BF2S Forums Pandemic thread

Wuhan​ is one of the great cities of China, bigger than any European city apart from Moscow, but I knew nothing about it before the outbreak. I know a little more now, but my own city, the pre-Covid London of midwinter 2019, has become a remote, fantastical place. I look back at the first week of December. S. and I had just moved into a new house. Her sister came to stay. A friend came over to cook us coq au vin; he was in our kitchen for hours. I went to the pub with my family, and stood close to strangers at the bar. Nobody was masked. I watched the highlights of the Liverpool-Everton game. Tens of thousands of people roared from the terraces. We checked out a primary school for our son. Dozens of unmasked parents trooped into classrooms filled with children and unmasked teachers. Nobody washed their hands. It was my birthday; we got a babysitter; we met friends at a restaurant in Soho. Black cabs and Ubers seeded Frith Street with revellers. The boozing-rooms roared. Unmasked waiters leaned in. The skies were full of planes, underground and overground trains full of people. And at this time, somewhere in a great city in China whose name held no meaning for me, was an individual with a bad cough who was going to stop it all.

A WHO bulletin on 12 January said, citing the Chinese authorities, that the first patient reported symptoms on 8 December. An article in the Lancet in January by 29 Chinese medical professionals, including doctors from Wuhan, said the first symptoms in a patient appeared a week before that, on 1 December. In its first public statements the Wuhan Municipal Health Commission was adamant all the cases were linked to the local seafood market, and that there was no evidence of human to human transmission. But the Lancet article reported that only two-thirds of the patients could be linked to the market, and that the 1 December case could not. Nor were any links found between that case and any other cases; none of patient one’s family ever showed symptoms.

Patient one, in other words, probably wasn’t patient zero. ‘To be honest, we still do not know where the virus came from,’ one of the lead authors of the Lancet article, Bin Cao, wrote in an email to Science magazine. In March the Hong Kong-based South China Morning Post, citing leaked Chinese government data, suggested that the first identifiable case was actually in mid-November. In May Gao Fu, head of the Chinese Centre for Disease Control and Prevention (CCDCP), said no trace of the virus had been found in any animal samples from the market. Adding to the origin mystery are reports of early cases, or possible cases, in other countries. A retrospective test of a sample from a recovered pneumonia patient in France, who was swabbed on 27 December, came back positive for Covid-19. The patient hadn’t travelled abroad. The late Andy Gill, a member of the band Gang of Four, fell ill with what seemed to be pneumonia after coming back from a tour of China in November. The band didn’t gig in Wuhan, but did visit Beijing, Shanghai and Guangzhou. Gill died at St Thomas’s Hospital in London in February. His widow, Catherine Mayer, wrote on her blog that one of the specialists treating him told her there was ‘a real possibility that Andy had been infected by Sars-CoV-2’.

The first known cases in Wuhan were scattered between a number of hospitals. According to an account on the website of the Chinese National Health Commission, on 27 December, an unspecified private genetic testing company alerted staff at Wuhan’s Tongji Hospital that a sample from one of its pneumonia patients had tested positive for ‘coronavirus RNA’. Staff at Tongji called another hospital, Jinyintan, which had a specialist infectious disease unit, asking if the patient could be transferred there. Instead of alerting the national CCDCP, local officials kept the information within Wuhan and Hubei province. On 29 December, a senior specialist at Jinyintan, Huang Chaolin, was asked by local officials to investigate seven patients with inexplicable lung conditions at a third hospital, Hubei Provincial. What Chaolin found was worrying enough to prompt the transfer of the patients to Jinyintan in ambulances designed to prevent the leakage of potentially contaminated air.

A fourth hospital, Wuhan Central, had admitted a worker from the seafood market with an unusually intractable fever on 16 December. A sample of fluid from his lungs was sent to the Guangzhou-based firm Vision Medicals for genetic analysis on 22 December. According to an investigation by the Chinese business news site Caixin Global, Vision Medicals found, as early as 27 December, ‘an alarming similarity to the deadly Sars coronavirus that killed nearly eight hundred people between 2002 and 2003’. Instead of sending a written report to Wuhan Central, Vision Medicals conveyed the news by phone. In an interview with the Chinese magazine People, subsequently removed from its website, the head of the A&E department at Wuhan Central, Ai Fen, said the consultant looking after the patient had told her: ‘That person’s diagnosis is coronavirus.’

The same day, a new patient was brought in to Central Hospital with the same unusual symptoms. Samples from his lungs were sent off for testing to another lab, CapitalBio of Beijing. At noon on 30 December, Ai was watching a CT scan of yet another pneumonia patient linked to the seafood market when a former classmate, now at Tongji, sent her a screenshot of a WeChat exchange warning against visiting the market because ‘there are lots of people with high fever.’ He asked whether this was true. Ai sent him a clip of the video of the lungs of her latest patient. Four hours later, Ai got a copy of the 27 December lab report. This time the coronavirus finding was printed on the page. After alerting her superiors, she drew a red circle round the part of the report identifying Sars coronavirus in the patient, photographed it, and sent the image to a group of medical friends and colleagues. It quickly spread online. Among the doctors who pushed the report on Chinese social media in those first hours on 30 December, eight were later punished by local security services for putting out ‘false information’, including the ophthalmologist Li Wenliang, who would later die of Covid-19. Ai was bawled out by her bosses for spreading rumours and bringing the hospital into disrepute.

Whether because of the unofficial warning Ai put out on the Chinese language internet, or because they’d been planning to do it anyway, local health officials issued a red alert that night, warning all local hospitals to be on the lookout for unusual pneumonia cases. That alert quickly joined Ai’s picture of the lab report on social media. A journalist from China Business News saw the posts and got confirmation of the story from Wuhan’s health committee. The next day, New Year’s Eve, a team from the National Health Commission arrived from Beijing to investigate. News organisations around the world, from the South China Morning Post to the Daily Mail, reported on a mysterious pneumonia-like illness in Wuhan that had infected 27 people. Although no one had died, and Wuhan health officials assured everyone that all the cases seemed to be linked to the now closed seafood market and there was no sign of human to human transmission, Hong Kong began to put its well-laid epidemic contingency plans into action.

On 2 January, the WHO activated its incident management system, and on 5 January, issued its first bulletin. By this time there were 44 cases. Reliant on the Wuhan authorities for information, the WHO bulletin repeated its insistence that there was no evidence of ‘significant’ human to human transmission of the disease, although it didn’t dismiss the danger: ‘The occurrence of 44 cases of pneumonia requiring hospitalisation clustered in space and time,’ it stated, ‘should be handled prudently.’

For all the impression China can give of being a monolithic state with a clear top to bottom chain of command, it seems to have taken the national authorities the best part of the first three weeks of January to get to grips with what the local authorities in Wuhan had been in denial about. The WHO, dependent on the information China chose to share, took a reputational hit. As it turns out, it was already known in Wuhan in late December that it was extremely likely inter-human transmission of the virus was taking place, and that the connection with the seafood market was shaky. In an interview in April with CGTN, China’s international state TV service, Zhang Jixian, the head of respiratory medicine at Hubei Provincial Hospital, explained that her first three Covid-19 cases, admitted on 26 and 27 December, were members of the same family, parents and son, living together. None had any connection to the market. At the time Zhang had made clear her opinion on whether human to human transmission was taking place by immediately ordering masks and other protective gear for herself and her team.
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Last edited by uziq (2020-07-04 06:11:04)

Superior Mind wrote:

Anybody else lose a family member to miss Rona? Grandfather took the hit at 93. Pretty weird feeling.

Cordero entered the emergency room on 30 March and had a succession of health setbacks including mini-strokes, blood clots, sepsis infections, a tracheostomy and a temporary pacemaker implant. He had been on a ventilator and unconscious and had his right leg amputated. A double lung transplant was being explored.