Beijing’s attempt to find a line between warning the public and avoiding panic set the stage for a pandemic that has infected nearly two million people and claimed more than 126,000 lives.
In the six days after leading Chinese officials secretly concluded that they were likely facing a pandemic of a new coronavirus, the city of Wuhan, in the center of the outbreak, hosted a huge banquet for tens of thousands of people, and millions of travelers began to scroll for Lunar New Year celebrations.
President Xi Jinping warned the population on the seventh day, on January 20. But by then, more than 3,000 people had become infected during nearly a week of silence from authorities, according to internal documents accessed by The Associated Press and estimates based on retrospective infection data.
The delay between January 14 and 20 was not the first mistake made in managing the outbreak by Chinese authorities at all levels, nor was it the largest delay, as governments around the world took weeks and even months to complete. respond to the virus.
However, that delay in the first country to deal with the new coronavirus came at a critical moment: the start of the outbreak. Beijing’s attempt to find a line between warning the public and avoiding panic set the stage for a pandemic that has infected nearly two million people and claimed more than 126,000 lives.
However, another epidemiologist, Benjamin Cowley of the University of Hong Kong, noted that it may have been difficult to determine. If the health authorities raise the alarm too soon, he explained, they can damage their credibility by understanding that they have overreacted, impairing their ability to mobilize people.
The Chinese government’s six-day delay in Beijing followed nearly two weeks during which the national center for Disease Control registered no new cases, according to internal bulletins to which AP had access. However, in that period between January 5 and 17, hundreds of patients came to hospitals not only in Wuhan – which came out of isolation last week – but across the country.
The first warnings were silenced by the strict control of information in China, the bureaucratic obstacles and the repairs in the official ladder to give bad news to the superiors. Without those internal reports, it took the first case outside of China to appear on Jan. 13 in Thailand for leaders in Beijing to recognize the possible pandemic before Thai authorities.
The Chinese government has insisted that it withheld no information in the first few days, claiming that it immediately reported the outbreak to the World Health Organization.
“The allegations of concealment or lack of transparency in China have no basis,” Foreign Ministry spokesman Zhao Lijian said at a press conference on Thursday.
The documents show that the head of the Chinese National Health Commission, Ma Xiaowei, painted a bleak picture in a confidential conference call on January 14 with provincial health officials. An internal bulletin notes that the conference call was held to broadcast instructions from the president, Xi Jinping, the prime minister, Li Keqiang, and the deputy prime minister, Sun Chunlan, but does not detail what those instructions consisted of.
“The epidemic situation remains serious and complex, the most serious challenge since SARS in 2003, and is likely to become a major public health episode,” Ma said, according to the document.
In a faxed statement, the National Health Commission said China released information on the outbreak “openly, transparently, responsibly and in a timely manner” according to successive “important instructions” by President Xi.
The documents came from an anonymous source in the medical field, who did not want to be identified for fear of retaliation. AP confirmed the content of the files with two other public health sources familiar with the conference call.
In a section titled “Serene Understanding of the Situation,” the bulletin mentions the case in Thailand, noting that the situation has “been significantly changed” by the possible spread of the virus abroad.
“All nationalities must prepare to respond to a pandemic,” added the text.
The National Health Commission distributed a 63-page manual to provincial medical managers, which AP had access to . The instructions, which include a warning against publication, directed provincial officials to identify possible cases, open units for fever patients in hospitals, and have doctors and nurses use protective equipment.
However, authorities continued to downplay the threat in their public statements.
“The risk of sustained human-to-human transmission is low,” said Li Qun, head of the Chinese Center for Disease Control’s emergency center, speaking to state television on January 15.
The new rules meant that on January 16, authorities in Wuhan and elsewhere finally received test kits approved by the Center for Disease Control and were able to start confirming new cases. Then dozens of suspected cases began popping up across the country, in some cases from patients who had been infected before but had not been tested.
On January 20, Xi made his first public statements about the virus, stating that the outbreak “must be taken seriously.” A leading epidemiologist, Zhong Nanshan, first announced that the virus was contagious to humans on national television.
This delay could fuel accusations by United States President Donald Trump that the Chinese government’s secrecy delayed the global response to the virus. However, even that public announcement on January 20 left the United States nearly two months to prepare for the pandemic, a time the United States wasted.
Some health experts noted that Beijing took decisive action given the information available to it.
“They may not have said the right thing, but they were doing the right thing,” said Ray Yip, founder of the China office of the US Centers for Disease Control and who is now retired. “On the 20th they raised the alarm throughout the country, which is not an unreasonable delay.”
However, others noted that advancing the warning would have saved lives. If the population had been alerted a week before to practice social distancing, wear face masks and educate their movements, the cases could have been reduced by two thirds, according to a later study.
“The sooner you act, the easier it is to control the disease,” said Los Angeles epidemiologist Zhang.