[At critical turning points, Chinese
authorities put secrecy and order ahead of openly confronting the growing
crisis and risking public alarm or political embarrassment.]
By
Chris Buckley and Steven Lee Myers
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|
Officials
at the scene on Thursday where a man collapsed and died on a street near a
hospital in Wuhan. It was unclear
whether he had contracted the coronavirus. Credit Hector Retamal/Agence France-Presse — Getty Images |
WUHAN,
China — A mysterious illness
had stricken seven patients at a hospital, and a doctor tried to warn his
medical school classmates. “Quarantined in the emergency department,” the
doctor, Li Wenliang, wrote in an online chat group on Dec. 30, referring to
patients.
“So frightening,” one recipient replied,
before asking about the epidemic that began in China in 2002 and ultimately
killed nearly 800 people. “Is SARS coming again?”
In the middle of the night, officials from
the health authority in the central city of Wuhan summoned Dr. Li, demanding to
know why he had shared the information. Three days later, the police compelled
him to sign a statement that his warning constituted “illegal behavior.”
The illness was not SARS, but something
similar: a coronavirus that is now on a relentless march outward from Wuhan,
throughout the country and across the globe, killing at least 304 people in
China and infecting more than 14,380 worldwide.
The government’s initial handling of the
epidemic allowed the virus to gain a tenacious hold. At critical moments,
officials chose to put secrecy and order ahead of openly confronting the
growing crisis to avoid public alarm and political embarrassment.
A reconstruction of the crucial seven weeks
between the appearance of the first symptoms in early December and the
government’s decision to lock down the city, based on two dozen interviews with
Wuhan residents, doctors and officials, on government statements and on Chinese
media reports, points to decisions that delayed a concerted public health
offensive.
In those weeks, the authorities silenced
doctors and others for raising red flags. They played down the dangers to the
public, leaving the city’s 11 million residents unaware they should protect
themselves. They closed a food market where the virus was believed to have
started, but didn’t broadly curb the wildlife trade.
Their reluctance to go public, in part,
played to political motivations as local officials prepared for their annual
congresses in January. Even as cases climbed, officials declared repeatedly
that there had likely been no more infections.
By not moving aggressively to warn the public
and medical professionals, public health experts say, the Chinese government
lost one of its best chances to keep the disease from becoming an epidemic.
“This was an issue of inaction,” said
Yanzhong Huang, a senior fellow for global health at the Council on Foreign
Relations who studies China. “There was no action in Wuhan from the local
health department to alert people to the threat.”
The first case, the details of which are
limited and the specific date unknown, was in early December. By the time the
authorities galvanized into action on Jan. 20, the disease had grown into a
formidable threat.
It is now a global health emergency. It has
triggered travel restrictions around the world, shaken financial markets and
created perhaps the greatest challenge yet for China’s leader, Xi Jinping. The
crisis could upend Mr. Xi’s agenda for months or longer, even undermining his
vision of a political system that offers security and growth in return for
submission to iron-fisted authoritarianism.
On the last day of 2019, after Dr. Li’s
message was shared outside the group, the authorities focused on controlling
the narrative. The police announced that they were investigating eight people
for spreading rumors about the outbreak.
That same day, Wuhan’s health commission, its
hand forced by those “rumors,” announced that 27 people were suffering from
pneumonia of an unknown cause. Its statement said there was no need to be
alarmed.
“The disease is preventable and
controllable,” the statement said.
Dr. Li, an ophthalmologist, went back to work
after being reprimanded. On Jan. 10, he treated a woman for glaucoma. He did not
know she had already been infected with the coronavirus, probably by her
daughter. They both became sick. So would he.
Hazmat
Suits and Disinfectants
Hu Xiaohu, who sold processed pork in the
Huanan Seafood Wholesale Market, sensed by late December that something was
amiss. Workers were coming down with nagging fevers. No one knew why but, Mr.
Hu said, several were in hospital quarantine.
The market occupies much of a block in a
newer part of the city, sitting incongruously near apartment buildings and
shops catering to the growing middle class. It is a warren of stalls selling
meats, poultry and fish, as well as more exotic fare, including live reptiles
and wild game that some in China prize as delicacies. According to a report by
the city’s center for disease control, sanitation was dismal, with poor
ventilation and garbage piled on wet floors.
In hospitals, doctors and nurses were puzzled
to see a cluster of patients with symptoms of a viral pneumonia that did not
respond to the usual treatments. They soon noticed that many patients had one
thing in common: They worked in Huanan market.
On Jan. 1, police officers showed up at the
market, along with public health officials, and shut it down. Local officials
issued a notice that the market was undergoing an environmental and hygienic
cleanup related to the pneumonia outbreak. That morning, workers in hazmat
suits moved in, washing out stalls and spraying disinfectants.
It was, for the public, the first visible
government response to contain the disease. The day before, on Dec. 31,
national authorities had alerted the World Health Organization’s office in
Beijing of an outbreak.
City officials struck optimistic notes in
their announcements. They suggested they had stopped the virus at its source.
The cluster of illnesses was limited. There was no evidence the virus spread
between humans.
“Projecting optimism and confidence, if you
don’t have the data, is a very dangerous strategy,” said Alexandra Phelan, a
faculty research instructor in the department of microbiology and immunology at
Georgetown University.
“It undermines the legitimacy of the
government in messaging,” she added. “And public health is dependent on public
trust.”
Nine days after the market closed, a man who
shopped there regularly became the first fatality of the disease, according to
a report by the Wuhan Health Commission, the agency that oversees public health
and sanitation. The 61-year-old, identified by his last name, Zeng, already had
chronic liver disease and a tumor in his abdomen, and had checked into Wuhan
Puren Hospital with a raging fever and difficulty breathing.
The authorities disclosed the man’s death two
days after it happened. They did not mention a crucial detail in understanding
the course of the epidemic. Mr. Zeng’s wife had developed symptoms five days
after he did.
She had never visited the market.
The
Race to Identify a Killer
About 20 miles from the market, scientists at
the Wuhan Institute of Virology were studying samples from the patients
checking into the city’s hospitals. One of the scientists, Zheng-Li Shi, was
part of the team that tracked down the origins of the SARS virus, which emerged
in the southern province of Guangdong in 2002.
As the public remained largely in the dark
about the virus, she and her colleagues quickly pieced together that the new
outbreak was related to SARS. The genetic composition suggested a common
initial host: bats. The SARS epidemic began when a coronavirus jumped from bats
to Asian palm civets, a catlike creature that is legally raised and consumed.
It was likely that this new coronavirus had followed a similar path — possibly
somewhere in or on the way to the Huanan market or another market like it.
Around the same time, Dr. Li and other
medical professionals in Wuhan started trying to provide warnings to colleagues
and others when the government did not. Lu Xiaohong, the head of
gastroenterology at City Hospital No. 5, told China Youth Daily that she had
heard by Dec. 25 that the disease was spreading among medical workers — a full
three weeks before the authorities would acknowledge the fact. She did not go
public with her concerns, but privately warned a school near another market.
By the first week of January, the emergency
ward in Hospital No. 5 was filling; the cases included members of the same
family, making it clear that the disease was spreading through human contact,
which the government had said was not likely.
No one realized, the doctor said, that it was
as serious as it would become until it was too late to stop it.
“I realized that we had underestimated the
enemy,” she said.
At the Institute of Virology, Dr. Shi and her
colleagues isolated the genetic sequence and the viral strain during the first
week of January. They used samples from seven of the first patients, six of
them vendors at the market.
On Jan. 7, the institute’s scientists gave
the new coronavirus its identity and began referring to it by the technical
shorthand 2019-nCoV. Four days later, the team shared the virus’s genetic
makeup in a public database for scientists everywhere to use.
That allowed scientists around the world to
study the virus and swiftly share their findings. As the scientific community
moved quickly to devise a test for exposure, political leaders remained
reluctant to act.
‘Politics
is Always No. 1’
As the virus spread in early January, the
mayor of Wuhan, Zhou Xianwang, was touting futuristic health care plans for the
city.
It was China’s political season, when
officials gather for annual meetings of People’s Congresses — the Communist
Party-run legislatures that discuss and praise policies. It is not a time for
bad news.
When Mr. Zhou delivered his annual report to
the city’s People’s Congress on Jan. 7 against a backdrop of bright red
national flags, he promised the city top-class medical schools, a World Health
Expo, and a futuristic industry park for medical companies. Not once did he or
any other city or provincial leader publicly mention the viral outbreak.
“Stressing politics is always No. 1,” the
governor of Hubei, Wang Xiaodong, told officials on Jan. 17, citing Mr. Xi’s
precepts of top-down obedience. “Political issues are at any time the most
fundamental major issues.”
Shortly after, Wuhan went ahead with a
massive annual potluck banquet for 40,000 families from a city precinct, which
critics later cited as evidence that local leaders took the virus far too
lightly.
As the congress was taking place, the health
commission’s daily updates on the outbreak said again and again that there were
no new cases of infection, no firm evidence of human transmission and no
infection of medical workers.
“We knew this was not the case!” said a
complaint later filed with the National Health Commission on a government
website. The anonymous author said he was a doctor in Wuhan and described a
surge in unusual chest illnesses beginning Jan. 12.
Officials told doctors at a top city hospital
“don’t use the words viral pneumonia on the image reports,” according to the
complaint, which has since been removed. People were complacent, “thinking that
if the official reports had nothing, then we were exaggerating,” the doctor
explained.
Even those stricken felt lulled into
complacency.
When Dong Guanghe developed a fever on Jan. 8
in Wuhan, his family was not alarmed, his daughter said. He was treated in the
hospital and sent home. Then, 10 days later, Mr. Dong’s wife fell ill with
similar symptoms.
“The news said nothing about the severity of
the epidemic,” said the daughter, Dong Mingjing. “I thought that my dad had a
common cold.”
The government’s efforts to minimize public
disclosure persuaded more than just untrained citizens.
“If there are no new cases in the next few
days, the outbreak is over,” Guan Yi, a respected professor of infectious
diseases at the University of Hong Kong, said on Jan. 15.
The World Health Organization’s statements
during this period echoed the reassuring words of Chinese officials.
It had spread. Thailand reported the first
confirmed case outside China on Jan. 13.
A
City Besieged
The first deaths and the spread of the
disease abroad appeared to grab the attention of the top authorities in
Beijing. The national government dispatched Zhong Nanshan, a renowned and
now-semiretired epidemiologist who was instrumental in the fight against SARS,
to Wuhan to assess the situation.
He arrived on Jan. 18, just as the tone of
local officials was shifting markedly. A health conference in Hubei Province
that day called on medical workers to make the disease a priority. An internal
document from Wuhan Union Hospital warned its employees that the coronavirus
could be spread through saliva.
On Jan. 20, more than a month after the first
symptoms spread, the current of anxiety that had been steadily gaining strength
exploded into public. Dr. Zhong announced in an interview on state television
that there was no doubt that the coronavirus spread with human contact. Worse,
one patient had infected at least 14 medical personnel.
Mr. Xi, fresh from a state visit to Myanmar,
made his first public statement about the outbreak, issuing a brief set of
instructions.
It was only with the order from Mr. Xi that
the bureaucracy leapt into action. At that point the death toll was three; in
the next 11 days, it would rise above 200.
In Wuhan, the city banned tour groups from
visiting. Residents began pulling on masks.
Guan Yi, the Hong Kong expert who had earlier
voiced optimism that the outbreak could level off, was now alarmed. He dropped
by one of the city’s other food markets and was shocked by the complacency, he
said. He told city officials that the epidemic was “already beyond control” and
would leave. “I hurriedly booked a departure,” Dr. Guan told Caixin, a Chinese
news organization.
Two days later, the city announced that it
was shutting itself down, a move that could only have been approved by Beijing.
In Wuhan, many residents said they did not
grasp the gravity of the epidemic until the lockdown. The mass alarm that
officials feared at the start became a reality, heightened by the previous
paucity of information.
Crowds of people crushed the airport and
train stations to get out before the deadline fell on the morning of Jan. 23.
Hospitals were packed with people desperate to know if they, too, were
infected.
“We didn’t wear masks at work. That would
have frightened off customers,” Yu Haiyan, a waitress from rural Hubei, said of
the days before the shutdown. “When they closed off Wuhan, only then did I
think, ‘Oh, this is really serious, this is not some average virus.’”
Wuhan’s mayor, Zhou Xianwang, later took
responsibility for the delay in reporting the scale of the epidemic, but said
he was hampered by the national law on infectious diseases. That law allows
provincial governments to declare an epidemic only after receiving central
government approval. “After I receive information, I can only release it when
I’m authorized,” he said.
The official reflex for suppressing
discomforting information now appears to be cracking, as officials at various
levels seek to shift blame for the government’s response.
With the crisis worsening, Dr. Li’s efforts
are no longer viewed as reckless. A commentary on the social media account of
the Supreme People’s Court criticized the police for investigating people for
circulating rumors.
“It might have been a better way to prevent
and control the new coronavirus today if the public had believed the ‘rumor’
then and started to wear masks and carry out sanitary measures and avoid the
wild animal market,” the commentary said.
Dr. Li is 34 and has a child. He and his wife
are expecting a second in the summer. He is now recovering from the virus in
the hospital where he worked. In an interview via text messages, he said he
felt aggrieved by the police actions.
“If the officials had disclosed information
about the epidemic earlier,” he said, “I think it would have been a lot better.
There should be more openness and transparency.”
This article is based on reporting and
research by Elsie Chen, Sheri Fink, Claire Fu, Javier Hernandez, Zoe Mou, Amy
Qin, Knvul Sheikh, Amber Wang, Yiwei Wang, Sui-Lee Wee, Li Yuan, Albee Zhang
and Raymond Zhong.
