Coronavirus: China's old habits kept the world in the dark as an epidemic grew

WUHAN: A mysterious illness had affected seven patients in a hospital, and a doctor tried to warn his classmates in medical school. In quarantine in the emergency department, the doctor, Li Wenliang, wrote in an online chat group on December 30, referring to patients.

So scary, a receiver replied, before asking about what started in China in 2002 and finally killed almost 800 people. Does the SARS come again?

In the middle of the night, officials of the health authority in the central city of Li convened, demanding to know why he had shared the information. Three days later, the police forced him to sign a statement that his warning constituted illegal behavior.

The disease was not SARS, but something similar: one that is now in a relentless march from Wuhan, across the country and around the world, killing at least 304 people in China and infecting more than 14,380 worldwide .

The initial management of the epidemic by the government allowed the virus to remain tenacious. At critical moments, officials opted to put secrecy and order before facing openly the growing crisis to avoid public alarm and political shame.

A reconstruction of the crucial seven weeks between the appearance of the first symptoms in early December and the government's decision to close the city, based on two dozen interviews with Wuhan residents, doctors and officials, in government statements and reports of the Chinese media. to decisions that delayed a concerted public health offensive.

In those weeks, authorities silenced doctors and others for raising red flags. Dangers to the public decreased, leaving the 11 million residents of the city unaware that they should protect themselves. They closed a food market where the virus is believed to have started, but they told the public that it was due to renovations.

His reluctance to go public, in part, played with political motivations as local officials prepared for their annual congresses in January. Although the cases increased, officials repeatedly stated that there were probably no more infections.

By not acting aggressively to warn the public and medical professionals, public health experts say, the Chinese government lost one of its best opportunities to prevent the disease from becoming an epidemic.

This was a problem of inaction, said Yanzhong Huang, principal investigator for global health at the Foreign Relations Council studying China. There were no actions in Wuhan by the local health department to alert people about the threat.

The first case, whose details are limited and the specific date unknown, was in early December. By the time the authorities took action on January 20, the disease had become a formidable threat.

Now it is a global health emergency. It has triggered travel restrictions around the world, shook the financial markets and created perhaps the biggest challenge for China's leader, Xi Jinping. The crisis could nullify Xi's agenda for months or more, even undermining his vision of a political system that offers security and growth in exchange for submission to fierce authoritarianism.

On the last day of 2019, after Li's message was shared outside the group, the authorities focused on controlling the narrative. Police announced that they were investigating eight people for spreading rumors about the outbreak.

That same day, Wuhan's health commission, forced by those rumors, announced that 27 people suffered pneumonia for an unknown cause. His statement said there was no need to be alarmed.

The disease is preventable and controllable, the statement said.

Li, an ophthalmologist, returned to work after being reprimanded. On January 10, he treated a woman for glaucoma. He did not know that she had already been infected with the coronavirus, probably by her daughter. Both got sick. He would too.

Suits and disinfectants for hazardous materials

Hu Xiaohu, who sold processed pork at the wholesale seafood market in Huanan, felt at the end of December that something was wrong. The workers came with persistent fevers. No one knew why, but Hu said several were in hospital quarantine.

The market occupies a large part of a block in a newer part of the city, located incongruously near apartment buildings and shops that cater to the growing middle class. It is a maze of stalls selling meat, poultry and fish, as well as more exotic dishes, including live reptiles and wild animals that some in China value as delicacies. According to a report from the city's disease control center, sanitation was appalling, with little ventilation and accumulated garbage on wet floors.

In hospitals, doctors and nurses were baffled to see a group of patients with symptoms of viral pneumonia who did not respond to usual treatments. They soon noticed that many patients had one thing in common: they worked in the Huanan market.

On January 1, police officers showed up at the market, along with public health officials, and closed it. The Xinhua News Agency reported that the market was being renovated, but that morning, workers in hazardous materials suits moved, washing stalls and spraying disinfectants.

It was, for the public, the first visible response of the government to contain the disease. The previous day, on December 31, the national authorities alerted the office of the World Health Organization in Beijing to an outbreak.

City officials took optimistic notes in their ads. They suggested that they had stopped the virus at its source. The set of diseases was limited. There was no evidence of the spread of the virus among humans.

Projecting optimism and confidence, if you don't have the data, is a very dangerous strategy, said Alexandra Phelan, a faculty research instructor in the department of microbiology and immunology at Georgetown University.

The legitimacy of the government in the messenger is undermined, he added. And public health depends on public trust.

Nine days after the market closed, a man who bought there regularly became the first fatal victim of the disease, according to a report from the Wuhan Health Commission, the agency that oversees public health and sanitation. The 61-year-old man, identified by his last name, Zeng, already had chronic liver disease and a tumor in his abdomen, and had registered at Wuhan Puren Hospital with fever and shortness of breath.

Authorities revealed the man's death two days after it happened. They did not mention a crucial detail to understand the course of the epidemic. Zeng's wife had developed symptoms five days after him.

She had never visited the market.

The race to identify a murderer

About 20 kilometers from the market, scientists from the Wuhan Institute of Virology studied samples of patients admitted to the city's hospitals. One of the scientists, Zheng-Li Shi, was part of the team that traced the origins of the SARS virus, which emerged in the southern province of Guangdong in 2002.

As the public remained largely in the dark about the virus, she and her colleagues quickly rebuilt that the new outbreak was related to SARS. The genetic composition suggests a common initial host: bats. The SARS epidemic began when a coronavirus jumped from bats to Asian palm civets, a feline creature that is raised and consumed legally. It is likely that this new coronavirus has followed a similar path, possibly somewhere on the road to the Huanan market or another market like this.

Almost at the same time, Li and other medical professionals in Wuhan began trying to provide warnings to colleagues and others when the government did not. Lu Xiaohong, director of gastroenterology at City Hospital No. 5, told China Youth Daily that he had heard on December 25 that the disease was spreading among medical workers, three weeks before authorities recognized the fact . He was not made public with his concerns, but privately warned a school near another market.

In the first week of January, the emergency room at Hospital No. 5 was filling up; The cases included members of the same family, making it clear that the disease was spreading through human contact, which the government had said was unlikely.

No one realized, said the doctor, that it was as serious as it would be until it was too late to stop it.

I realized that we had underestimated the enemy, he said.

At the Institute of Virology, Shi and his colleagues isolated the genetic sequence and the viral strain during the first week of January. They used samples from seven of the first patients, six of them vendors in the market.

On January 7, the institute's scientists gave the new coronavirus its identity and began referring to it by the technical abbreviation nCoV-2019. Four days later, the team shared the genetic makeup of the virus in a public database for scientists around the world to use.

That allowed scientists around the world to study the virus and quickly share their findings. As the scientific community moved quickly to devise an exposure test, political leaders were reluctant to act.

Politics is always number 1

As the virus spread in early January, Wuhan Mayor Zhou Xianwang was promoting futuristic health plans for the city.

It was China's political season, when officials meet for the annual meetings of the People's Congresses, the legislatures led by the Communist Party that discuss and praise the policies. It is not a time for bad news.

When Zhou delivered his annual report to the city's People's Congress on January 7 in a context of bright red national flags, he promised the city's premier medical schools, a World Health Exhibition and a futuristic industrial park to medical companies Neither he nor any other city or provincial leader publicly mentioned the viral outbreak.

Emphasizing politics is always number one, Hubei Governor Wang Xiaodong told officials on January 17, citing Xi's precepts of obedience from top to bottom. Political issues are at any time the most fundamental main issues.

Soon after, Wuhan went ahead with a massive annual banquet for 40,000 families from a city compound, which critics then cited as evidence that local leaders took the virus too lightly.

While the congress was taking place, the daily updates of the health commission on the outbreak said time and again that there were no new cases of infection, no firm evidence of human transmission or infection of medical workers.

We knew that this was not the case! He said a complaint filed before the National Health Commission on a government website. The anonymous author said he was a doctor in Wuhan and described an increase in unusual chest diseases as of January 12.

Authorities told doctors at a city hospital not to use the words viral pneumonia in image reports, according to the complaint, which has since been removed. People were complacent, thinking that if the official reports had nothing, then we were exaggerating, the doctor explained.

Even those affected were pleased.

When Dong Guanghe had a fever on January 8 in Wuhan, his family was not alarmed, his daughter said. He was treated at the hospital and sent home. Then, 10 days later, Dong's wife became ill with similar symptoms.

The news said nothing about the severity of the epidemic, said the daughter, Dong Mingjing. I thought my dad had a common cold.

Government efforts to minimize public disclosure persuaded more than untrained citizens.

If there are no new cases in the next few days, the outbreak will be over, Guan Yi, a respected professor of infectious diseases at the University of Hong Kong, said on January 15.

The statements of the World Health Organization during this period echoed the reassuring words of Chinese officials.

It had spread. Thailand reported the first case confirmed outside of China on January 13.

A besieged city

The first deaths and the spread of the disease abroad seemed to capture the attention of the main authorities in Beijing. The national government sent Zhong Nanshan, a renowned and now semi-sold epidemiologist who was instrumental in the fight against SARS, to Wuhan to assess the situation.

It arrived on January 18, just when the tone of local officials was changing noticeably. That day, a health conference in Hubei province called on medical workers to make the disease a priority. An internal document from Wuhan Union Hospital warned its employees that the coronavirus could spread through saliva.

On January 20, more than a month after the spread of the first symptoms, the current of anxiety that had been gaining strength broke out in public. Zhong announced in an interview on state television that there was no doubt that the coronavirus spread with human contact. Worse, a patient had infected at least 14 doctors.

Xi, newly arrived from a state visit to Myanmar, made his first public statement about the outbreak, issuing a brief set of instructions.

It was only with Xi's order that the bureaucracy went into action. At that time, the death toll was three; in the next 11 days, it would rise above 200.

In Wuhan, the city banned the visit of tourist groups. Residents began putting on masks.

Guan Yi, the Hong Kong expert who had previously expressed optimism that the outbreak could stabilize, was now alarmed. He stopped at one of the other food markets in the city and was surprised by complacency, he said. He told city officials that the epidemic was already out of control and that he would leave. I quickly booked a way out, Guan told Caixin, a Chinese news organization.

Two days later, the city announced that it was closing, a measure that could only have been approved by Beijing.

In Wuhan, many residents said they did not capture the severity of the epidemic until closing. The massive alarm that officials feared at first became a reality, accentuated by the previous lack of information.

Crowds of people crushed the airport and train stations to leave before the deadline fell on the morning of January 23. The hospitals were full of people desperate to know if they were also infected.

We do not wear masks at work. That would have scared customers, said Yu Haiyan, a waitress in rural Hubei, about the days before closing. When they closed Wuhan, only then did I think, 'Oh, this is really serious, it's not an average virus.'

Wuhan Mayor Zhou Xianwang later took responsibility for the delay in reporting the magnitude of the epidemic, but said the national law on infectious diseases hindered him. That law allows provincial governments to declare an epidemic only after receiving approval from the central government. After receiving information, I can only disclose it when authorized, he said.

The official reflex to suppress awkward information now seems to be cracking, as officials at various levels seek to blame the government's response.

With the worsening of the crisis, Li's efforts are no longer considered reckless. A comment on the social media account of the Supreme People's Court criticized the police for investigating people for circulating rumors.

It could have been a better way to prevent and control the new coronavirus today if the public had believed the rumor at that time and started using masks and applying sanitary measures and avoiding the wild animal market, the comment said.

Li is 34 years old and has a son. He and his wife wait a second in the summer. Now he is recovering from the virus in the hospital where he worked. In an interview through text messages, he said he was aggrieved by police actions.

If officials had revealed information about the epidemic before, he said, I think it would have been much better. There should be more openness and transparency. ”