Wuhan's regret: How did you miss the golden prevention and control period?

Note: The original text was published by China News Weekly on February 5, 2020, and was later deleted by the entire network . This time is reproduced from Hong Kong Commercial Daily. If there is any infringement, please contact this account.

China News Weekly reporter / Li Xiangmao Li Mingzi Peng Danni Du Wei

On December 31, 2019, a rumor disturbed the joy of Chinese people preparing for the New Year. A red-headed document with the official seal of the Wuhan Municipal Health and Health Commission circulated on social media, and the document urgently notified that "pneumonia of unknown cause has appeared one after another in the Huanan Seafood Market in Wuhan". Some people asked in horror: Could it be a comeback of SARS?

Just the day before, Li Wenliang, a doctor at Wuhan Central Hospital, heard from colleagues that the emergency department had isolated seven SARS patients from the Huanan Seafood Market. At 5:00 p.m. that day, he sent this message to a group of university classmates, and explained that "the expression of SARS is not very accurate, it should be a coronavirus, and the specific type has yet to be confirmed", asking everyone to strengthen prevention, and stressed that Don't spread the word. However, this WeChat screenshot of "Seven cases of SARS diagnosed in the South China Seafood Market" still circulated and was reposted in large numbers online.

At 1:30 a.m. on December 31, Li Wenliang received a call and asked him to go to the Wuhan Municipal Health Commission. "At that time, the Health and Health Commission held a meeting overnight. It should be a meeting to deal with the epidemic. The leaders of our hospital and the director of the medical office attended." After the meeting, the leader of the hospital asked Li Wenliang's source and sent him home at 4:00 in the morning. During the day, Li Wenliang went to the hospital's supervision department two or three times. He was repeatedly asked about the source of the news and whether he recognized the "mistake of spreading rumors."

On the afternoon of this day, the Wuhan Municipal Health and Health Commission issued a notice saying, "Recently, some medical institutions have found that many pneumonia cases admitted to the South China Seafood City are related to the South China Seafood City, and 27 cases have been found, of which 7 are in serious condition", and pointed out, "No obvious human-to-human transmission was found, and no medical staff infection was found." At the same time, the first group of experts from the National Health and Construction Commission arrived in Wuhan on the same day.

The announcement from Wuhan quickly extinguished the topic. People breathe a sigh of relief, thinking they can safely enter the third decade of the 21st century. As everyone knows, a nationwide epidemic with far more confirmed cases than SARS has just begun, and a month later, it was designated by WHO as a "public health emergency of international concern".

"Cold Processing"

On December 31, 2019, when the news of "pneumonia of unknown cause" first appeared in Wuhan, a reporter from "China News Weekly" came to the Huanan Seafood Market and found that it was still operating normally, and few people wore masks. Some merchants said that after the incident, the market has increased the number of disinfections. Huanan Seafood Market is located in the downtown area of ​​Wuhan, only one kilometer away from Hankou Railway Station. It is divided into two areas, east and west, with more than 600 merchants. It is an old market that has been in operation for many years and has been rumored to be demolished.

A citizen said, "This place is really dirty and messy. It sells seafood on the surface. In fact, cats and dogs, live snakes and live turtles, all kinds of pheasants and groundhogs are sold, as well as signboards such as sika deer and live monkeys."

On January 1, 2020, under the witness of media reporters from all over the country who came to hear the wind, the Huanan Seafood Market was officially closed for renovation. Afterwards, Zhang Zuofeng, associate dean of the School of Public Health at the University of California, Los Angeles, and senior tenured professor of epidemiology, pointed out that according to a later report from Wuhan, as early as December 8 last year, several cases of patients with new coronary pneumonia were found in the South China Seafood Market. The market was closed for the next week, and the sick, suspected cases and contacts were quarantined, and the outbreak could never have reached its current level, but the market did not close until January 1, 2020. During these 22 days, many citizens may have been infected and missed the best opportunity for prevention and control.

Also on New Year's Day, the official Weibo account of the Wuhan Municipal Public Security Department @Safe Wuhan said, "Some informants published and forwarded false information on the Internet without verification, causing adverse social impact. The public security organs have investigated After verification, 8 offenders have been summoned and dealt with according to law." But after more than 20 days, the Weibo has been deleted.

On the morning of January 3, Li Wenliang received another call from the police station, asking him to sign a "Letter of Admonishment" regarding the illegal act of making false statements on the Internet. Since then, the director of the hospital's department verbally communicated not to publish relevant information on the Internet.

Lin Yu, a doctor at the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, recalled to China News Weekly that at the beginning of the epidemic, Wuhan's strategy was "cold treatment". The hospital where he works has notified that without the authorization of the unit, it is not allowed to discuss the condition privately on the public platform, and it is not allowed to be interviewed by the media privately, not only the clinical system, but also the hospital sense, and the CDC's information control is more serious, "The whole Don't say it." At that time, the only thing doctors could do was to repeatedly instruct patients to "mask, mask, be sure to buy a mask and wear a mask", and even half-jokingly told "don't go to the Huanan Seafood Market to buy things, the things there are not fresh".

From January 6 to January 10, the Wuhan Municipal Health Commission did not report the epidemic. During this period, that is, from January 6 to 10 and from January 7 to 10, Wuhan City held local "two sessions".

On January 9, Xu Jianguo, the leader of the expert group for the preliminary evaluation of the pathogenic detection results of pneumonia of unknown cause in Wuhan and an academician of the Chinese Academy of Engineering, announced that the pathogens of these cases in Wuhan were initially determined to be a new type of coronavirus. According to people familiar with the matter, in addition to Xu Jianwai, the first group of experts included Li Xingwang, the chief expert of the Beijing Ditan Medical Center for Infectious Disease Diagnosis and Research, and the director of the Department of Respiratory and Critical Care Medicine and the Department of Respiratory and Critical Care Medicine of the China-Japan Friendship Hospital. Cao Bin, director of the second department.

On January 11, the Wuhan Health and Health Commission notified a total of 41 confirmed patients and 1 death, reiterating that "no medical staff infection was found, and no clear evidence of human-to-human transmission was found." Wang Guangfa, an expert from the National Medical Expert Group and director of the Department of Respiratory and Critical Care Medicine at Peking University First Hospital, said in an interview with the media on the same day that the situation in Wuhan was "preventable and controllable."

But 11 days later, Wang Guangfa himself was revealed to have contracted the new crown pneumonia during his stay in Han, and he became the object of "onlookers" on social media for a while. After recovering, Wang Guangfa said in an interview with the media on February 1 that the information they saw at that time was the 41 cases originally reported in the journal The Lancet, and there must be no medical staff infected.

People familiar with the matter told China News Weekly that the second batch of expert groups were in Wuhan from January 8 to January 16 to guide epidemic prevention work. Clinical experts such as Gao Zhancheng, director of the Department of Respiratory Medicine, also include Feng Zijian, deputy director of the Chinese Center for Disease Control and Prevention, and Yang Wei, the former deputy director of the Center for Disease Control and Prevention.

Related to this, in the early morning of January 15, the Wuhan Municipal Health and Health Commission released a "Q&A on the Knowledge of New Coronavirus Infected Pneumonia". In this file, the official statement of the contagiousness of new coronary pneumonia has changed for the first time: "No clear evidence of human-to-human transmission has been found, and the possibility of limited human-to-human transmission cannot be ruled out, but the risk of continuous human-to-human transmission is low." "Q&A" The emergence of "family cluster cases" was also confirmed for the first time. Among the sick couple, the wife denied having a history of exposure to the Huanan Seafood Wholesale Market.

From January 12 to January 17, Wuhan reported no new cases. During this period, the CPPCC and National People's Congress meetings in Hubei Province were held successively.

When no new cases were reported in Wuhan for several days, new cases of new coronary pneumonia were discovered one after another abroad. On January 13, Thailand reported a case of pneumonia caused by the novel coronavirus in Wuhan. On January 16, Japan confirmed its first case of new coronary pneumonia in the country. The patient is a Chinese citizen who has been to Wuhan, but has not been to the Huanan Seafood Market, and may have had close contact with pneumonia patients in Han Dynasty. On the 17th, Thailand discovered the second case of new coronary pneumonia, the patient was a 74-year-old Chinese woman. Under this circumstance, the US CDC announced that passengers from Wuhan will be screened at three major international airports.

The Wuhan Municipal Health and Health Commission resumed the notification again in the early morning of January 18, announcing that 4 new cases of new crown patients were added from 0:00 to 24:00 on January 16. In the early morning of January 19, Wuhan City reported 17 new confirmed cases throughout the day on the 17th, bringing the total number of confirmed cases to 62.

On January 18, the "Wanjia Banquet" was held in the Baibuting Community of Wuhan, which was attended by more than 40,000 families. 13,986 dishes filled the main venue and 9 branch venues of the Party and Mass Activity Center. Regarding the doubts raised by the "Wanjia Banquet" in the Baibuting community, Wuhan Mayor Zhou Xianwang responded, "The reason why we continue to hold this event this year is based on our previous understanding that the spread of this epidemic is limited between people. This judgment of sexual transmission, so the early warning of this matter is not enough."

science competition

When the first group of experts from the National Health and Medical Commission arrived in Wuhan on December 31, a scientific research race also began. At 10:00 p.m. on December 30, Shi Zhengli, director of the Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, was commissioned by the Wuhan Center for Disease Control to test samples from several patients. On January 2, they obtained the whole genome sequence of the virus, which was confirmed to be a brand-new coronavirus; on January 5, the virus was isolated and obtained, and on January 11, assigned by the National Health Commission, they reported to the World Health Organization. The full genome sequence of the virus was submitted.

At the same time, on December 26, 2019, the team of Zhang Yongzhen, a virologist from the China Institute for Disease Control and Infectious Disease Prevention and Control and an adjunct professor at the Shanghai Public Health Clinical Center of Fudan University, received unknown information from Wuhan Central Hospital and Wuhan CDC. One specimen from the patient with the cause of fever. On the morning of January 5, the center detected a new type of coronavirus from the specimen, obtained the whole genome sequence of the virus through high-throughput sequencing, and released the gene sequence of the virus to the outside world on January 10.

No matter who was the first person to isolate the virus, compared to the SARS time when the pathogen was wrongly judged to delay the timing, Chinese scientists have isolated the virus in such a short period of time and made it public to the world, which has been unanimously praised by the international community. It's a good start.

After the data on the new coronavirus was made public, the "contest" of Chinese scientists' papers was launched. On January 21, two top universities in China were at odds over "rushing to publish papers". The Gaoshan Scientific Research Group of Nankai University published the paper "Bioinformatics Analysis of Wuhan 2019 Virus Sequences" in the Chinese core journal "Bioinformatics", which was accused by Zhang Yongzhen of Fudan University for using his research and development without consent. public data. Gao Shan responded that the data that has been made public means that the copyright is lost and others can use it.

What really detonated public opinion was an article published in the New England Journal of Medicine on January 29. The corresponding authors were Feng Zijian, deputy director of the Chinese Center for Disease Control and Prevention, Yang Bo, director of the Hubei Provincial Center for Disease Control and Prevention, and Gao Gao, director of the China Center for Disease Control and Prevention and an academician of the Chinese Academy of Sciences. Fu is also a co-author.

By analyzing 425 patients with new coronary pneumonia as of January 22, the article found that 55% of the cases with onset before January 1, 2020 were related to the Huanan seafood market, while only 8.6% of the cases after that were related to seafood. market related. In this regard, Wang Liming, a professor at Zhejiang University, said on Weibo, "From this article, the National Centers for Disease Control and Prevention had clear evidence of human-to-human transmission of the virus as early as the first few days of January...then this news is At what step was it covered up?"

Wang Liming's question was forwarded and commented by tens of thousands of informants in just two hours. For a time, Gao Fu and China CDC faced an unprecedented crisis of trust. Some people pointed out that Gao Fu is a virologist and lacks experience in epidemic prevention and public health.

In this regard, Feng Zijian, deputy director of the China Centers for Disease Control and Prevention, explained on January 31 that they obtained the data on January 23, and then did a retrospective analysis. All cases were announced to the public before the paper was written.

Eric Rubin, editor-in-chief of the New England Journal of Medicine and chair of the Department of Immunity and Infectious Diseases at the Harvard School of Public Health, revealed that the paper took only 48 hours from submission to publication. Gao Fu told "China News Weekly", "I just want to find a way to suppress the epidemic now, and I don't want to say anything. Many people go from one extreme to the other. What do you say I say? I will do my best. my job."

In fact, before the publication of the paper by Gao Fu et al., several papers had revealed the possibility of further expansion of the epidemic. On January 24, Huang Chaolin, vice president of Jinyintan Hospital, the designated hospital for Wuhan’s new coronary pneumonia, and others published a paper in The Lancet that pointed out that among the 41 initial cases in Wuhan, 14 had no Huanan seafood. The history of market exposure, and believes that the South China Seafood Market is not the only source of the epidemic. According to the paper, the onset date of the first infected person admitted to Wuhan Jinyintan Hospital can be traced back to December 1, 2019, and there is no history of exposure to the South China seafood market.

This means that the first infection of people may be as early as November last year, and the virus first spread among the population until a cluster outbreak in the Huanan seafood market at the end of December.

According to incomplete statistics, by the end of January, Chinese scientists had published a total of 6 articles in The Lancet and the New England Journal of Medicine on the novel coronavirus pneumonia in Wuhan. Zhang Zuofeng said that the scientific research results of Wuhan pneumonia this time are first-class, and articles have been published in many well-known journals in a very short period of time.

On January 30, the Ministry of Science and Technology of the People's Republic of China issued a document stating, "All project undertaking units and their scientific researchers must adhere to the supremacy of national interests and people's interests, 'write papers on the land of the motherland', and apply research results to epidemic prevention and control. Before the epidemic prevention and control task is completed, we should not focus on publishing papers."

Judging from the actual development of the epidemic, these instructive research data and conclusions were not disclosed to the domestic public in a timely manner, nor were they used in the process of fighting the epidemic in a timely manner. In the government's decision-making process, it is still a mystery as to which link went wrong.

The role of disease control

Equally ambiguous is the role of the CDC in decision-making in this outbreak.

The infectious disease surveillance system, which exposed major problems during SARS, was rebuilt in 2004. Yang Gonghuan, the former deputy director of China CDC, introduced to China News Weekly that the National CDC has established a direct online reporting system, "horizontal to side, vertical to the end" - horizontally covering the whole country, vertically "to the computers of township health centers" You can see this network system in all of them.” As long as infectious cases, including pneumonia of unknown cause, are found, the hospital must report the case directly on this system, and the disease control departments at all levels, including the China Centers for Disease Control and Prevention, can immediately understand the situation. The CDC has a team of people dedicated to monitoring and writing analysis reports every day. Once more than 5 cases of unknown pneumonia are found in one place, the verification mechanism will be automatically triggered: CDC will send people to conduct epidemiological investigations, visit patients, and take samples.

Yang Gonghuan emphasized that this online direct reporting system is not a step-by-step report, but as long as the hospital clicks to report a case in the online system, the CDC should receive it immediately, "In all parts of the country, as long as the lower Report, click, even if it is an example, we can see it on the system for the first time.”

The Wuhan outbreak is a new infectious disease caused by a new virus. Regarding such situations, Li Liming, former director of the China Center for Disease Control and Prevention, also said in an interview with China News Weekly that on December 1, 2004, China revised the Law on the Prevention and Control of Infectious Diseases. In addition to adding "infectious atypical pneumonia" to Category B infectious diseases and preventing and controlling them according to Category A infectious diseases, especially in the scope of infectious diseases that need to be reported, adding "or discovering other infectious diseases" Outbreaks, epidemics, and sudden outbreaks of infectious diseases of unknown cause".

However, real-time monitoring by the disease control department does not mean timely release and timely decision-making. According to the "Law on the Prevention and Control of Infectious Diseases", "When an infectious disease breaks out or becomes popular, the health administrative department of the State Council is responsible for releasing information on the epidemic situation of infectious diseases to the public."

In this regard, Zeng Guang, the chief scientist of China's disease control epidemic, also told "China News Weekly" that China's disease control system only has the "power to work" and can collect and analyze data, but it is not a decision-making body. In contrast, the CDC in the United States is a government department, while the CDC in China is a public institution and has no power. The status of China's disease control in the health system is absolutely weak. You can only talk about the epidemic situation if the government authorizes you to talk about it. The CDC is still mainly doing technical work, and it only has the right to make suggestions on epidemic prevention work, but not to make decisions.

Huang Yanzhong, a professor at the School of Foreign Affairs and International Relations at Seido University and a senior researcher in global health at the Council on Foreign Relations, told China News Weekly that the China CDC is affiliated with the National Health Commission, and is more of a technical and supportive institution. It extends to the county level, but the power is more restricted, and there is no permission to announce the epidemic situation; in contrast, although the US CDC is subordinate to the Department of Health and Human Resources, it has great independent licensing rights, including declaring the epidemic situation, taking necessary measures. measures, etc.

Zhong Nanshan came to Wuhan

January 20 was the turning point of the Wuhan epidemic. On this day, the Wuhan Municipal Health and Health Commission updated the data on the 18th and 19th at one time, adding a total of 136 confirmed patients. In this notification, for the first time, the judgment that "limited human-to-human transmission is not excluded" and "the risk of continuous human-to-human transmission is low" is not mentioned.

A high-level expert group from the National Health Commission headed by Zhong Nanshan, an academician of the Chinese Academy of Engineering, went to Wuhan on January 19 to guide and investigate the epidemic prevention and control work. On the evening of January 20, Zhong Nanshan affirmed the phenomenon of human-to-human transmission of the new coronavirus in the live connection with CCTV's "News 1+1", and said that 14 medical staff were infected while caring for a patient. .

The news quickly ignited public opinion. The Wuhan Municipal Health and Health Commission quickly confirmed in a notification on the 21st that a total of 15 medical staff in the city were diagnosed with pneumonia cases of new coronavirus infection, and another was a suspected case.

On the 21st, Wuhan Mayor Zhou Xianwang explained in an interview with CCTV that the infection of medical staff occurred during the treatment of a brain surgery patient at the Union Hospital affiliated to Huazhong University of Science and Technology. "Because the neurosurgery ignored the patient's infection with this new type of coronavirus before he was admitted to the hospital. So after the operation, the patient developed a fever. At this time, a doctor and 13 nurses were infected."

However, a neurosurgeon from Wuhan Union Medical College posted on social media, "There is no such thing as 'ignorance'!"

69-year-old Zhao Junshi, who has a pituitary tumor, is the brain surgery patient who was treated by Zhou Xianwang. He has no history of contact with the South China seafood market. In December 2019, he was admitted to Wuhan Union Medical College Neurosurgery. Before the operation, the medical staff did not find any respiratory symptoms. "It is normal to have a history of smoking, inflammation in the lungs, or thickening of the lung markings." Therefore, there is hardly any reason to think that the patient should be isolated and the medical staff should be given a tracheotomy. Level 3 protection required only for endotracheal intubation.

The surgery was performed on January 7, 2020. After the operation, Zhao Junshi was transferred to four wards successively. On the 3rd day after the operation, Zhao Junshi developed a lung infection. On the 5th day, he was considered to be "suspected of pneumonia of unknown cause", and many medical staff who were in contact with him also developed fever symptoms one after another. On January 15, Zhao Junshi was diagnosed with new coronary pneumonia.

In the process, 10 neurosurgery nurses and 4 medical staff in pediatric surgery, gynecology, cardiology and cardiology were infected. By January 19, the medical examination center of Wuhan Union Medical College Hospital had been temporarily requisitioned as an "infection ward", and a medical staff isolation room was set up on the 4th floor, where suspected infected medical staff were placed. At the peak, more than 20 medical staff were suspected of being infected. Infect. The doctor Li Wenliang, who was previously identified as publishing false news, was admitted to the respiratory isolation ward on January 14 due to fever, nausea and other symptoms more than ten days after the news was released, and was admitted to the respiratory isolation ward on February 1. Confirmed positive for the new coronavirus.

On January 20, Xi Jinping, General Secretary of the Central Committee of the Communist Party of China, gave important instructions for the first time on the outbreak of pneumonia caused by the new coronavirus. On this day, with the approval of the State Council, the pneumonia caused by the new coronavirus was classified as a Class B infectious disease, similar to SARS, and prevention and control measures for Class A infectious diseases were adopted. But at that time, experts judged that the current epidemic is still "preventable and controllable".

As early as 10 days ago, that is, on January 10, the curtain of the country's annual Spring Festival travel has been opened. On January 20, Shanghai, Beijing, and Guangdong confirmed 1, 5, and 14 cases of new coronary pneumonia respectively. This is the first time that other provinces in the country have reported the epidemic. Almost all of these cases were imported cases, with a history of travel or residence in Wuhan, or close contact with patients. Since January 21, the National Health Commission has started to report new cases across the country on a daily basis.

While the number of cases in Wuhan has increased significantly and the epidemic has begun to spread across the country, large-scale gathering activities in Wuhan are still proceeding step by step. On the afternoon of January 20, the Hubei Provincial Emergency Management Department also held a Spring Festival Gala of "Watering the harvest with sweat and moving forward with hard work".

On January 21, Hubei held a theatrical performance of the provincial Spring Festival troupe at the Hongshan Auditorium in Wuhan. Jiang Chaoliang, Secretary of the Provincial Party Committee and Director of the Standing Committee of the Provincial People's Congress, Wang Xiaodong, Deputy Secretary of the Provincial Party Committee and Governor, and other leaders watched the performance together with representatives from all walks of life in the province. According to the official account of the Hubei Provincial National Song and Dance Troupe, more than 40 cast members of the troupe participated in the performances of several programs. "In Wuhan, everyone wore layers of masks to overcome the panic of pneumonia, and went all out with dedication, perseverance, and seriousness... In Xiaogan, the actors traveled long distances and caught a cold. When they were waiting for the stage, they felt cold all over.

On January 21, the Wuhan Municipal Health and Health Commission conducted two more epidemic notifications, announcing that as of 24:00 on January 20, Wuhan had reported a total of 258 cases of pneumonia caused by new coronavirus infection. On the evening of the 22nd, the Wuhan Municipal Government issued a notice requiring Wuhan citizens to wear masks in public places.

In the early morning of January 22, Hubei Province launched the second-level emergency response to public health emergencies. In contrast, Guangdong Province, which was not the origin of the epidemic, directly launched the first-level emergency response the next day.

Ma Guoqiang, deputy secretary of the Hubei Provincial Party Committee of the Communist Party of China and secretary of the Wuhan Municipal Party Committee, later said in an interview with CCTV, "I am also thinking that if we can take measures earlier, the effect may be better, for example, on January 12th and 13th, the test On Wen's day, can we take measures to control travel by planes, high-speed rails, cars, and ferries like we did on the 23rd? If measures are taken at that time, the epidemic situation may be alleviated, and it will not be the same as it is now. Now I feel a sense of guilt and guilt , self-blame mentality, if severe control measures were taken early, the results would be better than now, the impact on all parts of the country would be smaller, and the Party Central Committee and the State Council would be less worried."

In the early morning of January 23, Wuhan announced the "closure of the city". But Wuhan Mayor Zhou Xianwang said on January 26 that more than 5 million people have left the city due to the Spring Festival and the epidemic.

(Lin Yu and Zhao Jun are actually pseudonyms in the text)​​​

[Editor in charge: Li Zhenyang]