Science vs COVID-19 the early days, and Bob Woodward’s new book

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 2^nd 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?