Editor's note: This article has been deleted from the original public account.
The following article is from Caixin E-law, written by Yu Qin and Li Shirun.
Caixin E-law is an original content brand derived from "Caixin" magazine. We focus on the topics of rule of law, governance, and ethics in the Internet industry.
By Yu Qin and Li Shirun, reporters from "Caixin" magazine
Edited by Lu Wei and Song Wei
A member of the second batch of experts from the National Health Commission, who chose to remain anonymous, said in an interview with "Caixin" reporter that at the time, they had limited information and materials in Wuhan and could not come to the conclusion that the novel coronavirus was transmitted from person to person. However, there has always been a demand from the public to hold the expert group accountable. Did they really fulfill their duties?
On January 20, 2020, Zhong Nanshan, the head of the high-level expert group of the National Health Commission, academician of the Chinese Academy of Engineering, and respiratory disease expert, stated in an interview with CCTV's "News 1+1" that the novel coronavirus "definitely spreads from person to person."
The discovery of "human-to-human" transmission is of great significance for public protection and medical treatment. January 20 also became an important time point for epidemic prevention and control.
Since the "unexplained pneumonia" was publicly disclosed by the Wuhan Municipal Health Commission on December 31, 2019, whether the novel coronavirus can be transmitted from person to person has always been a topic of concern. On the evening of January 18, 2020, 84-year-old Zhong Nanshan publicly announced the information of "human-to-human" transmission of the virus, two days after arriving in Wuhan.
It is already known that before Zhong Nanshan, two batches of expert groups were sent to Wuhan on December 31, 2019, and January 8, 2020, respectively, but neither of them explicitly mentioned the "human-to-human" transmission of the virus. On January 4, the members of the first batch of expert groups from the National Health Commission publicly stated, "From what we can see so far, there is no obvious evidence of human-to-human transmission." On January 10, members of the second batch of expert groups also told the media that based on the condition of the patients and the spread of the disease, the overall situation was "preventable and controllable."
In retrospect, the investigation results and public statements of these two batches of experts may have been one of the factors that delayed epidemic prevention and control. Therefore, the public has been questioning in various ways: why couldn't the first two batches of expert groups come to the important conclusion of "human-to-human" transmission during their investigation in Wuhan?
"Caixin" magazine recently interviewed a member of the second batch of expert groups. This expert arrived in Wuhan on January 8, 2020, and left at the end of January. The expert requested to remain anonymous for the interview but did not object to "Caixin" identifying him as a member of the second batch of expert groups.
The expert emphasized to the "Caixin" reporter that at that time, the information and materials that the expert group had in Wuhan were limited, and they could not come to the conclusion of "human-to-human" transmission. The expert said, "If medical staff are infected, it must be 'human-to-human' transmission, and it also indicates that the virus is highly contagious." In hindsight, there were already cases of medical staff being infected in Wuhan at that time, but the expert claimed that the expert group did not have relevant information at the time.
"We also tried to find out." The expert explained that during their time in Wuhan, the expert group paid special attention to whether medical staff were infected. "Every time we went to a place, we asked if there were any medical staff infections." However, the replies they received were all "no." In hindsight, the expert group did not have a complete understanding of the situation in Wuhan at that time. But it is currently unknown who concealed the information about the infection of some medical staff from the expert group.
The expert also stated that the second batch of expert groups did not have much information when they arrived in Wuhan. "We did not see a formal report, including how the disease originated, how it was discovered, what investigations were conducted, what the investigation results were, and which initial cases were discovered... We did not have access to this information. Later on, we had no choice but to focus on clinical treatment."
On January 16, 2020, after the second batch of expert groups returned to Beijing, they organized a meeting. At that time, some members of the expert group expressed that the epidemic had been underestimated.
Nevertheless, the public still questioned whether the expert groups had truly fulfilled their duties and made the greatest effort to understand the situation in Wuhan.
The following is the content of the interview with the expert conducted by "Caixin" magazine.
Why was "human-to-human" transmission not discovered?
"Caixin": Why didn't the second batch of expert groups discover "human-to-human" transmission?
Expert: For transmission within families and communities, in order to confirm "human-to-human" transmission, there must be a clear chain of transmission because there is a possibility of common exposure. However, it is different for medical staff because they cannot have common exposure with patients, so there is no need to analyze the transmission chain. As long as medical staff are infected, it is definitely "human-to-human" transmission, and it also indicates that the virus is highly contagious because medical staff generally do not have close contact with patients.
Why could Academician Zhong Nanshan say "definitely human-to-human" transmission? First, he already knew the transmission chain of the virus in Guangdong. There were two cases in Guangdong where the patients did not go to Wuhan, but their family members who went to Wuhan were infected with the novel coronavirus. Second, because Academician Zhong Nanshan knew the transmission chain of the virus, when he arrived in Wuhan, he immediately received reports that medical staff were infected.
In comparison, although the materials we had at the time included two cases of family clustering, we did not have the transmission chain and cases of medical staff infections, so we could not come to the conclusion of "human-to-human" transmission.
"Caixin": Did the expert group discuss whether the novel coronavirus can be transmitted from person to person?
Expert: Everyone was confused. Because in the early stages, many cases were related to the Huanan Seafood Market, where vendors and their families worked or frequently visited. So, after a family was infected, it was unclear whether it was due to common exposure or "human-to-human" transmission. This question was not clear. At that time, some members of our expert group also asked experts from the disease control system, and the reply we received was that it was impossible to determine "human-to-human" transmission.
"Caixin": Did the information provided by Wuhan include whether medical staff were infected?
Expert: No. Later, according to media reports, there were already cases of medical staff infections at that time. Dr. Lu Jun, an emergency department doctor at Tongji Hospital, fell ill on January 5, 2020, was hospitalized on January 10, and was transferred to Jinyintan Hospital on January 17. (Editor's note: According to the Beijing Youth Daily, on the evening of January 5, 30-year-old Dr. Lu Jun, an emergency department doctor at Tongji Hospital, developed fever symptoms. He was hospitalized on January 10 for "viral pneumonia" and transferred to the ICU of Jinyintan Hospital on January 17 for treatment. Lu Jun stated that he was not sure of the exact date of his diagnosis of COVID-19, but it was definitely before he was transferred on January 17.)
We went to Tongji Hospital after January 10, and the reply we received at that time was that there were no medical staff infections. I think the situation of medical staff infections should be investigated one by one. Who reported it to the hospital, and where was this information blocked?
"Caixin": Which hospitals did the second batch of expert groups visit?
Expert: Jinyintan Hospital, Wuhan Pulmonary Hospital, Wuhan People's Hospital, Wuhan First Hospital, Xiehe Hospital, and Tongji Hospital. We mainly went to their fever clinics.
"Caixin": Did you personally ask if there were any medical staff infections at all the hospitals you visited?
Expert: We were particularly concerned about whether medical staff were infected, and we asked at every place we went. Whenever we heard that medical staff were infected, we would call and ask one by one, but the information we received was not accurate. We also did not see the area where medical staff infections were located. How could we find them in such a large hospital area?
"Caixin": Who accompanied the expert group at that time?
Expert: People from the hospital and the Health Commission were present.
"Caixin": Were the people from the hospital the hospital directors? Or were they administrative staff or doctors?
Expert: Some were hospital directors, and some were heads of the medical affairs department.
"Caixin": "Human-to-human" transmission is the most crucial factor in this infectious disease.
Expert: It is very crucial. We have always suspected "human-to-human" transmission, but there was no evidence.
"Caixin": Was there no evidence because they did not provide it or because the materials provided were not enough?
Expert: They did not tell us the truth. From the current situation, they were lying.
Did the expert group not have access to the true situation?
"Caixin": Did Wuhan provide the expert group with complete information about what they already knew at the time?
Expert: Regarding the investigation and findings of the first batch of expert groups and the investigation by Hubei and Wuhan, we did not see a formal report, including how the disease was discovered, what investigations were conducted, what the investigation results were, and which initial cases were discovered... We did not have access to this information. Later on, we had no choice but to focus on clinical treatment.
"Caixin": Why did this situation occur?
Expert: They simply did not cooperate, and that was the main problem. For example, regarding the infection of medical staff, even if you report one case of medical staff infection, we would realize that it is contagious.
"Caixin": Did you give up on the investigation later?
Expert: It was not that we gave up, but that they did not let us handle it. We received instructions after we arrived, and the general content was: local management, with the local authorities taking the lead and the expert group providing assistance.
Later on, Hubei and Wuhan each had their own expert groups, mainly responsible for the treatment of patients. Our main tasks were to receive delegations from Hong Kong, Macau, and Taiwan at the time, and to understand the situation in the fever clinics.
"Caixin": They asked for your help? Did you help?
Expert: It's simple. If I ask you to report all the cases, why don't you report them?
"Caixin": Did Wuhan listen to your suggestions and opinions?
Expert: After the pathogen was identified, before the information was released, there was a meeting between the members of the expert group and the local authorities. In reality, what we discussed was how many cases there were. In the information provided by Wuhan, there were 41 cases confirmed by laboratory testing, and in addition to this batch of cases, there was another batch of suspected cases that had not been tested in the laboratory.
There was a debate about what kind of cases to release. The unanimous opinion of our expert group was that both suspected and confirmed cases should be reported. We agreed on this before we left. But the next day, the news was not like that. The news released by the local authorities reported only 41 cases, which were the batch of people confirmed by laboratory testing. I don't understand what happened behind the scenes. (Editor's note: On January 11, the Wuhan Municipal Health Commission issued a notice stating that after the pathogen causing "unexplained viral pneumonia" was preliminarily determined to be a novel coronavirus, the Wuhan Health Commission organized testing of existing patient samples. As of 24:00 on January 10, there were 41 cases of pneumonia confirmed to be infected with the novel coronavirus, including 7 severe cases and 1 death, and the remaining patients were in stable condition.)
"Caixin": How many suspected cases did you see at that time?
Expert: I can't remember the exact number. But I can say for sure that the number of suspected cases I saw at that time was greater than the number of confirmed cases.
"Caixin": If the number of suspected cases had also been announced at that time, would the public have been more alert?
Expert: That's how it would have been.
"Caixin": The first batch of experts had already been to Wuhan before you. Why did they organize the second batch of experts to go to Wuhan?
Expert: They stayed there for too long. They were there during New Year's.
"Caixin": How did the second batch of expert groups hand over with the first batch of expert groups?
Expert: They briefly introduced the situation to us, mainly about the handover of cases. We understood the basic situation, and that was it. Our focus was on visiting Jinyintan Hospital and Wuhan Pulmonary Hospital to guide their treatment.
"Caixin": Did you have a preliminary judgment on the novel coronavirus at that time?
Expert: It definitely was not the same virus as SARS because the information I received showed that they only had about 70% similarity. It is incorrect to classify it as SARS. In addition, based on the cases we saw at the time, there were indeed fewer severe cases compared to SARS, which is undeniable and has been further confirmed. There were deaths, but not many. Among the 41 confirmed cases at that time, there was one death.
"Caixin": How did you hand over with the third batch of expert groups?
Expert: I did not meet Academician Zhong Nanshan. After the members of the second batch of expert groups returned, we had a meeting at the National Health Commission to assess the situation. At that time, some members said that the epidemic had been underestimated. From my memory, the attitude of the Health Commission changed the next day, and they began to take it seriously.
"Caixin": Compared to the issue of "human-to-human" transmission, the conclusion of "preventable and controllable" by the second batch of expert groups caused even greater controversy.
Expert: The situation that the expert group had at that time was indeed preventable and controllable. If you have 41 patients, can you say it is preventable or controllable? The main issue is not whether it is preventable or controllable. It is certain that the disease is preventable and controllable. You should make this clear. It is not about not preventing or controlling it. Have we prevented it? Have we controlled it? The problem is that if you don't prevent or control it, whose responsibility is it? Can any disease be controlled if it is not prevented or controlled? The lack of prevention and control has caused the current consequences, not the concept of preventability and controllability.
"Caixin": Looking at the situation today, why do you think they concealed the information?
Expert: I don't know. You can ask them. Who knows? We shouldn't speculate about others without evidence.
I believe it is not like this in Beijing or Guangdong, and it is probably not like this in other places either. You can see from the current prevention and control measures.
"Caixin": If they had told you the actual situation (medical staff infections) at that time, would the situation be different today?
Expert: If they had said that medical staff were infected, it would not have been limited to "human-to-human" transmission. It would have been certain and clear "human-to-human" transmission.
"Caixin": Why could the third batch of expert groups see clear evidence of "human-to-human" transmission when they went there?
Expert: When it reached that point, they couldn't hide it anymore. It was exposed. From Academician Zhong Nanshan's speech, the fact that medical staff were infected is very important evidence. If they had told us that medical staff were infected at the beginning, our judgment of the epidemic would definitely have been different.
"Caixin": At that time, Wuhan consistently claimed that there were no medical staff infections. As an expert group, did you not doubt this?
Expert: Of course, we doubted it, but our doubts were useless. When we heard about the news of medical staff infections, we contacted the hospital because we didn't know which doctor it was. But after contacting them, they didn't tell us the truth. We couldn't do anything because it was clearly stated that local authorities were in charge, and we received instructions that the local authorities were in charge and the national expert group was there to help, guide, and assist.
"Caixin": Since you had doubts, why didn't you directly ask the local government or hospital?
Expert: When we discussed it, we asked them to report the truth. The leader of the Health Commission said on the spot, "Do you suspect that I am concealing information?" He openly questioned us, and all the members of the expert group were present. If he said that, what else could we say?
"Caixin": How did the expert group feel when they heard that?
Expert: You shouldn't ask us. You should ask the leadership. The person from the Health Commission has already been dismissed. (Note: On February 10, the Hubei Provincial Committee decided to remove Zhang Jin from the position of Party Secretary of the Hubei Provincial Health Commission and remove Liu Yingzi from the position of Director of the Hubei Provincial Health Commission. The two positions were taken over by the newly appointed member of the Hubei Provincial Committee, Wang Hesheng.)
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