birth of a pandemic
As COV ID-19 continues to wreak havoc around the world, Stuart Thomson takes a look back at how it started and when it arrived in Canada
Chinese officials told the world about a new coronavirus on Jan. 7, but alarm bells had been ringing in Wuhan, the capital city of the central Chinese province of Hubei, for weeks.
The unofficial version of events begins much earlier and is buried in unpublished Chinese government data, whistleblower accounts and chilling instant messages shared between doctors.
The story begins with a 55- year- old man in Hubei province who got sick on Nov. 17, according to a report in the South China Morning Post that was based on unreleased government data. About a handful of cases were reported each day after that and by Dec. 20 there were 60 confirmed cases.
The search for patient zero continues but some experts doubt that the person will ever be found, especially with a disease that can present almost no symptoms in some people. So far, health authorities in China have identified at least 266 people who were infected last year.
Ai Fen, a doctor in Wuhan who ran the intensive care unit at one of the city’s hospitals, described the first patient who distressed her in an interview that was removed from the internet by government censors. Her startling report continues to live on blogs and even computer code repositories in an effort to keep it published.
Ai Fen treated a person on Dec. 16, who was suffering from a high fever that wouldn’t break, no matter what medicine or treatment they were given. A week later, the person was diagnosed with a disease caused by a new coronavirus.
“Later, we learned that the patient was working in a local seafood market,” said Ai Fen. That market, where people, live animals and dead animals are squeezed together in an impossibly small area, was closed by the Chinese government on Jan. 1.
Although wet markets have been re- opened in China, including in Wuhan, the government introduced rules in February that banned the sale of wild animals at markets. Dr. Anthony Fauci, who is leading the U.S. response to COVID-19, has joined other experts urging China to close the markets completely due to the potential for disease.
“Poorly regulated, live animal markets mixed with illegal wildlife trade offer a unique opportunity for viruses to spillover from wildlife hosts into the human population,” the Wildlife Conservation Society said in a statement calling for them to be closed. Most likely, the virus hopped over to humans from a bat via some other animal at the market.
On Dec. 30, while Ai Fen continued to deal with the overload of patients suffering from acute respiratory symptoms, she got an instant message from a colleague who asked her about the rumours going around about an eruption of fevers in the area. She happened to be watching a CT scan of a patient with a pulmonary infection at the time and she sent a short video of the scan back to her friend. “SARS coronavirus” was circled in red pen on the chart. The new patient came from the same seafood market.
Another message she sent circulated among doctors in Wuhan and, soon, eight doctors were reprimanded by the police for spreading similar messages. Ai Fen was given an “unprecedented and severe rebuke” by her bosses at the hospital, she said.
Even while Wuhan was struggling to cope with overflowing intensive care units and COVID-19 cases were spiralling, the Chinese government was chasing away inconvenient information from instant messaging services and news websites.
Li Wenliang, a doctor who contracted the virus while working at Wuhan Central Hospital, sent out a warning to his colleagues about the virus, urging them to wear protective clothing to avoid getting infected because he had seen seven cases that were reminiscent of SARS. Li was one of the doctors rebuked by police for “spreading rumours” about the virus and, on Jan. 30, he was diagnosed with the coronavirus. On Feb. 7 he died, causing a wave of anger on the Chinese social media site Weibo.
On Jan. 7, China finally confirmed that a new coronavirus had been identified. Two days later, officials from Wuhan confirmed that a 61- year- old man had died from a case of severe pneumonia that had developed from the disease. He had been given infection- fighting medicine, ventilator- assisted breathing and other extreme interventions, to no avail. He was the first person confirmed to have died from COVID-19.
On April 1, after Wuhan had mostly battled the virus into submission, Ai Fen was reported by several media sources to have gone missing and possibly detained for speaking out.
The coronavirus family is a group of viruses that targets both birds and mammals.
Among humans, coronaviruses are responsible for the annoying- but- harmless colds many of us suffer from in the winter and deadly diseases like SARS. We have no vaccines or antiviral drugs to treat infections.
Coronaviruses get their name from the image of a crown that appears around the virus when it is viewed under a microscope. Corona is latin for crown and those spikes help the virus invade cells.
Deadly pandemics like the COVID-19 outbreak have been an eternal feature of human life. In the 14th century, the Black Death wiped out at least a third of Europe’s population, altering human history and changing society irreparably. In 1918, as the First World War ground to a halt, the Spanish Flu gripped the world, killing up to 50 million people.
Viruses are silent killers and they spread through small droplets that reside near the mouth or nose, scattering when a person coughs or sneezes. The most likely scenario for transmission is that another person touches a surface that droplets landed on and then touches their own face. You can also breathe in droplets from the air after someone coughs or sneezes, which is why politicians and health officials are urging people to stay two metres apart and out of the sneeze-radius.
The new coronavirus that causes COVID-19 measures 120 nanometres. For perspective, a nanometre is one-billionth of a metre and obviously invisible to human eyes.
When people die from disease, there are no vivid images like the planes flying into the World Trade Center, although the death toll from COVID-19 in the United States already exceeds the number of people who died on 9/11, even weeks before the expected peak of the virus.
Most of the carnage takes place in hospitals and longterm care homes, where television news cameras usually can’t venture. The streets are empty as most people stay home to avoid spreading or contracting the virus.
The tragi-comic images of people hoarding toilet paper and a spring break partier shrugging and telling a TV reporter that he wasn’t going to change his plans and “if I get corona, I get corona” could be the enduring images of this pandemic.
That is, if there even are enduring images. Despite some of the staggering death tolls, a recurring feature of pandemics is that people sweep them entirely under the rug after emerging from them.
“I’ve never heard anyone satisfactorily explain why so little has been written about this,” said John M. Barry, author of The Great Influenza: The Story of the Deadliest Pandemic in History and a professor at the Tulane University School of Public Health and Tropical Medicine. “( American author) John Dos Passos, for example, got influenza while on a troop ship, and they were floating coffins, yet he hardly wrote a word about it.”
The 1918 Spanish Flu has been called the “forgotten pandemic,” so strong was the urge to consign it to oblivion.
While pandemics rip t hrough our societies, though, they create acute anxiety. During the H1N1 outbreak in 2009, some emergency rooms were loaded to capacity based solely on rumours about the disease.
“In the minds of many people, whenever you have a cough, the first thing that comes to mind is COVID-19 because you’ve been exposed to so much information,” said Steven Taylor, a University of British Columbia psychiatry professor and author of The Psychology of Pandemics.
In their public messaging, governments try to calm the fears of people suffering from high levels of anxiety, while also communicating the seriousness of the situation. At the other end of the spectrum are people who feel very low levels of anxiety, sometimes to a reckless or unsafe degree. Those people need stern warnings or even criminal consequences to encourage them to follow the advice of public health officials.
“Now, unfortunately, that message although it’s necessary for the low anxiety people is just going to ramp up the anxiety for people who are already very anxious about this. There are no easy answers to this dilemma that the message to motivate one group creates excessive anxiety in another group,” said Taylor.
On Jan. 8, a 61- year- old woman from Wuhan joined a 16-person tour group to Thailand along with five family members. Three days earlier she had developed a fever with chills, a sore throat and a headache. She had also been frequenting the Wuhan wildlife market that authorities had closed on New Year’s Day.
Thailand reported on Jan. 13 that the woman from Wuhan was now the first imported case of COVID-19. A day later, the World Health Organization assured the world that there was still no clear evidence of “human- to- human transmission” and no reported infections among health-care workers. A month later, major outbreaks in Iran and Italy would begin.
“The pace at which this has gone global is unprecedented historically,” Elena Conis, historian of medicine at UC Berkeley.
“It’s a combination of things. It’s the fact that we’re so globalized. It’s the fact that we are so urban and our cities are so much larger and denser than they have been historically and it also has to do with the virus and how good it is at transmitting itself,” said Conis.
Mathematical models that map how a country reacted — or failed to react — to the pandemic are already cropping up. As officials respond in real-time to the virus, they know that in the aftermath, there will be second-guessing.
The models already show that if social distancing measures were implemented three weeks earlier in China, the number of cases would have been reduced by 95 per cent and surely spared the rest of the world the horrifying ordeal that is now underway. Starting those measures even a week earlier, scientists say, would have cut the number of cases by 66 per cent.
But it works both ways. The same study shows that imposing social distancing measures a week later would have tripled the amount of cases and imposing them three weeks later would have caused an 18- fold increase. The exponential nature of a virus is unforgiving on policymakers.
On Jan. 15, Canada’s Public Health Agency activated its Emergency Operation Centre to get the country ready for what might be coming, representing the first major movement from Canadian authorities.
On the same day, a man from Snohomish County, Washington, arrived home from Wuhan and took group transportation home from Seattle-tacoma International Airport. He may have sneezed or coughed in the shuttle or leaned on a railing while he waited for his bags to arrive. Whatever it was, researchers tracing the path of the virus now believe others in the area were infected between Jan. 15 and 19, according to Bloomberg Businessweek.
The man visited an urgentcare clinic near his home on Jan. 17, sending American health officials into overdrive. By the end of the month, the man’s symptoms had resolved but COVID- 19 had gained a foothold in the Pacific Northwest.
Another man climbed the gangway onto the Diamond Princess cruise ship on Jan. 20 for a five-day trip from Tokyo to Hong Kong. Six days after leaving the ship he tested positive for COVID-19 but the ship sailed on without him, carrying 3,700 other people. At least 712 became infected. Twelve have died.
Two days later, on Jan. 22, a man arrived in Toronto from China after spending some time in Wuhan. He probably wasn’t aware as he travelled home from the airport on that Wednesday night, but he was carrying Canada’s first case of COVID-19.