Were the COVID responses of China and the WHO too slow?
Can someone be blamed?
 |
| Progress of pandemic, China Source: JAMA Feb 24. Wu and McGoogan. Annotations by Tomas Pujeyo |
The Figure gives a number of important dates, and other dates in the Table below show the speed of China's reaction, at least the official record.
17 November Probable first patient infected
26-27 December Dr Zhang notices and reports an unusual cluster of pneumonia cases
28-30 December Active case finding in Wuhan
26-27 December Dr Zhang notices and reports an unusual cluster of pneumonia cases
28-30 December Active case finding in Wuhan
31 December WHO is notified of mysterious pneumonia.
1 January Seafood market closed. WHO activates at all levels.
3 January Screening of all airline passengers in Thailand.
5 January Threat assessment from WHO, "Pneumonia of unknown cause".
5 January Japan activates national threat response
7 January Novel coronavirus isolated
1 January Seafood market closed. WHO activates at all levels.
3 January Screening of all airline passengers in Thailand.
5 January Threat assessment from WHO, "Pneumonia of unknown cause".
5 January Japan activates national threat response
7 January Novel coronavirus isolated
11 January First coronavirus death in Wuhan
12 January Sequences shared internationally by China, to help others develop test kits
19-22 January First cases in USA, Iran, Japan, Korea and Thailand
21 January Daily WHO situation reports on novel coronavirus
12 January Sequences shared internationally by China, to help others develop test kits
19-22 January First cases in USA, Iran, Japan, Korea and Thailand
21 January Daily WHO situation reports on novel coronavirus
23 January Strict lockdown in Wuhan. Person-to-person transfer confirmed
30 January WHO declares global emergency
22-25 February First cases detected in Italy and Spain
22-25 February First cases detected in Italy and Spain
7 March New daily cases in China fall below 100
18 March Zero new infections in Wuhan
8 April Wuhan lockdown lifted
It is never an easy matter to be the 'first cab off the rank' in identifying a new disease. First the novel cases have to be identified, then authorities have to be notified. Falsely identifying a novel outbreak would be a subject of widespread condemnation.
On this account it perhaps took a little long, about five weeks after the first symptoms of any patient appeared, before the pneumonia cluster was "noticed", and officially reported, but well before anyone had died and still three weeks before the disease was found outside of China.
The speed of identifying the new virus in China was truly extraordinary however and showed how far medical science had come since 2002. It took three months from the conclusion of the SARS-1 epidemic before the cause of that outbreak was identified and testing kits became available. This time, it took 11 days to locate, identify and sequence the agent. The rapid medical response was apparently due to advance preparations they had made after SARS-1.
The response of neighbouring countries was also rapid, and stood them in very good stead.
As soon as human-to-human spread was confirmed, the Chinese government declared a lockdown in Wuhan. This was on 23 January, 16 days after the virus had been isolated. This time might have been been shortened, possibly limiting the spread to other countries. A sufficiently rapid intervention may quash a pandemic before it even gets started. A model simulation has suggested that if China had implemented its control measures a week earlier, it could have prevented 67% of all cases there.
At this stage however, no-one was aware of the potential for international spread or that a true pandemic was on the way, since the related viruses SARS-1 and MERS had not spread far and had been eradicated after some effort. Also their neighbours were all acting on the WHO alert.
On 30 January, WHO declared a global emergency, giving the details that were available and stating "it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures". They stated:
All the Western countries had been notified from 31 December and strongly warned from 30 January of the likelihood of a global pandemic. Unlike the Asian countries, their preparedness was woeful. They did not "rapidly develop a diagnostic tool". They had no pandemic plans that could be launched. They did not assemble equipment, educate the public, search for cases or make preparations. All the Western countries were caught without ventilators, testing equipment, hospital beds or masks. They did not appear to think the early WHO warnings applied to them.
In the USA, nothing was done through January, despite finding several cases. After the WHO emergency declaration, the US President created a Task Force, and declared a state of emergency on 31 January, blocking most Chinese nationals from entry and requiring quarantine for Americans who had been to Wuhan - an unusual move.
The real problem from here was testing. The USA refused the offer of testing kits from WHO and elected to develop their own, yet belated attempts by the CDC to develop a testing kit were abortive. Regulatory controls did not permit private centres to use their own kits, so there was almost no testing until March.
The President downplayed the threat despite private warnings from senior public officials from mid-January of the likelihood a severe pandemic. Only on 28 February were travellers from other places blocked, while in the meantime untested cases were accumulating in all the major urban areas, especially New York
In 2015 Bill Gates had warned in a Ted Talk that the next global crisis would be a pandemic and that there was no sign of readiness. Although the Americans knew a novel virus was on the loose in their country, and may have known about the Chinese situation from November, it was not till 17 March that the first American city ordered a lockdown (in San Francisco, where the disease has actually been contained). By this time the epidemic had been running away for at least ten days and almost 1000 cases had been identified. In other major cities, particularly New York, it was soon too late to restrain the disease in any meaningful way.
The situation in Europe was even worse than the USA and ultimately more deadly. The phylogeny shows that the major basal European strain developed around 14 January, with several others soon afterwards, a week before the Wuhan lockdown by China. Yet it took five weeks to identify the first cases in Italy and Spain, and longer than that to take the threat seriously. No blocks were put in place anywhere against Europeans until late February. In the meantime, the European strains had been spread around the world.
WHO and others had certified the USA as having a high state of readiness. Other affected countries had a higher state of readiness in theory than China, Korea or Thailand, but in practice they did not. As a result, Western countries and the world have paid a terrible cost.
It is the very speed of the reaction by Chinese medical authorities that is doubtful, not the slowness, and one must suspect the outbreak had been known for weeks beforehand. There have been persistent stories of wire and computer intercepts describing a contagion sweeping through Wuhan, changing the patterns of life. In briefings across the US government through November and December, intelligence analysts concluded that it might be a cataclysmic event. The Pentagon has denied the briefings.
18 March Zero new infections in Wuhan
8 April Wuhan lockdown lifted
It is never an easy matter to be the 'first cab off the rank' in identifying a new disease. First the novel cases have to be identified, then authorities have to be notified. Falsely identifying a novel outbreak would be a subject of widespread condemnation.
On this account it perhaps took a little long, about five weeks after the first symptoms of any patient appeared, before the pneumonia cluster was "noticed", and officially reported, but well before anyone had died and still three weeks before the disease was found outside of China.
The speed of identifying the new virus in China was truly extraordinary however and showed how far medical science had come since 2002. It took three months from the conclusion of the SARS-1 epidemic before the cause of that outbreak was identified and testing kits became available. This time, it took 11 days to locate, identify and sequence the agent. The rapid medical response was apparently due to advance preparations they had made after SARS-1.
The response of neighbouring countries was also rapid, and stood them in very good stead.
- On 3 January, three days after the initial WHO alert, airline passengers and staff were screened for symptoms in Thailand, Korea and China, with Japan soon following. By 20 January, 18,000 passengers and crew had been screened in Thailand.
- On 5 January, the "existing surveillance system for serious infectious illness with unknown etiology" was activated in all local governments in Japan. "Enhanced screening and quarantine" was begun for all travellers from Wuhan.
As soon as human-to-human spread was confirmed, the Chinese government declared a lockdown in Wuhan. This was on 23 January, 16 days after the virus had been isolated. This time might have been been shortened, possibly limiting the spread to other countries. A sufficiently rapid intervention may quash a pandemic before it even gets started. A model simulation has suggested that if China had implemented its control measures a week earlier, it could have prevented 67% of all cases there.
At this stage however, no-one was aware of the potential for international spread or that a true pandemic was on the way, since the related viruses SARS-1 and MERS had not spread far and had been eradicated after some effort. Also their neighbours were all acting on the WHO alert.
On 30 January, WHO declared a global emergency, giving the details that were available and stating "it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures". They stated:
The Committee welcomed the leadership and political commitment of the very highest levels of Chinese government, their commitment to transparency, and the efforts made to investigate and contain the current outbreak. China quickly identified the virus and shared its sequence, so that other countries could diagnose it quickly and protect themselves, which has resulted in the rapid development of diagnostic tools...The measures China has taken are good not only for that country but also for the rest of the world.At a press conference the next day, WHO communications officer Christian Lindmaier backpedalled somewhat, speaking of a "huge reason to keep official borders open" to prevent unmonitored crossings. Much has been made of this - but it was not part of any formal WHO communique. Lindmaier and WHO followed well-established procedures, quoting criteria under which an international emergency should be called, while stressing it was the responsibility of individual countries to act, both before and after the global warning.
Performance of Western countries
Faced with the likelihood of pandemic, the readiness and performance of the Western nations was embarrassingly poor. Eighteen years earlier, the SARS-1 epidemic had placed pandemics on the threat list of many countries, yet a proper response strategy was never put in place - anywhere.All the Western countries had been notified from 31 December and strongly warned from 30 January of the likelihood of a global pandemic. Unlike the Asian countries, their preparedness was woeful. They did not "rapidly develop a diagnostic tool". They had no pandemic plans that could be launched. They did not assemble equipment, educate the public, search for cases or make preparations. All the Western countries were caught without ventilators, testing equipment, hospital beds or masks. They did not appear to think the early WHO warnings applied to them.
In the USA, nothing was done through January, despite finding several cases. After the WHO emergency declaration, the US President created a Task Force, and declared a state of emergency on 31 January, blocking most Chinese nationals from entry and requiring quarantine for Americans who had been to Wuhan - an unusual move.
The real problem from here was testing. The USA refused the offer of testing kits from WHO and elected to develop their own, yet belated attempts by the CDC to develop a testing kit were abortive. Regulatory controls did not permit private centres to use their own kits, so there was almost no testing until March.
The President downplayed the threat despite private warnings from senior public officials from mid-January of the likelihood a severe pandemic. Only on 28 February were travellers from other places blocked, while in the meantime untested cases were accumulating in all the major urban areas, especially New York
In 2015 Bill Gates had warned in a Ted Talk that the next global crisis would be a pandemic and that there was no sign of readiness. Although the Americans knew a novel virus was on the loose in their country, and may have known about the Chinese situation from November, it was not till 17 March that the first American city ordered a lockdown (in San Francisco, where the disease has actually been contained). By this time the epidemic had been running away for at least ten days and almost 1000 cases had been identified. In other major cities, particularly New York, it was soon too late to restrain the disease in any meaningful way.
The situation in Europe was even worse than the USA and ultimately more deadly. The phylogeny shows that the major basal European strain developed around 14 January, with several others soon afterwards, a week before the Wuhan lockdown by China. Yet it took five weeks to identify the first cases in Italy and Spain, and longer than that to take the threat seriously. No blocks were put in place anywhere against Europeans until late February. In the meantime, the European strains had been spread around the world.
WHO and others had certified the USA as having a high state of readiness. Other affected countries had a higher state of readiness in theory than China, Korea or Thailand, but in practice they did not. As a result, Western countries and the world have paid a terrible cost.
Alternative narratives
As always when China is involved, there is always a suspicion that somehow they have 'manipulated the narrative'. Communist regimes have always tried to limit information, at least to their own people - as indeed has every major power.It is the very speed of the reaction by Chinese medical authorities that is doubtful, not the slowness, and one must suspect the outbreak had been known for weeks beforehand. There have been persistent stories of wire and computer intercepts describing a contagion sweeping through Wuhan, changing the patterns of life. In briefings across the US government through November and December, intelligence analysts concluded that it might be a cataclysmic event. The Pentagon has denied the briefings.
The notification of the breakout on December 31 apparently followed several instances the previous day of 'whistle blowers' alerting colleagues through the Wechat platform that a dangerous SARS-like virus was on the loose. Local police briefly closed down Wechat and questioned those involved. [1] One of these, ophthalmologist Wi Lenliang, subsequently died of the disease.
Right-wing media in Australia alleged that Chinese operators quietly sequestered and imported many tonnes of equipment in the early days of the epidemic. However, China and Chinese communities made a substantial effort to ramp up production of personal protective equipment, and to supply help and provide equipment to other countries.
Further claims surfaced that China deliberately understated the number of deaths, the assumption apparently being that China (unwarned) could not have brought the disease under control when the USA (warned) did not. Reports of larger numbers of funerary urns than usual shipped to Wuhan have been cited as evidence. On 17 April, China added 1300 to the death toll, from extra-hospital deaths and late reports. When France added 1500 to their death toll on 4 April for the same reasons, there was no reaction.
Private class actions (essentially symbolic) were commenced in three states of the USA and in Israel against China, claiming a failure to arrest and contain the disease. There have been no similar charges against European countries and the USA.
From 15 April, President Donald Trump began a campaign of attempting to smear China and to accuse his likely Democrat opponent of being 'soft on China'. A campaign of disinformation against China soon followed.
A report from 2018 surfaced that American researchers had visited a laboratory in Wuhan that was investigating coronavirus in bats, and the researchers felt that biological security was inadequate. This was rapidly magnified as "the mysterious lab where officials believe the coronavirus started."
Australia's Foreign Minister said China must reveal to the world how and why the outbreak occurred, calling for an "independent review to identify the genesis of the virus, how it was dealt with, how China shared information and its interaction with the WHO" (all of which is firmly on the record).
In our opinion, none of these allegations are relevant. What is important is whether China warned the world adequately. Certainly in a formal sense, the Chinese did, and WHO commended them for it. The argument might be that they did not make it sound bad enough, so no-one took any notice. However many of the nations of Asia were able to act on the advice and stabilise their epidemics.
The truth is that very few policy makers in Western countries thought UN warnings applied to them and scarcely bothered to monitor them until the global pandemic was declared. Even then they fumbled the ball very badly and missed their remaining window of opportunity.
Most of these allegations are, in my opinion, attempts to manipulate the narrative more than three months after the horse had bolted, by claiming that China somehow tried to manipulate the narrative. [2] Another problem is that most of these critics are unfamiliar with and apparently do not regard the procedures and protocols of the world arbitrator WHO as valid, although these have been negotiated between the governments of the world over many decades of outbreaks.
Although WHO maintained a steady stream of notifications, no action was taken by any Western government until the International Emergency was announced. This endorses what I have personally observed many times among Western countries - they think UN activities are only for developing countries and do not apply to them. Most of the time nobody is even monitoring UN communications, or if they do it is in international aid departments, far from the executive.
Given what actually happened, it seems unlikely that any Western country would have performed better than China if they had been Ground Zero for a novel virus epidemic. The results for the world might well have been worse.
{WHO knew about secondary transmission but did not act
Right-wing media in Australia alleged that Chinese operators quietly sequestered and imported many tonnes of equipment in the early days of the epidemic. However, China and Chinese communities made a substantial effort to ramp up production of personal protective equipment, and to supply help and provide equipment to other countries.
Further claims surfaced that China deliberately understated the number of deaths, the assumption apparently being that China (unwarned) could not have brought the disease under control when the USA (warned) did not. Reports of larger numbers of funerary urns than usual shipped to Wuhan have been cited as evidence. On 17 April, China added 1300 to the death toll, from extra-hospital deaths and late reports. When France added 1500 to their death toll on 4 April for the same reasons, there was no reaction.
Private class actions (essentially symbolic) were commenced in three states of the USA and in Israel against China, claiming a failure to arrest and contain the disease. There have been no similar charges against European countries and the USA.
From 15 April, President Donald Trump began a campaign of attempting to smear China and to accuse his likely Democrat opponent of being 'soft on China'. A campaign of disinformation against China soon followed.
A report from 2018 surfaced that American researchers had visited a laboratory in Wuhan that was investigating coronavirus in bats, and the researchers felt that biological security was inadequate. This was rapidly magnified as "the mysterious lab where officials believe the coronavirus started."
Australia's Foreign Minister said China must reveal to the world how and why the outbreak occurred, calling for an "independent review to identify the genesis of the virus, how it was dealt with, how China shared information and its interaction with the WHO" (all of which is firmly on the record).
In our opinion, none of these allegations are relevant. What is important is whether China warned the world adequately. Certainly in a formal sense, the Chinese did, and WHO commended them for it. The argument might be that they did not make it sound bad enough, so no-one took any notice. However many of the nations of Asia were able to act on the advice and stabilise their epidemics.
The truth is that very few policy makers in Western countries thought UN warnings applied to them and scarcely bothered to monitor them until the global pandemic was declared. Even then they fumbled the ball very badly and missed their remaining window of opportunity.
Most of these allegations are, in my opinion, attempts to manipulate the narrative more than three months after the horse had bolted, by claiming that China somehow tried to manipulate the narrative. [2] Another problem is that most of these critics are unfamiliar with and apparently do not regard the procedures and protocols of the world arbitrator WHO as valid, although these have been negotiated between the governments of the world over many decades of outbreaks.
Discussion
The disease began in China, but novel viruses can of course have their origins anywhere. Their severity and whether they spread or not is purely a matter of chance. It is probably beyond the Statute of Limitations, but one might as well ask should Europeans pay reparations for the many diseases they spread across the world during the Colonial Era. In any case, according to the phylogeny, most of COVID-19 actually spread via Europe.Although WHO maintained a steady stream of notifications, no action was taken by any Western government until the International Emergency was announced. This endorses what I have personally observed many times among Western countries - they think UN activities are only for developing countries and do not apply to them. Most of the time nobody is even monitoring UN communications, or if they do it is in international aid departments, far from the executive.
Given what actually happened, it seems unlikely that any Western country would have performed better than China if they had been Ground Zero for a novel virus epidemic. The results for the world might well have been worse.
{WHO knew about secondary transmission but did not act
https://www.theatlantic.com/health/archive/2020/04/why-world-health-organization-failed/610063/]
[1] This seems very restrained for a Communist country, which in the past might have dealt harshly with dissidents. Even in Australia, hospital staff that tried to spread panic without going through proper channels would most certainly be disciplined, though police would probably not be involved.
[2]AUTHOR NOTE : I do not know anyone from mainland China nor have I had any connection with China. Over the years I have heard many stories about China suppressing information - starting in 1966 when I was informed by educated adults in all seriousness that Mao Zedong had been dead for ten years and China was propping up an effigy.
SECOND DRAFT. 21 April 2020. Joe Flood
<Return to Index>
[1] This seems very restrained for a Communist country, which in the past might have dealt harshly with dissidents. Even in Australia, hospital staff that tried to spread panic without going through proper channels would most certainly be disciplined, though police would probably not be involved.
[2]AUTHOR NOTE : I do not know anyone from mainland China nor have I had any connection with China. Over the years I have heard many stories about China suppressing information - starting in 1966 when I was informed by educated adults in all seriousness that Mao Zedong had been dead for ten years and China was propping up an effigy.
SECOND DRAFT. 21 April 2020. Joe Flood
<Return to Index>
Comments
Post a Comment