain.

So what about the other half of your detective story? What was it like, day after day, to be in that research laboratory in Hong Kong? I don't imagine it's very exciting to watch scientists looking through microscopes.

Hong Kong's public health director, Dr. Margaret Chan

Hong Kong's public health director, Dr. Margaret Chan (l.), with Simone.
Science can be boring. But the scientists who work with David Ho [Dr. Richard Kao, Dr. Leo L.M. Poon and Dr. LinQi Zhang] -- he calls them the Three Amigos -- are young and excited and smart. They told me this was the biggest experiment of their lives. They looked forward to every morning. We'd get there at 6:30am in the morning with our camera and they would already be there after leaving past midnight every night. They came in talking about their dreams. They'd say, "Last night I dreamed that we pulled out the plates, the cultures, and we forgot to add the virus." Anxiety dreams, excitement dreams, aspiration dreams. I felt all my hopes go with them too.

Tell me about that amazing moment when they got positive results.

It's Saturday morning, they've been waiting for three days. They'd expected to get results in 24 hours. You can just feel the frustration. David Ho has been called to Taiwan, so the young researchers are on their own. They stand outside, and they're talking about how nervous they are. They're wringing their hands inside their rubber gloves and fiddling with their masks. I ask them why they're so nervous. They say, "Because so much rides on this. It's not just science. This is about people's lives. This is why we are virologists."

We go in with them, and they methodically check the results. One of them looks in the microscope, the other one takes down the results. They start using code words. They say, "Something interesting." It's the tone of voice and the urgency in the voice rather than the language that tells me this is really good news. Then they say, "These readings are consistent!" And finally they say, "Number two looks very interesting" and "Excellent!"

What was it that they were seeing exactly?

What they saw was that the cells that were combined only with the virus were dead, but that the pools of cells combined with the virus and the experimental peptide were healthy.

The results were that clear-cut?

They were basically looking for life and death and that's what they saw. When there was a peptide preparation combined with everything, the cells were alive. They tested 12 peptides and several different concentrations of each. They ran more than 100 assays. Five of the peptides at specific concentrations definitely had a protective effect. So that was real success.

Production assistant Olga Wong and Simone at Amoy Gardens

Production assistant Olga Wong and Simone at Amoy Gardens.
Is this a definitive step toward a treatment for SARS?

The next steps are make-or-break. They're going to test it in rhesus monkeys and then they're going to test it in people. They're optimistic though. They have a realistic sense of optimism because these peptides are modeled directly on the drugs that are already approved for AIDS and proven to be nontoxic.

SARS seems to threaten adults much more than children. Is that because so much of the damage caused by exposure to the virus is actually a result of the behavior of the infected person's own immune system?

Right. In fact, a priest who became infected when he went to visit a parishioner in the hospital came home and, before he knew he was sick, he infected his wife. The two of them became sick, but the children didn't get it. He has two little boys under 12 and they didn't get sick. That's even though they were in the same household, sharing utensils and towels and things.

Both he and his wife survived?

Yes, they're in good health.

Compared with other epidemics you've covered, like HIV, for example, SARS is something of a piker -- maybe 8,240 cases by the end of May, 745 deaths, and none of those in the United States. What's the broader significance?

This shows us the dark side of globalism. Maybe years ago it didn't matter to somebody in Minneapolis that somebody in Guangdong Province in China had a new virus. But now it does. When you look over the history of flu viruses and really lethal flu pandemics, most of them have come out of Guangdong. Hong Kong is really the gateway, then, for those diseases, those emerging diseases -- which then go all over the world by air travel. A thousand flights a day, 100,000 people.

Reporter/producer Renata Simone, Guangdong Province

Reporter/producer Renata Simone, Guangdong, Mainland China
What is it about Guangdong Province that turned it into such a viral petri dish?

People live close together. Not only do they live close together, but they also live close to their animals. Then there's the fact that the custom is to sell live animals in markets. That means slaughtering takes place in the midst of daily life, it's not segregated off in slaughter houses where conditions can be controlled and separated from everything else. This happens right in the middle of everyday life. There's blood spurting everywhere. So not only do viruses have a chance to get into the environment and into people's immediate surroundings, but they also have a chance to combine from animal to animal and animal to human, and it's those combinations that create the conditions for new viruses. The climate is the last factor -- in the subtropics, it never freezes, so the viruses thrive.

As you got more deeply into reporting on the science of the story and understood it better yourself, what was your appraisal of the daily coverage of SARS?

I was worried about the sensationalism. There were some pieces that presented SARS like the archetypal airborne killer from Mars that's going to wipe out the planet. That worried me because when I talked to the scientists they said that's not what this one is. But they did say let's use this as a lesson because we might get one of those kind of cases in the future.

I had a couple of other reactions too. As somebody who has covered AIDS so much, I felt, well, sad. AIDS has affected over 60 million people. More than 24 million people have died. As you said before, even up to the end of May we're talking much smaller numbers of deaths from SARS -- under 1,000 people.

Look at the whole continent of Africa and the way AIDS is surging through Asia and Russia. So I felt tremendously sad that here was this was firestorm of an epidemic -- I mean that both in the sense that it's damaging and in the sense that it's attracting so much attention. Part of me wanted to say, "Hey, look over here, there's this other thing, let's not forget about AIDS."

Is SARS a kind of wake-up call in terms of future infectious diseases?

Absolutely. We're so lucky to have had something come at us that's not even as infectious as the flu, for example. That's why SARS hasn't caused a global health disaster. This experience can show us where the weaknesses are in our public health system. We ought to use SARS as fair warning to try to get our system prepared -- because if the past is a record, we will see another lethal infectious disease emerge from that corner of the world.

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