By Norihide Miyazaki and Ya-Jung Chih

Since it’s first announcement on New Year’s Eve 2019, this coronavirus has spread worldwide. The fact that the beginning was in China is still fresh in many people’s minds. How did China cope with and report on the disease at that time? 

On January 5, 2020, Wuhan Municipal Health Commission released the following statements.

1. By 8 a.m. on the same day, there were 59 patients diagnosed with viral pneumonia of unknown cause.
2. The earliest disease onset was December 12, 2019, of which seven were seriously ill and no deaths were reported.
3. The latest disease onset was December 29. Some of the patients are the staff of South China Seafood Wholesale Market whose close contacts were 163 people who have already been placed under medical observation. There is no clear evidence of human-to-human transmission (from shopkeepers in the market).
4. There is no infection of medical personnel.
5. Pathogens such as influenza, avian flu, adenovirus infection, SARS, and MARS which cause respiratory disease, have been excluded.

On January 9, China Central Television, Xinhua News Agency, and other state-owned media reported that a pneumonic pathogen of unknown cause had been identified as a new form of coronavirus. In China, this can be considered almost identical to an official CCP announcement. The Xinhua News report was as follows.

As regards to the unknown viral pneumonia outbreak in Wuhan, Hubei Province, Xu Jianguo, leader of a team of experts and a member of the Chinese Academy of Engineering, said the results of pathogenicity tests have provisionally determined that a new type of coronavirus is the pathogen behind this pneumonia.

This team of experts detected a new type of coronavirus in the laboratory by 9:00 p.m. on January 7, and obtained the whole genome of the virus. The whole genome of the virus was then sequenced, and 15 positive cases were detected via nucleic acid test. The virus isolated from a sample of a positive patient was observed under an electron microscope, where its morphology confirmed it was a typical coronavirus.

Following the January 5th report, Wuhan Municipal Health Commission released another statement on the coronavirus on January 11, after the identification of a new coronavirus’s pathogen by those experts. 

The announcement on January 11 began as follows.

After the identification of the new coronavirus as the pathogen of “viral pneumonia of unknown cause, ” National, provincial and municipal professional groups immediately revised and improved their diagnosis and measurement methods of viral pneumonia of unknown cause.

In addition to the report on the infection, the first deaths were also announced. 

1. By 24:00 midnight on January 10, forty-one people have been infected, two have been discharged from the hospital, seven are in critical condition and one has died.
2. 739 close contacts, of which 419 are health care workers, are currently under medical observation. No cases were found.
3. Patients are mainly owners and buyers of South China Seafood Wholesale Market. This market was closed on January 1, and infection prevention guidance and hygiene control were strengthened in all public areas, especially in farmers’ markets.
4. No new cases have been identified since January 3. No clear evidence of person-to-person or infection among health care workers has been detected. 

The number of infected patients was revised from 59 to 41 between January 5 and 11, because of the (Wuhan Municipal Health Commission’s) “revised and improved” diagnosis and other methods following the identification of the new coronavirus. However, there is no explanation as to why the reduced number of 18 people were treated as pneumonia patients of unknown cause.

On that same day, apart from the announcement on the situation of the infection, there was another report titled “Experts Explain the Latest Notifications of Viral Pneumonia of Unknown Cause”. The report provided further details on the symptoms of infected patients and changes in the condition of deceased patients in a question-and-answer format, as follows.

Q: How was this infectious disease case diagnosed?

A: Through comprehensive prognosis based on the patient’s clinical presentation, epidemiological history, and laboratory results of the pathogen.

Q: What are the clinical characteristics of this outbreak?

A: The general clinical symptoms such as fever, malaise, dry cough, and dyspnea is common seen in hospitalized patients. The vital signs of the majority of patients are stable upon admission.

Q: There is currently one case of death, but what exactly is the case?

A: The patient, a 61-year-old male, was hospitalized for respiratory failure, severe pneumonia, abdominal tumor, and a chronic liver disease. The patient had been purchasing goods from the South China Seafood Market in Wuhan for many years. After admission, the patient was administered symptomatic treatments, anti-infection drugs, ventilator support, and continuous extracorporeal oxygenation (ECMO) life support, but his symptoms did not improve and he died of cardiac arrest on the night of January 9, 2020. Pathogenic testing came back positive with the new coronavirus nucleic acid. The diagnosis of death was severe pneumonia, acute respiratory distress syndrome, septic shock, multiple organ failure, severe acid-base metabolism disorder, and liver cirrhosis. The direct cause of death was respiratory and circulatory failure.

Q: What do you mean by “no new cases have been identified since January 3, 2020”?

A: According to epidemiological investigations by national, provincial and municipal experts, all viral pneumonia of unknown cause in Wuhan City occurred between December 8, 2019 and January 2, 2020. Since January 3, 2020, no new cases of infection have been found, according to the results of clinical and epidemiological investigations.

Q: What do you mean by “there is no clear evidence of human-to-human transmission”?

A: Epidemiological investigations by national, provincial, and municipal experts indicate that many of the people who developed viral pneumonia of unknown cause in Wuhan had a history of visits to seafood markets in southern China, and so far no clear evidence of person-to-person transmission has been found. Further epidemiological investigations and related clinical tests are still being conducted. In addition, all close contacts, including health care workers, have not been found to have developed the disease to date.

The assessment that “no clear evidence of person-to-person transmission has been found” was used repeatedly. It is now a well-known fact that the new coronavirus is highly contagious from person to person. In this regard, the announcement by Wuhan Municipal Health Commission perpetrated a false impression of the new coronavirus.

The original article in Japanese is here.

(To be continued)