Covid-19 Blog Series #2

And it begins

Late in the day of 29^th December 2019, Dr Li Wenliang, an ophthalmologist at Wuhan Central Hospital, became worried enough about the increasing number of pneumonia cases at the hospital, that he took to WeChat, a social media and messaging platform. In a group chat with some former University colleagues, he shared information about the cases and the fact that the cause had been identified as a “SARS like” virus.

Li was worried about the number of cases and how contagious it seemed to be.

Early the next morning, Wuhan Central Hospital, along with every other hospital in the region, received a formal request from the Wuhan Hygiene and Health Board. The message noted a recent outbreak of unexplained pneumonia and contained 3 key points;

1. Be focussed and careful in your work.
2. Advise the ER, prepare for additional demand for ventilators, take careful notes, provide additional training where necessary, ensure hand sanitiser supplies are sufficient.
3. Unauthorised persons must not disclose anything about the outbreak.

At the same time, a second notice, also from the same board, advised that the disease appears to originate from the Wuhan market and that all hospitals must complete a track and trace on contacts of the past seven days by 4pm that afternoon.

Dr Li again shared his concerns among his colleagues on WeChat. Somebody took screenshots and shared the news more widely and on 31 December, a twitter account called @DCheng36387164 tweeted images of the chat at 01:19am HK time on 31 December[i].

Once the message had reached social media outside China’s control, the Wuhan authorities convened to decide how to proceed, where a decision was taken to notify Beijing and, in turn, the World Health Organisation.[ii] The board also summonsed Dr Li to determine what he knew, what he told and how widely the news had likely spread.

Dr Li appeared before the board late on 31^st December and would, no doubt, have realised the grave consequences of his actions.

Censure, warning and grave illness

On 3^rd January, Dr Li was officially censured by Wuhan Public Security Bureau for spreading “false information”. He was not detained, although he was required to sign an acknowledgement of his misdeeds and promise not to do it again. He returned to work later that day.

On 10^th January, Li treated a patient that was later diagnosed with Coronavirus and later on the same day, he became ill and after repeated testing, was diagnosed as positive for Covid-19 on 30^th  January. If his initial illness was indeed due to Coronavirus, the onset was remarkably quick.

Dr Li was listed as critical on 5^th February and admitted to intensive care. He passed away on 7^th February.

Dr Li was in good health and at just 34 years old is one of the youngest victims of the virus.

The World Health Organisation

On the same day that the Wuhan authorities were debating what to do about the social media gossip, the story was picked up by The Straits Times, a Singapore based newspaper, and The South China Morning Post based out of Hong Kong. Both of the papers reported on a “pneumonia outbreak” with a possible link to SARS.

Both of the newspapers are considered reliable and serious reporters in their respective regions and the story was one of global interest. There was little doubt that there would be further reporting in the western press. This is what appears to have led to the Chinese authorities reluctantly reporting the outbreak to the WHO.

It would be several days later that the World Health Organisation (WHO) would issue their first advisory regarding “pneumonia of unknown etiology (unknown cause) detected in Wuhan City.”[iii]

The WHO advised “against the application of any travel or trade restrictions on China” and noted that there was “no evidence of significant human-to-human transmission and no health care worker infections have been reported.”

Chinese authorities blamed the virus on the Huanan Market and claimed that only workers from that market were infected. The insistence that there was “no evidence of human-to-human transmission would continue for several weeks. The World Health Organisation repeated these claims as late as 14^th January 2020.[iv]

When was human-to-human transmission confirmed?

The process of publishing academic papers is generally an arduous one that involves the paper being reviewed anonymously by experts in the subject. Papers are submitted to journals, journals consider whether the papers are publishable and farm them out to reviewers for comment. Papers come back from reviewers, get revised based on reviewer suggestions and resubmitted for another go around. It’s quite usual for a paper to take more than 2-3 months before it gets published and not at all uncommon that it takes much longer.

In times of crisis however, everything changes and when The Lancet, a highly esteemed medical journal, received a draft paper on 19^th January, it was fast tracked and ultimately published online on 24^th January[v]. The paper had a total of 29 authors, all Chinese medical professionals and found that, among other things, human-to-human transmission was already happening. In light of what had already happened to Li Wenliang, it was a brave but necessary step for the Chinese medical community.

While not specifically highlighted, the report did include a graphic that showed those that had contracted the virus early and what their connection was to the Huanan Markets. Of particular interest is that the first patient confirmed as having the disease had no connection to the market at all.

I repeat, the earliest case of Covid-19 contracted the disease on or before 1^st December and that case had no connection to the Wuhan markets at all. If China was to insist that the disease originated in the Wuhan markets, it would be impossible for a case without connection to the markets to exist unless through human-to human transaction.

Taiwanese advice ignored by WHO

In the last few months, it has been reported and later confirmed that Taiwan warned of human-to-human transmission as early as 31 December 2019[vi] [vii] but that this advice was ignored.

The relationship between Taiwan and the United Nations in its various incarnations is fraught and troubled. China insists that Taiwan is a region of China and not a state in its own right. On the rare occasions that an international body makes any sort of recognition of Taiwan, China complains vociferously and if the matter is uncorrected, will simply leave the body. As the worlds most (or second most) populous nation, China wields that sort of power.

So, Taiwan exists in a sort of international limbo. A country that is successful and free by any objective measure, it has good relationships with most first world nations but in a sort of informal way.

Nonetheless, Taiwan can get no formal standing and while diplomats recognise the impossibility of the situation, they struggle to deal with it. This lead to a recent situation where a Hong Kong reporter asked a WHO representative about the situation with China and was first ignored, then hung up on and finally told that WHO is working with “all areas of China”.[viii]

Taiwan has been forced to master the art of international relations in a way that perhaps no country before it has faced. Deprived of normal diplomatic resources, it have become a master at using backchannels, euphemisms and patience to achieve its outcomes. Among its successes in this regard has been a much closer and more profitable relationship with China in recent times.

This placed Taiwan in an enviable position when the Coronavirus outbreak began in early December. Taiwan enjoyed a shared language and close economic relationship and the outbreak occurred in an economic hub. Taiwan was also acutely aware of the potential damage it could cause by simply ‘blowing the whistle’ on the fact that there was a serious and new virus in China.

Taiwan therefore did what Taiwan does best. Using its backchannels and reaching out to the WHO, it provided all the information that the WHO would need to alert member nations of the dangers ahead. Acknowledging that it was not a member, Taiwan suggested that the WHO simply repost the data and advice to its member countries, something that any member country could do themselves, but that Taiwan could not do.

At the same time, Taiwan began effectively but quietly shutting its own borders. The Taiwanese government knew full well that the virus was dangerous and virulent. They knew that it was a close relative of the SARS virus that had wreaked havoc a few years earlier. They knew that a quick buckling down could avert a crisis. What Taiwan did not know and could not have foreseen was the reaction of the WHO. The WHO simply ignored Taiwan[ix][x].

Who is Culpable?

There are questions that will need to be asked as the current pandemic continues and eventually winds down. One of the first questions will need to be the culpability of China in the extent of the pandemic, but perhaps even before that, we need to ask about the extent of culpability shared by the World Health Organisation.

The WHO exists for the benefit of its members, all of them. Like any member based organisation it need to be aware of the foibles and quirks of individual members, but it also need to be aware of when those foibles and quirks are superseded by benefits to the majority. China can complain loudly about Taiwan being a “rogue province” and as a member of the UN, I suppose it can ask the UN to nod sagely at the comment.

What is not acceptable is that the UN endangers the rest of the world as an indulgence for China’s vanity. The Un should be sharing information based on the value of that information, not on the foibles of its member states.

Beyond this however there are very serious questions to be asked about how China plans to engage with the rest of the world. There is no doubt that the extent of the pandemic was covered up well beyond the point where it should have been reported. There can be no doubt that China knew the disease was contagious late in December and there is suspicion that it knew well before that.

Even now, China’s reporting of the number of infections and number of deaths does not stand up to scrutiny. Official reports of 3500 dead nationwide are almost laughable when “Wuhan funeral homes have returned 3,500 urns a day since March 23”[xi]. Locals approached by The Washington Post declined to give there names but universally found numbers of 3500 nationwide and 2500 dead in Wuhan to be simply laughable.

US intelligence has found similar results.[xii] The Chinese government is underplaying the number of infections and the number of deaths by at least a factor of ten.

China’s obsession with controlling the messaging that its citizens can access is well founded. The fall of the Soviet Union has largely been attributed to the access East German Citizens gained to West German broadcasting. TV soap operas and programs depicting families living in wealth and comfort that could only be dreamed of by Soviet citizens led to an uprising that was inconceivable just 2 or 3 years earlier.

In China, it’s not broadcast television but the internet that is leaking information into the carefully controlled state. The bureaucracy is used to hiding and suppressing information and the knee jerk reaction at the lowest level is to just not talk about it. As the most populous country in the world and the origin of three pandemics in the last 20 years, we need China to be more open and direct on its communications.

This is not a new issue either. The doctor that first reported on the SARS outbreak in China was arrested and imprisoned for his misdeeds. He was a formal Army General and thus held quite some power but nonetheless was punished for not complying with government dictates. Now 88 years old, he has been imprisoned again for suggesting that the Tiananmen protests were the act of patriots[xiii]

In countries like Australia it’s common to mock and ridicule any attempts to suggest that freedom of speech is imperilled. We don’t do patriotism very well and we stand dithering over niceties when confronted by atrocities, simply to avoid being labelled as racist. We have been blessed and cursed by over a century of government that has varied between “OK” and “great”. We don’t know what it is like to be governed by tyrants and idiots.

China needs to improve. That’s not racist and it’s not a condemnation of Chinese people. It’s simply a fact that the People’s Republic of China has hidden important facts from the world due to its own incompetence and desire to control the facts. China needs to be more open and more free.

That means it needs to allow greater freedoms to its citizens.

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Note from the author
In would be very pleased if you could comment/like/share or otherwise promote this little scribble. Every bit helps.

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[i] https://twitter.com/DCheng36387164/status/1211698349532831744?s=20

[ii] https://edition.cnn.com/2020/02/03/asia/coronavirus-doctor-whistle-blower-intl-hnk/index.html

[iii] https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/

[iv] https://twitter.com/WHO/status/1217043229427761152?s=20

[v] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext

[vi] https://amp.ft.com/content/2a70a02a-644a-11ea-a6cd-df28cc3c6a68

[vii] https://www.thenation.com/article/world/taiwan-who-coronavirus-china/

[viii] https://youtu.be/RLvg0KnTKhU

[ix] https://www.reuters.com/article/us-health-coronavirus-taiwan-who-idUSKBN21H1AU

[x] https://www.bloomberg.com/amp/news/articles/2020-03-30/taiwan-hits-back-at-who-over-collaboration-claims-in-virus-fight

[xi] https://www.washingtonpost.com/world/asia_pacific/chinese-families-should-be-sweeping-graves-now-but-thousands-still-havent-buried-their-dead/2020/04/03/5a6daa50-7234-11ea-ad9b-254ec99993bc_story.html

[xii] https://www.bloomberg.com/news/articles/2020-04-01/china-concealed-extent-of-virus-outbreak-u-s-intelligence-says?utm_source=Pico&utm_campaign=befaee1a04-EMAIL_CAMPAIGN_2020_04_01_11_12&utm_medium=email&utm_term=0_aa6d5ab160-befaee1a04-165462421

[xiii] https://www.theguardian.com/world/2020/feb/09/sars-whistleblower-doctor-under-house-arrest-in-china-family-confirms-jiang-yangyong

Image Description: 3D medical animation still shot showing the structure of a coronavirus https://www.scientificanimations.com/coronavirus-symptoms-and-prevention-explained-through-medical-animation/