Kai KupferschmidtVerified account

The episode is really a tale of two viruses, a story of what @JeremyFarrar told me were “the two times I've really been frightened in my professional life”. The first moment is on the eve of Vietnamese New Year, Têt, in January 2004 in Ho-Chi-Minh City.

That night Farrar (who had been working in Vietnam since 1995) and his colleague Professor Hien were called to see a young girl who had been admitted to the hospital with a severe but unusual pneumonia. The fear on everyone’s mind: Could SARS have returned?

The year before, 2003, SARS1 had come to Vietnam. A friend of Farrar’s, Carlo Urbani, had treated the first patient there, recognised that it was probably a new disease and warned the @WHO. He had tragically died after contracting the disease himself.

After examining the girl, doctors concluded it was not SARS. But Hien took a detailed history of the patient and discovered an interesting story:

The girl had a pet duck that had recently died. But as Farrar told me she wasn’t happy with the burial. "So she dug it up again and … kissed it and cuddled it and then re-buried it. And then a few days later came down with what was a really incredibly severe lung infection.”

Hien took a nose and a throat swab "put it in his rucksack, got on his motorbike and drove across to the hospital where he and I worked some two or three kilometres away in the middle of the night on the eve of Vietnamese new year”. Tests showed it was H5N1, bird flu.

At the time it wasn’t clear whether the virus had learnt to spread from humans to humans (it had only been recognised that it could infect humans at all in an outbreak in Hong Kong in 1997).

“It was a very, very frightening time”, Farrar told me. "I remember staying in the hospital and not leaving, in fact, following the sort of thing that Carlo Urbani did, who was a good friend with three small children, and, you know, we had three small children and he died.”

Luckily for Farrar - and the world - the virus did not readily spread form person to person, as became clearer over time. (The teenage girl survived as well.) 
There is a lot to be said about why, but that’s for another thread.

The second time Farrar got really scared, was early 2020. Reports of a new coronavirus sickening people emerged - of all places - in Wuhan, a city with a lab studying these viruses. Farrar says his first thought was “Is that a laboratory accident?”. He thought chances were 50/50.

Farrar was afraid that the possibility alone could put the already tense geopolitical situation over the edge. “If this is an accidental or deliberate release, then … you could easily be into something unstoppable, war, who knows. Who knows what you're unleashing?”, he told me.

And he started to be afraid for his safety: „if this is an accident, or it's deliberate, … the world is on the precipice of something. And that's a very, very frightening thought when you think that … it's a small number of people in the world that know that.”

Farrar knew who to talk to: Eliza Manningham-Buller was the chair of the Wellcome Trust, but before that she had been the head of MI5, the UK’s security service. This is where it all gets a bit James Bond (yes, I know he’s MI6).

“Look after your own security”, Manningham-Buller told Farrar. “Don't make the same trips on the same journeys every day.” And she told him to assume he had been hacked and to get a burner phone that he could use to have confidential conversations.

In retrospect he says it was partly irrational, down also to a lack of sleep. “I remember phoning my brother and saying the same thing to him that, that there were things going on that that I was not in control of, and I don't know why I was frightened, but I was frightened.”

Today, Farrar says, with what has been learnt he puts the likelihood of natural spillover at 95% and the likelihood of some kind of lab leak at 5%. (We‘ll cover this in an upcoming episode…)

What I find striking about these two moments, is this:
The fear in 2004 was a fear of what the virus could do. The fear in 2020 was really a fear of what humans could do. I’m not sure that Farrar would agree, but to me this says a lot about where we are as a society.

Maybe I am biased. Throughout this pandemic the behaviour of the virus has seemed easier to understand and predict than the behaviour of humans. It makes a certain sense to me that the fear of other people may be as potent in this pandemic as the fear of the virus.

We may be in the worst of both worlds now: As Farrar reminded me, big outbreaks have happened every 2 to 3 years in the last 2 decades. “It hasn't stopped happening in the animal kingdom”, he told me. At the same time global cooperation on surveillance has ceased in many areas.

“The world is very, very vulnerable at the moment”, Farrar told me. “Because if there were those spillover events happening at the moment, we wouldn't know about them. They're not being picked up. They're not being looked for.”