As the
UK marks four years since its first lockdown, a battle of competing narratives has emerged around the Covid-19 pandemic and China’s initial response to the outbreak in Wuhan. Critics of Beijing’s response have accused it of outright concealment and highlighted the punishment of Dr Li Wenliang and other early whistleblowers. The Chinese government, in contrast, averred that it had mounted a “swift response.” “As soon as cases of pneumonia of unknown cause were identified in Wuhan City , Hubei Province,
China acted immediately to conduct etiological and epidemiological investigations and to stop the spread of the disease, and promptly reported the situation,” a Chinese government white paper stated emphatically. As I detail in my book, Wuhan: How the COVID-19 Outbreak in China Spiraled Out of Control , neither of these narratives comes close to describing the handling of the initial outbreak in the sprawling provincial capital. Four years after the pandemic turned our lives upside down, it has never been more urgent to have a more accurate understanding of what happened so that societies can learn lessons, adopt reforms, and be better prepared for the very real possibility of another within just a few years. Following the Sars
Coronavirus of 2003, China’s health leaders resolved to prevent the concealments and other missteps that bedevilled the 21st century’s first pandemic, and quickly invested to build a national notifiable disease surveillance system (NNDSS). As the years went past, public health leaders took pride in the NNDSS, the world’s largest disease reporting system, as well as China’s growing capabilities in virology and infectious disease prevention and control. Unfortunately, as Wuhan documents, when the unusual pneumonia cases cropped up in Wuhan in December 2019, local health authorities did not allow the initial cases, with their Sars-like symptoms, to be reported through the NNDSS system until national expert teams arrived in Wuhan on 31 December. George F. Gao, the China CDC head, first learned of the outbreak from
Social Media on 30 December. While the NNDSS failed to perform as expected, investment in diagnostic and scientific capabilities paid off at the end of that month. While clinicians recognised the Sars-like symptoms, at least four laboratories, in Guangzhou,
Beijing and Wuhan, had assembled genomic sequences of the coronavirus that would later be named Sars-CoV-2 by 31 December. Gao personally reviewed the genomic sequence of the novel coronavirus that day. Armed with such clinical information and experiences with Sars, authorities launched a health emergency response action programme in Wuhan on 1 January, 2020. This included shutting down Huanan Seafood Market, believed to be the source of the unusual infections, and contact tracing and quarantining individuals with exposure to that market. It was an excellent head start. However, my findings in Wuhan demonstrate the emergency response programme was deeply flawed. As decision-makers prioritised socio-political stability over public health transparency, health professionals such as Dr Ai Fen and Dr Li Wenliang were silenced and efforts were made to suppress the submission of emerging suspected cases on the NNDSS. The action programme fell victim to a thicket of political constraints, bureaucratic disincentives and cognitive blinders. Cognitive biases of China CDC leaders and organisational disincentives at the local level compounded the issues with case identification. Leading hospitals in Wuhan did not want to disclose they had staff infected partly because in-hospital infections are a metric by which they can be penalised. That head start at the beginning of January was squandered. While the number of coronavirus infections was increasing rapidly in Wuhan in the first half of the month, new suspected cases were dismissed in Wuhan and not submitted to the China CDC. Taking the absence of newly reported cases from Wuhan as an absence of cases, national health decision-makers made the colossal misjudgement by 10 January 10 that the outbreak was “limited” and being contained. As I reveal in Wuhan , it was outsiders in Shenzhen/Guangdong and
Thailand who identified new cases from Wuhan as evidence of contagion, and prompted the national health leadership to reverse course and again take the outbreak seriously. However, weeks of precious time had elapsed when the Chinese leadership finally imposed the unprecedented cordon sanitaire on Wuhan on 23 January. Amid the lockdown, communities such as Baibuting, which put on a massive community feast days earlier, were largely left to fend for themselves. “Some bitterness you’ve got to bear on your own,” lamented one interviewee. Read Next My Susan was allowed to die of Covid because she had Down's syndrome, father says Wuhan’s experiences offer clear lessons: dealing with new infectious diseases demands transparency, early and proactive measures, and global collaboration. Yet the reforms China has undertaken since the outbreak are tentative at best. Amid geopolitical tensions, there’s reluctance in China to openly discuss initial errors made during the crisis. Legislative efforts to amend the infectious disease prevention and treatment law and to introduce a new health emergency response law have slowed down. While China has pushed for improvements in diagnostic capabilities and has started to integrate public health specialists into hospitals, these technical adjustments are overshadowed by significant political obstacles in Wuhan. Despite efforts to improve disease surveillance, it is not clear that, should novel coronaviruses cases surface, local authorities would permit the immediate use of the NNDSS for reporting cases to the China CDC. Wuhan’s legacy is a stark reminder of a disaster that might have been lessened or even prevented. And the distressing possibility remains: such a situation could recur. This situation should serve as a wake-up call for the global community, emphasising the need for a strong, transparent, and efficient global health infrastructure to protect global health and safety. The world needs not only a new pandemic accord but also robust domestic public health capabilities for outbreak response. Wuhan: How the COVID-19 Outbreak in China Spiraled Out of Control is published by Oxford University Press at £26.99