Epidemic Special

Published February 2020

The Beginning

Based on a paper published by the UK medical journal LANCET, the first known Corona Virus case appeared in Wuhan, Hubei province on Dec 1st. The journal studied 41 of the earliest cases in Wuhan Jinyintan Hospital. However, the presence of the virus was not known to the Chinese public until late Dec – many people learned about this highly contagious “SARS like” new virus from unofficial social media posts generated by eight medical staff. On Jan 2nd, Chinese national TV announced this information was a “false statement and causing a social disturbance”; it urged people “not to believe such “rumours”” and confirmed that all eight rumour spreaders had been punished in accordance of the law.

The Chinese CDC National Virus Control and Prevention Institute believes the source of the virus is from a Seafood Market in Wuhan, after examining over 500 environmental samples and identifying 30+ samples containing the virus. While a high proportion of initial cases had direct contact with the seafood market, a smaller proportion also had zero contact with the seafood market. There are multiple markets like this one existing in China, trading seafood as well as illegally trading wild animals.The Deputy Head of Jinyintan Hospital HUANG Chaoyin and the Chief Physician of the Respiratory and Critical Illness Department of Huashan Hospital in Shanghai Dr. CAO Bin publicly shared their suspicion that the virus may have come from multiple sources

The Chinese Government Response

In early Jan, both the Central and the Hubei provincial bureaus conducted investigations; they concluded there was no evidence of human to human transmission. As hospitals started filling up with a huge number of possible cases, the Wuhan Government admitted on Jan 15th that “people to people transmission is not impossible”, but they decided to wait for further confirmation. As a result, many Chinese New Year celebrations went ahead as usual, including a 40,000 people’s “super banquet” held in a suburb of Wuhan. On Jan 20th, the Chair of the Advisory Committee of China’s National Health Commission, a whistle-blower during SARS, Dr. Zhong Nanshan confirmed “people-to-people transmission” on National Television. On Jan 23rd at 2 am, Wuhan, a city of 11 million people, declared a “lockdown” less than 48 hours before Chinese New Year. One of the first eight whistle-blowers, Dr. Li Wenliang, a 34-year-old ophthalmologist, died from Corona Virus on Feb 7th.

The Impact

To date, there are over 70,000 confirmed cases in China (all provinces), with over 1,500 deaths. Wuhan and the nearby regions took the worst hit; many medical staff have been affected. Despite medical staff flying in from all over the country, there is still a huge shortage of all medical staff / equipment and logistics channels. The whole of China and even the world appears to be suffering a shortage of surgical masks. Almost all Chinese cities, towns and villages are under “lockdown”, with over 160,000 people under quarantine and many major cities enforcing rules which require everyone to stay at home. Due to the high numbers of infected, three new quarantine centres / hospitals have been built in Wuhan. All social activities are cancelled, banned, and discouraged. The virus has spread to at least 28 countries. Chinese nationals are banned from entering at least 90 countries and many countries require people returning from China to implement 14 days self-quarantine. WHO is taking action by sending a delegation to China this weekend, 2.5 months since the first known case. Since the earlier cases, Chinese New Year holidays have been extended and extended, although there is an expectation for people to return to work/school at some level, through working / studying remotely and on rotation.

Dr. Zhang Wenhong, Chief Physician of the Infectious Diseases Department of Shanghai Huashan Hospital, outlined three possibilities for China under threat of the Corona Virus: 1) The most positive outcome would be for the situation to be under control by April/May; 2) The most negative outcome would be for the situation to be out of control and start spreading worldwide; 3) Largely under control and remain in China for another 6-12 months. Dr. Zhong Nanshan predicted the virus will peak in late February and be under control by April.

What Happened During SARs in 2003?

The first case appeared in Shunde, Guangdong in Nov 2002; “rumours” started becoming public in December and the Government started reporting / investigating in Jan 2003. The Guangdong Government officially announced SARS on Feb 10th and the WHO was informed. At that time, the CDC believed it was largely confined to Guangdong and under control; it should only have had marginal impact on other regions in China, so many large sporting events / concerts still proceeded. From Feb to March, SARS spread to Hong Kong—including over 100 infections in one building—then to many other countries. A large number of medical staff were infected. Only in March was the source of SARS confirmed by US CDC and the University of Hong Kong to be pigs. WHO delegates arrived in Guangdong in April, excluding Beijing as an “infectious area” on April 9th, as Beijing reported only 12 cases. A military Doctor JIANG Yanyong told the TIMES that they were angry that the released figure grossly underreported actual cases in Beijing. On April 20th, Beijing reported 339 confirmed cases (10 times more than the April 9th figure) and over 402 suspected cases. On April 30th, the usage of central air conditioning was prohibited. In May, the hospital designated to treat SARS, Xiaotangshan, started receiving patients from all over the country. On May 9th, the number of infectious cases started going down. All quarantined people were set free on May 21st. The Ministry of Public Health abolished the SARs Control Centre on the 1st of June. In mid-June, WHO announced the removal of China’s SARs infectious status. Over 5,000 SARs survivors continue to suffer from areas of dead bone tissue and lung scarring disease and severe depression, as side effect of treatment. In 2015, the first P4 Lab (P4: the highest biosafety level) was established in Wuhan, studying Ebola and SARS virus.

From the Editorial

In 1918, 50m people died from Spanish Flu, which infected an estimated 300m people, or 1/3rd of the World’s population at the time. The novel Corona Virus (COVID-19), although a growing global emergency which has infected over 70,000 people, remains far less deadly. A lot of questions have been raised: Have public servants, doctors, researchers and journalists been honest enough, fast enough in performing their duties? If not, is that due to incompetency? Fear of repercussions? Is it a systematic error of a unique regime, or could it occur anywhere in human society? It’s worth questioning the cost of limited freedom of speech and limited information transparency, and whether it is contributing to the number of fatalities. We should also question what if an infectious disease outbreak happens in an ultra-developed society such as the US, the UK, or Japan – which we all hope will react faster, and with better results? Can we truly identify and control new diseases with scientific know-hows, administrative power and public confidence in government institutions? Infectious disease epidemics are not limited to any one particular country, but are a challenge faced by all of us. Not all conjectures can be confirmed, not all distrust is beyond reason. At this point, all we can do is correct mistakes if they have been made, and guard against them if they have not in order to build a better system of governance, information transparency, emergency response, research ethics and social responsibility. The Winter may be long, but Spring will arrive.

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