Anita Barry, a veteran disease investigator for the city of Boston, was at Logan International Airport, briefing officials about a worrisome new virus, when her cellphone jangled.
We need you back in the office, the caller said. Right now. Swine flu had landed in Boston.
Barry listened with growing apprehension. This new flu had taken root on Harvard University’s medical campus, in the shadow of some of the world’s most-famous hospitals. A dental student involved with treating patients was sick, and lab tests strongly suggested he was infected with the mysterious virus that headlines that morning warned had killed more than 150 people in Mexico.
And he wasn’t the only one feeling ill.
“I thought, ‘This could be a real problem,”’ Barry recalled. “And of all the places for this to happen, to have it happen in the Longwood Medical Area, it was kind of the perfect storm.”
Over the next 10 hours on that Thursday a week ago, as afternoon melted into evening, investigators from the city and administrators from Harvard embarked on a race to stop the virus’s spread. Harvard is a temple of medical knowledge where ego and arrogance are not unknown, but by all accounts, the university’s top officials worked seamlessly with Boston’s experienced disease detectives.
The Boston team had spent years preparing for this moment, primed for action after the anthrax attacks of 2001, and, more recently, the fears of global epidemic fanned by avian flu. Barry, a physician, has devoted more than two decades of her life to tracking germs in Boston, from measles to AIDS to tuberculosis. In a crisis, she is renowned for her serenity, her words measured and unflappable and direct.
Now, after all the dress rehearsals, there was no time to waste as investigators dug for clues that would tell them where the virus had been - and where it was headed.
‘This is going to test us’
It is a story of disease and disease hunters in the 21st century, when viruses migrate across the globe in days and decisions about what to do must be made in hours, often amid great uncertainty and grave consequences.
“I’m thinking, could we have gotten a more complicated first case in Boston? This is going to test us,” said Barbara Ferrer, Barry’s boss at the Boston Public Health Commission.
Swine flu, caused by the H1N1 virus, commanded the immediate attention of global health authorities when reports filtered out of Mexico City last month that it was responsible for the deaths of dozens of adults and children. In short order, the virus made its US debut in California and Texas, raising alarm across the country.
On Monday evening, April 27, it arrived at a Harvard after-hours clinic just off Harvard Square. A student from the School of Dental Medicine walked in complaining of fever and cough. He was given a prescription for the antiviral medication Tamiflu and told to stay home and not attend classes. The next day, a specimen from the student was sent off for testing.
Early on the afternoon of April 30, the state laboratory in Jamaica Plain called the city with startling news - the dental student had tested positive for a probable case of swine flu.
A health department nurse immediately called the student. A classmate was also feeling sick, the student told the nurse. That woman’s boyfriend, a student at MIT, had returned from a trip to Mexico with flu-like symptoms.
And both of the dental school students had gone to a party the previous Friday night at Vanderbilt Hall, a dormitory across Longwood Avenue from the quadrangle that is the architectural signature of Harvard’s medical campus. The other guests included third-year students from both the dental and medical schools.
Fertile ground for virus
Dental students at Harvard spend their first two years in classes with their medical school counterparts, and some share the same dorm. Each class of about 35 dental students is divided into what the school calls societies. There are four: Peabody, Holmes, Castle, and Cannon.
“You’re in it from day one,” said Dr. Elsbeth Kalenderian, an assistant dean for clinical affairs at the dental school. “You become really tight that way with your society classmates. It’s almost like a little frat thing.”
A flu virus, transmitted by a handshake or an uncovered cough or sneeze, could find fertile ground among students so tightly knit.
So, in offices in Boston and Cambridge, across telephone lines left open for hours on end, representatives of the city and university began making a series of quick-draw decisions. Even as Barry drove back from Logan, Julia Gunn, who helped direct the investigation, dispatched a rapid response team of nurses and epidemiologists to the dental school.
Ferrer, sitting in her sixth-floor corner office in the health commission’s headquarters, spoke with Harvard officials, including Anne Berg, the dental school’s director of admissions and student affairs.
It was roughly 3:30 p.m., less than two hours after the ominous test results were reported by the state lab. Inside the treatment bays where patients are seen at the dental school, the whir and hiss of machinery continued. Ferrer wanted to immediately empty all 69 dental chairs at the school. Berg asked whether it would be possible to finish that day’s appointments.
“Actually, no. I need you to close the clinic today, now,” Ferrer replied, and Berg readily agreed.
As the treatment bays emptied, students, faculty, and staff were instructed to assemble in an auditorium. The city health department was on the way, they were told, because at least two of their classmates were suspected of carrying swine flu. All 80 red upholstered seats were filled, and about 50 more people stood along the walls.
“They were a little bit wondering why they were there, and a little bit confused, and a little bit like, ‘Let’s get going,”’ Kalenderian said.
Standing at the front of the room, Barry was determined to diffuse the tension.
“Well, Harvard is once again number one and this time it’s in having a case of the swine flu in the city of Boston. Congratulations,” Barry recalled saying, evoking laughter.
The city disease trackers had drafted a questionnaire for the dental students and faculty to complete, asking about their health and their activities, including whom they’d had contact with. Each person was summoned into one of two classrooms and greeted by mask-wearing health workers.
In all, 117 people were interviewed during the next two to three hours. Five more students reported symptoms consistent with the flu and were sent to the Longwood branch of the student health service.
Meanwhile, Harvard administrators - including university provost Steven E. Hyman, president Drew Gilpin Faust’s second-in-command - moved toward an inescapable conclusion: It would not be enough to close the dental clinic and cancel classes at the dental school. Given the extensive interaction among students on the Longwood medical campus, the decision was made to also suspend classes at the schools of medicine and public health.
And medical students - including third-years who were scheduled to begin clinical rotations that Friday - were ordered to stay out of hospitals and clinics.
“They were aggressive decisions,” said Dr. David Rosenthal, director of Harvard University Health Services. “We didn’t know the infectivity of the virus, we didn’t know the severity, we didn’t know how contagious this was.”
The consequences of the emerging cluster of cases rippled outward.
In one instance, a Harvard dental faculty member was scheduled to perform surgery at Beth Israel Deaconess Medical Center, and Barry told the woman she needed to find someone to replace her.
As darkness fell, Gunn took the questionnaires back to the dingy warren of offices where the communicable disease specialists work at the health commission. She worked deep into the night, hoping to learn how many people were sick or had been ill in previous days, and how far the web of illness extended.
“It’s like a really good book, and you’ve got all these characters,” Gunn said. “And it all came together and just told you the story.”
That narrative pointed her, mainly, toward two of the third-year societies. “Within these groups, there was more illness than in any other groupings that I had seen throughout all 117 people,” she said.
That told investigators that the virus appeared to be relatively contained, and it also helped the dental school the next morning to quickly compile a list of patients who had contact with potentially infectious students.
About 40 letters were sent to patients urging them to seek medical attention if they experienced flu symptoms - more urgent measures were not deemed necessary because there was only a slight concern that patients had been exposed.
Neither the city nor the university has received any report of an infected patient. In under 24 hours, the count of suspected swine flu cases at the dental school had grown to nine.