Viral Mistruths

The world is facing a global economic challenge unseen since the Great Depression of the early-1930s and a global public health challenge unseen since the Great Pandemic of the late-1910s. Rather than come together to face the common challenge, the U.S. and China are growing apart as the Trump Administration and Congressional Republicans accuse China with increasing venom on the origins of the COVID-19 virus, alleged cover-ups, and – incredibly – on future damages due.

The bitter blame-game has been spawned by the uncritical acceptance by many of China’s supposed early COVID-19 related failings. The crux of the accusation is that China knew – and the World Health Organization (WHO) was separately kept informed by Taipei – that there was evidence of human-to-human transmission of COVID-19 as early as 31 December 2019. Yet, rather than alert the U.S. and international public health community, China allegedly suppressed this vital piece of information until 20 January 2020, silenced the medical professionals who tried to raise the alarm, and engaged in deception. Had China acknowledged this truth and moved aggressively three weeks earlier, the number of global coronavirus cases could have been reduced significantly.

This accusation is, for the most part, misplaced.

First, Taiwan did not alert the WHO to evidence of human-to-human transmission of COVID-19 on 31 December 2019. What Taiwan did convey to the WHO on December 31^st contained information that was no more useful than what the Wuhan Municipal Health Commission had, in fact, already publicly announced by that date, i.e. that a viral pneumonia of unknown causes had broken out in Wuhan and that the public should not go to enclosed public places or congregate; furthermore, face masks were recommended when stepping outdoors. As with any respiratory pathogen, it was understood that the risk of person-to-person spread could not be discounted.

Second, the key question to ask regarding human-to-human transmission is not whether the COVID-19 virus was capable of person-to-person spread but, rather, how it is transmitted via person-to-person spread – as in, the nature (and uniqueness) of the virus’ transmission-related parameters. To argue that knowledge of person-to-person spread is sufficient to mount a successful prevention, containment and mitigation regime is to entirely discount the ferocious characteristics of the COVID-19 virus – i.e., its aggressive infection rate, long incubation period, asymptomatic carry-and-spread capability, and peak contagiousness at the pre-symptomatic stage. And to presuppose that these cryptic characteristics of COVID-19 would have been miraculously divined had China acknowledged human-to-human transmission three or two weeks earlier is to indulge in an utter fantasy. As should be well known by now, there can be a considerable lag between new exposures to the virus and subsequent increase in infections and hospitalizations. It is telling, in this context, that even a full month after China’s admittedly belated confirmation of human-to-human transmission of the COVID-19 virus on 20 January 2020, there was ambivalence on the part of senior U.S. infectious diseases specialists (let alone Donald Trump) to apply the war-paint and transition the U.S. to full battle stations mode. That heightened moment of alarm, and panic, did not occur in the scientific community until late-February/early-March and within the broader political establishment until mid/late-March. By this time, community transmission had already exploded domestically.

Third, there was no three-week delay in movement at the Chinese end. To the contrary, authorities were laser-focused on investigating, isolating and detecting the early spread of the COVID-19 virus. The race to identify the pathogen kicked off on January 2^nd; four institutions tasked with carrying out parallel laboratory testing the next day; the WHO notified on the differences with past respiratory pathogens (avian flu, MERS) on January 5^th; the pathogen was confirmed as a new coronavirus on January 9^th; its genetic sequence was deposited with the WHO on January 12^th; and a detailed protocol of initial public health countermeasures were instituted on January 15^th. The WHO-China Joint Mission of 25 national and international experts termed China’s response as the “most ambitious, agile and aggressive disease containment effort in history.” To those who argue that the country sat on its hands during the early days of the outbreak, the frenetic pace of China’s early response utterly belies their claim.

Fourth, there were no major shortcomings on China’s part in alerting the U.S. and the international public health community. The WHO as well as Hong Kong, Macao and Taiwan were informed of the brewing epidemic on January 3^rd, the U.S. Centers for Disease Control and Prevention (CDC) was kept in the loop the next day (on the basis of which the CDC issued its highest level travel notice on January 6^th ), preliminary progress on pathogen identification was relayed to the WHO on January 9^th, and COVID-19’s genetic sequence shared with the WHO on January 12^th. Counterparts from Hong Kong, Taiwan, Macao and the WHO even paid field visits between January 13^th and January 20^th. This having been said, China was indeed parsimonious in sharing early epidemiological data on person-to-person spread to its international counterparts. The epidemiological characteristics and investigation results of the virus was only published for the first time on January 21^st and January 22^nd.

Fifth, China could have done a better job in relaying the developing gravity of the COVID-19 outbreak to its own citizens. Notable public alerts were provided on December 31^st, 2019 by the Wuhan Municipal Health Commission and on January 9^th, 2020 by the National Health Commission, when it released information on the virus’ cause. The public alerts should have been supplemented with earlier controls on population movement in and out of Wuhan and stronger monitoring, more broadly, of arrivals and exits in Hubei province – the approaching lunar holiday travel period notwithstanding. Arguably, this was the authorities’ most significant failing. And during the second trimester of January, a desire to downplay the possible infectiousness of the disease can also be detected.

Sixth, the tragic muzzling of Dr. Li Wenliang, whose message of December 30^th was intended to alert colleagues and their families privately (but got disseminated publicly and resonated widely) of a potential SARS-type outbreak, was handled crudely. It reflects poorly on the authorities’ knee-jerk propensity to exercise control, especially during a brewing public health emergency when immediate action on early alerts is to be encouraged, not suppressed. That said, Dr. Li’s message was neither the first to alert authorities and colleagues to the approaching peril (that distinction belongs to Dr. Zhang Jixian) nor was it materially significant. His message was based, in fact, on the internal notification to medical institutions that had been sent out by the Wuhan Municipal Health Commission on December 30^th. A day later, the Wuhan Municipal Health Commission even alerted the public and recommended respiratory pathogen-related common-sense precautions. These precautions could, and should, have been amplified though during the first half of January without necessarily stoking panic.

Seventh, and the above point having been made, the only defense at the time of the outbreak – as is also the case today – was an early, concerted and strict prevention, containment and mitigation regime on the lines adopted by South Korea, Singapore, Taiwan and Hong Kong – failing which, the global case-load would have been just as large today. It is instructive that the first imported case of COVID-19 was recorded in, both, the U.S. and these East Asian countries and regions between January 20^th and January 24^th. Yet, three months later at end-April 2020, the United States death count stands at 60,000-plus, the United Kingdom death count at 25,000-plus, while the analogous numbers for Seoul, Singapore, Taipei and Hong Kong are 247, 15, 6 and 4, respectively. And consistent with the foremost lesson learned from the Great Pandemic of 1918, countries, provinces and cities which have implemented multiple cautionary interventions – social distancing measures; isolation and quarantining measures – at the early phase of the COVID-19 outbreak are also the ones which have witnessed peak death rates that are orders of magnitude lower than their less vigilant peers.

The U.S. and the international community bear an obligation to reckon honestly with the facts of China’s early coronavirus response. Failings there were on China’s part, and from which China will no doubt learn. A once-in-100-year pandemic event does not lend itself to predictable management and facile solutions. The early ‘fog of war’ notwithstanding, the integrity of the Chinese authorities’ initial response and successes, particularly in terms of isolating the causative virus and establishing diagnostic tools, overwhelmingly outweigh the failings. Febrile times in international relations have not been conductive for the rigorous vetting of charged accusations (think: Iraq War of 2003), with calamitous consequences thereafter. With multilateralism on the back foot, this time all sides must do better.