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COVID-19: Getting to the Bottom of What Happened in China

China knowingly violated the terms of a World Health Organization (WHO) disclosure agreement

It is widely recognized that medical professionals and journalists in China are being silenced if they publish any information about COVID-19 that contradicts the ruling Chinese Communist Party’s official narrative. But now mainland Chinese scientists must ensure that their research publications also toe the CCP party line.

The Ministry of Education’s science and technology department recently issued a directive that any research papers that trace the origin of the SARS-CoV-2 virus that causes Covid-19 “must be strictly and tightly managed.” According to CNN (April 12, 2020), the directive appeared on the websites of the Fudan University in Shanghai and the China University of Geoscience in Wuhan. (It has since been taken down.)

In China, research papers are already vetted by the government; however, this new directive has added several more layers of scrutiny for papers about Covid-19 and its origins. In February, when researchers from China were still able to publish freely about Covid-19, some of the published data contradicted CCP’s narrative of the origin of the virus and exactly when human-to-human transmission was demonstrated.

Much as the CCP would like to control the avenues of information, their suppression may be having the opposite of its intended effect. Professor Yanzhong Huang, a senior fellow for global health at the Washington-based Council on Foreign Relations told CNN,

It is no surprise that the government seeks to control related scientific research so that the findings do not challenge its own narrative on the origin of the virus and the government response to the crisis… The danger is that when scientific research is subject to the needs of those in power, it further undermines the credibility of the government narrative, making accusations of underreporting and misinformation more convincing.

Nectar Gan, Caitlin Hu, Ivan Watson, “Beijing tightens grip over coronavirus research, amid US-China row on virus origin” at CNN (April 12, 2020)

What we don’t know

The CCP’s sensitivity is due in part to the controversies that swirl around the virus’s origin. One theory says the SARS-CoV-2 virus originated in bats that were used in experiments to study SARS-CoV at the Wuhan Institute of Virology, as opposed to the more conventional account that it originated in a Wuhan food market as a zoonotic disease (spread from animals to humans). The Institute had been conducting studies for several years on how SARS spreads from animal to human, with the goal of preventing future outbreaks. Some people believe sloppy practices led to a graduate student getting bitten by a bat carrying the virus, and then the student unknowingly infected other people. Others go so far as to claim that the lab was working on a bioterror weapon.

The U.S. Army conducted an investigation to try to determine if the virus originated at the Institute or had occurred naturally. Thus, one CCP narrative accused the U.S. army itself of bringing the virus to China, contradicting earlier scientific studies that concluded that the virus originated among local bats.

Army General Mark Milley, chairman of the Joint Chiefs of Staff, said the evidence seems to point to a natural origin for the virus, “but we don’t know for certain.” (Reuters, April 14, 2020) Similarly, Defense Secretary Mark Esper, Pentagon Chief, told media that the evidence points to a natural origin of the virus but the results of the investigation are inconclusive. However, he added that he finds it “hard to trust much of what comes out of the Chinese Communist Party… I don’t have much faith that they’re even being truthful with us now.” (U.S. News & World Report, April 16, 2020)

Espers’ comments highlight the real problem: we don’t know and we can’t know because there is an information vacuum. American journalists from the New York Times, the Wall Street Journal, and the Washington Post were recently told to return their media passes, effectively kicking them out of China. Citizen journalists reporting from the hardest-hit regions have been detained and silenced:

The whereabouts of Chen Qiushi, Fang Bing and Li Zehua have been a mystery since February, and Chinese officials have not publicly commented on them.

The three citizen journalists had sought to expose the true scale of the outbreak from the then epicentre by uploading videos to YouTube and Twitter, both banned in mainland China.

All of their dispatches revealed a grim side of Wuhan unseen on state-run Chinese media outlets.

Mailonline Reporter, “Three coronavirus whistle-blowers remain missing two months after exposing the true scale of the outbreak from Wuhan” at Daily Mail (April 15, 2020)

Neither the CDC’s infectious disease team nor the WHO was granted permission to enter Wuhan in the first days after the CCP announced the outbreak. (New York Times, February 7, 2020), so independent observers are rare.

What we do know

Thus the question remains, what do we know? Thanks to information pieced together from leaked documents, intelligence investigations, and data from other countries, we now at least have a better picture of the beginning of the outbreak:

A recent Washington Post article on the Wuhan Institute of Virology shows that the laboratory was dinged by the U.S. Embassy in 2018 for poor management and shoddy practices:

What the U.S. officials learned during their visits concerned them so much that they dispatched two diplomatic cables categorized as Sensitive But Unclassified back to Washington. The cables warned about safety and management weaknesses at the WIV lab and proposed more attention and help. The first cable, which I obtained, also warns that the lab’s work on bat coronaviruses and their potential human transmission represented a risk of a new SARS-like pandemic.

Josh Rogin, “State Department cables warned of safety issues at Wuhan lab studying bat coronaviruses” at Washington Post (April 14, 2020)

So the cables indicate that the Wuhan lab was in fact doing virus research, probably intended to prevent another SARS outbreak, but also that it was poorly managed and lacked appropriate personnel for a lab with its high-level designation (BSL-4). Agence France Presse had reported very little activity inside the lab and a sign on the door that read, “Strong Prevention and Control, Don’t Panic, Listen to Official Announcements, Believe in Science, Don’t Spread Rumors.” A statement issued by the lab in February claimed, however, that the story was a rumor. ( Medical Xpress, AFP, April 17, 2020)

A study by Chinese scientists in the medical journal The Lancet indicates that the first patient to show symptoms of Covid-19 was identified on December 1. Curiously, this patient, along with 12 of the 41 others that the researchers studied, could not be connected to the Wuhan market.

A critical factor, in any event, was that, as an Associated Press article on leaked documents shows, Chinese authorities knew about human-to-human transmission for six days before they let other nations know on January 20, 2020:

The early story of the pandemic in China shows missed opportunities at every step, the documents and AP interviews reveal. Under Xi, China’s most authoritarian leader in decades, increasing political repression has made officials more hesitant to report cases without a clear green light from the top.

Global Investigative Team, “China didn’t warn public of likely pandemic for 6 key days” at Associated Press (April 15, 2020)

As a member of the World Health Organization, China had signed the 2005 International Health Regulations document, which requires members to notify the WHO within 24 hours of assessment of anything that would constitute a “public health emergency of international concern.” The documents acquired by Associated Press indicate that China knowingly violated the terms of this document.

The Washington, DC, non-profit Victims of Communism report on the coronavirus timeline shows that, even though the Chinese government (as well as the WHO) maintained that there was no evidence of human-to-human transmission until January 20, for a week prior to that, China was amassing large amounts of medical supplies from other countries, with a focus on personal protective equipment. This chain of events implies that China knew that the virus was contagious and was violating the IHR in order to procure equipment from other countries.

The Lancet study on the first patients hospitalized in Wuhan for Covid-19 also indicated that medical professionals knew about human-to-human transmission as early as December, with forty-one patients admitted to the same hospital by January 2, 2020, with symptoms that resembled SARS-CoV. An article published online on January 24 reports,

Reports have been released of exported cases in many provinces in China, and in other countries; some health-care workers have also been infected in Wuhan. Taken together, evidence so far indicates human transmission for 2019-nCoV. We are concerned that 2019-nCoV could have acquired the ability for efficient human transmission.

– Chaolin Huang et al., Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, The Lancet (open access)

Others had begun to suspect something of the sort. Taiwan, notably, had sent an email to the WHO on December 31, warning of probable human-to-human transmission of the virus. But the warning received little attention.

University of Hong Kong virology expert, Dr. Guan Yi, who had helped identify the 2003 SARS-CoV virus, told Chinese periodical Caixin that, after visiting Wuhan to help scientists track the virus, he left feeling “powerless, and very angry” over the lack of precautions that were taken in the city. Because the Wuhan market had been cleaned, there was also no way to investigate the origin of the disease. Dr. Guan had told Caixin (in the New York Times’s translation):

I’ve experienced a lot, and I’ve never felt scared, most of these are controllable,” he said, citing previous battles with SARS, avian influenza and other outbreaks. “But this time I’m scared.

Austin Ramzy, “Coronavirus deaths are so far mostly older men, many with previous health issues” at New York Times (January 23, 2020)

His comments, quoted in Chinese media and reposted in social media, contradicted the government’s portrayal of the situation in Wuhan as under control.

What we know ain’t so

Significantly, The Economist reported some interesting patterns in the erratic spikes in Covid-19 deaths in China. First, spikes in cases in mainland China are more erratic than those in other countries:

Across the nine Chinese provinces with serious outbreaks, we identified 15 episodes in which new cases of covid-19 jumped by more than 20% in a single day, before quickly returning to earlier levels. Although such spikes can occur in any dataset—because of erratic record-keeping, for example—we found that other countries and regions with covid-19 outbreaks, of a similar size to these provinces, have experienced fewer.

China’s data reveal a puzzling link between covid-19 cases and political events ” at The Economist (April 7, 2020)

Secondly, these spikes seem to correspond to major government decisions:

Of the 15 such episodes observed in the data, two-thirds appeared to occur within a day of the sacking of a provincial official or other significant political event.

China’s data reveal a puzzling link between covid-19 cases and political events ” at The Economist (April 7, 2020)

One of several examples cited by The Economist was the spike in new Covid-19 cases on February 12 in Hubei province. (Wuhan is the capital of Hubei.) New cases increased by 742%, then fell sharply. On the same day, the party chiefs of Hubei were sacked.

And then more recently, on Friday, April 17, China raised its death toll in Wuhan by 1,290 and the number of infections by 325. The changes seem to be in response to the publication of evidence that China’s numbers cannot be trusted.

What happened with SARS, 2003?

The Chinese government is essentially managing information about the epidemic in the same way as it managed information about SARS in 2003. Just as in the current pandemic, top-down authoritarian-style government meant no one could report on the 2003 outbreak until they were given permission. Thus, the timeline in 2003 is similar to the timeline in 2020. The first case of SARS was likely mid-November 2002, but the authorities continued to keep the Chinese people in the dark about it until February, 2003:

In other words, until such time as the Ministry chose to make information about the disease public, any physician or journalist who reported on the disease would risk being persecuted for leaking state secrets… A virtual news blackout about SARS thus continued well into February.

Yanzhong Huang Institute of Medicine (US) Forum on Microbial Threats; Knobler S, Mahmoud A, Lemon S, et al., editors., “The SARS epidemic and its aftermath in China: A political perspective ” at Washington (DC): National Academies Press (US); 2004

In Guangdong province, site of the first outbreak, news spread via text messages that a “deadly flu” was going around so the health officials went public, stating there were three hundred cases of “atypical pneumonia.” But, as with the current pandemic, the Chinese government downplayed the severity of SARS and the extent of the outbreak and banned media reports about the outbreak for political reasons

When some reports began to question the government’s handling of the outbreak, the provincial propaganda bureau again halted reporting on the disease on February 23. This news blackout continued during the run-up to the National People’s Congress in March, and government authorities shared little information with the World Health Organization until early April.

Yanzhong Huang Institute of Medicine (US) Forum on Microbial Threats; Knobler S, Mahmoud A, Lemon S, et al., editors., “The SARS epidemic and its aftermath in China: A political perspective ” at Washington (DC): National Academies Press (US); 2004

The WHO issued a travel advisory to Hong Kong and Guangdong and the Wall Street Journal called on other countries to issue a travel ban. In response, the Chinese government issued a statement saying SARS was under control, even though it really wasn’t.

One doctor, Dr. Jiang Yanyong, a retired surgeon at Beijing’s 301 military hospital, sent emails at the time, accusing the Chinese officials of lying. TIME magazine ended up publishing his story.

During the current pandemic, people asked about the whereabouts of Dr. Jiang after Dr. Li Wenliang, one of the first doctors to report on a new SARS-like virus, died. The Guardian reports that Dr. Jiang has been under house arrest since last year for calling on the Chinese government to reassess the 1989 Tiananmen Square event.

Dr. Jiang is apparently in ill health and cannot comment on the current situation. However, in 2013 he had said in an interview, “As a doctor, protecting patients’ health and lives is first and foremost… the most basic requirement for a doctor is to speak the truth. I have experienced numerous political movements for 50 years, I feel deeply that it is easy to lie, so I insist on never telling lies.”

Now, Chinese journalists, medical professionals, and scientists face some difficult choices as they are asked to go against their conscience and compromise the integrity of their profession to further a narrative that absolves the CCP of its responsibility to the global community.


Further reading from Heather Zeiger on the COVID-19 crisis in China:

China: Rewriting the history of COVID-19: Making the government the improbable hero of the tale

Coronavirus in world without trust In China, medical heroism thrives despite both paranoia and justified mistrust of authorities.

Censorship? But coronavirus doesn’t care! Back when SARS was a threat, social media wasn’t the giant it is today. Censorship, secrecy, and detention are less effective tools of control now.

and

Serious media in China have gone strangely silent. With a compulsory new app, the government can potentially access journalists’ phones, both for surveillance and capturing data. Liu Hu sums up the scene in a few words: “Outside of China, journalists are fired for writing false reports… Inside China, they are fired for telling the truth.”


Heather Zeiger

Heather Zeiger is a freelance science writer in Dallas, TX. She has advanced degrees in chemistry and bioethics and writes on the intersection of science, technology, and society. She also serves as a research analyst with The Center for Bioethics & Human Dignity. Heather writes for bioethics.com, Salvo Magazine, and her work has appeared in RelevantMercatorNet, Quartz, and The New Atlantis.

COVID-19: Getting to the Bottom of What Happened in China