Origin of COVID-19

The origin of COVID-19 or the underlying virus is fundamentally a scientific question, as soon as the disease emerged.  It gets immensely complicated when it is muddled with a political question.

Humans have had diseases and pandemics throughout history.  The black plague, smallpox, cholera, influenza, AIDS, etc.  Because most happened so long ago, studying their origins is purely academic and elicits neither wide attention nor much controversy.  This is unlike COVID-19 disease, which is ongoing and highly politicized to attack China.  But even if one wants to make a political case, he still has to look at science as well as history.  

Scientists are still trying to figure out where the virus came from or jumped to humans.  People have been able to trace pathogens or diseases many years before they were first recognized.  For example, first AIDS/HIV samples can now be retrospectively identified around 1900, and first US cases in the 1960s, even though it broke out in the US around 1980.   So, even though COVID-19 was first found in Wuhan in Dec 2019, it might well have been around for a while, even years, in Wuhan or elsewhere.  This will take a long time to figure out, so the current feverish search has settled nothing.  

Even when we eventually identify the so-called patient 0 or the first case, we still have an essential question: since the virus can’t appear out of thin air, how did it come around?  It must have its parents, its parents their own parents, on and on, same with the animal carries.  This situation is unlike the case of Hitler and his parents: Hitler was born harmless, but COVID-19 harmful the minute it appears.  Its immediate predecessor or parent might be 99.9% identical to COVID-19 virus; even if it is not itself dangerous, it is still the necessary step upon which COVID-19 exists.  And then its predecessor, etc.  One can go to the end of the world not finding the answers, since they are truly open-ended, but without such answers, the origin question is never settled.  

So in other words, the true origin of COVID-19 (and other pandemics) might never be satisfyingly nailed down in science.  This leaves one with a gushing hole for any political answer.  But because we may never know the origin, the next best solution is to just focus on the first outbreak, or where it was first identified. 

   

This solution is convenient, but if one wants to use this to blame China, then he faces a mountain of obstacles in history.  Because historically many pandemics didn’t break out in China; even if China could be retrospectively linked, according to the aforementioned criterion, China didn’t have the most obvious or major outbreak, so the blame must be on the other countries.  But did or does anybody get attacked for the previous pandemics?  

Furthermore, for smallpox, influenza, AIDS, and COVID-19, etc, a virus hijacks the human cells and body to cause diseases, and jumps out of the hostage without his or her noticing.  The virus doesn't have any ID card or passport, and humans are simply the hijacked victims.  Does anybody seriously blame a hostage?  Only because you don't see the hijacker?

  

So history is not on the side of the Sinophobia either.  The only talking point left is, hence, a common refrain: China was hiding something, which wasted us time to prevent COVID-19. 

This accusation is open-ended and hard to dispel.  Being a Monday-morning-quarterback, one can always find faults in anything, even though in previous pandemics nobody reacted with any such vigor.  In reality, China had the excuse of not knowing the virus at first, with COVID-19 occurring in the confusing mid of cold and flu season, but China identified the virus first and enacted containment measures, all within 4 weeks’ time.  Finding cases earlier than Dec 2019 is meaningless in terms of disease control, since we can also discover old HIV samples from the 1960s or 1900s.  Identifying the virus is crucial, because only after that can one correctly diagnose COVID-19 and differentiate from cold and flu.

One can question whether 4 weeks’ time is too long.  But it is actually two weeks: from sequencing the virus in early Jan to Jan 20-23, when the Wuhan lockdown was announced.   A few things happened during that period of time.  Based on the new viral sequence one had to design and make test kits.  The new kits must undergo quality controls, get tested themselves, and mass produced.  All these took time.  Then patients needed to be identified.  Retrospectively a few hundreds were already infected.  But based on what we now know, some patients show no or mild symptoms, especially at the early stage of COVID-19.  And it is certain that cold and flu patients vastly outnumbered COVID-19 patients then.   By Jan 20 it was announced that human-to-human transmission occurred, and since voluntary travel restriction was not possible, lockdown was imposed on Jan 23.   

Critics will still claim two week’s time is still too long, or China provided wrong information.  Although it is very hard to see what wrong information China could have provided.  Virus sequence was wrong?  Or whether there was or wasn’t human-to-human transmission?  The latter controversy had always been based on the best information at the time, reported and debated openly in real time before Jan 20, and well dissected since then.  Or China didn’t really impose a lockdown?

Judging what China did in a vacuum is folly, as one must compare with what the countries where most those critics reside responded to COVID-19 themselves.  Since Feb 20-Mar 1, many European countries and the US have had outbreaks, some confirmed cases exceeding China’s.  That was 4 weeks past Jan 23 and without any of the excuses China had before.  Even if one thought COVID-19 was all China’s problem, when the lockdown measures unprecedented in human history were enacted on Jan 23, does China still need to mail everybody a postcard to inform the seriousness of COVID-19?  By analogy, when 911 happened, did any airport in the world still need prodding to beef up security?  

The best fallback from China critics now is COVID-19 patients left China earlier than thought.  Yet this reflects more on the nature of COVID-19 than China’s response, because HIV also spread earlier than 1980.  In truth, the current affair or debate concerning COVID-19 origin is never scientific but political.  The undertone of China’s critics is always ideological, so COVID-19 is merely a cheap exercise.   Initially, before Feb 20, the theme was only China could have screwed up in their own country (we would never do).  After Feb 20, it becomes we screwed up but it is all China’s fault.  But if ideology is truly to blame, did Europe or US respond to COVID-19 any better than China, even though most of these countries are technologically more advanced, less populated, minus the discovery phase China went through?    Going one step further, if COVID-19 had broke out in one of these countries, can anybody be certain that it would have performed any better than China, given how awfully they were unprepared even with so much information already available?

Origin of COVID-19 is a valid scientific and medical problem.  Understanding it is important to prevent future outbreaks.  Mixing it up with politics, however, hurts humanity, which is already abundantly clear in the brief history of COVID-19.  Because what is lacking in the debate of COVID-19 origin is historical perspectives, sound logic and reasoning.  It will persist after COVID-19 has passed.  

Note on 4/29/20: NY Gov. Andrew Cuomo said on 4/28/20: “I know … people are feeling emotional, but emotions can’t drive a reopening process, ... We have to separate the emotion from the logic.”(https://www.yahoo.com/news/as-states-move-to-reopen-covid-19-death-rate-numbers-raise-a-red-flag-153852997.html).  He was talking about reopening, but I'm sure his words will be used much more.

One disease, two phases. Or three.

COVID-19 started in Wuhan, China in late Dec 2019.  Panic, which I was more worried about in Jan 2020, has become a reality all over the world.  I’d never had thought I would see so many empty shelves in so many stores for a week now in the US.  

The disease has, so far, two distinct phases.  The first is to about Feb 20.  The second is till now, and ongoing.

The first phase is more or less like SARS in 2003.  Most cases were in China, with the most restrictions applied.  In 2003, when it was over in China, it was all over in the world, and we haven’t seen SARS since.  For almost two months COVID-19 seemed to be on the same but faster trajectory.  China had 75000 cases, 2500 deaths, while most other countries had single- or low double-digit cases.  By Feb 20, China had clearly turned the pages, with significant, overall drops of new cases, and many provinces 0 or close to 0.  Compare this to the 2003 SARS struggle lasting 6 months.  

The second phase started with the dramatic new cases in South Korea, then Iran and Italy.  By Mar 1, the US and many other European countries.  At this moment, no end in sight.

Humans have always had pandemics.  Cholera, influenza, AIDS, and many others.  Is COVID-19 any different, or how is it different from or worse than its relative, SARS?  There are three major contributing factors.  The first is that COVID-19 is milder than SARS, yet many patients have few symptoms but are still infectious.  This makes it harder to identify and sequester.  The second is that the degree of globalization is higher than in 2003.  But humans had had pandemics before, throughout history.  The third is political: China and US have a much worse relationship now than in 2003.  In 2003 the US and the West were preoccupied with wars in Iraq and Afghanistan.  In 2020 the US has been waging an economy and propaganda war against China for three years.  So when COVID-19 broke out in China, the media and politicians in the US and the West so dutifully and gleefully watched a horror movie and bashed from afar that they forgot to prepare for it.  And then when it hits, of course it is still China’s fault.  The current panicking is more a consequence of these governments’ actions than of the virus itself.   Strongest evidence?  See when exactly the stock markets started to drop precipitously.

Clearly there are blames all around.  For China, the first mistake is why subsequent research has been so lacking after SARS.   An excuse is that SARS is gone since 2003, and MERS didn’t affect the mainland.  Still, we know other coronaviruses cause problems, and new viruses can jump to humans.  More focused research could have yielded better diagnostics, drugs, or broad-spectrum vaccines.  The second is regulation of wet markets.  But this problem is more complex than most people realize: a blanket ban of eating wild animals?  I don’t know of any country where no wild animals are not consumed.  How does one define “wild animals” anyway?  Fish you caught, wild ducks you shot, deer?  The list is endless.   The third is whether the Chinese government could have acted quicker, say imposing restrictions earlier than Jan 23.  Much documentation about it has long been in the public domain, and my earlier blogs had elaborated on it extensively.  The fourth is whether the lockdowns in Wuhan and other places are worthy.  Nobody can dispute its result of shutting down virus transmission, but how about the cost?  This could have been the end of the story, except COVID-19 is no SARS, and we are now in phase two. 

In phase two, many of the affected countries are more medically or technologically advanced than China, and have a lower population density.  Most importantly, they have more than one month’s time and all the knowledge needed to prepare.  Since Jan we have known what the virus is, the symptoms, carriers, transmission, treatments, and one unprecedented example of how to contain it.  The only things left to discover is whether we can identify better drugs, treatments, vaccines, and whether a less harsh way than the Wuhan lockdown will suffice.  Indeed, measures adopted by other provinces in China soon after Jan 23, less drastic than in Wuhan and Hubei, were able to contain COVID-19 and keep the fatality at 0.9%.   Unfortunately, much of this was oblivious to most Western countries.  First they failed to test and identify potential carriers since late Jan when they reported their first cases.  This was actually in retrospect where Wuhan failed in the first half of Jan, although much of it was due to not knowing the virus and the disease characteristics then.  Because of prevailing attitudes of the media and politicians, who were and still are more than eager to blame others, ordinary citizens thought it was merely a problem unique to China, and that would never happen here.  And then one month later, everybody was stunned, but should he really be?  

All the negative descriptions of China over the years, especially the last three years, by the politicians and media, have not swayed China, but have succeeded in poisoning the well in the West.  Public opinion is that China can do no right.  Cover-up is default.  Lockdown is just another attempt to repress human rights.  Which of course will never happen here.  It is mind boggling that the tremendous efforts and tolls in China since Jan 23, 2020 failed to ring a bell for a majority of people.  This political and media virus is now having its invisible but much bigger toll.

One thing is clear: COVID-19 can be contained.  For most of China, except Wuhan and imported cases, COVID-19 is effectively over.  As written in my Mar 5, 2020 blog, even though the same lockdowns in China are not applicable everywhere, many countries have their own advantages in infrastructures.  So all hope is not lost.  But the real danger lies in politics and panics created by the actions of these governments and citizens.  It is now believed that reactions after 1929 made it worse and longer.

There will be phase three of COVID-19.  It is not going away, at least not like SARS.  It will spring up here and there from now on.  Without a vaccine, humans will have to live with it. 

The case of Dr Li Wenliang

When the Chinese government was criticized for COVID-19, Dr Li Wenliang was the most frequently invoked name.  Western media and politicians love to parrot this same line:  Dr Li and others sounded the alarm of COVID-19, but the Chinese government silenced them, so nobody knew about the disease until it was too late.  Notice that “silence” is a loaded yet vague word perfect for propaganda.  Even though most these people don’t know what exactly what he said or what the government did.  Truth doesn’t matter, as long as the narratives fit a purpose.  And the next, popular accusation is: China was hiding something, so that the world lost time to prepare.  Again, "hiding sth" is a vague term perfect for propaganda.  In real life everybody is hiding sth from everybody else, so the phrase, even if true, is meaningless.  In reality, the right questions are: what was hidden, was it really hidden, and what was the consequence?

My earlier blogs didn’t mention it, because I don’t believe what happened to Dr Li affected COVID-19 response one iota.  But truth does matter, and his story raises a number of important points, just not the way people in the West think of.  Part of the incorrect reporting and commentaries could be due to bias and arrogance, but part might also be due to simply not able to read the original reports in Chinese and being patently lazy.  There have been tons of Chinese reports from late Dec 2019 till now, about the disease discovery process, about Dr Li, interviews when he was alive, and after he died of COVID-19 on Feb 7.  So the following facts are not in dispute.

Dr Li was an eye doctor at Wuhan Central Hospital.  From his colleagues he knew a respiratory system disease was circulating in late Dec 2019 and was shown a diagnosis report of SARS.  So on Dec 30, 2019, he mentioned in his WeChat that there were seven cases of SARS, and everybody must be careful.  One should know that WeChat is a private chatroom for families and friends. Dr Li had about 150 contacts, so only these people could see it.  But someone published his message, hence he became famous, even though whoever published it in reality played a bigger role.

On Jan 1, the Wuhan police summoned eight people for disseminating false rumors about the disease.  Dr Li was not one of them, but called on Jan 3.  As far as we know, nobody was arrested, lost a job, or whatever.  They maybe wasted a few hours’ time, got anxious, but were ultimately served a notice or warning, and then let go.  Dr Li continued to work at the hospital until he got sick.  

At this point, the question is: how important was Dr Li’s message in alerting the public, i.e., without it, would the public be still in the dark?  Another question is, is Wuhan police’s action justified?

About the first question, my blog “Updates on the Wuhan 2019-nCoV outbreak” on Feb 9, 2020 already mentioned the timeline of how the disease was discovered.  It was first recognized and reported up by Dr Zhang Jixian at another hospital on Dec 27, 2019 (https://www.zhihu.com/question/367431679?utm_source=wechat_session).  On Dec 30, 2019 Wuhan Health Commission issued an internal notice to all the hospitals for lookout for the disease.   On Dec 31, 2019 Beijing notified WHO and also sent a team of experts to Wuhan for investigation.  Around the New Year Day’s time, the media reported that a mysterious disease surfaced in Wuhan.  Beijing would send a second and third teams to Wuhan later, and both the teams and Wuhan authorities answered questions non-stop, and all reported in the news since Jan 1, 2020.  Some of those official and expert statements have been scrutinized and criticized then and later, but the underlying disease was never denied.  Memories are still fresh.  If you paid any attention, you would know.  You really don’t need Dr Li or anybody else whispering to you.

 

About the second question, legally Wuhan police is within its right to do so, although it can be argued that it is in its discretion not to do so as well.  In essence the laws say: one has freedom of expression, but not freedom of making up rumors, especially those with potentially serious consequences.  Things concerning infectious diseases, which might cause widespread panicking, must come from official channels.  One can have all kinds of opinions about this, but let’s focus on the issue here.  First is, was Dr Li’s information correct?  Technically it was not: COVID-19 is not SARS.  The second problem is, it is not an official channel.  Dr Li, of course, could argue that his message was meant to be private, and he actually said in later WeChat messages that the disease was still being categorized (thus not necessarily SARS).  So not black and white.  An argument for the police not acting is that even though it was not SARS, by warning people, it would have the same, beneficial effects of encouraging social distancing.  But the opposite argument is that, if a patient gets tested and determined not to have SARS, will he now go free and happy back onto the streets?  This scenario could happen in the early days of COVID-19, when little was known and many people had no or slight symptoms.  My thinking is that the whole episode is akin to minor speeding.  Everybody speeds, but the police don’t give everybody a ticket.  And sometimes even when he stops you, he gives you only a warning.  Which is exactly what the Wuhan police did, so what is the big fuss about?  Except maybe in the US the police don’t do this, but in China it was merely a slap in the wrist.  

It is crystal clear that Dr Li’s WeChat message had little bearing on the public’s right or ability to know, and Wuhan police was by no means out of bound.  But here comes the murkier part: did the warning to Dr Li and others hinder the subsequent understanding or reporting of COVID-19?

COVID-19 is a new disease.  Unlike SARS and MERS, also unlike other known coronaviruses.  Throughout the month of Jan 2020 the scientific discovery process continued smoothly as clockwork: sequencing the virus, developing testing kits, identifying symptoms, patients, treatments, etc.  The progress and reporting was all in the public domain, if you know how to read Chinese, and even if you don’t.  No matter what the local Wuhan government wanted to do or hide, there were no negative effects or interruption in the process whatsoever.  The only contention during the first half of Jan 2020 was whether there was human-to-human transmission.  In hindsight, there was, but solid evidence didn’t emerge immediately.  Perhaps we shouldn’t have expected or waited for solid evidence, but is it "hiding sth" when we don't know sth for sure?  In perfect psychological sense, we all think we can predict the future, only after the future becomes present or the past.  Like, I knew the stock would double a month ago, now it did.  But I didn’t buy it a month ago.

Dr Li’s own case illustrates this point well (https://www.hatdot.com/yule/3139045.html, and https://baike.baidu.com/reference/24300481/620dK2y1D2AWOYHfiaUphSibFMMdB-ih_V1fyefHNgxK3dBIwYypsE_y5oll7x2h_yql9OMbKzkHh3EYYTVtzdutFsWUfjnacvZ6zBM3Yr1P0gE7).  Dr Li might get COVID-19 from one of his unknowing eye patients on Jan 8, although it is always hard to pinpoint exactly when.  He felt sick on Jan 10, yet his RNA tests were repeatedly inconclusive or negative, even by Jan 31, got confirmed positive only on Feb 1.  One can imagine a lot of the early cases were just like this.  Even if one was positive, could he eliminate the chance associating with the wet market in Wuhan?  As the saying goes, hindsight is 20/20, but it really took time to test patients and realize some could be asymptomatic or false negative.   Media later reported that at the time confirmation required a positive RNA test, which is now deemed too stringent, but this had nothing to do with suppressing information.  Indeed, criteria adopted by CDC for COVID-19 testing in the US throughout Feb 2020 were also criticized for being too strict.  My Feb 9, 2020 blog imagined the expert thinking at the time and argued that maybe we could have acted earlier by squeezing maybe 5 days out of it.  But I also fail to see any bad intention.  I would blame the virus for being unusual before blaming the medical experts. And thankfully nobody should have to make the same decision again.  

The Chinese government can be criticized for being indecisive at first, or the harsh lockdown later, but no way for hiding anything.  Indeed, Chinese scientists and doctors start publishing data and results since early Jan, and almost all we now know about COVID-19 came from publications by the Chinese, by late Jan-early Feb 2020.  Is this how one is being not transparent?  

The most outlandish thing I heard is that by hiding something China wasted the world two months’ reaction time.  I absolutely have no idea where those two months came from.  From the first cases being picked up on Dec 26 to WHO notification on Dec 31 to official confirmation of human-to-human transmission on Jan 20 to Wuhan lockdown on Jan 23, this is merely four weeks’ time, and unless you live under a rock, you can’t miss it, and one even should have known it much earlier than Jan 23 2020.  If you say, maybe the first case was actually in Nov?  Well, this is retrospective, and no one knows for sure.  Even if that is true, the two-month accusation is valid only if the Chinese did and said absolutely nothing for two months.  Moreover, if one doesn’t know something, can he hide it?  Lastly, from the latest date of Jan 23 to Feb 20-March 1, the rest of the world had at least one month to prepare.  Even if China wasted 5 days, didn't a few other countries waste a month, none the excuse that so much about the virus was unknown back in Jan?  Is someone hiding something as well?  And if one applies this criterion, the HIV/AIDS outbreak occurred in early 1980s, but the first cases can now be traced back to 1900s in Africa, under colonial rules, and the first case in the US in the 1960s.  We can always push the dates still earlier.  Does it mean somebody was hiding something in 1900s or 1960s?

The case of Dr Li was tragic, but using him in this manner is like 吃人血馒头.  These people are intellectually lazy, or vicious and shameless. 

Note on Mar 19, 2020: The central government sent an investigative team to Wuhan for Dr Li on Feb 7, the results were announced on Mar 19, and Q&A about the report is here: http://news.m4.cn/2020-03/1363915.shtml.  Wuhan police had followed through.  About Wuhan police, it was concluded to have made a mistake, and two persons were given disciplinary action or warning.  Wuhan police has rescinded the warning and apologized to Dr Li's family.  This concurs with my thinking: the whole thing is not black and white, and it was a judgement call to do it or not.  If the police was really deemed out of bound, someone would have been fired, but nobody was.  About Dr Li's illness, the team found that Dr Li admitted an 82-year-old patient on Jan 6, who died on Jan 23 from COVID-19.  Dr Li got sick on Jan 10 and was himself admitted.  He was treated in the hospital but because of the lack of test kits and facilities, he took RNA tests only on Jan 28 and Jan 31.  The first test was negative, second test positive, hence he was confirmed on Jan 31.  The lag between testing and notification could explain the slight discrepancy with Dr Li's interviews and social media posts (https://www.hatdot.com/yule/3139045.html, and baidu.com/reference/24300481/620dK2y1D2AWOYHfiaUphSibFMMdB-ih_V1fyefHNgxK3dBIwYypsE_y5oll7x2h_yql9OMbKzkHh3EYYTVtzdutFsWUfjnacvZ6zBM3Yr1P0gE7.  There is abundance of reports of false negatives in Jan and Feb, as many suspected cases need multiple tests to confirm.  Clearly disease progression and sample collection are critical factors.  But I also think the initial test kits might not be sensitive enough.