Demystifying Wuhan’s COVID-19 outbreak investigation

Demystifying Wuhan’s COVID-19 outbreak investigation

by Dr Chan Chee Khoon

On May 6, 2020, Laurie Garrett, former senior fellow for global health at the Council on Foreign Relations (US), Pulitzer Prize-winning science writer and author took to the left-liberal platform DemocracyNow! to denounce China’s handling of the COVID-19 outbreak, echoing the Trumpian line ‘China Lied, People Died’:

a deliberate cover-up [of the Wuhan outbreak] extended out until January 20…you had about 6-8 weeks of transmission of this virus in Hubei province and Wuhan, and it was basically being lied about… they were reporting false figures to WHO, they were distorting the information to the world, until Xi Jinping ordered transparency on January 19.

So you saw this huge jump in the reported number of cases between January 19 and January 20, a tenfold increase, because all of a sudden, you know, “OK, bring all those hidden files out of the shelves and tell the world the truth, or some semblance of the truth.”

Remarkably, TIME magazine sounded more measured by comparison, but it still fed into a narrative of party apparatchiks delaying the release of information by ‘conscientious whistleblowing’ scientists and clinicians (such as the unfortunate Dr Li Wenliang, lionised in the western media as a martyr to the scourge he so bravely tried to expose).

We should thank Stephen Roach and Shan Weijian for a detailed timeline (with documentation links) which clarified firstly that the Wuhan doctor who first raised the alert on a viral pneumonia of unknown cause, was not Dr Li, but Dr Zhang Jixian, head of respiratory and intensive care at Hubei Provincial Hospital of Integrated Chinese and Western Medicine.

On December 27, three days before Dr Li warned his colleagues of a possible SARS-like outbreak, Dr Zhang had diagnosed a family of three as suffering from a viral pneumonia of unknown cause.  She had immediately submitted a report to her hospital, which in turn contacted the Wuhan Health Commission on December 29.

The following day (December 30), the Wuhan Health Commission dispatched an urgent warning to all medical institutions under its jurisdiction about the outbreak of a mysterious new pneumonia.

On the same day, an expert working group from the National Health Commission in Beijing was assembled to conduct on-site investigations and review contingency plans for an epidemic response. The team arrived in Wuhan early on December 31, and by 1pm that day, the Wuhan Health Commission had issued a public announcement regarding 27 pneumonia cases of unknown etiology.

On the same day (December 31), the WHO China country office was informed “of cases of pneumonia of unknown etiology (unknown cause) detected in Wuhan City”.

Many non-specialists attempting to follow the early chronology of the outbreak investigation, amidst allegations of cover-ups and unwarranted delays (or worse), may have missed important nuances in the frenetic coverage of pathogen identification and its sequencing, isolation of viable virus and establishing its causative role, and exploring the possible modes of transmission.

Dr Shi Zhengli (Wuhan Institute of Virology) for instance made the important point in CGTN interviews (May 25, 2020 and August 26, 2020) that in the absence of other known pathogens, detecting an unknown coronavirus in a nasal swab and sequencing its genome, doesn’t constitute proof that the novel coronavirus is the causative pathogen of the severe pneumonia afflicting the patient.

Viable virus has to be isolated from the patient’s tissue samples and used to carry out animal infection experiments (on transgenic mice and rhesus monkeys) to confirm that the purified virus isolate can produce symptoms analogous to what is observed in a human patient.

Beyond that, person-to-person transmission may be suspected on the basis of identified familial, workplace, or other clusters, where not all infected persons had histories of exposure at known early epicentres (like the Huanan seafood market).

Precautionary practice would be prudent under such circumstances, but confirmation of person-to-person transmission is usually announced only after careful (i.e. time-consuming) epidemiological investigations have ruled out other possibilities like (familial) sharing of contaminated foods and fluids, contaminated surfaces in shared spaces, exposure to other infected persons outside the cluster, etc.

Unfortunately, the three weeks between December 29, 2019 and January 20, 2020 has been spun by much of western liberal (and even some progressive) media as a period of deliberate cover-up, delays, and persecution of ‘whistleblowers’.

The TIME piece was additionally dishonest, or sloppy, in disregarding its own cited source (Caixin) which acknowledged that once health officials realised (in early January 2020) that they were likely dealing with a lethal SARS-like virus of uncertain contagiousness, the order went out to commercial and other labs which had been testing scores of patient samples from Wuhan hospitals all through December 2019 (these labs were not certified biosecurity labs), to destroy all patient samples (or transfer them to designated biosecure labs) and to co-ordinate on information management (recall that Li Wenliang’s private communication with his colleagues on December 30, 2019 misidentified the pathogen as SARS coronavirus, and this misinformation had circulated out of control).

These perfectly sensible precautions were interpreted by those with a fixation on ‘authoritarian public health governance’, as further evidence of a concerted attempt at cover-up.

Let’s also recall that when the Nipah (encephalitic) virus first emerged in Malaysian pig farms in 1998, it was initially misdiagnosed as a virulent mutant of Japanese encephalitis virus (spread only by Culex mosquitoes, and not air-borne via aerosols).

That misdiagnosis proved fatal for dozens of pig farm workers who had been instructed to vaccinate squealing, coughing sick pigs against JEV, without wearing any personal protective gear against air-borne pathogens. Pig farm workers who had themselves been previously vaccinated against JEV were further gulled into a false sense of security.

The lessons we should learn from all this?

  • With a novel, lethal pathogen, you can’t be too careful about getting the science right, especially with regard to etiological agent (causative pathogen) and its mode(s) of transmission.
  • On the other hand, with a novel, lethal pathogen undergoing explosive exponential spread, we may need to depart from previous normal practice of confirming etiology (causation) before announcing the identity of the etiological agent and its genomic sequence, in order to hasten the development of nucleotide probes for the all-important screening and diagnostic tests.

Fevered imaginations and ingrained prejudices do not help in negotiating this tortuous path.

Dr Chan Chee Khoon ScD (Epidemiology) – Citizens’ Health Initiative

Health Policy Analyst and Former Professor

September 1, 2020 – Shah Alam, Malaysia

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