Science typically progresses in a
step-wise, monotonic fashion, which the general public may consider boring,
slow, and not appreciate the subtleties.
While the deliberate process is necessary to seek truth, scientists have
rarely had to apply their understanding with so much urgency and so much
instant impact until COVID-19. Looking now
at some of the early findings and resulting actions by the scientific and
medical communities, one can see a clearer picture of the intended and
unintended consequences on the societies, with the benefits of hindsight of
course.
At the end of 2019, COVID-19
patients checked into two Wuhan hospitals.
Zhang Jixian, a doctor at one of the hospitals, who worked on SARS
before, recognized 4 unexplainable pneumonia cases on Dec 26 and reported them
to the authority on Dec 27. She reported
more on Dec 29, after in-house and outside experts agreed with her assessments. On Dec 30 morning 7 patient biopsies were
taken for further analyses, and the Wuhan Health Commission issued a notice alerting
all Wuhan hospitals to report similar cases within the past week. On Dec 31 Wuhan Health Commission issued a
second, longer notice. Both notices were
reported widely by Chinese media at the time.
The second notice even asked people to avoid crowds, but, fatefully,
nobody paid any attention. WHO
representative in China learned of the Wuhan notice on Dec 31, although it was unknown
at the time whether there was a new disease.
Beijing assembled the first national expert team that arrived at Wuhan
on Jan 1, 2020. Because the earliest
patients were connected to the Huanan Market, a red flag, China’s CDC took over
500 samples from the market, and the city shut it down on Jan 1, 2020.
By Jan 3, 2020 Chinese scientists had
determined, and media reported, that all the usual suspects had been eliminated
as the cause, so it was indeed a new disease.
WHO was officially notified. Directors
of the Chinese and American CDCs talked over the phone on Jan 3. So perhaps tellingly, throughout this whole
COVID-19 saga Dr Robert Redfield, head of the American CDC, has noticeably said
the least bad things about China among all US officials, unlike Birx, even
Fauci, and CDC, with a much reduced but still non-zero presence in China, is
the only US agency that hardly if ever complains about China. On Jan 5 a virus sequence was submitted to
GenBank. The virus was from one patient
only, so the conclusion was not definitive, and the sequence was close to, but
not 100% complete. On Jan 7 Chinese
isolated a CoV, confirming the sequence and presence of a novel CoV, a finding reported
in the news. Of the 7 patient samples
taken, the same virus, by sequencing, was identified in 5, convincingly
demonstrating the causative pathogen. On
Jan 11 China reported a few more and the complete virus sequences to the
world.
From Dec 27, 2019 to Jan 11, 2020,
the discovery process was thorough, exemplary, and record-settingly
speedy. No biologists will fault any of
it. But how about the patients? What happened between Jan 1 or 11 and Jan 20,
2020, when the third expert team announced human-to-human transmission? Was there a coverup, or more recently the
Western media terminology, downplaying the severity of COVID-19? It must be noted that for a coverup or
downplaying to stand, someone must know the truth but not reveal it, like he
knows there are 200 cases but says only 100, and this person must also be an
authoritative figure. Otherwise a
coverup is like the air, true everywhere but without pointed meaning or significance.
A disconnect between the true
COVID-19 infections and publicly reported cases existed in Wuhan, acknowledged
early on. According to later analyses,
by Jan 20-22, 2020 there might be ~ 5K infections from Wuhan (including those
who had left Wuhan), while the official count was only hundreds. Did it amount to coverup or downplaying,
though? My many blogs (including the
summary on June 3, 2020) have explained why it did not, as well as the reasons
why many cases were missed early (e.g., July 30, 2020 blog). But digging deeper reveals the unexpected limits of scientific
knowledge and negative consequences of the rapid but imperfect application of a
new discovery. Nonetheless, one must
note that even today, the publicly confirmed cases remain only a fraction of the
actual infections around the world. Thus,
the Wuhan discrepancy-paradox is actually universal and never the smoking gun
of any coverup.
My July 30, 2020 blog links much of
the initial responses to COVID-19 to lessons from SARS. A positive is how fast the disease was
recognized and determined this time.
Negatives include not realizing COVID-19 might have been different from
SARS in many ways, hence delaying the diagnosis of new patients. Also focusing on the Huanan market, which
ultimately led to nothing. In fairness,
during Jan most scientists and the public did consider the market the source of
virus, even the site of a zoonotic jump.
The evidence was thin in retrospect, but it was all we had at the time, reinforced
by the SARS memory 17 years ago. New
evidence since then has greatly diluted the value of Huanan market. It also shows the difficulty sorting out how
a disease originated. My Aug 6, 2020
blog detailed a few small outbreaks in China since April. Only the one in Heilongjiang province has had
its origin reasonably answered. For the
others, the sites of the initial spread were determined, but patients 0 were
never known, nor how they got infected in the first place. This is despite China has had all the tools
ready, identified the outbreaks quickly, tested, traced, sequenced, and limited
the transmission very efficiently. Drastically
different from Wuhan in Jan. Still can’t
get to the bottom of the outbreaks, not for the lacking of trying. If these are hard, one can imagine how much harder
it is to know the origin of COVID-19 or any other diseases. Practically impossible.
SARS lessons, however, don’t explain
fully why Wuhan missed cases in Jan. A
critical factor is likely that diagnostic criterion changed after the novel CoV
was determined. Before then, COVID-19
patients were diagnosed with CT and/or connection to known patients or the
Huanan Market. Once the virus was known,
guidelines switched to qPCR tests or even sequencing, which looked for the
presence of viral RNA. And this decision,
discussed among doctors in Wuhan at the time, may have been the most
consequential.
In theory no biologists or doctors can
argue against RNA test: it is and remains the gold standard and the most conclusive. COVID-19 symptoms are cold/flu like, Jan was the
flu season, flu is also contagious, and numerous illnesses produce similar CT
scans. During much of Jan cold/flu
patients were expected to outnumber COVID-19 patients, even in Wuhan. As a result, although there were anecdotal reports
of more COVID-19 infections in early-mid Jan, recounted in Chinese media afterwards,
as evidence that human-to-human transmission should have been concluded earlier
than Jan 20, 2020, hence the “coverup” charge, they were hard to assess in real
time, even if they turned out to be true later.
For example, a doctor might suspect being infected by a patient on Jan
10. But without a positive COVID-19 diagnosis,
perhaps not even for that patient, how could one be certain it wasn’t, e.g.,
flu? Someone in a different city might
get sick after a relative returning home from Wuhan. But again, how does he know it wasn’t flu or
something else? Did Wuhan eliminate flu
already? It is not that these anecdotal
examples were wrong, but that their mere suggestions were not enough for
medicine. New infections must show
symptoms more COVID-19 than flu, and preferably a positive RNA test
result.
Decoding the disease and virus was a
milestone, which gave scientists and doctors an early, essential, and better
weapon against COVID-19. Applying the new information, however,
injected an unjustified sense of certainty. Sure, RNA is better than CT, but it is not
omnipotent, a point underappreciated initially.
Even today, false negatives may appear in 20% of the cases. Sampling is a factor. Also the asymptomatic and presymptomatic,
which makes diagnosis difficult no matter the criteria. Testing was especially challenging for Wuhan:
test kits were new, so there were trials and errors, not to mention
manufacturing; workers needed training; more
P2 labs must be set up, etc. It is now
estimated that only a few hundred tests were performed per day until Jan 23,
2020. Factoring in new kits’ unreliability,
this level of testing was massively insufficient for perhaps the already >1k
infections in Wuhan. Only an increase in
testing capacity, coupled with more infected people developing symptoms or
producing more viruses for easier detection, solved the problem. And all these developments took time.
In short, the Wuhan
discrepancy-paradox has an easy explanation: COVID-19 is harder to detect than
SARS, the delineation of virus and the confident adoption of such knowledge unintentionally
set a high bar for COVID-19 diagnosis, without further considering the
logistics of a new kind of tests. From
this angle, there is another paradox: virus
discovery might have delayed disease discovery, albeit briefly. Hospitals should have continued to use CT and
reported cases regardless of whether RNA results were available. This method, in the best-case scenario, might
have been able to shave a few days off the human-to-human transmission
conclusion. But if so, would Wuhan still
have a lockdown, and if not, what happened next? And all these have the benefit of hindsight:
nobody can say RNA test was not better than CT or other symptom tests, then or
now. Only its rollout and adaptation
presented an unforeseen challenge.
But why was it not due to a coverup
by the government, instead of honest mistakes by the scientists and
doctors? Because the latter is the
simpler answer, also a visible one, while the former has no evidence. The most-cited support for the “coverup” is
the 6-day delay in announcing human-to-human transmission (4/15/2020
blog). China sent three teams of experts
to Wuhan. The first team stayed for a
week, followed by the second one, stating sth like “human-to-human transmission
can’t be ruled out” on Jan 14, as much maligned as undeserved. Months later the 2nd team members
maintained they based their conclusions, technically still correct, on the best
data available to them at the time.
Their only regret was that, while they visited many patients and their
doctors, they didn’t talk to other doctors at the hospitals, who might have
known more unconfirmed cases. So if
there was a “coverup”, at least its public face was these scientists and
doctors from Beijing and Wuhan, not some unprofessional, unnamed government
officials. Then, what was it in there
for these scientists and doctors to cover up? Why were they so different from the Chinese
scientists and doctors who reported the first cases, treated the first
patients, identified the virus, etc? In
fact, some are the same people.
In early-mid Jan, Wuhan once reduced
the official tallies of patients from >60 to >40, then didn’t report any new
cases for a few days, largely around the same time of a local congress
meeting. This is often used to explain
why the government wanted to cover up or downplay COVID-19. But it would be an odd and overtly blatant way
for that purpose. Does 60 vs 40 signal a
sea change to any normal person? Chinse
media, Wuhan and the national expert teams were talking about the new disease
daily, so everybody knew, and it is not going away. Timing of the local congress overlapped with
that of virus discovery too, so a parsimonious explanation is that diagnosis
criterion changed right around the same time, after the virus was isolated. Not reporting new cases might be simply
because doctors were waiting for RNA confirmation, which was then known to
involve tests performed outside Wuhan.
Surely there were room for improvement.
For example, the eliminated cases could have been false positive or false
negative. Hospitals shouldn’t have
placed all the eggs on the RNA test basket.
But there are better reasons than
the jerk-knee coverup allegation. On Jan
18, 2020 a large Wuhan community held an annual, dinner festival involving 18K
residents. Clearly the government,
communities, and public didn’t heed the advice of the second, Dec 31 notice by
the Wuhan Health Commission to avoid crowds.
On the other hand, media reported, later, that the community in question
itself had an infection rate lower than Wuhan average. It will be interesting to see whether there
will be a scientific paper about that.
As my blogs (e.g., 9/7/2020) argued,
even if other countries acted only on Jan 23, 2020, the same day of Wuhan
lockdown, thereby eliminating the whatever coverup discussion, they would still
have enough time to minimize COVID-19.
But mistakes were still made, included by scientists, indicating that Chinese
are not exceptional. The American CDC
was the best example.
Missteps by the CDC were well documented. They designed the first test kit, based on
the virus genome China published on Jan 11, around Feb 1, but its manufacturing
was contaminated. Avoidable but perhaps
just unlucky. Yet it took CDC 3 weeks to
rectify the issue, and that was inexcusable.
There are tens of labs at any major medical center in the US that can design
a good kit and initiate testing within a week or less. No way to understand why it took so long to
solve the problem, except that there might be a lack of urgency at CDC. Another, less egregious mistake by CDC was to
restrict testing, such that only a few thousand total tests were performed by
late Feb. And during this time the FDA
was swaying left and right regulating and approving tests. If testing at Wuhan was poor in the early
days, what to call the testing situation in the US, one month later? If China not confirming cases fast enough in
mid Jan meant covering up, what to call the US hardly finding any cases even by
late Feb? Lastly, how about the mask
recommendation? Even when the
asymptomatic and presymptomatic were well-known by the end of Jan, and China
and many other Asian countries started wearing masks in Jan?
When humans encounter something new,
it is easy or natural to stumble or detour.
China had the excuse of being the very first. The US did not. Still, there is no reason to believe what the
Chinese and American scientists did wrong was anything but innocent mistakes. Nothing amounts to coverup. Those mistakes were corrected sooner or
later. Then the rest depends on how the
governments and societies have responded, where the largest differences lie.
When COVID-19 broke out in the West,
especially the US, the media and politicians reflexively blamed China for
coverups: because China didn’t give us the info, didn’t tell us how bad it was,
etc., we didn’t know and didn’t prepare.
None of the accusations, however, hold any water based on open evidence,
and make any differences any way (Jun 3, 2020, Sept 7, 2020 blogs). Now, thanks to Bob Woodward’s interviews,
many on tapes, and his new book, “Rage”, we have Trump’s own words and others’
to reveal that they knew exactly what COVID-19 was and could do. For example, the NSA Robert O’Brien briefed
Trump on Jan 28 it could be the worst crisis for his presidency, yet in May he
said in public he didn’t know it was a big deal. And Trump described to Woodward on Feb 7 that
he knew COVID-19 was deadly stuff, but then on Mar 19 he said he wanted to play
it down. These people lying is a given,
but there are a few more takes on the new info.
First is that US officials
understood the danger of COVID-19, as they all warned WH about it in late
Jan. It means that the Jan 23, 2020
Wuhan lockdown, and China’s actions in general, clearly sent a shockwave and
sounded the alarm. There is no longer minimizing
the lockdown’s symbolic global impacts.
Second, in their own words, they essentially
admitted that China didn’t do any of the coverups, or it didn’t matter anyway,
because the US knew full well COVID-19 potentials in late Jan and early
Feb. They have been lying straight in
your face to fake ignorance and cover for their incompetency ever since Mar.
Third is that the date Feb 7, 2020 Trump
admitting it to Woodward on is significant.
Few US media have introduced the background on Sept 9, 2020 except
perhaps MSNBC’s Lawrence O’Donnell, but it is in the book, as on Feb 7 Xi
Jinping and Trump talked over the phone about COVID-19. What everything transpired is that Xi almost
certainly explained the COVID-19 situation in China to Trump, and Trump clearly
came away with the understanding of its gravity, before he talked to
Woodward. In other words, the conclusion
is inevitable that Xi didn’t downplay it (if anything, he up-played it a bit,
or Trump exaggerated a bit), otherwise Trump wouldn’t have said the serious stuff
to Woodward. While few knew Xi’s exact
words, no one can deny that Xi did tell and warn Trump in very specific terms,
leaving such a strong impression that Trump then told Woodward. What Trump said to Woodward on Feb 7 might just
as well have been Xi’s own words, with Trump’s interpretation. If China,
by Xi’s words, had warned Trump and the US, on Feb 7, that COVID-19 was deadly,
5X as flu, could be transmitted through air, what exactly did China hide from
the US that could make any more difference? Besides Lawrence O’Donnell, CNN’s Sanjay Gupta
also made a passing reference (https://www.rawstory.com/2020/09/dr-sanjay-gupta-asked-trump-about-facts-from-medical-journals-and-the-president-lied-to-his-face/).
Joe Biden said the Feb 7 episode showed at least Trump could read. Biden likely thought Trump talked to Woodward based on US reports, yet he was misinformed. While most US media don't show it, both the book and tapes mentioned Trump talked to Xi first. In early Feb that COVID-19 might be airborne had just started to be discussed in China, as some evidence and reports suggested it. So Xi mentioned it to Trump, no hiding. But the US officials were in no way to understand and make a conclusion, hence in no position to warn Trump then. Even today, WHO ranks droplet transmission much higher.
Fourth, the date Feb 7, 2020 is
important further in that all case and virus sequencing data indicated that
sustained transmission in the US (corresponding to Wuhan situation in early Jan)
didn’t start until mid Feb, later for the NY area. When Trump said COVID-19 was no big deal in
early-mid Feb, he was actually right, because there might be only 12 confirmed
and a few dozen cryptic cases in the US.
And when he said China was fighting COVID-19 hard, and it would go away,
e.g., on Feb 7 and Feb 10, he wasn’t wrong, either: can everyone say that China
didn’t work hard against COVID-19 in Feb, or that COVID-19 didn’t practically
go away in China in April? Democrats’ many
attack ads are conflating things and misleading: what Trump did wrong wasn’t he said something wrong in Feb, but what he
didn’t do in Feb. Trump, US politicians,
the public thought, and many still think the China travel ban on Feb 2 was
essential and enough. That, along with
the mentality, is the big problem.
Fifth, by their own admission, the
US played it down, not China. Certainly
Trump. And in Trump’s own words, Xi and China
told him exactly the way it was on Feb 7, 2020.
What more evidence does one need before jumping off the China-bashing bandwagon? Then will the media still parrot the official
lines to blame Chinese coverup, and will the Democrats still swallow the lies
while attacking Trump at the same time?
Both still likely. Because it is
good politics, it makes the US feel good, and because they don’t or choose not to
see the contradictions, irony, and truth in plain sight. If these people constantly and continuously
lie about COVID-19, on all easily verifiable facts, about what else don’t they
lie? Xinjiang, HK, Huawei, Chinese
threats, etc? Why should they be trusted?
