BEIJING – It was almost the Lunar New Year and Pan Chuntao was feeling festive.
He knew there were reports of a virus in his city, Wuhan. But local officials urged calm. There was no evidence it was transmitted person to person, they said. They had not reported a new case in days.
On Jan. 16, the 76-year-old left his apartment to attend a government-organized fair. “We told him not to go because we saw some rumors on WeChat of doctors getting infected,” said Pan’s son-in-law, Zhang Siqiang. “But he insisted on going. He said, ‘The government says it’s not a problem, there are no cases anymore.’ ”
Pan and his daughter may now be among the more than 14,000 people infected with a new strain of coronavirus — an outbreak that has killed at least 304 people in China, spread to more than 20 countries, disrupted the global economy and left 55 million people in China’s Hubei Province under an unprecedented lockdown.
Pan was one of millions of Chinese who mingled, traveled and carried on with daily life during the critical period from mid-December to mid-January.
It was a time when Chinese officials were beginning to grasp the threat of a contagious new disease but did little to inform the public — even with the approach of the Lunar New Year that has hundreds of millions of Chinese traveling.
An analysis of those early weeks — from official statements, leaked accounts from Chinese medical professionals, newly released scientific data and interviews with public health officials and infectious disease experts — reveals potential missteps by China’s overburdened public health officials.
It also underscores how a bureaucratic culture that prioritized political stability over all else likely allowed the virus to spread farther and faster.
“It’s clear that a much stronger public health system could save China lives and money,” said Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention.
In 2002, China suffered an outbreak of severe acute respiratory syndrome (SARS) that was caused by a genetically similar coronavirus, which sickened more than 8,000 people and killed nearly 800 as it spread to more than two dozen countries. China’s government, which was blamed for covering up cases and reacting slowly, vowed to learn from its mistakes and established a surveillance system to quickly react to new pathogens.
Parts of that system — namely Chinese science — held up well in the past two months. But obfuscation from public health officials and other government missteps show a more rigid and authoritarian system than in 2002.
Medical professionals who tried to sound an alarm were arrested. Key state media omitted mention of the outbreak for weeks. Cadres focused on maintaining stability — and praising party leader Xi Jinping — as the crisis worsened.
“China’s public health system has modernized, but China’s political system hasn’t,” said Jude Blanchette, head of China studies at the Center for Strategic and International Studies in Washington.
In mid-December, patients in Wuhan presented with what seemed like a mix of wintry symptoms: fever, trouble breathing, coughs.
It looked like viral pneumonia. But doctors in Wuhan, a city of 11 million in central China, could not pinpoint the cause. Rumors of a mysterious virus started to swirl on Chinese social media, particularly among medical professionals.
It is clear now that Chinese officials knew something was amiss. An account published Thursday on Chinese news sites by an anonymous technician who claimed to work at a lab contracted by hospitals said his company had received samples from Wuhan and reached a stunning conclusion as early Dec. 26. The samples contained a new coronavirus with an 87% similarity to SARS.
A day later, lab executives held urgent meetings to brief Wuhan health officials and hospital management, the technician wrote.
Scientists outside China would later confirm that the genetic sequence bore a striking resemblance to that of SARS. By Dec. 30, word was beginning to get out.
At 5:43 p.m., Li Wenliang, an ophthalmologist at Wuhan Central Hospital, told his fellow medical school alumni in a private chat that seven people had contracted what he believed to be SARS, and one patient was quarantined.
He posted a snippet of an RNA analysis finding “SARS coronavirus” and extensive bacteria colonies in a patient’s airways.
That same evening, Wuhan’s public health authorities took action. The health commission sent an “urgent notice” to all hospitals about the existence of “pneumonia of unclear cause” — but omitted any mention of SARS or a coronavirus — and ordered all departments to immediately compile information about known cases and report them up their chain of command.
The first official reports of a mysterious outbreak in Wuhan came Dec. 30, when Chinese authorities confirmed that they were investigating 27 cases of viral pneumonia.
Wuhan health officials linked the outbreak to the Huanan Seafood Wholesale Market, where shoppers look for all manner of live animals — and quickly shut it down.
Chinese officials began looking for others who may have been sickened, but they were focused on people with pneumonia and had some connection to the seafood and animal market. They were not looking for people with broader respiratory illnesses.
Only later would scientists and officials suspect that many others were infected. But they had milder illnesses and were released after some medical care, allowing the virus to further spread, experts said.
Chinese scientists would later confirm that “the apparent presence of many mild infections” posed a challenge to controlling the outbreak, according to a study published Thursday in the New England Journal of Medicine.
On Dec. 31, the Chinese informed the World Health Organization’s China Country Office of Wuhan’s mysterious pneumonia cases. WHO officials sent Beijing a list of questions about the outbreak and offered assistance.
While scientists and public health experts scrambled to collect more information, China’s security services tried to smother it.
On Jan. 1, the Wuhan Public Security Bureau summoned eight people for posting and spreading “rumors” about Wuhan hospitals receiving SARS-like cases — detentions that were reported on “Xinwen Lianbo,” a newscast watched by tens of millions.
The police followed up in the state-run Xinhua News Agency with a chilling warning. “The police call on all netizens to not fabricate rumors, not spread rumors, not believe rumors.”
All eight people detained that day were doctors, including Li, the Wuhan ophthalmologist.
Wang Guangbao, a surgeon and popular science writer in eastern China, later said speculation about a return of a SARS-like virus was rampant around Jan. 1 within medical circles, but the detentions dissuaded many, including himself, from speaking openly about it.
“The eight posters getting seized made all of us doctors feel we were at risk,” he said.
Chinese scientists raced to decode the virus. On Jan. 9, with 59 cases, China announced that it had isolated and obtained the genome sequence of the new form of coronavirus, confirming rumors that the mystery ailment was linked to SARS and Middle East respiratory syndrome (MERS).
They sequenced the virus genome and posted it on a publicly accessible genetic data repository, allowing scientists to quickly develop tests to confirm infections.
Their work garnered praise from scientists and public health experts around the world — but there was information missing.
Epidemiologists need to know the details about when people get sick, what their symptoms are, and other demographic characteristics, such as age, gender, and underlying medical conditions that might make them at higher risk for respiratory diseases.
But key information about who got sick and when was not released publicly until weeks later.
The NEJM study of the first 425 patients in Wuhan who became sick between Dec. 10 and Jan. 4 revealed long delays for patients to get admitted to hospitals. Those delays indicate how hard it was to identify and isolate cases earlier in their illness, according to the study, which was led by researchers at China’s Center for Disease Control and Prevention. Person-to-person spread occurred as early as mid-December, and cases were doubling every seven days.
Yet in Wuhan, local cadres were focused on a dayslong Communist Party conclave set to run from Jan. 11 to 17. During that time, the Wuhan Health Commission each day claimed there were no new infections or deaths.
Then, on Jan. 18, the commission announced the existence of four new infections. Still, officials downplayed the risk of human-to-human transmission.
Even after cases were being reported in Thailand and South Korea, Wuhan officials organized holiday shopping fairs like the one Pan visited. They held a downtown community potluck attended by as many as 40,000 families.
“Everything was down to not collecting cases, not letting the public know,” said Dali Yang, a prominent scholar of China’s governance system at the University of Chicago. “They were still pushing ahead, wanting to keep up appearances.”