In the six days after top Chinese officials secretly determined they likely were facing a pandemic from a new coronavirus, the city of Wuhan at the epicentre of the disease hosted a mass banquet for tens of thousands of people; millions began traveling through for Lunar New Year celebrations.
Chinese President Xi Jinping warned the public on the seventh day, January 20. But by that time, more than 3,000 people had been infected during almost a week of public silence, according to internal documents obtained by The Associated Press and expert estimates based on retrospective infection data.
That delay from January 14 to January 20 was neither the first mistake made by Chinese officials at all levels in confronting the outbreak, nor the longest lag, as governments around the world have dragged their feet for weeks and even months in addressing the virus.
But the delay by the first country to face the new coronavirus came at a critical time — the beginning of the outbreak. China’s attempt to walk a line between alerting the public and avoiding panic set the stage for a pandemic that has infected almost 2 million people and taken more than 126,000 lives.
“This is tremendous,” said Zuo-Feng Zhang, an epidemiologist at the University of California, Los Angeles. “If they took action six days earlier, there would have been much fewer patients and medical facilities would have been sufficient. We might have avoided the collapse of Wuhan’s medical system”.
Other experts noted that the Chinese government may have waited on warning the public to stave off hysteria, and that it did act quickly in private during that time.
But the six-day delay by China’s leaders in Beijing came on top of almost two weeks during which their National Centre for Disease Control did not register any cases from local officials, internal bulletins obtained by the AP confirm. Yet during that time, from January 5 to January 17, hundreds of patients were appearing in hospitals not just in Wuhan but across the country.
It’s uncertain whether it was local officials who failed to report cases or national officials who failed to record them. It’s also not clear exactly what officials knew at the time in Wuhan, which only opened back up last week with restrictions after its quarantine.
But what is clear, experts say, is that China’s rigid controls on information, bureaucratic hurdles and a reluctance to send bad news up the chain of command muffled early warnings. The punishment of eight doctors for “rumour-mongering,” broadcast on national television on January 2, sent a chill through the city’s hospitals.
“Doctors in Wuhan were afraid,” said Dali Yang, a professor of Chinese politics at the University of Chicago. “It was truly intimidation of an entire profession".
Without these internal reports, it took the first case outside China, in Thailand on January 13, to galvanise leaders in Beijing into recognising the possible pandemic before them. It was only then that they launched a nationwide plan to find cases — distributing test kits, easing the criteria for confirming cases and ordering health officials to screen patients, all without telling the public.
“Allegations of a cover-up or lack of transparency in China are groundless,” said foreign ministry spokesman Zhao Lijian at a Thursday press conference.
The documents show that the head of China’s National Health Commission, Ma Xiaowei, laid out a grim assessment of the situation on January 14 in a confidential teleconference with provincial health officials. A memo states that the teleconference was held to convey instructions on the coronavirus from President Xi Jinping, Premier Li Keqiang and Vice Premier Sun Chunlan, but does not specify what those instructions were.
“The epidemic situation is still severe and complex, the most severe challenge since SARS in 2003, and is likely to develop into a major public health event,” the memo cites Ma as saying.
The National Health Commission is the top medical agency in the country. In a faxed statement, the Commission said it had organised the teleconference because of the case reported in Thailand and the possibility of the virus spreading during New Year travel. It added that China had published information on the outbreak in an “open, transparent, responsible and timely manner,” in accordance with “important instructions” repeatedly issued by President Xi.
The documents come from an anonymous source in the medical field who did not want to be named for fear of retribution. The AP confirmed the contents with two other sources in public health familiar with the teleconference. Some of the memo’s contents also appeared in a public notice about the teleconference, stripped of key details and published in February.
Under a section titled “sober understanding of the situation,” the memo said that “clustered cases suggest that human-to-human transmission is possible.” It singled out the case in Thailand, saying that the situation had “changed significantly” because of the possible spread of the virus abroad.
“With the coming of the Spring Festival, many people will be traveling, and the risk of transmission and spread is high,” the memo continued. “All localities must prepare for and respond to a pandemic.”
The early story of the pandemic in China shows missed opportunities at every step, documents and AP interviews reveal.