BEIJING – The current speed of new developments in the 2019-nCov outbreak is illustrated by a Jan. 28, 2020, press conference in Munich, where Andreas Zapf, head of the infection task force in the Bavarian ministry for health and food safety, briefed reporters on the first confirmed German case.
“As far as we know currently,” he said, then stopped in mid-sentence, looked at his watch, and emphasized “currently – that is, 10:30 – there are no other individuals with symptoms” connected to the case, which began when an infected but asymptomatic Chinese national traveled to Germany for work, and infected a German colleague.
“You are being informed almost in real time,” Zapf told reporters. “I heard about this case last night at 8:30.”
By Friday, Jan. 31, five confirmed infections had been linked to the same source.
The explosive speed with which outbreaks can spread early accounts for the fact that China’s Center for Disease Control and Prevention (CCDC) found itself under fire for allegedly delaying warning that the coronavirus can be transmitted between humans, until after experts from the agency co-published a paper on the subject in The New England Journal of Medicine (NEJM) on Jan. 29.
The CCDC’s current head, George Gao, along with other experts, analyzed data on the first 425 confirmed cases in the Chinese city of Wuhan. According to the data, the number of cases not linked to the Huanan Seafood Wholesale market, which is believed to be to origin of the outbreak, started to rise after Dec. 29 and reached a peak on Jan. 8. Since Jan. 14, there have been only cases not linked to the market.
Gao and his colleagues wrote that “the majority of the earliest cases included reported exposure to the Huanan Seafood Wholesale Market, but there was an exponential increase in the number of nonlinked cases beginning in late December.”
The rapid expansion of cases suggests that 2019-nCov was being transmitted via human-to-human transmission from very early on.
But Chinese authorities had been reassuring the public that “no evidence of human-to-human transmission has been found” in early and mid-January. Local health authorities in Wuhan reiterated the same message in notices released on Jan. 3, Jan. 5 and Jan. 11.
It wasn’t until Jan. 20 that the public became aware of possible transmission between humans, when Chinese respiratory expert Zhong Nanshan confirmed it in a press conference broadcast nationwide.
Since then, China has been imposing intense measures to curb the spread of the coronavirus, which has already infected 9,810 people globally and killed 213 in China as of Jan. 31.
“Most of us in the biotech sector believe that the [China] CDC did not do what it was supposed to,” Feng Chen, founder of Beijing-based venture capital firm Youxuan Capital, told BioWorld. “This has caused the coronavirus to spread exponentially in China and to overseas.”
“The problem is the CDC had the firsthand data and the resources to collect samples, but it did not put its responsibility [to control the spread of the virus] as priority,” he added.
As outcry arose among the public, the CCDC made a brief statement on Friday to respond to the fierce criticism.
“Our view that human-to-human transmission occurred in December 2019 is based on the retrospective inference we derived from the research data from the 425 cases,” the CCDC said.
“Publishing findings in academic journals helps experts at home and abroad understand the characteristics of the disease in a timely manner, so they can evaluate the situation to come up with better control and prevention solutions,” it added.
“Relevant information should be made public as quickly as possible and not be kept in the dark for reasons of publishing a paper,” Shengjie Qu, investment manager at China Pharmaceutical Biotechnology (Guangzhou) Co. Ltd., told BioWorld. “Efforts shouldn’t be wasted in something other than combating the coronavirus.”
It remains unclear when the paper was submitted to the journal for review. A timeline included in the paper goes up to Jan. 21, meaning the maximum period between submission and publication was eight days, and the paper was submitted after human-to-human transmission had been publicly announced by Zhong Nanshan.
In the academic world, eight days to publication counts as warp speed under most circumstances. In the early days of an emerging infectious outbreak, though, a week can make a big difference in whether it is possible to slow down or even contain an outbreak.
Other researchers have published transmission estimates on the preprint server Biorxiv, which aims to rapidly disseminate important scientific knowledge without undermining the peer review process that assures, however imperfectly, the quality of published scientific research.
Publications and public health
In recent years, China has been boasting about the number of papers published by its scientists in academic journals to demonstrate that the country is advancing in science and technology. There have been concerns that Chinese scientists are chasing published papers numbers instead of doing actual work.
“Publishing papers has become the priority and self-interest is above anything,” said Qu. “Nowadays, the researchers are evaluated based on the number of papers they publish and the impact factors.”
Those priorities may change, at least for the time being, with new knowledge about the virus emerging daily.
In an unusual response on Jan. 29, China’s Ministry of Science and Technology said researchers must put the interest of the country and the patients first and apply research findings in the battle against the coronavirus.
“[The researchers] should not use their energy on publishing papers before the mission to control and prevent the virus is completed,” the Ministry said in a statement.
Compared to the SARS outbreak in 2003, during which Chinese officials were accused of hiding the spread of the virus for months, the Chinese government has been praised by the WHO this time for its openness with respect to the epidemic. The WHO was notified of the emergence of 2019-nCov on Dec. 31.
Given the sequence similarities between viruses isolated from different patients, it is likely that the first human infections occurred in mid-December, showing that the new virus was both noticed almost immediately by public health authorities and reported promptly.
Compared to SARS, this time around the Chinese government has also taken much more prompt measures to curb the spread of the novel coronavirus. It has sealed off cities, imposed travel bans and reported to the public in a more timely manner.
But it remains to be answered as to whether there was a deliberate decision to keep critical information from the public in the early days – or a focus on publications over public health.
“Publishing papers is important as it helps others understand the disease,” Jiawen Han, head of business development (USA) at Qilu Pharmaceutical Co. Ltd., told BioWorld. “But many in the public believe that it shouldn’t be prioritized over taking care of the patients. We don’t know if the CDC had reported to the State Council, or who decided not to tell people the truth.”
But she said she also believed that in China, it would not be up to those researchers to make decisions regarding the release of information and the emergency measures.
“If the CDC felt it was not in its control and that it could only release information by publishing papers, it needs to speak out,” Mingchao Fan, director of arbitration and ADR for North Asia of International Chamber of Commerce, told BioWorld. “Otherwise, it will be the CDC’s fault.”
“Even if someone from a higher level is to blame, the CDC and the local authorities in Wuhan cannot shirk their responsibilities since they had their own agenda, which made them buckle to that person,” he added. “We have seen the consequences of the lack of public openness. This is something that government agencies need to take into account.”