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.