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China and Covid-19: what went wrong in Wuhan?

This is the first part of a major Financial Times series, Coronavirus: Could the World Have Been Spared ?, investigating the global response to the crisis and whether the catastrophe could have been avoided.

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

During the investigation, some of those approached were threatened by the police, who said the FT had come to the city with “malicious intent”. Police harassment of virus victims, their relatives and anyone who hopes to speak to them continues, raising doubts that Xi Jinping’s administration is truly willing to facilitate the impartial investigation into the pandemic it has promised the world .


The virus is coming

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

It was at the end of December, while scrolling through his Twitter feed, that Gao Fei first noticed discussions about a possible virus epidemic in Wuhan.

Mr. Gao, who had grown up near Wuhan, regularly used virtual private network software to break through the “Great Firewall,” as China’s Internet censorship regime is best known, to access banned sites such as than Twitter. While government officials and state media spoke very little about the virus, he was determined to find out more.

As doubts about the actual scale of the epidemic grew until January, Mr. Gao, 33, decided to run home from southern Guangdong province where he worked as a welder. He arrived in his home village, about 120 km from Wuhan, on January 21, just a day after the Chinese government finally broke its silence on the epidemic and confirmed that the virus is spreading from person to person.

The Chinese government officially notified the World Health Organization on January 3 that “severe pneumonia of unknown aetiology” – science speaks of a mysterious new respiratory disease – had been discovered in Wuhan, the provincial capital. of Hubei with a population of 11 million. But for the first three weeks of January, Chinese officials said there were only a few dozen confirmed cases and downplayed the risk of human transmission.

China, Wuhan location map

Devastated to find life in his village unchanged, Mr. Gao confronted the local authorities. “They told me that they had not received any orders from a higher level [officials], so there was nothing they could do, ”he told the Financial Times. “People in my village always visited relatives and gathered as usual.

On January 23, the very day that Wuhan was placed under strict quarantine, he ventured one step higher in China’s administrative hierarchy, visiting the county government. The message was the same, “They told me they should wait for orders from higher-level city officials” in Huanggang, the town that encompasses Mr. Gao’s village.

“It was shocking,” Mr. Gao said. “By the time the situation in Wuhan was totally out of control, other cities just an hour’s drive away were completely unprepared. . . A lot could have been avoided if people had only learned the truth about the virus.


China and the united front of the WHO

Health workers in the passenger area of ​​Suvarnabhumi Airport in Bangkok, Thailand, January 24
Health workers in the passenger area of ​​Suvarnabhumi Airport in Bangkok, Thailand. The coronavirus spread beyond China, from Wuhan to Bangkok, on January 13 © Lilian Suwanrumpha / AFP / Getty

The laziness and complacency Mr. Gao encountered in his home village is at the heart of the ongoing geopolitical blame game over the coronavirus pandemic, which has now infected 39 million people worldwide, killing more than one million and devastated economies on a scale not seen since the Great Depression of the 1930s.

On January 14, a day after the coronavirus spread beyond China, from Wuhan to Bangkok, the country’s top health officials called a confidential meeting in Beijing in which they raised concerns about ” a “high” risk of human-to-human transmission. The sudden emergence of Wuhan-related cases in Bangkok and, days later, in Tokyo suggested that Wuhan’s official case tally, which remained at just a few dozen until mid-January, was absurd.

Coronavirus: Could the world have been spared?

The coronavirus pandemic has killed more than a million people across the world. But could it have been avoided? Unique FT investigation examines what went wrong – and what worked well – as Covid-19 spread around the world

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

October 18: The global crisis – in data

October 20: Why the coronavirus exposed Europe’s weaknesses

21st of October: Will the coronavirus break the UK?

October 22: How New York’s missteps let Covid-19 overwhelm the United States

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

In response to the news from Bangkok and Tokyo, epidemiologists from Imperial College London released a study estimating that for the virus to spread beyond Chinese borders, there must be around 4,000 symptomatic people in Wuhan. Yet, during this critical week, a major annual legislative meeting took place and a now infamous chinese new year dinner, attended by 40,000 families, took place in the city on January 18.

The Chinese government and the WHO have also downplayed growing concerns over whether the disease could be easily transmitted between humans. Speaking at a press conference in Geneva on January 14, Maria Van Kerkhove, acting head of the WHO’s Emerging Diseases Unit, was quoted by Reuters as saying there had been “a limited human-to-human transmission ”in Wuhan.

The WHO made an effort to clarify Dr Van Kerkhove’s comments, saying it only mentioned that human transmission was “possible” and “could” occur. “There was a misunderstanding at the press conference,” WHO told FT that day. “Preliminary investigations carried out by the authorities have found no clear evidence of human-to-human transmission.” Six more days would pass before Zhong Nanshan, a Chinese epidemiologist and government adviser, finally confirmed in an interview with state media on January 20 that the virus could indeed spread between people.

It was the start of what would become a regular pattern during the early stages of the pandemic. At least on the outside, President Xi Jinping’s administration sought to downplay the potential threat of the virus and initially lobbied against “excessive actions,” such as the early declaration of a global health emergency and travel bans against Chinese nationals.

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

Officially, WHO’s policy remains not to support travel bans during pandemics – as the Chinese government urged in late January, when its citizens were the main targets of those bans. However, at the end of March, when the virus was under control in China but spreading unchecked across Europe and the United States, Beijing changed its mind on the wisdom of travel bans because it banned almost all foreign arrivals.

During a meeting with Xi on January 28 in Beijing, Tedros Adhanom Ghebreyesus, director-general of the WHO, praised “the seriousness with which China is taking this epidemic, in particular the commitment of the highest leaders and the transparency they demonstrated, including sharing of data and genetic sequence of the virus. . . WHO will continue to work alongside China and all other countries to protect human health and ensure human safety ”.

Ross Upshur, a public health expert at the University of Toronto and a WHO consultant, notes that China has always had a lot of political influence at the WHO, and this has only increased since the president American Donald Trump announced in April that he would decline funding. for the organization. “It’s like David and Goliath, you have greater China and you have Tedros. . . there is an asymmetry of power there. “

Critics of China who blame Mr. Xi and the Chinese Communist Party for the ongoing disaster – including Mr. Trump – say that at the very least, his administration missed opportunities in late December and early January to slow down the spread of the virus in China and around the world. . Many argue that this failure was a direct result of increasingly authoritarian tendencies and the growing opacity of China’s unique “state party” model of governance.

“The coronavirus has alerted [the world] that China has become a threat to people’s livelihoods, and even their lives, around the world, ”said Jimmy Lai, Hong Kong’s pro-democracy printing mogul and one of the most critical critics. tougher party. “Without freedom, the Chinese people are deprived of information and facts [they need] take care of them.

Grieving relatives: anger at the human cost of the cover-up

Zhong Hanneng with his deceased son Peng Yi and daughter in 2019

Zhong Hanneng (left) with his deceased son Peng Yi (right) and daughter in 2019. They visited many hospitals after Peng contracted the 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 has died from Covid-19. “The government kept saying there was no human-to-human transmission and we believed them. We had a great family dinner on January 20th with 20 people.

After Peng, a Wuhan Primary School teacher with a young girl, developed a fever, a scan of his lungs suggested he had contracted the virus. But the city’s first hospital where he was treated did not have enough test kits to confirm his condition and refused to admit it.

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

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

“The government knew how severe the virus was at an early stage, but did not give a public warning and chose to cover up the truth. It cost so many lives, ”Zhang said. He is now trying to sue the Wuhan government for 2 million rmb ($ 294,000) in compensation, but Chinese party-controlled courts will not take his case. Such lawsuits of citizens alleging local government negligence after disasters are not uncommon in China, although they are rarely successful.

The Chinese government has defended its decision not to publicly recognize the severity of the outbreak and the risk of human-to-human transmission until Jan. 20, saying it faces an incredibly complex situation under unclear circumstances. Dale Fisher, an infectious disease specialist at National University Hospital in Singapore, agrees with this argument. “You have to remember that this is a new virus and chaos is really normal, especially at the start of an epidemic, said Dr Fisher, who has experience working in Ebola hot spots in West Africa and was a member of a WHO delegation that visited China in mid-February. “You don’t want to push [the panic] button until you have reasonable confidence [in your diagnosis]. “


A growing catastrophe

Wang Linfa, Director of the Emerging Infectious Diseases Program at Duke-NUS Medical School
Wang Linfa, director of the Emerging Infectious Diseases program at Duke-NUS Medical School, said the Chinese political system was a “double-edged sword” that inhibited the country’s initial response to the epidemic, but it finally helped to apply effective containment measures © Ore Huiying

As Wang Linfa visited Wuhan in mid-January, he had no idea he was witnessing the start of a global catastrophe.

Professor Wang is one of the world’s leading authorities on bat-borne diseases, but his presence in Wuhan during the early stages of the outbreak was a coincidence. Originally from Shanghai, living in Singapore, where he is director of the Emerging Infectious Diseases program at Duke-NUS Medical School, Professor Wang has traveled regularly to China to meet with colleagues. His trip had been planned since early December.

Many of the initial cases in Wuhan were already linked to a living wet market, a fact that sparked memories of the Sars outbreak that emerged in the winter of 2002-2003. The Sars originated from southern Guangdong Province and Hong Kong, infecting over 8,000 people and killing 774. The scientific consensus is that Sars originate from bats before being transmitted to humans via an “intermediate host.” , most likely a civet sold for food in a market.

“The market news has certainly been a déjà vu moment,” Professor Wang said. “I was like, ‘Oh my God,’ it’s winter, right before the Chinese New Year and the market. . . I really thought it must be similar to Sars.

Professor Wang’s vast experience with Chinese medical institutions seemed reassuring during his visit to Wuhan on January 15, 16 and 17. [in China] are much, much better than 17 years ago, ”he said. “Chinese doctors and scientists are top notch, among the world’s leading scientists. So I figured that even if it was like Sars, the impact would be smaller than Sars. “

Arriving in Wuhan by high-speed train on January 14, Prof. Wang noticed that very few people were wearing masks. There were also no temperature checks, two signs that would have suggested that 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 would go to a public restaurant, [all] very crowded with people ”. It wasn’t until the wee hours of January 18 that he began to fear that the situation in Wuhan was much more serious than he had imagined.

As Professor Wang prepared to board his flight back to Singapore, he saw the authorities at the battle posts. “They were doing very strict temperature control” before boarding, he said. “There were a lot of cameras, security personnel and medical personnel wearing full PPE. [If you had a] fever you have been banned from traveling outside of Wuhan.

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

Dale Fisher, infectious disease specialist at Singapore National University Hospital, said: “You have to remember that this is a new virus and chaos is really normal, especially at the onset of a disease. epidemic »

Dale Fisher, infectious disease specialist at Singapore National University Hospital, said: “You have to remember that this is a new virus and chaos is really normal, especially at the onset of a disease. epidemic ”© Ore Huiying

Professor Wang called China’s political system a “double-edged sword” that inhibited the country’s initial response to the epidemic, but ultimately helped it implement effective containment measures. “It is not very effective at the start of an epidemic because you are not allowed to speak until the government says, ‘OK, I am convinced that you are right, you can speak’, did he declare. “If the Chinese system became more democratic, it would help [with transparency] but it can do [containment] less efficient.”

So far, Chinese health officials have traced the first confirmed coronavirus case to December 1, but the hunt for the pandemic’s true “patient zero” will likely be in vain. Although the majority of people who contract the virus have mild symptoms or no symptoms, they can still pass it on to others. In medical jargon, Covid-19 is caused by an “early-shedding” coronavirus that quickly spreads in communities because most people don’t know they are infectious. Sars was a ‘late-shedding’ coronavirus – patients typically became contagious after being hospitalized, which made it much easier to contain. “The hospital control that we can easily implement to stop things,” Dr Fisher said. “Community infection control is much more difficult.”

In this regard, finding the patient of coronavirus – the man, woman, or child who ate the bat-bitten cat, pangolin, or other as yet undetermined intermediate host – is as difficult as finding the first person to contract a seasonal flu. “Patient zero could be someone who spread to 30 other patients but never knew they were infected,” Professor Wang said.

confusion and denial

Inside Wuhan Central Hospital

Staff of an intensive care unit treating Covid-19 patients at a hospital in Wuhan on February 22
Hospital doctors were increasingly confused over what information they were supposed to give to which authorities during the first two weeks of January © AFP / Getty

Three weeks before Xi’s administration publicly acknowledged that a deadly new respiratory disease was spreading in one of China’s largest cities, doctors at Wuhan Central Hospital realized they had a problem.

At 2:00 p.m. on December 29, Yin Wei, a doctor from the hospital’s public health department, received a call from a colleague reporting that four patients were showing symptoms of viral pneumonia. The four patients, added Dr Yin’s colleague, were from a local seafood market.

According to an internal report later prepared by Dr. Yin and viewed by the FT, he immediately informed the local district government health official, Wang Wenyong. Mr. Wang was not surprised by Dr. Yin’s call.

“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 performing several tests,” wrote Dr. Yin. . “Wang added that he would respond to me after reporting the situation in 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., officials from the district CDC came to the hospital to collect patient samples, after which they told Dr. Yin and his colleagues to wait.

Two days later, on December 31, they were still waiting. So Dr. Yin called one of Mr. Wang’s bosses at the district CDC to inquire about the test results. “I was told to wait for a further opinion,” wrote Dr. Yin.

On January 3, Dr. Yin tried again, asking Mr. Wang if Wuhan Central should at least complete an Infectious Disease Bulletin (IDRC), an online reporting system shared by local and national health authorities. Again, he was pushed back. “Wang replied that we should wait for further advice from higher authorities before reporting a special infectious disease like this,” Dr Yin recalled in his report.

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

Mr. Wang, the official mentioned several times by Dr. Yin, said that “Wuhan Central Hospital seeks to blame me in the report.”

“I didn’t do anything wrong,” he told the FT, adding that everyone in the system was just following orders. “Wuhan Central has failed to meet the standards set by the city and provincial health commissions. . .[Yes]we were careful in reporting cases early on. But it was a collective decision, not mine.

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

As Wuhan Central medical staff tried to figure out what they were and were not allowed to report higher in the chain, Beijing central government officials were already at zero point in Wuhan. A delegation from the China Center for Disease Control and Prevention first arrived on December 31, according to the Chinese government’s official timeline of its virus control efforts.

An academic who advises central government health officials said they even discussed in the early days of the New Year whether to hold daily public briefings. But Beijing officials did not do so until January 22, in part because of the chaotic situation in Wuhan. “Information [from Wuhan] was not clear, ”said the adviser, who asked not to be identified. “There were a lot of rumors and the attitude of local officials was to say little or, if possible, to say nothing. It was a mess. “

The WHO said it asked Chinese government officials about the Wuhan outbreak on January 1 and received the response from Beijing two days later, on January 3. Communist Party officials also admitted that Xi gave orders regarding the development of the situation in Wuhan during a meeting on January 7. the highest organ of the Politburo, the Politburo Standing Committee, composed of seven members. According to a major party newspaper, the president instructed officials to find the source of the virus and “confirm the transmission mechanism as quickly as possible.”

Another person who advises the State Council on public health matters said the problem runs deeper than the fog of war conditions on the ground in Wuhan. “The Chinese government, especially at the local level, lacks the capacity to communicate effectively with the public in crisis situations,” he told the FT, also on condition of anonymity. “The main task of the advertising services is to keep the Communist Party in power, not to promote transparency. The pandemic has exposed the weaknesses of the system. “

Confusion among Wuhan Central medics over what information they were supposed to communicate to which authorities increased steadily during the first two weeks of January. Municipal and provincial health officials have advised them to “exercise caution” and “exercise caution” before reporting any new cases, according to Dr. Yin’s report.

On January 13, conflicting instructions from the Wuhan Health Department and the municipal CDC finally overwhelmed Dr. Yin’s morale. “Dear Director Wang,” he wrote. “We have a situation regarding the reporting of suspected cases. The health department said we should ask the CDC to collect samples and conduct investigations, but the CDC said we must wait for instructions from the health department. This prevented a suspected patient from being tested and investigated. We have no idea what is wrong. Can you help us solve the problem? “

Within days, however, patients falling through the cracks of the notification system were the least of Wuhan Central’s problems. Hospital staff were starting to get sick, with at least 56 hospitalized as of January 24. An epidemic among hospital staff is a tragic but telling sign that a disease is transmissible between humans.

Li Wenliang, ophthalmologist at Wuhan Central Hospital, fell ill with Covid-19 and died in early February

L’ophtalmologiste de l’hôpital central de Wuhan, Li Wenliang, qui a été réprimandé par la police le 3 janvier pour avoir prétendument «répandu des rumeurs» sur le virus mystérieux, vu ici avant et après son hospitalisation. Il est décédé début février des suites de la maladie © Social Media / AFP / Getty

Parmi les médecins du centre de Wuhan qui mouraient dans leurs propres quartiers se trouvait Li Wenliang, un ophtalmologiste de 33 ans et l’un des nombreux membres du personnel médical réprimandés par la police le 3 janvier pour avoir prétendument «répandu des rumeurs» sur le virus mystérieux de l’époque, bien que tout ce qu’ils avait fait était d’en discuter entre eux dans un groupe de discussion privé. La mort de Li début février provoquerait une tempête de colère publique, bien que largement dirigée contre le gouvernement local plutôt que le gouvernement central à Pékin.

Avec la confusion qui sévit dans toute la Chine pendant presque tout le mois de janvier, l’un des plus grands mystères sur les étapes initiales de la pandémie est la raison pour laquelle des grappes de la taille de Wuhan n’ont pas émergé dans tout le pays. Selon les données de vol chinois citées par les médias d’État, entre le 30 décembre et le 22 janvier, plus de 465000 personnes ont volé de Wuhan vers 10 destinations nationales populaires, de Pékin au nord à la station balnéaire du sud de Sanya. Dans le même temps, des flux beaucoup plus faibles de personnes de Wuhan vers des destinations internationales ont semé le cataclysme mondial qui se déroule toujours.

La réponse réside dans les réponses très différentes des gouvernements en Chine et dans la région Asie-Pacifique, en Europe et aux États-Unis.

Graphique des cas cumulatifs de coronavirus en Chine par province, montrant que la Chine a réussi à contenir le virus dans la province du Hubei, qui représente 80% de tous les cas

Le nombre réel d’infections chinoises était significativement plus élevé que ce qui avait été officiellement signalé, mais n’a pas été enregistré car la quasi-totalité de la population a été contrainte de fermer à clé de la fin janvier à la mi-février.

«Chaque province de Chine a été infectée en un mois [of the Wuhan outbreak] and [their official case counts] se sont généralement installés dans des chiffres triples parce que leurs verrouillages étaient durs », a déclaré le Dr Fisher. «Les diagnostics n’ont pas été faits parce que tout le monde restait à la maison. Les personnes atteintes de cas bénins l’ont probablement transmise à quelques personnes de leur famille qui avaient également des cas bénins et le virus s’est tout simplement brûlé. . . En trois à quatre semaines, ils ont pu débloquer des choses.

Graphique des cas de coronavirus en Chine au fil du temps, montrant comment la Chine a réussi à contenir le virus à son apogée en février et mars

«J’étais en Chine [in mid-February] et a pu voir l’ampleur de la réponse », a-t-il ajouté. «Des verrouillages incroyables avec des trains immobiles, des avions tous avec des capots sur leurs moteurs et un ciel bleu absolument dégagé dans [often polluted] Pékin. Cela s’est donc répandu dans toute la Chine, mais ils l’ont simplement fermée.

Parallèlement, d’autres pays et territoires d’Asie de l’Est – notamment la Corée du Sud, Taïwan, Hong Kong et Singapour – ont utilisé un mélange plus flexible d’interdictions de visiteurs, de recherche des contacts et de verrouillages plus doux que ceux de la Chine propagation communautaire du virus effectivement.

Mais pour les pays qui ont rapidement émis des interdictions de voyager tout en ne faisant rien d’autre de manière coordonnée à l’échelle nationale, comme les États-Unis, il était trop tard.

Barricades outside a residential compound in Hubei province, China in March

Real infection numbers in China were significantly higher than officially reported, but not recorded because almost the entire population was forced into strict lockdowns from late January through mid-February © Getty

Dr Fisher was speaking to the FT by phone from Singapore on the morning of August 28. As he did so, he was also watching a live TV feed of the final night of the US Republican National Convention. While responding to the FT’s questions, he occasionally interjected his amazement at the scene in Washington. “There’s Donald Trump’s daughter addressing everyone and she’s not wearing a mask!” he exclaimed at one point. “Nor is anyone else. They haven’t even distanced the seats!”

Dr Fisher’s view was that “another couple of weeks” of advance notice about the pandemic would not have helped many countries. He pointed out that despite it being confirmed that the virus could be transmitted from person to person on January 20, “it’s not like [everyone] jumped up and sprang into action”.

“Most of Asia really respected this, had systems ready to go, and did a lot of work in January and February for the day that was coming when they were going to get smashed,” said Dr Fisher. “Unfortunately, most of the rest of the world needed to get smashed to have that realisation. As we said in our February [WHO China delegation] report, this virus can have devastating health, social and economic effects but the world is not ready, in capacity or in mindset, to deal with it.”

Prof Wang added that for all of the Chinese system’s shortcomings in the earliest days and weeks of the outbreak, the rest of the world should have been on high alert. As soon as human-to-human transmission was confirmed and Wuhan went into quarantine a few days later, countries could have prepared themselves for its arrival as effectively as Taiwan and South Korea did, among others.

Most did not. In particular the Trump administration’s response will go down as one of the worst national security failures in the history of the US republic, with the virus breaching even the White House and the president himself. As Prof Wang said: “For other countries not to have taken [the virus] seriously, there’s just no excuse.”

Additional reporting by Qianer Liu and Anna Gross

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