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China Created a Fail-Safe System to Track Contagions. It Failed. China Created a Fail-Safe System to Track Contagions. It Failed.
(1 day later)
The alarm system was ready. Scarred by the SARS epidemic that erupted in 2002, China had created an infectious disease reporting system that officials said was world-class: fast, thorough and, just as important, immune from meddling.The alarm system was ready. Scarred by the SARS epidemic that erupted in 2002, China had created an infectious disease reporting system that officials said was world-class: fast, thorough and, just as important, immune from meddling.
Hospitals could input patients’ details into a computer and instantly notify government health authorities in Beijing, where officers are trained to spot and smother contagious outbreaks before they spread.Hospitals could input patients’ details into a computer and instantly notify government health authorities in Beijing, where officers are trained to spot and smother contagious outbreaks before they spread.
It didn’t work.It didn’t work.
After doctors in Wuhan began treating clusters of patients stricken with a mysterious pneumonia in December, the reporting was supposed to have been automatic. Instead, hospitals deferred to local health officials who, over a political aversion to sharing bad news, withheld information about cases from the national reporting system — keeping Beijing in the dark and delaying the response.After doctors in Wuhan began treating clusters of patients stricken with a mysterious pneumonia in December, the reporting was supposed to have been automatic. Instead, hospitals deferred to local health officials who, over a political aversion to sharing bad news, withheld information about cases from the national reporting system — keeping Beijing in the dark and delaying the response.
The central health authorities first learned about the outbreak not from the reporting system but after unknown whistle-blowers leaked two internal documents online.The central health authorities first learned about the outbreak not from the reporting system but after unknown whistle-blowers leaked two internal documents online.
Even after Beijing got involved, local officials set narrow criteria for confirming cases, leaving out information that could have provided clues that the virus was spreading among humans.Even after Beijing got involved, local officials set narrow criteria for confirming cases, leaving out information that could have provided clues that the virus was spreading among humans.
Hospitals were ordered to count only patients with a known connection to the source of the outbreak, the seafood market. Doctors also had to have their cases confirmed by bureaucrats before they were reported to higher-ups.Hospitals were ordered to count only patients with a known connection to the source of the outbreak, the seafood market. Doctors also had to have their cases confirmed by bureaucrats before they were reported to higher-ups.
As the United States, Europe and the rest of the world struggle to contain the coronavirus pandemic, China has cast itself as a model, bringing down a raging outbreak to the point where the country has begun to lift the kinds of onerous restrictions on life that are now imposed around the world.As the United States, Europe and the rest of the world struggle to contain the coronavirus pandemic, China has cast itself as a model, bringing down a raging outbreak to the point where the country has begun to lift the kinds of onerous restrictions on life that are now imposed around the world.
This triumphant narrative obscures the early failures in reporting cases, squandered time that could have been used to slow infections in China before they exploded into a pandemic.This triumphant narrative obscures the early failures in reporting cases, squandered time that could have been used to slow infections in China before they exploded into a pandemic.
“According to the rules, this of course should have been reported,” Yang Gonghuan, a retired health care official involved in establishing the direct reporting system, said in an interview. “Of course they should have seized on it, found it, gone to understand it.”“According to the rules, this of course should have been reported,” Yang Gonghuan, a retired health care official involved in establishing the direct reporting system, said in an interview. “Of course they should have seized on it, found it, gone to understand it.”
Aggressive action just a week earlier in mid-January could have cut the number of infections by two-thirds, according to a recent study whose authors include an expert from Wuhan’s municipal Center for Disease Control and Prevention. Another study found that if China had moved to control the outbreak three weeks earlier, it might have prevented 95 percent of the country’s cases.Aggressive action just a week earlier in mid-January could have cut the number of infections by two-thirds, according to a recent study whose authors include an expert from Wuhan’s municipal Center for Disease Control and Prevention. Another study found that if China had moved to control the outbreak three weeks earlier, it might have prevented 95 percent of the country’s cases.
“I regret that back then I didn’t keep screaming out at the top of my voice,” Ai Fen, one of the doctors at Wuhan Central Hospital who spotted cases in December, said in an interview with a Chinese magazine. “I’ve often thought to myself what would have happened if I could wind back time.”“I regret that back then I didn’t keep screaming out at the top of my voice,” Ai Fen, one of the doctors at Wuhan Central Hospital who spotted cases in December, said in an interview with a Chinese magazine. “I’ve often thought to myself what would have happened if I could wind back time.”
China’s leader, Xi Jinping, has sought to move quickly past the early failings and shift attention to the country’s drive to end the outbreak. The Chinese government has been widely castigated for its initial mistakes, which have become a top talking point of President Trump.China’s leader, Xi Jinping, has sought to move quickly past the early failings and shift attention to the country’s drive to end the outbreak. The Chinese government has been widely castigated for its initial mistakes, which have become a top talking point of President Trump.
The central leadership has focused blame on local bureaucrats, including for censuring doctors who warned others about the infections. It promptly dismissed two health officials and, later, the party secretaries for Hubei Province and its capital, Wuhan.The central leadership has focused blame on local bureaucrats, including for censuring doctors who warned others about the infections. It promptly dismissed two health officials and, later, the party secretaries for Hubei Province and its capital, Wuhan.
Now, interviews with doctors, health experts and officials, leaked government documents, and investigations by the Chinese media reveal the depth of the government’s failings: how a system built to protect medical expertise and infection reports from political tampering succumbed to tampering.Now, interviews with doctors, health experts and officials, leaked government documents, and investigations by the Chinese media reveal the depth of the government’s failings: how a system built to protect medical expertise and infection reports from political tampering succumbed to tampering.
Others tried to fill the void of information when the early warning system failed. The medical community found other, informal ways to alert others, disclosing government directives and hospital reports on the internet. During a rare burst of relative transparency early in the epidemic, Chinese journalists did much to expose the problems, but censors closed that window.Others tried to fill the void of information when the early warning system failed. The medical community found other, informal ways to alert others, disclosing government directives and hospital reports on the internet. During a rare burst of relative transparency early in the epidemic, Chinese journalists did much to expose the problems, but censors closed that window.
The government has vowed to fix flaws exposed in the disease surveillance system, but similar promises were made after SARS. Fresh efforts to repair the system now could also falter under a political hierarchy that leaves experts — doctors, even public health officials — unwilling to take on local leaders. In China, politics often ends up overriding the very safeguards created to prevent interference in the flow of information.The government has vowed to fix flaws exposed in the disease surveillance system, but similar promises were made after SARS. Fresh efforts to repair the system now could also falter under a political hierarchy that leaves experts — doctors, even public health officials — unwilling to take on local leaders. In China, politics often ends up overriding the very safeguards created to prevent interference in the flow of information.
The failures in the first weeks “greatly reduced the vigilance and self-protection of the public and even medical workers, making it harder to contain the epidemic,” said a study of the epidemic by 12 medical experts from Shanghai Jiao Tong University. “Only precautions in ordinary times can prevent great disasters from arising.”The failures in the first weeks “greatly reduced the vigilance and self-protection of the public and even medical workers, making it harder to contain the epidemic,” said a study of the epidemic by 12 medical experts from Shanghai Jiao Tong University. “Only precautions in ordinary times can prevent great disasters from arising.”
Last year, health officials exuded confidence that China would never again suffer a crisis like SARS.Last year, health officials exuded confidence that China would never again suffer a crisis like SARS.
In July, the Chinese Center for Disease Control and Prevention held what it called the nation’s biggest infectious outbreak training exercise since the SARS epidemic in 2002 and 2003, showcasing the strides that the government had made since the virus killed hundreds and traumatized the nation.In July, the Chinese Center for Disease Control and Prevention held what it called the nation’s biggest infectious outbreak training exercise since the SARS epidemic in 2002 and 2003, showcasing the strides that the government had made since the virus killed hundreds and traumatized the nation.
More than 8,200 officials took part in the online drill, focused on a traveler arriving from abroad with a fever who sets off temperature monitors, triggering a hunt for other passengers. The officials raced to test how quickly and effectively they could track, identify and contain the virus, including by notifying Beijing.More than 8,200 officials took part in the online drill, focused on a traveler arriving from abroad with a fever who sets off temperature monitors, triggering a hunt for other passengers. The officials raced to test how quickly and effectively they could track, identify and contain the virus, including by notifying Beijing.
“Who knows what the next one will be?” said Feng Zijian, a senior disease control official who helped design the exercise, according to the center.“Who knows what the next one will be?” said Feng Zijian, a senior disease control official who helped design the exercise, according to the center.
“The enemy is constantly evolving,” Dr. Feng said, “and our capacity to respond must also constantly improve.”“The enemy is constantly evolving,” Dr. Feng said, “and our capacity to respond must also constantly improve.”
At the heart of China’s defenses was the Contagious Disease National Direct Reporting System. Started in 2004, it was designed to prevent a repeat of the SARS epidemic, when slow, patchy reporting, compounded by local leaders’ reluctance to share bad news, delayed the government’s fight.At the heart of China’s defenses was the Contagious Disease National Direct Reporting System. Started in 2004, it was designed to prevent a repeat of the SARS epidemic, when slow, patchy reporting, compounded by local leaders’ reluctance to share bad news, delayed the government’s fight.
Using this system, health officers in Beijing could pore over screens showing reports from hospitals or local disease control centers, ready to spot warning signs within a few hours of a doctor diagnosing a troublesome infection, such as cholera or tuberculosis, as well as hard-to-diagnose cases of viral pneumonia.Using this system, health officers in Beijing could pore over screens showing reports from hospitals or local disease control centers, ready to spot warning signs within a few hours of a doctor diagnosing a troublesome infection, such as cholera or tuberculosis, as well as hard-to-diagnose cases of viral pneumonia.
“Viruses like SARS could emerge anytime, but there’ll never be another SARS incident,” Gao Fu, director of China’s disease control center, said in a speech last year. “That’s thanks to how well our national contagious disease surveillance system works.”“Viruses like SARS could emerge anytime, but there’ll never be another SARS incident,” Gao Fu, director of China’s disease control center, said in a speech last year. “That’s thanks to how well our national contagious disease surveillance system works.”
The boasts were not empty.The boasts were not empty.
The system had helped when China and other countries suffered outbreaks of avian influenza. In 2013, authorities filed cases of a potentially deadly H7N9 avian influenza virus, with orders to submit them within two hours of confirmation.The system had helped when China and other countries suffered outbreaks of avian influenza. In 2013, authorities filed cases of a potentially deadly H7N9 avian influenza virus, with orders to submit them within two hours of confirmation.
Last November, the country’s Center for Disease Control alerted the public to an outbreak of pneumonic plague in the sparsely populated Inner Mongolia, after only two cases emerged.Last November, the country’s Center for Disease Control alerted the public to an outbreak of pneumonic plague in the sparsely populated Inner Mongolia, after only two cases emerged.
Since the outbreak in Wuhan, some doctors have said they were unsure how to report early cases, which did not fit into the standard list of infections. But little-understood infections could still be logged as “pneumonia of unknown etiology” — or unknown cause — when the patients did not respond to the usual treatment.Since the outbreak in Wuhan, some doctors have said they were unsure how to report early cases, which did not fit into the standard list of infections. But little-understood infections could still be logged as “pneumonia of unknown etiology” — or unknown cause — when the patients did not respond to the usual treatment.
Year after year, Chinese health authorities warned hospitals to look out for such outliers.Year after year, Chinese health authorities warned hospitals to look out for such outliers.
“For many infectious diseases when you don’t know the cause, it can often present itself as pneumonia of unknown etiology,” said Dr. Yang, the retired official. “This was a way of capturing an outbreak while it was embryonic.”“For many infectious diseases when you don’t know the cause, it can often present itself as pneumonia of unknown etiology,” said Dr. Yang, the retired official. “This was a way of capturing an outbreak while it was embryonic.”
The health authorities held regular meetings to train disease control officials in spotting and investigating unexplained and hard-to-treat pneumonia cases; the last was in Shanghai in October.The health authorities held regular meetings to train disease control officials in spotting and investigating unexplained and hard-to-treat pneumonia cases; the last was in Shanghai in October.
They inspected hospitals and local disease control centers to try to ensure that they were reporting all listed diseases, and the National Health Commission demanded 100 percent compliance. Although implementation was patchy, doctors reported a handful of unusual pneumonia infections, galvanizing investigators to track down the cause.They inspected hospitals and local disease control centers to try to ensure that they were reporting all listed diseases, and the National Health Commission demanded 100 percent compliance. Although implementation was patchy, doctors reported a handful of unusual pneumonia infections, galvanizing investigators to track down the cause.
In early December, Hubei’s local Center for Disease Control called together officials from across the province to instill the system’s importance.In early December, Hubei’s local Center for Disease Control called together officials from across the province to instill the system’s importance.
Huang Xibao, a deputy director of the center, told them to make sure that in 2020 Hubei was “number one nationwide in the overall quality of its contagious disease information.”Huang Xibao, a deputy director of the center, told them to make sure that in 2020 Hubei was “number one nationwide in the overall quality of its contagious disease information.”
Dr. Ai, the head of the intensive care unit at Wuhan Central Hospital, was among the first doctors to note a disturbing pattern among patients staggering into the city’s hospitals with dry coughs, high fevers and crippling lethargy. Computerized tomography or “CT” scans often revealed extensive damage to their lungs.Dr. Ai, the head of the intensive care unit at Wuhan Central Hospital, was among the first doctors to note a disturbing pattern among patients staggering into the city’s hospitals with dry coughs, high fevers and crippling lethargy. Computerized tomography or “CT” scans often revealed extensive damage to their lungs.
“It was a baffling high fever,” Dr. Ai said of a patient who turned up on Dec. 16, according to an interview in a Chinese magazine called People. “The medicines used throughout didn’t work, and his temperature didn’t move.”“It was a baffling high fever,” Dr. Ai said of a patient who turned up on Dec. 16, according to an interview in a Chinese magazine called People. “The medicines used throughout didn’t work, and his temperature didn’t move.”
By the end of the month, local disease control centers in Wuhan were receiving worried calls from doctors, telling of the strange, tenacious pneumonia cases that often seemed to emanate from the Huanan seafood market. Seven in one hospital, three in another, three in yet another.By the end of the month, local disease control centers in Wuhan were receiving worried calls from doctors, telling of the strange, tenacious pneumonia cases that often seemed to emanate from the Huanan seafood market. Seven in one hospital, three in another, three in yet another.
“These patients may be infectious. Caring for them in a general hospital is a safety risk,” warned Huang Chaolin, a senior doctor at Jinyintan Hospital, the city’s main facility for infectious diseases. He saw seven patients from another hospital on Dec. 27, according to a report in the Health News, the official newspaper of the medical system.“These patients may be infectious. Caring for them in a general hospital is a safety risk,” warned Huang Chaolin, a senior doctor at Jinyintan Hospital, the city’s main facility for infectious diseases. He saw seven patients from another hospital on Dec. 27, according to a report in the Health News, the official newspaper of the medical system.
In theory, doctors could have reported such cases directly, but Chinese hospitals also answer to Communist Party bureaucracies. Over time, hospitals often came to defer to local health authorities about reporting troublesome infections, apparently to avoid surprising and embarrassing local leaders.In theory, doctors could have reported such cases directly, but Chinese hospitals also answer to Communist Party bureaucracies. Over time, hospitals often came to defer to local health authorities about reporting troublesome infections, apparently to avoid surprising and embarrassing local leaders.
That deference may not have mattered much most of the time. Now it gave officials in Wuhan an opening to control and distort information about the virus.That deference may not have mattered much most of the time. Now it gave officials in Wuhan an opening to control and distort information about the virus.
Updated June 22, 2020 Updated June 24, 2020
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Local disease control offices in the city had counted 25 such cases by Dec. 30, said an official internal report that was leaked online last month by unknown whistle-blowers. The brief document was one of the first attempts by Wuhan to understand the extent of cases, and listed patients had fallen ill starting Dec. 12.Local disease control offices in the city had counted 25 such cases by Dec. 30, said an official internal report that was leaked online last month by unknown whistle-blowers. The brief document was one of the first attempts by Wuhan to understand the extent of cases, and listed patients had fallen ill starting Dec. 12.
“The local health administration clearly made a choice not to use the reporting system,” said Dali Yang, a professor of political science at the University of Chicago who studies policymaking in China. “It is clear they were trying to resolve the problem within the province.”“The local health administration clearly made a choice not to use the reporting system,” said Dali Yang, a professor of political science at the University of Chicago who studies policymaking in China. “It is clear they were trying to resolve the problem within the province.”
Leaders in Wuhan seem to have assumed that the outbreak would peter out like bursts of avian flu infection — short-lived and localized — Shao Yiming, a virologist at the Center for Disease Control, said in an interview with Caixin, a Chinese magazine.Leaders in Wuhan seem to have assumed that the outbreak would peter out like bursts of avian flu infection — short-lived and localized — Shao Yiming, a virologist at the Center for Disease Control, said in an interview with Caixin, a Chinese magazine.
“This fixed mind-set caused errors in judgment, so we lost the opportunity to early on adopt encircling tactics and tell the public how to self-protect,” Dr. Shao said.“This fixed mind-set caused errors in judgment, so we lost the opportunity to early on adopt encircling tactics and tell the public how to self-protect,” Dr. Shao said.
Word of the outbreak started to reach disease control officials in Beijing after rumors and the leaked documents began to spread online. The national center for disease control has pointedly avoided saying in announcements that it had been notified by Wuhan, instead noting that it had “learned of” the outbreak. Local officials have hedged over when and how they told Beijing.Word of the outbreak started to reach disease control officials in Beijing after rumors and the leaked documents began to spread online. The national center for disease control has pointedly avoided saying in announcements that it had been notified by Wuhan, instead noting that it had “learned of” the outbreak. Local officials have hedged over when and how they told Beijing.
The leaked documents were two internal Wuhan government directives, which emerged online on Dec. 30, possibly released by worried medical workers. The directives, marked “urgent,” ordered hospitals to send the city health commission information about cases of the mysterious pneumonia, improve treatment of patients and avoid infection in hospitals. At the same time, doctors alerted colleagues to the outbreak in private group chats on social media, which prompted official reprimands.The leaked documents were two internal Wuhan government directives, which emerged online on Dec. 30, possibly released by worried medical workers. The directives, marked “urgent,” ordered hospitals to send the city health commission information about cases of the mysterious pneumonia, improve treatment of patients and avoid infection in hospitals. At the same time, doctors alerted colleagues to the outbreak in private group chats on social media, which prompted official reprimands.
Gao Fu, the director of the Center for Disease Control, spotted the information circulating online and raised alarms, according to an account by Hua Sheng, a prominent Chinese economist who has defended the center. Dr. Gao declined to answer questions. The center ordered teams of experts to rush to Wuhan, and the first group arrived by the next morning.Gao Fu, the director of the Center for Disease Control, spotted the information circulating online and raised alarms, according to an account by Hua Sheng, a prominent Chinese economist who has defended the center. Dr. Gao declined to answer questions. The center ordered teams of experts to rush to Wuhan, and the first group arrived by the next morning.
“News that pneumonia of unknown cause had emerged in Wuhan shook the nerves of every emergency response worker in the Chinese Center for Disease Control,” said a report issued by the center.“News that pneumonia of unknown cause had emerged in Wuhan shook the nerves of every emergency response worker in the Chinese Center for Disease Control,” said a report issued by the center.
Officials from the National Health Commission have said that they ordered Wuhan to issue its first official announcement on the outbreak on Dec. 31. That day the government also informed the World Health Organization’s office in Beijing.Officials from the National Health Commission have said that they ordered Wuhan to issue its first official announcement on the outbreak on Dec. 31. That day the government also informed the World Health Organization’s office in Beijing.
Some of the first cases were finally entered into the system on Jan. 3, though by then it was too late to serve as the early warning system it was intended to be.Some of the first cases were finally entered into the system on Jan. 3, though by then it was too late to serve as the early warning system it was intended to be.
When the central government became involved, local officials outwardly welcomed the expert investigators sent by Beijing. Officials described the infections as nothing too serious.When the central government became involved, local officials outwardly welcomed the expert investigators sent by Beijing. Officials described the infections as nothing too serious.
“They said that the illness was quite light, not much different from seasonal influenza, and there’d been no illnesses among hundreds of people with close contact,” Zeng Guang, a Chinese epidemiologist who visited Wuhan on Jan. 9, said of his talks there, according to the China Youth Daily. “They sounded very relaxed.”“They said that the illness was quite light, not much different from seasonal influenza, and there’d been no illnesses among hundreds of people with close contact,” Zeng Guang, a Chinese epidemiologist who visited Wuhan on Jan. 9, said of his talks there, according to the China Youth Daily. “They sounded very relaxed.”
Behind the scenes, officials in Wuhan mounted an effort to limit the number of infections counted as part of the outbreak, creating barriers against doctors filing cases.Behind the scenes, officials in Wuhan mounted an effort to limit the number of infections counted as part of the outbreak, creating barriers against doctors filing cases.
A leaked report from Wuhan Central Hospital describes how in the first half of January local officials told doctors that cases had to be confirmed by bureaucratic overseers, above all, city and province health authorities.A leaked report from Wuhan Central Hospital describes how in the first half of January local officials told doctors that cases had to be confirmed by bureaucratic overseers, above all, city and province health authorities.
An official from a district disease control center in Wuhan told the hospital doctor handling infection reports on Jan. 3 that “this was a special contagious disease and we should report only after superiors had notified us,” the leaked report said.An official from a district disease control center in Wuhan told the hospital doctor handling infection reports on Jan. 3 that “this was a special contagious disease and we should report only after superiors had notified us,” the leaked report said.
Starting on Jan. 3, Wuhan’s Health Commission set narrow criteria for confirming that a case was officially part of the outbreak, according to a copy of the diagnostic guide that was leaked to the Chinese media, possibly by a medical professional. The rules said patients could be counted if they had been to the market or had close contact with another patient who had. That excluded a growing number of likely cases with no clear link to the market.Starting on Jan. 3, Wuhan’s Health Commission set narrow criteria for confirming that a case was officially part of the outbreak, according to a copy of the diagnostic guide that was leaked to the Chinese media, possibly by a medical professional. The rules said patients could be counted if they had been to the market or had close contact with another patient who had. That excluded a growing number of likely cases with no clear link to the market.
For most of the first half of January, local officials maintained that there had been no new confirmed infections, even as doctors in Wuhan and visiting experts suspected that a dangerous contagion was spreading from person to person.For most of the first half of January, local officials maintained that there had been no new confirmed infections, even as doctors in Wuhan and visiting experts suspected that a dangerous contagion was spreading from person to person.
“I lived through SARS, and to me the early period of this epidemic felt shockingly like SARS,” Li Liming, a Peking University professor of public health who was among the experts sent to Wuhan, told a Chinese newspaper. “In both, there was no rapid system response at the start.”“I lived through SARS, and to me the early period of this epidemic felt shockingly like SARS,” Li Liming, a Peking University professor of public health who was among the experts sent to Wuhan, told a Chinese newspaper. “In both, there was no rapid system response at the start.”
Zhong Nanshan, a disease expert who helped identify SARS, was also skeptical of the official optimism in Wuhan after visiting the city and hearing from his former students there.Zhong Nanshan, a disease expert who helped identify SARS, was also skeptical of the official optimism in Wuhan after visiting the city and hearing from his former students there.
He and other experts finished their assessment of Wuhan on Jan. 19, convinced the virus had gained a menacing foothold, and conveyed their alarm to senior officials in meetings in Beijing.He and other experts finished their assessment of Wuhan on Jan. 19, convinced the virus had gained a menacing foothold, and conveyed their alarm to senior officials in meetings in Beijing.
“All the members of the expert team reported that the situation was grim,” Yuen Kwok-yung, a professor of infectious diseases at the University of Hong Kong who was among the expert group, told Caixin magazine. “Preventive measures had to fall in place immediately.”“All the members of the expert team reported that the situation was grim,” Yuen Kwok-yung, a professor of infectious diseases at the University of Hong Kong who was among the expert group, told Caixin magazine. “Preventive measures had to fall in place immediately.”
After weeks of reporting no new infections, the Wuhan government disclosed four new cases on Jan. 18, followed by 17 the next day and 136 the next.After weeks of reporting no new infections, the Wuhan government disclosed four new cases on Jan. 18, followed by 17 the next day and 136 the next.
Four days later, Wuhan was shut down to contain the spread.Four days later, Wuhan was shut down to contain the spread.
At the time, the coronavirus had killed 26 people and sickened more than 800. By Sunday, there were more than 670,000 cases worldwide; more than 31,000 people have died.At the time, the coronavirus had killed 26 people and sickened more than 800. By Sunday, there were more than 670,000 cases worldwide; more than 31,000 people have died.
Reporting and research were contributed by Amber Wang, Claire Fu, Lin Qiqing and Paul Mozur.Reporting and research were contributed by Amber Wang, Claire Fu, Lin Qiqing and Paul Mozur.