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China and Covid-19: What went flawed in Wuhan?

This is the first in a large series from the Financial Times, Coronavirus: Could the World Have Been Spared? He examines the global response to the crisis and whether the disaster could have been averted.

The FT has spoken to dozens of medical professionals, government officials, and ordinary citizens in Wuhan to find out what really happened in the first few weeks of the outbreak.

During the investigation, some of those targeted were threatened by police, who said the FT entered the city with "malicious intent". Police harassment of virus victims, their relatives and anyone who wants to speak to them continues, casting doubts as to whether Xi Jinping's government is really ready to facilitate the impartial investigation into the pandemic it has promised the world.

Early warnings

The virus arrives

On December 29th, Wuhan Central Hospital discovered four patients with symptoms of viral pneumonia. All came from a local fish market © Hector Retamal / AFP / Getty

When Gao Fei was flipping through his Twitter feed in late December, he first noticed gossip about a possible virus outbreak in Wuhan.

Mr. Gao, who grew up near Wuhan, regularly used virtual private network software to jump over the "Great Firewall" as China's internet censorship regime is well known to access prohibited websites such as Twitter. While government officials and state media said very little about the virus, he was determined to learn more.

As doubts about the actual size of the outbreak grew by January, 33-year-old Gao decided to rush home from southern Guangdong Province, where he worked as a welder. He arrived in his home village, about 120 km from Wuhan, on Jan. 21, just a day after the Chinese government finally broke its silence on the epidemic and confirmed that the virus was spreading from person to person.

The Chinese government officially announced to the World Health Organization on January 3rd that "severe pneumonia of unknown etiology" had been discovered in Wuhan, the capital of Hubei Province with 11 million people – science suggests a mysterious new respiratory disease. However, in the first three weeks of January, Chinese officials said there were only a few dozen confirmed cases and downplayed the risk of human transmission.

Mr. Gao was appalled to find life in his village unchanged and confronted the local officials. "They told me they hadn't received orders from higher levels (officials) so there was nothing they could do," he told the Financial Times. "People in my village were still visiting relatives and gathering as usual."

On January 23, the day Wuhan was under strict quarantine, he ventured one step higher in China's administrative hierarchy and visited the district government. The message there was the same, "They told me to wait for orders from senior city officials" in Huanggang, the city that includes Mr. Gao's village.

"It was shocking," said Mr. Gao. “When the situation in Wuhan got completely out of hand, other cities just an hour's drive away were completely unprepared. . . Many things could have been avoided if only people had been told the truth about the virus. "

DEBT ALLOCATIONS

China and the WHO United Front

Health officials in the passenger area of ​​Suvarnabhumi Airport in Bangkok, Thailand. The coronavirus was confirmed to spread beyond China from Wuhan to Bangkok on January 13th. © Lilian Suwanrumpha / AFP / Getty

The indolence and complacency that Mr. Gao faced in his home village is central to the ongoing geopolitical guilt game against the coronavirus pandemic, which is now infecting 39 million people, killing more than 1 million people and devastating economies on a scale worldwide that has not been seen since the Great Depression, 1930s.

On January 14, the day after the coronavirus was confirmed to have spread beyond China from Wuhan to Bangkok, the country's top health officials convened a confidential meeting in Beijing, where they were concerned about a "high" risk of transmission annoyed from person to person. The sudden emergence of Wuhan-related cases in Bangkok and a few days later in Tokyo suggested that Wuhan's official case count, which was only a few dozen by mid-January, was nonsense.

Coronavirus: Could the world be spared?

The coronavirus pandemic has killed more than 1 million people worldwide. But could it have been averted? A unique FT investigation examines what went wrong and right when Covid-19 spread around the world

Part 1: China and Covid-19: What went wrong in Wuhan

October 18th: The global crisis – in data

the 20th of October: Why the coronavirus exposed Europe's weaknesses

October 21: Will the coronavirus break the UK?

October 22nd: How New York's Covid-19 missteps overwhelmed the US

23rd October: What Africa taught us about coronavirus and other lessons the world has learned

In response to the news from Bangkok and Tokyo, epidemiologists at Imperial College London published a study that estimated that there had to be around 4,000 symptomatic people in Wuhan for the virus to spread beyond China's borders. However, a major annual legislative session was held during this critical week, and the city hosted an infamous pre-Chinese New Year dinner on January 18, attended by 40,000 families.

The Chinese government and WHO have also downplayed growing concerns about whether the disease can easily be transmitted between people. At a press conference in Geneva on January 14th, Maria Van Kerkhove, acting head of the WHO's Emerging Diseases Division, was quoted by Reuters as saying that there was "limited human-to-human transmission" in Wuhan.

The WHO endeavored to use the Dr. Van Kerkhove clarified reported comments, saying she only mentioned that human transmission was "possible" and "possible". "There was a misunderstanding at the press conference," the WHO told the FT that day. "Preliminary investigations by the authorities have produced no clear indications of human-to-human transmission." Another six days would pass before Zhong Nanshan, a Chinese epidemiologist and government adviser, finally confirmed in an interview with state media on Jan. 20 that the virus could indeed spread between people.

This was the beginning of a regular pattern in the early stages of the pandemic. At least outwardly, President Xi Jinping's administration tried to downplay the potential threat posed by the virus, initially speaking out against "excessive measures" such as the early declaration of a global health emergency and travel bans for Chinese nationals.

WHO Director General Tedros Adhanom Ghebreyesus (left) met with Chinese President Xi Jinping (right) in Beijing on January 28. Mr Tedros praised "the seriousness with which China is taking this outbreak" © Naohika Hatta / Pool / Getty

Officially, it remains WHO's policy not to support travel bans during pandemics – as the Chinese government called for in late January, when its citizens were the main targets of such bans. However, when the virus got under control in China in late March but spread uncontrollably in Europe and the US, Beijing changed its mind on the wisdom of travel bans as it ruled out almost all foreign arrivals.

Speaking to Mr. Xi in Beijing on January 28, Tedros Adhanom Ghebreyesus, WHO Director General, praised “the seriousness with which China is taking this outbreak, particularly the commitment and transparency they have shown, including the exchanges, from top leadership of data and genetic sequence of the virus. . . WHO will continue to work side by side with China and all other countries to protect health and keep people safe. "

It's like David and Goliath, you have big China and you have Tedros. . . There is an asymmetry of power there

Ross Upshur, a public health expert at the University of Toronto and advisor to WHO, notes that China has always had a lot of political influence at WHO, and this has only increased since US President Donald Trump announced in April that it would withhold funding for the organization. "It's like David and Goliath, you have big China and you have Tedros … there is an asymmetry of power there."

China's critics, blaming Mr Xi and the Chinese Communist Party for the ongoing disaster – including Mr Trump – claim that his administration at least missed the opportunity in late December and early January to see the virus spread in China and around the world slow it down . Many argue that this failure is a direct result of the increasingly authoritarian tendencies and the increasing opacity of China's unique government model of the "party state".

"The coronavirus has alarmed (the world) that China has become a threat to livelihoods and even people's lives around the world," said Jimmy Lai, the pro-democracy print mogul in Hong Kong and one of the party's harshest critics. "Without freedom, the people of China are withheld information and facts (they need to) take care of themselves."

Grieving Relatives: Anger at the human cost of the cover-up

Zhong Hanneng (left) with their late son Peng Yi (right) and daughter in 2019. They visited numerous hospitals after Peng contracted coronavirus, but they were all full © Zhong Hanneng

"The government cover-up cost my son his life," said Zhong Hanneng, whose 39-year-old son Peng Yi died of Covid-19. “The government kept saying that there was no human-to-human transmission and we believed them. We had a big family dinner with 20 people on January 20th. "

After Peng, an elementary school teacher in Wuhan with a young daughter, developed a fever, a CT scan of his lungs suggested he had contracted the virus. However, the first hospital in town to receive treatment did not have enough test kits to confirm his condition and refused to accept him.

"We visited numerous hospitals over the next two weeks," said Ms. Zhong. "They were all full." When the family finally found one on the outskirts of Wuhan, no ambulance was available. Peng was put in a small truck at around 1:30 a.m. on February 7th. The bumpy 90-minute drive would be his last. He died in the hospital 12 days later. "Before the virus, my son had just paid off his mortgage and life couldn't have been happier," said Ms. Zhong. "Now every day is a misery."

Zhang Hai, a Wuhan native who now lives in southern Shenzhen City, also blames the government for the death of a loved one. In January, he unknowingly made his father Zhang Lifa return to Wuhan for leg surgery. In the hospital, his father contracted the virus and died a week later.

"The government knew how bad the virus was early on, but did not issue a public warning and decided to cover up the truth. It cost so many lives," said Zhang. He is now trying to get compensation in the Wuhan government Slaughtering Rmb 29 million (US $ 294,000), but China's party-controlled courts will not bring its action. Citizens' lawsuits alleging negligence of the local government after disasters are not uncommon in China, although they rarely succeed.

The Chinese government has defended its decision not to publicly acknowledge the severity of the outbreak and the risk of human-to-human transmission until January 20, arguing that it has been dealing with an incredibly complex situation under unclear circumstances. Dale Fisher, an infectious disease specialist at Singapore's National University Hospital, agrees with this argument. "You have to keep in mind that this was a novel virus and the chaos is really normal, especially at the beginning of an outbreak," said Dr. Fisher, who has experience working on West African Ebola hotspots and was a member of a WHO delegation that visited China in mid-February. "You don't want to press the (panic) button until you have reasonable confidence (in your diagnosis)."

COMBAT STATIONS

A growing disaster

Wang Linfa, program director for emerging infectious diseases at Duke-NUS Medical School, said China's political system was a "double-edged sword" that stymied the country's initial response to the outbreak but eventually helped enforce effective containment measures. © Ore Huiying

Little did he know when Wang Linfa toured Wuhan in mid-January that he was witnessing the beginning of a global catastrophe.

Prof. Wang is one of the world's premier bat-borne disease agencies, but his presence in Wuhan at the start of the outbreak was a fluke. The native of Shanghai, who lives in Singapore and heads the Emerging Infectious Disease Program at Duke-NUS Medical School, regularly traveled to China to meet colleagues. His trip had been planned since early December.

Many of the first cases in Wuhan were already associated with a live wet market, which sparked memories of the Sars epidemic that occurred in the winter of 2002-2003. Hailing from southern Guangdong Province and Hong Kong, Sars infected more than 8,000 people and killed 774. The scientific consensus is that Sars came from bats before they were transmitted to humans through an "intermediate host", most likely a civet that fell on a fodder market.

"The news from the market was certainly a déjà vu moment," said Prof. Wang. "I was like, 'Oh my god,' it's winter, just before the Chinese New Year and the market … I really thought it must be like Sars."

Prof. Wang's extensive experience working with Chinese medical institutions seemed reassuring as he toured Wuhan on January 15th, 16th and 17th. "Conditions (in China) are much, much better than 17 years ago," he said. “Chinese doctors and scientists are among the leading scientists in the world. So I thought that even if this is like Sars, the effects will be less than Sars. "

When Prof. Wang arrived in Wuhan by high-speed rail on January 14th, he noticed that very few people were wearing masks. There were also no temperature controls, both signs indicating local and central authorities were on high alert. When he was entertained by his Chinese hosts, as on many previous trips, "at every meal we went to a public restaurant, (all) very full of people." It wasn't until the early hours of January 18 that he began to fear that the situation in Wuhan could be far more serious than he had thought.

As Prof. Wang was preparing to fly back to Singapore, he saw the authorities at combat stations. "They did very strict temperature tests," he said before boarding. “There were a lot of cameras, security guards, and medical personnel wearing full PPE. You were forbidden (if you had a fever) to travel out of Wuhan. "

For the first time he was afraid and moderated his behavior: "I thought it was like a war zone, now it's really serious." He avoided contact with other passengers as best he could. The precautions he took may have prevented him from contracting the virus, or worse. A woman on the same flight was later confirmed to be one of the first coronavirus patients in Singapore.

Dale Fisher, Infectious Disease Specialist at Singapore's National University Hospital, said, "You need to remember that this was a novel virus and that chaos is really normal, especially at the beginning of an outbreak." © Ore Huiying

Prof. Wang called China's political system a "double-edged sword" that prevented the country's initial response to the outbreak but eventually helped enforce effective containment measures. "It's not very effective at the beginning of an outbreak because you are not allowed to speak until the government says, 'OK, I'm sure you are right, you can speak," he said. "If China's system becomes more democratic, it would it will help (with transparency), but it might make (containment) less effective. "

So far, Chinese health officials have traced the first confirmed coronavirus case back to December 1, but the search for the true “patient zero” of the pandemic is likely to be unsuccessful. While the majority of people who contract the virus have either mild or no symptoms, they can still pass it on to others. In medical parlance, Covid-19 is caused by a coronavirus that is spreading rapidly in communities as most people do not know they are infectious. Sars was a "late dandruff" coronavirus – patients generally became infectious after being hospitalized, which made containment much easier. "We can easily implement hospital controls to turn things off," said Dr. Fisher. "Controlling infection in the community is much more difficult."

In that regard, finding the original coronavirus patient – the man, woman, or child who ate the bat-bitten cat, pangolin, or other as yet undetermined intermediate host – is just as difficult as finding the first person who did has caught seasonal flu. "Patient Zero could be someone who spreads to another 30 patients but never knows they are infected," said Prof. Wang.

Confusion and denial

At the Wuhan Central Hospital

Hospital doctors became increasingly confused about what information to report to which authorities in the first two weeks of January. © AFP / Getty

Three weeks before Mr. Xi's government publicly recognized that a deadly new respiratory disease was spreading in one of China's largest cities, doctors at Wuhan Central Hospital discovered they had a problem.

At 2:00 pm on December 29th, Yin Wei, a doctor at the hospital's health department, received a call from a colleague who reported that four patients had symptoms of viral pneumonia. All four patients, added Dr. Yin's colleague also came from a local fish market.

According to an internal report later published by Dr. Yin was created and viewed by the FT, he immediately notified the local county government health officer Wang Wenyong. Mr. Wang was from Dr. Yin's call isn't surprised.

"Wang replied that he had received similar reports from other hospitals and that the Wuhan Center for Disease Control and Prevention could not determine the cause of the disease after several tests," wrote Dr. Yin. "Wang added that he would answer me after reporting the situation at our hospital to his supervisor."

At 4 p.m., three more cases of viral pneumonia were discovered at Wuhan Central Hospital. At 8 p.m., district CDC officials came to the hospital to collect patient samples. Then they challenged Dr. Yin and his colleagues to wait.

Wuhan Central Hospital tried to blame me in the report. I did nothing wrong

Two days later, on December 31, they were still waiting. So Dr. Yin contacted one of Mr. Wang's chiefs at the district CDC to inquire about the test results. "I was told to wait for further announcement," wrote Dr. Yin.

On January 3rd, Dr. Yin did it again and asked Mr. Wang if Wuhan Central should fill out at least one Infectious Disease Report Card (IDRC), an online reporting system shared by local and national health authorities. Again he was turned away. "Wang replied that we should wait for more information from higher authorities before reporting a specific infectious disease like this," recalled Dr. Yin in his report.

It wasn't until January 4th, seven days after Dr. Yin and his colleagues had tried to alert city officials, they were finally allowed to fill out IDRCs for all suspected cases of unknown viral pneumonia.

Mr. Wang, who was led by Dr. Yin repeatedly mentioned officials said that "Wuhan Central Hospital tried to blame me on the report."

"I didn't do anything wrong," he told the FT, adding that everyone in the system was simply following orders. "Wuhan Central has failed to meet the standards set by the city and provincial health committees… (Yes) We have been careful about reporting cases early. But that was a collective decision, not my own."

Wuhan Central referred the FT's requests for interviews with its administrators and doctors to the city government, which did not respond.

When the Wuhan Central medical staff tried to find out what it was and were not allowed to report further up the chain, Beijing central government officials in Wuhan were already at zero. A delegation from the Chinese Center for Disease Control and Prevention first arrived on December 31, according to an official chronology published by the Chinese government.

A scientist who advises central government health officials said he debated whether or not to hold daily public briefings even in the first few days of the new year. However, Beijing officials didn't do so until January 22nd, partly due to the chaotic situation in Wuhan. "The information (from Wuhan) was not clear," said the agent, who asked not to be identified. “There were a lot of rumors and the attitude of the local officials was little or, if possible, nothing to say. It was a disaster."

WHO said it questioned Chinese government officials about the Wuhan outbreak on January 1 and received Beijing's response two days later on January 3. Communist Party officials also acknowledged that Mr. Xi gave orders to evolve the situation in Wuhan at a January 7 meeting of the seven-member Politburo Standing Committee. According to a leading party magazine, the president instructed officials to determine the origin of the virus and "confirm the mechanism of transmission as soon as possible."

Another person who advises the State Council on public health issues said the problem went deeper than the fog of war conditions on the ground in Wuhan. "The Chinese government, especially at the local level, lacks the ability to communicate effectively with the public in a crisis situation," he told the FT, also on condition of anonymity. “The main job of the advertising departments is to keep the Communist Party in power and not to promote transparency. The pandemic exposed the system's weaknesses. "

Confusion among doctors in Wuhan Central about what information to report to which authorities increased steadily during the first two weeks of January. According to the report by Dr. Yin, they were instructed in various ways by local and regional health officials to "use caution" and "be careful" before reporting new cases.

On January 13, conflicting orders from the Wuhan Health Department and the city CDC finally had Dr. Yin's temper boil over. "Dear director Wang," he wrote. “We have a situation in which suspicious cases are reported. The health department said we should ask the CDC to collect samples and conduct tests, but the CDC said they would have to wait for instructions from the health department. This prevented a suspicious patient from being tested and examined. We have no idea what went wrong. Can you help us figure out the problem? "

Within days, the patients falling through the cracks in the reporting system were the least of Wuhan Central's problems. The hospital's own staff was slowly getting sick. As of January 24, at least 56 had been hospitalized. A hospital staff outbreak is a tragic but tell-tale sign that a disease is communicable between people.

Wuhan Central Hospital ophthalmologist Li Wenliang, who was reprimanded by police on January 3 for allegedly spreading rumors of the mysterious virus seen here before and after his hospital stay. He died of the disease in early February © Social Media / AFP / Getty

Among the Wuhan Central doctors who were dying on their own wards was Li Wenliang, a 33-year-old ophthalmologist and one of several medical workers who were reprimanded by police on Jan. 3 for alleging "rumors" had spread about the mystery virus at the time, it was discussed among themselves in a private chat group. Li's death in early February would spark a firestorm of public anger, but most of it was directed at the local government rather than the central government in Beijing.

Given the confusion in China for most of January, one of the biggest puzzles about the early stages of the pandemic is why Wuhan-sized clusters didn't emerge across the country. According to Chinese flight data quoted by state media, more than 465,000 people flew from Wuhan to 10 popular domestic destinations, from Beijing in the north to the southern resort town of Sanya, between December 30 and January 22. At the same time, far lower flows of people from Wuhan to international destinations have sparked the global catastrophe that is still unfolding.

The answer lies in the very different responses from governments in China and Asia-Pacific, Europe and the US.

The real Chinese infection numbers were significantly higher than officially reported, but were not recorded as almost the entire population was forced into strict lockdowns from late January to mid-February.

"Every province in China was infected within a month (after the Wuhan outbreak) and (their official case numbers) have generally hit triple digits because their lockdowns were tough," said Dr. Fisher. "Diagnoses were not made because everyone was home. People with mild cases probably passed it on to a few people in their families who also had mild cases, and the virus just burned itself out … within three to four weeks could they unlock things.

"I was in China (mid-February) and saw the extent of the reaction," he added. “Incredible barriers with non-moving trains, aircraft with covers on the engines and an absolutely clear blue sky in (often polluted) Beijing. So it spread all over China, but they just shut it down. "

Meanwhile, other East Asian countries and areas – South Korea, Taiwan, Hong Kong and Singapore in particular – have used a more flexible mix of visit bans, contact tracing and lockdowns that are milder than China to effectively contain the spread of the virus in the community.

But it was too late for countries like the United States, which were quick to put travel bans in place and did little else in a coordinated, nationwide manner.

The actual numbers of infections in China were significantly higher than officially reported, but were not recorded as almost the entire population was forced into strict lockdowns from late January to mid-February. © Getty

Dr. Fisher spoke to the FT in Singapore by phone on the morning of August 28. He was also watching a live TV feed from the last night of the US Republican National Convention. Occasionally, while answering questions from the FT, he voiced his astonishment at the Washington scene. "Donald Trump's daughter speaks to everyone and she doesn't wear a mask!" he exclaimed at one point. “Nobody else either. You haven't even removed the seats! "

Dr. Fisher said that "a few more weeks" notice of the pandemic would not have helped many countries. He noted that despite confirmation that the virus could be transmitted from person to person on Jan. 20, "it's not like (anyone) has jumped up and taken action".

"Die meisten Asiaten haben dies wirklich respektiert, hatten Systeme einsatzbereit und haben im Januar und Februar viel Arbeit für den Tag geleistet, an dem sie zerschlagen werden", sagte Dr. Fisher. „Leider musste der größte Teil der Welt zerschlagen werden, um diese Erkenntnis zu erhalten. Wie wir in unserem Bericht vom Februar (WHO-China-Delegation) gesagt haben, kann dieses Virus verheerende gesundheitliche, soziale und wirtschaftliche Auswirkungen haben, aber die Welt ist weder in ihrer Kapazität noch in ihrer Denkweise bereit, damit umzugehen. "

Prof. Wang fügte hinzu, dass der Rest der Welt trotz aller Mängel des chinesischen Systems in den frühesten Tagen und Wochen des Ausbruchs in höchster Alarmbereitschaft sein sollte. Sobald die Übertragung von Mensch zu Mensch bestätigt wurde und Wuhan einige Tage später in Quarantäne ging, hätten sich die Länder auf ihre Ankunft genauso effektiv vorbereiten können wie unter anderem Taiwan und Südkorea.

Die meisten taten es nicht. Insbesondere die Reaktion der Trump-Regierung wird als eines der schlimmsten nationalen Sicherheitsmängel in der Geschichte der US-Republik gelten, da das Virus sogar das Weiße Haus und den Präsidenten selbst verletzt. Wie Prof. Wang sagte: "Damit andere Länder (das Virus) nicht ernst genommen haben, gibt es einfach keine Entschuldigung."

Zusätzliche Berichterstattung von Qianer Liu und Anna Gross

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