Revealed: Inside Wuhan’s failed Covid response – and how the pandemic could have been avoided

Members of staff of the Wuhan Hygiene Emergency Response Team drive their vehicle as they leave the closed Huanan Seafood Wholesale Market in the city of Wuhan, in Hubei, Province on January 11, 2020
The book draws the devastating conclusion that the pandemic, which started in Wuhan, was not inevitable - AFP/NOEL CELIS
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The pandemic that killed millions and wreaked havoc on the global economy could have been contained within the first weeks of January 2020 if not for mistakes made by the Chinese authorities, according to a damning new book due to be released on Friday.

‘Wuhan: How the Covid-19 Outbreak in China Spiraled Out of Control’, by Prof Dali Yang, a leading authority on the Chinese political system, charts in forensic detail the key weeks, events and mistakes that preceded the imposition of lockdown in the eastern Chinese city in late January.

This includes a mass banquet, held on January 18, just days before Wuhan was sealed off, that brought together more than 100,000 people – despite knowledge among health officials at the time that the virus was spreading between humans.

The book offers a dispassionate and chronological analysis of who knew what and when about the emerging SARS-related virus, but avoids accusations of a grand, top-down conspiracy by Beijing and barely touches on the heated debate over the origins of Covid-19.

Instead, it builds a very human picture of pockets of individual heroism mingled with flawed decision-making and deliberate obfuscation as doctors, epidemiologists, lab workers, and local and national politicians grappled with the appearance of a mysterious “pneumonia of unknown etiology” in real time.

The blow-by-blow account, starting with the first known patients in the last few days of December 2019, through to the shock lockdown of the city of 11 million a month later, draws the devastating conclusion that the pandemic, with an estimated global death toll of 13.3 to 16.6 million, was not inevitable.

“I do think there was a meaningful chance that the pandemic could have been avoided,” said Prof Yang, a political scientist at the University of Chicago, in a Telegraph interview this week.

He believes the Chinese health authorities were dealt a “remarkably strong hand of cards” at the start of the outbreak.

“China is a country with significant capabilities, which could have advanced the knowledge and response more rapidly at the end of December 2019,” said Prof Yang, who has connections across the political and health elite of China.

But this initial advantage was ultimately eroded by a fragmented, authoritarian political system that was ill-suited to handle the rapidly escalating emergency.

The crisis began when several of Wuhan’s highly educated doctors at some of the country’s best hospitals recognised in the closing days of 2019 that a “pneumonia of unknown etiology” (PUE) circulating in clusters of cases within the city showed clear signs of “human-to-human” transmission.

Experts among them feared it was linked to the SARS (Severe Acute Respiratory Syndrome) coronavirus that traumatised East Asia in 2002-2004, with one doctor telling the local Centre for Disease Control (CDC): “It’s a disease we’ve never encountered before, it’s also a family [cluster of] infections. Something is definitely wrong!”

The suspected coronavirus was swiftly confirmed by Vision Medicals, a Guangzhou-based lab, which performed genome sequencing lung fluid from “Patient A”, a 65-year-old man with severe pneumonia and “multiple scattered patchy faint opacities in both lungs” and who was not responding to drugs.

Medical workers in protective suits attend to Covid patients at the intensive care unit (ICU) of a designated hospital in Wuhan, February 6, 2020
Medical workers in protective suits attend to Covid patients at the intensive care unit (ICU) of a designated hospital in Wuhan, February 6, 2020 - China Daily CDIC/REUTERS

The book notes that “due to the sensitivity of the diagnostic results”, the lab only provided confirmation of the positive test result for a SARS-like coronavirus to the hospital by phone and not in writing.

The team had discovered it was 81 per cent similar to the first SARS coronavirus outbreak.

Screenshots that appeared on social media between an anonymous scientist at the lab, known as ‘Little Mountain Dog’, and her boss showed that they immediately recognised the coronavirus “should be treated in the same class as the plague” for prevention and control purposes.

Yet despite the mounting evidence pointing to potential catastrophe, the local CDC was slow to react.

The growing number of cases were not fed, as they should have been, into the National Notifiable Infectious Disease Surveillance System (NNDSS), created after the 2002-2004 SARS epidemic killed close to 800 people globally.

The system – the largest in the world and a source of national pride – had broken down. Gao Fu, the director general of the national CDC, only learned of the latest Wuhan outbreak on social media on December 30.

Although he swiftly set in motion a series of emergency responses by the National Health Commission and China CDC, the next crucial few weeks were characterised by missteps, censorship, political interests and counterproductive moves that failed to prevent the uncontrolled spread of the virus.

“The first week in January became a pivotal turning point for handling the outbreak. Just the wrong kind,” concludes the book. “The failure to act before January 20 was monumental,” it adds.

One significant misstep was failing to acknowledge and respond to the several emerging cases in Wuhan that were not linked to the Huanan Seafood Market, the location of the first concentration of disease clusters and suspected ground zero of the virus.

There was tunnel vision on the market, the author suggests, so when it was closed, it was assumed among the public that the situation was under control, fostering a false sense of security and allowing the virus to continue spreading among the city as people went about their business.

China’s political tradition of information suppression to maintain social stability and the focus of the authorities on dominance and control, rather than transparency, were further factors working against the containment of disease.

This aerial view shows the P4 laboratory (centre L) on the campus of the Wuhan Institute of Virology in Wuhan in China's central Hubei province on May 27, 2020
The book does not concern itself with the theory that Covid emerged from the Wuhan Institute of Virology - HECTOR RETAMAL/AFP

“Clearly many [doctors] are heroes but, if you read between the lines, they also operated within constraints,” said Prof Yang.

“It’s clearly not a black and white picture but shades of grey. Some of the most heroic doctors happened to be also ones who might not have spoken up like they could have. It’s a very complicated picture.”

The fear of censure within Wuhan’s medical circles was very real. The most outspoken doctors, the first to alert the world of the looming danger, put their careers on the line and were reprimanded by the police. Infections among hospital staff were covered up, and frontline experts sidelined.

The central authorities did not appear to have a firm grip of the situation. Poor public health leadership combined with the myopic ambitions of local politicians, obsessed with polishing the city’s image and reassuring the public.

Even as Wuhan hurtled towards a crippling lockdown, the city authorities showcased high-profile events to demonstrate that everything was under control ahead of the late January Chinese New Year celebrations.

One community banquet on January 18, in an area six miles from the Huanan market, attracted more than 40,000 families and over 100,000 participants.

The feast came several days after visiting experts from Taiwan, Macau and Hong Kong immediately understood the gravity of the public health crisis.

Drawing on the Telegraph’s own reporting, the book highlights that Taiwan’s Dr Chuang Yin-ching became convinced on January 13 that the outbreak was much worse than officially presented. Uneasy about cases with no connection to the market, he had no doubt humans were infecting humans.

On his return, Taiwan issued a travel alert for Wuhan and started to tighten its border controls.

However, back in Wuhan, the overarching official narrative did not shift from downplaying the severity of the situation.

Epidemic control workers wear PPE as they walk in the street by a closed shop near a community with residents under health monitoring for COVID-19 on December 4, 2022 in Beijing, China.
Wuhan's delayed response to Covid proved catastrophic - Kevin Frayer/Getty Images AsiaPac

By January 20, the credibility gap between the official rhetoric and reality was so wide, it was left to Dr Zhong Nanshan, 83, an esteemed and trusted veteran of the first SARS epidemic, to break the bad news to the public that the novel coronavirus pneumonia “is certainly transmissible from human to human.”

In “a 180-degree turn for the propaganda system,” he confirmed cases in Beijing, Guangdong, Shanghai, and Zhejiang, as well as abroad in Japan, South Korea, and Thailand.

The entire country was put on alert and advised to wear face masks.

Yet the Wuhan and Hubei province leadership still proceeded with New Year celebrations, inviting city residents to apply for 200,000 free passes to visit landmark sites, while the local media praised performers for continuing despite being sick.

Observing the crowded scenes and “inaction” by local authorities, Professor Guan Yi, a visiting expert on respiratory syndrome coronaviruses from the University of Hong Kong, admitted feeling “truly helpless” and “scared.”

By the time a stunned Wuhan was suddenly sealed off from the world on January 23, as many as 500,000 people had already left for the holidays.

Prof Yang’s book points to the sobering estimate in one model by Dr Zhong that if the public epidemic control measures had been implemented merely five days earlier in January 2020, China’s total Covid-19 cases would have decreased by a staggering two-thirds.

He told the Telegraph he had been driven to write the book as the pandemic ultimately impacted not just Wuhan, but billions of people globally.

“There is a lot of desire to know what happened in the early stages. In that sense, I try to be as neutral as I can be.”

Prof Yang’s long-standing interest in China’s handling of infectious diseases, including HIV, Hepatitis and TB, finds its roots in a very personal loss. His Chinese father passed away from an infection when he was just a toddler.

“It is emotional in a way, and it does help me to come to terms,” he said.

But the political scientist does not have confidence that China’s complex governance system would handle another emerging and dangerous coronavirus any better in the future.

“There is an effort to reform the disease prevention and control bureaucracy. But my sense is that those steps are really very tentative,” he said. “In a country like China with significant regional variations, it’s the weakest links that matter the most.

“So, I am not too optimistic at this point and this is why I feel a sense of mission to publish this.”

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