Chinese cover up
What did the scientists know and when?
I was wide awake during the early days of the COVID-19 pandemic, as were most of my colleagues in the field of epidemiology, I presume. We were trained to think exactly the way the rest of the world was learning to think as the pandemic unfolded — in numbers and graphs with precise definitions of what we were seeing on our TV screens. I recall that in January of 2020 the World Health Organization (WHO) reported a cluster of 41 strange pneumonia-like illnesses in the city of Wuhan, China. Researchers in China had identified a new coronavirus as the likely cause of the disease but found “no evidence of human-to-human transmission.” This was interesting to me but felt far removed from my own reality.
Watching the news today, we hear that the Chinese and the WHO may have been involved in an early cover-up of the virus, now known now as SARS-COV-2. What did the Chinese scientists know and when? What was the source of the virus and how did the virus transmit?
In the early days of the pandemic when the pneumonia cases were first appearing, Chinese researchers suspected a zoonotic pathogen, a virus that jumps from an animal to a human host. Because few of the pneumonia patients’ family members showed signs of disease and no health care workers had yet become ill, transmission mode was deemed unknown. Transmission might be from a food source (from a live-food market), an animal vector, toilets, bird droppings, and the like.
Every year disease outbreaks affecting humans occur all over the world due to zoonotic pathogens. For example the pathogens, Ebola, Marburg, West Nile, Sin Nombre, monkeypox, rabies, and many more have led to deadly disease in many countries, some with the potential for causing pandemics.
To date, the source of the virus has not been disclosed.
But, the pathogen itself was quickly identified through genetic sequencing of bronchial fluid samples taken from one of the pneumonia patients. The pathogen was determined to be a novel coronavirus, a new virus in the family of beta-coronaviruses. Doctors at Wuhan Central Hospital worried about the possibility of a reemergence of SARS-1, also a beta-coronavirus. The genetic code of old and new viruses showed similarities. The doctors shared their concern privately with family members and professional contacts, but word soon got out. Rumors traveled quickly through the Chinese social media app Whatsapp that the illnesses were SARS-1 or MERS, both deadly diseases that the Chinese citizenry knew well from outbreaks in 2003 and 2012, respectively. Nervous local authorities publicly admonished the doctors and censored the hashtag #WuhanSARS, threatening serious repercussions for public rumor mongering.
As local officials scrambled to manage the outbreak and control the narrative, the central government of Beijing stepped in to take over management of the outbreak and conduct investigations into the hospitals, laboratories, and the wet market. Meanwhile, a joint mission of experts was being assembled by China and the WHO to study circumstances of the outbreak and determine next steps.
During the frantic month of January, progress at the Wuhan JinYinTan Hospital, where the 41 patients were sequestered, moved forward. The medical team treating the 41 pneumonia patients ran tests ruling out influenza and 26 other pathogens. The team settled on the novel coronavirus as the likely pathogen and information on the outbreak was shared with the WHO and CDC director Robert Redfield. This all happened by January 4.
By January 10, the genetic sequence of the virus was confirmed by a consortium of researchers and posted on the website virological.org. By then, there were 57 laboratory confirmed cases of the disease (later to be named COVID-19) and one death. Four hundred medical personnel were screened and none were found to have the virus. No new cases were reported for several days.
Knowing that some zoonotic pathogens pass from animal-to-human only (for example, the wild bird virus H5N1 can result in severe respiratory disease and death in humans, but is not known to transmit between humans), authorities in Wuhan and at the WHO were reluctant to confirm human-to-human transmission. The local Wuhan authorities downplayed the illnesses, as they focussed on preparing for their annual Baibutinga community banquet, a 40,000-family “pot-luck,” to celebrate Chinese New Year. The event took place on January 18. There were 300 confirmed cases in Wuhan at the time.
Nevertheless the situation was threatening to spin out of control and authorities quarantined much of the city of Wuhan and, on January 23, shut down both incoming and outgoing travel. Businesses were shut down, as eventually were University and research laboratories.
As pandemics go, transmission mode for the new virus in Wuhan was unknown for a relatively short period time. Transmission mode became clear after a sufficient number of days passed for the patients’ contacts to be traced, new clusters to emerge, and health care workers tending the sick to become sick themselves or test positive for the disease. When two cases of the disease emerged outside Wuhan on January 20, the China National Health Commission confirmed human-to-human transmission.
Soon, all of China went into lockdown. On January 29, the WHO declared a “public health emergency of international concern.”
Scientific efforts moved forward, apparently unhampered, with rapid online postings of research articles in English. For example, on January 24, 28 Chinese doctors and scientists published an article in the British medical journal, the Lancet, with details of the pneumonia cluster involving the 41 hospitalized patients in JinYinTan Hospital. In the article, the pneumonia was attributed to the newly named virus, 2019 novel coronavirus (2019-nCoV) — later renamed SARS-COV-2. The patients’ median age was 49. Half had a connection to Wuhan’s live food market. Four, by then, had died. In retrospect, these patients were the tip of a COVID-19 infection iceberg spreading rapidly throughout Wuhan. Human-to-human transmission was reported. The article concluded:
“Thus far, more than 800 confirmed cases, including in health-care workers, have been identified in Wuhan, and several exported cases have been confirmed in other provinces in China, and in Thailand, Japan, South Korea, and the USA. ….Taken together, evidence so far indicates human transmission for 2019-nCoV… Airborne precautions, such as a fit-tested N95 respirator, and other personal protective equipment are strongly recommended.” Twenty-five deaths (including the 4 in the original pneumonia cluster) were attributed to the virus.
Publication of this and other articles might have been enough, on their own, to warn the world of the coming pandemic. Within days, many countries and provinces, such as Singapore, Russia, Hong Kong, Mongolia, Pakistan and others, restricted or closed their borders to incoming Chinese travelers. The U.S. followed suit on February 2, and closed its borders to foreign travelers from China, but not to U.S. citizens returning home from China.
The world watched as Wuhan locked down on January 23 and soon all borders throughout China were closed to incoming travel. Unfortunately, outgoing travel continued and the infection was seeded to the rest of the world. By February 11 the total number of confirmed cases in China escalated to 45,000 and the death toll was over 1,100. These numbers were reported on TV screens and news outlets around the world. By this time, 400 travel-related cases were identified in 24 countries outside of China.
Failure by most of Western world to take actions in January and February was a stunned, if understandable, response. What was happening in Asia could not apply to us in our country, right? Most of the West had not directly experienced the SARS-1 epidemic of 2003 or the MERS epidemic of 2013, but countries that had, like South Korea and Taiwan and others, took strong protective actions early, implementing mask wearing, testing for the disease, and hunting down infected persons and their contacts for quarantine and isolation.
The question remains, what did the Chinese know and what did they hide from the world, either intentionally or by happenstance? On February 28, the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) issued its report to the world.
From what I can gather from the joint mission report, online sources, and my own memory, I am unable to pinpoint any significant evasive action of a medical/public health nature that occurred during the early pandemic — at least not during January. Suspicion remains as to what was known in December and earlier and by whom. Maybe time will tell. Retrospective investigations, conducted much later revealed at least one COVID-19 case occurring before the December Wuhan cluster. The case was a 55-year old identified in November 17, 2019. As far as I can tell, no solid evidence for the disease exists before that time.
An article “Inside the early days of China’s coronavirus coverup” on Wired.com reports an “uncharacteristic degree of openness in the flow of information out of Wuhan” during January. “Coverup,” according to Wired, refers to government censorship later in February and March as authorities clamped down hard on journalists, regular citizens on social media, and medical personnel to cover-up the chaos, suffering, and death that resulted from the pandemic as it surged out of control and overwhelmed the medical system — not something the Chinese authorities wished to publicize.
Most suspicion now is directed to the wet market and to virology laboratories in Wuhan and Shanghai. Many people, including some at the highest levels of U.S. government, are urging further investigation into these possible sources of the virus. The possibility that the virus was man-made in a lab has been ruled out by a consensus of experts. But, the possibility that a virus under study at the Wuhan Institute of Virology, just 300 meters away from the Wuhan wet market, accidentally escaped is gaining traction. (Escaped viruses have caused sporadic infections around the world, including, many think, the 1977 pandemic due to H1N1 “swine flu.”) The U.S. intelligence agency is purportedly pursuing this line of inquiry, but so far evidence appears to be inconclusive. While many scientists believe a natural jump from a bat to an intermediary animal then to a human host is the most likely explanation for the introduction of the virus to the human population, the source of the virus remains unknown.
It seems to me that China, like many other countries, including the United States, took public health actions in earnest once deaths began to pile up. Death clusters do not appear immediately. There is a lag between infection and illness, and between illness and death (2 weeks on average from infection to death, but reporting of the death can take on average 7 days or longer). Cases of infection can skyrocket before medical confirmation with deaths lagging weeks behind. Once a substantial rise in deaths is evident, people wake up and take notice. This awakening due to death rise probably occurred most everywhere outside of Asia. By the time deaths take off and begin to exponentially rise, it may be too late to control the epidemic.
Compared to Western countries, the Chinese acted relatively quickly — from the time of the pneumonia cluster, to sequencing the genome, to producing a test, to taking actions like restricting travel, shutting down businesses, implementing stay-in-place orders, and wearing masks. All this transpired in less than a month and was transparent to the world. The WHO was criticized for endorsing China’s transparency and thus feeding in to the country’s controlled narrative. But our president acted similarly. On January 24, President Trump tweeted “China has been working very hard to contain the coronavirus. The United States greatly appreciates their efforts and transparency.”
What could the Chinese have done differently that might have prevented a worldwide pandemic effecting, so far, a total of 5 million confirmed cases of disease and 350,000 deaths? Stated another way, what are the lessons learned by the rest of the world and what could we, in our country, do differently when the next pandemic, or a resurgence of the current pandemic, arrives?
In an April 13, 2020 podcast entitled Coronavirus: Science and Solutions, Nick Jewell, a University of California Berkeley professor of epidemiology, was asked this question by the dean of the School of Public Health Michael C. Lu. Dr. Jewell replied (at 1:27:12 minutes into the podcast):
“I think the biggest lesson is we moved far too slowly. We didn’t pay attention. There were a few people, certainly, sounding the alarms in late December and early January, but there was a general kind of attitude in the West, in the developed countries, that this is something that might impact China, but it wouldn’t really come here — despite all evidence to the contrary that it was likely to come. And so, we didn’t take advantage of the warning time we had to better prepare.”
The Western countries were further stunned by the inconceivable reality of geometric spread. Even knowledgeable persons anticipating a quick rise expressed awe at how an R naught of 2.3 (the average capacity of an infected person to spread infection to others—it could be higher) with a contagious period of an average of 4–5 days can result in thousands of cases of disease and deaths in a matter of weeks. Perhaps, many in the public health world, including myself, were not so wide awake after all.
If a country was smart or lucky enough to have acted early, it might not need strong social distancing measures — such as shuttering businesses and stay-at-home orders — to the degree we are experiencing now in the U.S. As Tomas Pueyo’s articles have so lucidly pointed out, lockdown is a last ditch effort when consequences of an epidemic begin to spin out of control — when disease and deaths take on exponential growth and medical care systems are unable to cope.
When the former Director of CDC’s Office of Public Health Preparedness and Response Ali S. Kahn (also formerly of the National Center for Zoonotic, Vector-Borne and Enteric Diseases) was asked in an interview by David Quammen for the New Yorker, what happened in the West, he replied, “This is about lack of imagination.” Among other of Dr. Kahn’s reasons, Mr. Quammen explained, was that “there was both a failure to appreciate the SARS-1 and MERS warnings and a loss of capacity at high government levels, within recent years, to understand the gravity and immediacy of pandemic threats.”
U.C. Berkeley’s Nick Jewell concurred:
“Once (the virus) did move into the United States we were still very flat-footed about mounting a public health response. That has caused a significant amount of additional burden, or human loss, in illness and death that we could have avoided.”
Many media sources have tracked the early timeline of the pandemic, including the WHO itself, but also NPR, New York Times, Al Jazeera and others. A Wikipedia page of crowd-sourced details can be found here.
While continued investigations into China’s actions by public health officials from nations outside China seems reasonable to me, hyper focussing on rallying the public against China seems a dangerous way to proceed. Better to turn our attentions to understanding what we need to do next. As a nation, we need to be willing participants in testing, contact tracing, mask wearing, and other responses that will be required to the keep the virus from resurging in our communities as we open up.
Dr. Jewell concluded:
“Rather than looking back and trying to cast blame, I would urge that we look forward to protecting the population against any resurgence of the epidemic. Once we get our arms around this wave (of infection), we learn from these lessons and invest in the public health infrastructure to provide the resources to fight off infections of this virus and other viruses in the future.”
