How the Coronavirus outbreak started in China’s Wuhan, and how it spread to become a Global Pandemic

An excerpt from "The Coronavirus: What You Need To Know About The Global Pandemic", the first book that addresses the history, evolution, facts and myths around the pandemic.

Located in central China, 650 miles south of Beijing and 430 miles west of Shanghai, Wuhan has a rich cultural history spanning over 3500 years. Strategically positioned at the intersection of the Yangtze river and its most important tributary, the Han, Wuhan has been an important transportation hub over centuries, much like Chicago is to the US. Most of China’s major train routes pass through the city. Wuhan Tianhe International Airport is the only airport in the central mainland to have direct flights to five continents and over 120 destinations. It is also well connected by highways throughout the country’s nine provinces.

Wuhan is known for science, technology and education. It is home to eighty-four institutes of higher education, attracting students nationally and internationally, next only to Beijing. Steel and manufacturing industries attract immigrant workers from across the country. Wuhan’s designers take pride in designing about 50 per cent of the world’s long-span bridges and about 60 per cent of China’s high-speed railways.

Anticipation of the weeklong holiday marking the Chinese Lunar New Year in January makes workers toil harder through the months of November and December. Red ornaments and decorations start surfacing across public places in eager preparation for the celebrations. With the festivities scheduled to begin on 17 January 2020, the last quarter of 2019 was no different. Everyone was looking forward to wrapping up work and going back to the family, an indulgence many Chinese citizens enjoy just once a year.

This was the case at Huanan Seafood Market in Jianghan district. With a retail space of over 50,000 square metres, this is the largest wholesale seafood market in all of central China. With over a thousand vendors, stalls are compactly packed together in the market complex. Along with seafood, other animal products were also sold, some of which were illegally traded after being smuggled from overseas. Over 120 wild animals were sold in this market, including donkeys, sheep, pigs, camels, foxes, pangolins, badgers, bamboo rats, bats and hedgehogs, and reptiles such as snakes.

Chinese dietary habits include consuming exotic animal meat purchased from wet markets, where the live animal is inspected before being slaughtered. Floors are heaped with discarded remains of the butchered animals, which are delicacies for stray dogs. Table tops are covered in pools of blood and other animal fluids. Nearby are the live animal, awaiting customers’ inspection. Fish make their struggle apparent by splattering water in shallow tubs. It is, indeed, a wet market. The skinning and cleaning of slaughtered animals, in the presence of live animals, humans and stray dogs, create ideal circumstances for infections to pass between different animals, or between animals and humans.

Amidst the banter, bargaining and the sale of animal products, sometime in mid-November, a virus made the leap from animals to patient zero, a hitherto unidentified human. Over the next few weeks, it spread to dozens of individuals. There are accounts of patients reporting symptoms as early as 8 December 2019. As multiple reports of unexplained pneumonia cases surfaced, health authorities alerted the Chinese officials, but were silenced. One amongst these was Dr Li Wenliang, a thirty-four-year-old eye specialist who noticed that the hospital he worked at was quarantining several patients with SARS-like symptoms. The Communist Party of China came down heavily on any citizen who deviated from the official narrative. They wanted to control the information available to people.

Finally, with the situation growing out of control, the Chinese authorities announced the illness to the world on 31 December 2019, roughly six weeks after the first animal-to-human transmission. Compared to the SARS outbreak of 2002–03, where China concealed the epidemic for almost three months, this was a relatively prompt response.

On 1 January 2020, the US CDC identified that a wet animal’s market was responsible for the outbreak. Chinese officials reported that over half of these pneumonia cases traced back to the Huanan Seafood Market and immediately downed shutters. By the first week of January, hospitals in Wuhan were already reaching capacity. Meanwhile, Chinese authorities downplayed the situation to their citizens and citizens were comforted that the situation was under control. In the absence of adequate information about the virus, the WHO, on 5 January, issued a statement encouraging global travel and trade to continue with China. These initial lapses resulted in insufficient precautionary and preventive measures, and jeopardized medical personnel and the public.

The official numbers started rolling out on 6 January. Chinese authorities claimed sixty people were infected with seven critical cases. Data suggested this was a new virus. Bird flu, seasonal flu, SARS and MERS were ruled out. Next day, Chinese authorities identified a new coronavirus and temporarily named it 2019-nCoV. Within two days, China released the virus’s genome sequence to the world and confirmed that it was a zoonotic disease, transmitted to humans by animals.

On 11 January, China reported fresh numbers that baffled the world. It dropped its infected cases down to forty-one, as opposed to its earlier count of sixty while reporting the first death. Amidst reports of four suspected cases at Thailand’s Chiang Mai International Airport a few days before this announcement, the reduced numbers did not add up. Soon, Thailand and Japan confirmed cases of coronavirus in people who had recently returned from Wuhan, suggesting that the virus had commenced its international journey.

The first patient to have died from 2019-nCoV was a sixty-one-year-old male who frequented the Huanan Seafood Market and suffered chronic liver disease and abdominal tumours. A second death was reported nearly a week later. As more cases of death poured in, the picture became clearer— this virus was most ruthless with the elderly, the weak and those chronically ill.

By 20 January, China announced over 200 infected cases and three deaths due to the virus, unleashing fear and panic. In over three weeks, there was still no information on the origins of the virus. For the first time, a Chinese expert revealed that fourteen medical workers had been infected by a single patient, suggesting high rates of human-to-human transmission of the virus. This was confirmed when, over the next ten days, eighteen countries reported confirmed cases, including South Korea, US, Australia, Singapore, Canada, Nepal, Mexico, France, Taiwan, Sri Lanka and India.

A few days short of the country’s grandest festivities, Chinese President Xi Jinping announced a nationwide effort to contain the virus. By 22 January, in just two days, the numbers had more than doubled, with 500 infected cases and seventeen deaths in the country. Immediately, China’s Henan province, neighbouring Hubei province, announced a ban on the sale of live poultry. Next day, Beijing officially cancelled all Chinese New Year celebrations. Travel to and from Wuhan, Huanggang and Ezhou was banned. Wuhan’s three main railway stations, its thirteen bus stations, 251 ferry services, most of the city bus lines and its entire subway network services were suspended indefinitely. Major highways were blocked and the military took over. The transmission rate was estimated at 1.4–2.5 per infected patient. The only way to control the epidemic was to impose quarantine. Travel restrictions were placed on seven more cities.

But it was already too late. In the weeks before the travel ban, many thousands had already travelled overseas, a trend commonly seen that time of the year in China. In the eight-hour window between the announcement and implementation of the ban, millions of Chinese fled the city to be with their families for the Lunar New Year. Wuhan Railways reported that over 300,000 people had travelled out of Wuhan on 22 January itself, many of whom may have been infected and carried the virus with them. The Lancet estimated that over 5 million people left Wuhan before the citywide quarantine.

On 24 January, the eve of the Chinese New Year, 450 military medical staff entered Wuhan. Trained in combating viral respiratory infections like SARS and Ebola, they were sent by the Communist Party of China to contain the situation. Many international stores including Starbucks and McDonald’s shut down in Hubei. The streets were empty, and the red decorations and ornaments put up across the streets served as ominous reminders of the havoc the virus was causing. With more cities being mass quarantined, an area twice the size of Portugal containing about 60 million people became a ghost town.

The Chinese New Year came bearing sad news. Of the 1320 confirmed cases globally, 1297 were from China; fifty-six nationwide deaths were reported by the end of that day. All trade in wild animals was banned in the country. Chinese researchers and physicians were trying all treatment options, from traditional Chinese medicines to HIV drugs. It became clear that people could infect others while being asymptomatic themselves, which made it even harder to contain the virus. The number of people infected was doubling every 6.4 days.

As the number of cases increased, so did the pressure on the hospitals. Wang Zhen, a philosophy professor, in an interview with National Geographic described his experience at ground zero. At home, Wang experienced raging fever and felt he was about to die. He tried to contact medical emergency services, but received no response. Finally, desperate and despondent, he turned to social media for help. Hours following his failed attempts, an ambulance took him to Tianyou Hospital. Fortunately, he had no signs of a respiratory infection.

However, Wang was one among the many patients with other illnesses who struggled to get medical attention. Even if patients somehow reached hospitals, there were long queues and overcrowded lobbies, with hundreds of sick patients in close proximity. The hospitals themselves were hotspots for the spread of the infection. All beds being taken, thousands were sent back. Those suspected of mild symptoms were asked to quarantine themselves at home, without elaborate details on precautionary measures to be undertaken. Infections between family members became rampant.

Chinese authorities swiftly mobilized national resources. In Wuhan, over 6000 workers constructed a 1000-bed hospital to treat 2019-nCoV-infected patients in ten days. By 3 February, Huoshenshan Hospital was up and running, admitting its first patient. Two major stock exchanges, Shanghai and Shenzhen, were suspended on 28 January to prevent citizens from panic selling stocks.

Various restrictions were placed on citizens in different regions. These ranged from random temperature screenings on the road, to regular screenings at the lobby of each building in high-risk areas, to house arrest. In most of Hubei, only one member of each family could go out once in two days to purchase basic necessities. Schools and offices were indefinitely suspended. The police were seen enforcing the quarantine, with their eyeglasses and masks as armour. The only visible vehicles were military trucks transporting food, medicine and hospital supplies. By February, Vice Premier Sun Chunlan ordered door-to-door checks, rounding up of the sick and warehousing them in massive quarantine centres. Drones and robots disinfected spaces.

The Chinese government was setting restrictions and control that were impossible for most countries to implement. These actions, while containing the spread, had devastating effects on many people. Li Jing, a professor at Zhejiang University, Hangzhou, could not take her husband, who had choked on a fishbone, to a hospital. Her neighbourhood permitted only one family member to leave the house each day. Had she not convinced the officials that night, she might have lost her husband. Yan Cheng, a teenager with severe cerebral palsy, was separated from his father and younger brother who were taken into quarantine. Unable to move, talk or care for himself, he was left under the care of village cadres and doctors. On 28 January, his father took to Weibo, the Chinese version of Twitter, writing that his son was alone and needed care. Censors deleted the message. A day later, Yan Cheng died.

While families in Wuhan faced personal crises, WHO officials held regular meetings in Geneva between 22 and 31 January to assess the global situation. On 26 January, as the numbers were updated, the WHO changed the global risk of this epidemic from moderate to high. Meanwhile, scientists and researchers across the world worked together to combat the virus. Many countries including US, Japan, France, Spain, Portugal and India evacuated their citizens from Wuhan. Many countries issued a temporary ban on Chinese visitors from Hubei province, while others cancelled visa on arrival for Chinese citizens. Others, including Australia and India, barred entry to foreign nationals who had recently visited China. Airlines and cruise operators suspended operations to China. By the end of January, Russia, Mongolia and Singapore closed borders with China. Finally, on 30 January 2020, with 7818 cases of infection and 170 deaths worldwide, and the virus in nineteen countries, the WHO declared a global health emergency.

Excerpted with permission from The Coronavirus: What You Need To Know About The Global Pandemic, Dr. Swapneil Parikh, Maherra Desai, Dr. Rajesh Parikh, Penguin Ebury Press. Read more about the book here and buy it here.

 

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Dr. Swapneil Parikh, Maherra Desai & Dr. Rajesh Parikh