What happened in the first weeks: China covered up the outbreak.
The South China Morning Post, a newspaper owned by a major Chinese company, reported that Chinese officials found cases that date to Nov. 17, 2019. Several Western scientists said colleagues in China had told them of the outbreak by mid-December. Whistleblower doctors reported being silenced from mid-December on. Toward the end of December, hospitals in Wuhan were known to be quarantining sick patients, and medical staff members were falling sick — clear evidence of human-to-human transmission, the first step toward a pandemic.
Finally, on Dec. 31, 2019, as rumors were growing, the Wuhan health officials acknowledged 27 cases of an “unexplained pneumonia” caused by a virus, but claimed there was no evidence of “obvious human to human transmission.” The next day, a Chinese state media outlet announced that authorities had disciplined eight people for spreading rumors about the virus, including Dr. Li Weinglang, who had noted that the mystery pneumonia cases resembled SARS and warned colleagues to wear protective gear, and who would later die of Covid.
Not until Jan. 20, 2020, did Chinese authorities publicly admit that the virus was clearly passing from person to person. Three days later, they shut down the city of Wuhan.
What could have happened: China tells the world the truth and the pandemic is avoided.
What happened after China covered up: The world failed to heed warnings and take action.
On Dec. 30, 2019, ProMED, a service that tracks infectious disease outbreaks globally, warned of “unexplained pneumonia” cases in Wuhan. The veteran infectious disease reporter Helen Branswell shared the news alert on Twitter the next day and said it was giving her “#SARS flashbacks.” That same day, Taiwan’s Centers for Disease Control — with its close contacts on the ground in China — fired off an email to the W.H.O. with its concerns that patients were being isolated in Wuhan — a clear sign of an outbreak with person-to-person spread.
Doubts over whether the virus was capable of spreading from person to person should have been swept away in mid-January 20020 by reports that a woman in Thailand and a man in Japan had tested positive without having been to the Wuhan seafood market that Chinese authorities had said was the center of the spread. Meanwhile, despite such clear evidence of the virus’s transmissibility, the number of cases that China reported remained at 44. (We’d later learn that medical professionals weren’t even allowed to report cases that weren’t connected to the seafood market.) Yet, the W.H.O. kept repeating China’s line that there was no evidence of human-to-human transmission.
It wasn’t until China shut down Wuhan on Jan. 23, 2020, that the rest of the world could see how serious the threat was — even then, global response remained feeble.
What could have happened: The world sees through China’s deception and takes action.
How could nations have gotten around China’s smokescreen? They could have done what Taiwan did.
“We were not able to get satisfactory answers either from the W.H.O. or from the Chinese C.D.C., and we got nervous and we started doing our preparation,” Foreign Minister Joseph Wu told Time magazine.
What happened after the outbreak went global: The real contagious threat was ignored.
Nine public health workers attending to the ship were infected. It seemed quite unlikely, the Japanese virology professor Hitoshi Oshitani noted, that all these professionals with expertise in infection control had failed to take the recommended precautions.
After more evidence, and organized attempts by hundreds of aerosol scientists, minor course corrections started later in 2020, but they were halting, incomplete and underpublicized. For example, it wasn’t until December 2020 that the W.H.O. started recommending that masks be worn indoors regardless of distance, and even then only if the space was poorly ventilated, and it wasn’t until December 2021 — two years after it all began — did it recommend highly protective masks for health care workers.
On Jan. 26, 2020, the Chinese minister of health gave a news conference warning that people without symptoms could transmit the virus. The same week an article in The Lancet had documented a case in which infection was visible in the lungs of a patient who had shown no symptoms. An article published in the New England Journal of Medicine, also the same week, noted cases presenting only mild symptoms, with the authors stressing that this would make it easy to miss them. Multiple reports from German scientists soon disclosed similar conclusions based on cases there.
The rest of the world could have understood the virus as Japanese officials did. Based on their understanding, which was arrived at in February 2020, that Covid was airborne, spread without symptoms and driven by clusters, by early March they were recommending mask-wearing, emphasizing the need for ventilation and advising the public to avoid the three-Cs: closed spaces, crowded places and close-contact settings.
Instead of closing parks, activities could have been moved outside weather permitting, since natural ventilation more effectively dissipates the virus. The key role of masks would have been understood earlier, along with the benefits of higher quality masks. Rather than wasting money on plexiglass barriers — which can’t fully block aerosols and can even create dead zones for ventilation, increasing infection risk — schools would have begun updating their ventilation and HVAC systems, and installing HEPA air filters, which can filter viruses. Japan’s cluster-busting strategy could have been adopted.
South Korea experienced major superspreading events in February 2020, including one in a secretive church that accounted for more than 5,000 infections, with a single person suspected as the source. The country had the highest number of cases outside of China at that point.
South Korean officials sprang into action, rolling out a mass testing program — they had been readying their testing capacity since January — with drive-through options and vigorous contact tracing.
What happened: When vaccines were developed, rich countries hoarded them.
In January 2020, the C.E.O. of BioNTech, Ugur Sahin, started designing vaccines as soon as he read The Lancet study noting the case without symptoms, which convinced him that a pandemic was likely. He then persuaded Pfizer, his initially skeptical investor, to back him.
There also was too little commitment to how vaccines could be distributed fairly around the world.
Instead, wealthy countries that had preordered or financed research got most of the initial doses.
Vaccine production grew, but too slowly. There was no consortium or sharing of resources to ramp up supply. Technology wasn’t transferred to lower- and middle- income countries. Patents were left in place. The W.H.O. initiative to get vaccines to poorer countries, known as Covax, was not able to buy enough doses, and what donations were made were insufficient and haphazard.
What could have happened: Vaccine supply ramps up, with sensible distribution.
Trials could have been immediately started to assess whether delaying second doses might work well while allowing doses to be spread more widely geographically. Early results on the protective effect of first doses were encouraging.
The circus continues. China spends a lot of money and suffers a lot of inconvenience from pursuing a zero Covido policy. Elsewhere, restrictions are being lifted altogether because, you hear, we are tired. It has been shown that the virus damages extensively even in the brains of people who have become barely ill. Will we have a lot of dementia as those people get older? No one knows that. China does not risk it. The Zero Covido policy has already saved millions of lives in China, not to mention the problem of possible dementia.