The Chinese government shut down the city of Wuhan a year ago. Officials had previously maintained for weeks that the epidemic was under control – only a few hundred cases connected to the live animal market. But the virus was actually spreading all over the city and around China.
This is the story of the five critical days before the outbreak.
30 December 2019: Virus alert
The findings of a test carried out by the Capital Bio-Medicals sequencing laboratory in Beijing were reported to the head of the Emergency Department at Wuhan Central Hospital at about 16:00 on 30 December
According to an interview given to the Chinese state media later, she went into a cold sweat as she read the report.
At the top were the alarming words: “SARS CORONAVIRUS”. She circled them in bright red and passed it on to colleagues over the Chinese messaging site WeChat.
The grainy picture with its large red circle reached a doctor in the ophthalmology department of the hospital, Li Wenliang, within an hour and a half. He shared it with his hundreds-strong group of
Over the coming hours, screenshots of Li’s message spread widely online. Millions of people started talking about Sars online across China.
It would turn out that a mistake was made by the sequencers — this was not Sars, but a very similar new coronavirus. But this was a critical moment. News of a possible outbreak had escaped.
The Wuhan Health Commission was already aware that in the city’s hospitals something was going on. Officials from the National Health Commission arrived in Beijing that day, and lung samples were sent to at least five state laboratories in Wuhan and Beijing for simultaneous sequencing of the virus.
Now, as messages suggesting the possible return of Sars began flying over Chinese social media, the Wuhan Health Commission sent two orders out to hospitals. It instructed them to report all cases direct to the Health Commission and told them not to make anything public without authorization.
Within 12 minutes, these orders were leaked online.
It might have taken a couple more days for the online chatter to make the leap from Chinese-speaking social media to the wider world if it wasn’t for the efforts of veteran epidemiologist Marjorie Pollack.
The deputy editor of ProMed-mail, an organization that sends out alerts on disease outbreaks worldwide, received an email from a contact in Taiwan, asking if she knew anything about the chatter online.
Three hours later, she had finished writing an emergency post, requesting more information on the new outbreak. It was sent out to ProMed’s approximately 80,000 subscribers at midnight
31 December: Offers of help
As word began to spread, Professor George F Gao, director-general of China’s Center for Disease Control [CDC], was receiving offers of help from contacts around the world.
“I sent a really long text to George Gao, offering to send a team out and do anything to support them,” Dr. Peter Daszak, the president of New York-based infectious diseases research group EcoHealth Alliance, told the BBC. But he says that all he received in reply was a short message wishing him Happy New Year.
That day, the Wuhan Health Commission issued a press release stating that 27 cases of viral pneumonia had been identified, but that there was no clear evidence of human to human transmission.
1 January 2020: International frustration
International law stipulates that new infectious disease outbreaks of global concern be reported to the World Health Organization within 24 hours. But on 1 January the WHO still had not had official notification of the outbreak.
“It was reportable,” says Professor Lawrence Gostin, director of the WHO Collaborating Center on national and global health law at Georgetown University in Washington DC, and a member of the International Health Regulations roster of experts. “The failure to report clearly was a violation of the International Health Regulations.”
Dr. Maria Van Kerkhove, a WHO epidemiologist joined the first of many emergency conference calls in the middle of the night on 1 January.
“We had the assumptions initially that it may be a new coronavirus. For us it wasn’t a matter of if human to human transmission was happening, it was what is the extent of it and where is that happening.”
It was two days before China responded to the WHO. But what they revealed was vague – that there were now 44 cases of viral pneumonia of unknown cause.
China says that it communicated regularly and fully with the WHO from 3 January. But recordings of internal WHO meetings obtained by the Associated Press (AP) news agency some of which were shared with PBS Frontline and the BBC, paint a different picture, revealing the frustration that senior WHO officials felt by the following week.
The WHO was legally required to state the information it had been provided by China. Although they suspected human to human transmission, the WHO was not able to confirm this for a further three weeks.
“Those concerns are not something they ever aired publicly. Instead, they basically deferred to China,” says AP’s Dake Kang. “Ultimately, the impression that the rest of the world got was just what the Chinese authorities wanted. Which is that everything was under control. Which of course it wasn’t.”
2 January: Silencing the doctors
The number of people infected by the virus was doubling in size every few days, and more and more people were turning up at Wuhan’s hospitals.
But now – instead of allowing doctors to share their concerns publicly – state media began a campaign that effectively silenced them.
On 2 January, China Central Television ran a story about the doctors who spread the news about an outbreak four days earlier. The doctors referred to only as “rumor mongers” and “internet users”, were brought in for questioning by the Wuhan Public Security Bureau and ‘dealt with’ ‘by the law’.
One of the doctors was Li Wenliang, the eye doctor whose warning had gone viral. He signed a confession. In February, the doctor died of Covid-19.
The Chinese government says that this does not evidence that it was trying to suppress news of the outbreak and that doctors like Li were being urged not to spread unconfirmed information.
A health worker from Li’s hospital, Wuhan Central, told us that over the next few days “there were so many people who had a fever. It was out of control. We started to panic. [But] The hospital told us that we were not allowed to speak to anyone.”
The authorities would continue to maintain for a further 18 days that there was no human-to-human transmission.
3 January: Secret memo
Labs across the country were racing to map the complete genetic sequence of the virus. Professor Zhang Yongzhen a renowned virologist in Shanghai, began sequencing on 3 January and he obtained a complete sequence after working two days straight. His results revealed a virus that was similar to Sars, and therefore likely transmissible
On 5 January, Zhang’s office wrote to the National Health Commission advising taking precautionary measures in public places.
“On that very day, he was working to try and get information released as soon as possible, so the rest of the world could see what it was and so we could get diagnostics going”, says Zhang’s research partner, Professor Edward Holmes an evolutionary virologist at the University of Sydney.
But Zhang could not make his findings public. On January 3, the National Health Commission had sent a secret memorandum to labs banning unauthorized scientists from working on the virus and disclosing the information to the public.
“What the notice effectively did,” says AP’s Dake Kang, “is it silenced individual scientists and laboratories from revealing information about this virus and potentially allowing word of it to leak out to the outside world and alarm people.”
None of the labs went public with the genetic sequence of the virus. China continued to maintain it was viral pneumonia with no clear evidence of human-to-human transmission.
It would be six days before it announced that the new virus was a coronavirus, and even then, it did not share any genetic sequences to allow other countries to develop tests and begin tracing the spread of the virus
Three days later, on 11 January, Zhang decided it was time to put his neck on the line. As he boarded a plane between Beijing and Shanghai, he authorized Holmes to release the sequence.
At the beginning of any emerging disease outbreak, says health law expert Lawrence Gostin, it’s always chaotic. “It was always going to be very difficult to control this virus, from day one. But by the time we knew [the international community] it was transmissible human to human, I think the cat was already out the bag, it already spread.
“That was the shot we had, and we lost it.”
As Wang Linfa, a bat virologist at Duke-NUS Medical School in Singapore, says: “January 20th is the dividing line, before that the Chinese could have done much better. After that, the rest of the world should be really on high alert and do much better.”
The decision came at a personal cost – his lab was closed the next day for “rectification” – but his action broke the deadlock. The next day state scientists released the sequences they had obtained. The international scientific community swung into action, and a toolkit for a diagnostic test was publicly available by 13 January.
Despite the evidence from scientists and doctors, China would not confirm there was human-to-human transmission until 20 January.