Could the CCP have disclosed the COVID-19 pandemic much earlier as the U.S. claims?

Question

Could the CCP have disclosed the COVID-19 pandemic much earlier as the U.S. claims? What are the standards in terms of pandemic reporting and did the Chinese Communist Party meet those standards? What could they have done better, and historically-speaking was the U.S. ever held to the same standards?

Answer 1

It depends what one means by that. The Wuhan branch of the CCP is probably the one mostly responsible for muzzling the local doctors etc. But then the center was responsible for the initially overly bureaucratic response, which made it difficult to confirm new cases. AP has published (fairly recently, Apr 15) a long investigative piece focusing mostly on China's 6 key days (roughly Jan 14-20) during which the central CCP (and China CDC) changed their position significantly. Some selected quotes from that:

China didn’t warn public of likely pandemic for 6 key days [...]

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 epicenter of the disease hosted a mass banquet for tens of thousands of people; millions began traveling through for Lunar New Year celebrations.

President Xi Jinping warned the public on the seventh day, Jan. 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 Jan. 14 to Jan. 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 six-day delay by China’s leaders in Beijing came on top of almost two weeks during which the national Center for Disease Control did not register any cases from local officials, internal bulletins obtained by the AP confirm. Yet during that time, from Jan. 5 to Jan. 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. [...]

Without these internal reports, it took the first case outside China, in Thailand on Jan. 13, to galvanize leaders in Beijing into recognizing the possible pandemic before them. It was only then that they launched a nationwide plan to find cases — distributing [China] CDC-sanctioned test kits, easing the criteria for confirming cases and ordering health officials to screen patients. They also instructed officials in Hubei province, where Wuhan is located, to begin temperature checks at transportation hubs and cut down on large public gatherings. And they did it all without telling the public.

The documents show that the head of China’s National Health Commission, Ma Xiaowei, laid out a grim assessment of the situation on Jan. 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 organized 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.”

In the memo, Ma demanded officials unite around Xi and made clear that political considerations and social stability were key priorities during the long lead-up to China’s two biggest political meetings of the year in March. While the documents do not spell out why Chinese leaders waited six days to make their concerns public, the meetings may be one reason.

The National Health Commission also distributed a 63-page set of instructions to provincial health officials, obtained by the AP. The instructions ordered health officials nationwide to identify suspected cases, hospitals to open fever clinics, and doctors and nurses to don protective gear. They were marked “internal” — “not to be spread on the internet,” “not to be publicly disclosed.”

In public, however, officials continued to downplay the threat, pointing to the 41 cases public at the time.

“We have reached the latest understanding that the risk of sustained human-to-human transmission is low,” Li Qun, the head of the China CDC’s emergency center, told Chinese state television on Jan. 15. That was the same day Li was appointed leader of a group preparing emergency plans for the level one response, a CDC notice shows.

On Jan. 20, President Xi issued his first public comments on the virus, saying the outbreak “must be taken seriously” and every possible measure pursued. A leading Chinese epidemiologist, Zhong Nanshan, announced for the first time that the virus was transmissible from person to person on national television.

If the public had been warned a week earlier to take actions such as social distancing, mask wearing and travel restrictions, cases could have been cut by up to two-thirds, one [draft academic] paper later found. An earlier warning could have saved lives, said Zhang, the doctor in Los Angeles.

However, other health experts said the government took decisive action in private given the information available to them.

“They may not have said the right thing, but they were doing the right thing,” said Ray Yip, the retired founding head of the U.S. Centers for Disease Control’s office in China. “On the 20th, they sounded the alarm for the whole country, which is not an unreasonable delay.”

If health officials raise the alarm prematurely, it can damage their credibility — “like crying wolf” —and cripple their ability to mobilize the public, said Benjamin Cowling, an epidemiologist at the University of Hong Kong.

[...]

Doctors and nurses in Wuhan told Chinese media there were plenty of signs that the coronavirus could be transmitted between people as early as late December. Patients who had never been to the suspected source of the virus, the Huanan Seafood Market, were infected. Medical workers started falling ill.

But officials obstructed medical staff who tried to report such cases. They set tight criteria for confirming cases, where patients not only had to test positive, but samples had to be sent to Beijing and sequenced. They required staff to report to supervisors before sending information higher, Chinese media reports show. And they punished doctors for warning about the disease.

As a result, no new cases were reported for almost two weeks from Jan. 5, even as officials gathered in Wuhan for Hubei province’s two biggest political meetings of the year, internal China CDC bulletins confirm.

During this period, teams of experts dispatched to Wuhan by Beijing said they failed to find clear signs of danger and human-to-human transmission. [...]

The second [Beijing] expert team, dispatched on Jan. 8, similarly failed to unearth any clear signs of human-to-human transmission. Yet during their stay, more than half a dozen doctors and nurses had already fallen ill with the virus, a retrospective China CDC study published in the New England Journal of Medicine would later show.

The teams looked for patients with severe pneumonia, missing those with milder symptoms. They also narrowed the search to those who had visited the seafood market — which was in retrospect a mistake, said Cowling, the Hong Kong epidemiologist, who flew to Beijing to review the cases in late January. [...]

“I always suspected it was human-to-human transmissible,” said Wang Guangfa, the leader of the second expert team, in a Mar. 15 post on Weibo, the Chinese social media platform. He fell ill with the virus soon after returning to Beijing on Jan. 16.

When the Thai case was reported, health authorities finally drew up an internal plan to systematically identify, isolate, test, and treat all cases of the new coronavirus nationwide.

Wuhan’s case count began to climb immediately — four on Jan. 17, then 17 the next day and 136 the day after. Across the country, dozens of cases began to surface, in some cases among patients who were infected earlier but had not yet been tested. In Zhejiang, for example, a man hospitalized on Jan. 4 was only isolated on Jan. 17 and confirmed positive on Jan. 21. Shenzhen, where Yuen had earlier found six people who tested positive, finally recorded its first confirmed case on Jan. 19.

The Wuhan Union Hospital, one of the city’s best, held an emergency meeting on Jan. 18, instructing staff to adopt stringent isolation — still before Xi’s public warning. A health expert told AP that on Jan. 19, she toured a hospital built after the SARS outbreak, where medical workers had furiously prepared an entire building with hundreds of beds for pneumonia patients.

“Everybody in the country in the infectious disease field knew something was going on,” she said, declining to be named to avoid disrupting sensitive government consultations. “They were anticipating it.”

So yeah, as the WHO (and US CDC, ECDC) was/were repeating around Jan 14-17 what China had said a few days prior, the Chinese authorities were themselves waking up to the true extent of the problem and gearing up the response... while not quite revealing it in public until the 20th or so.

We have a somewhat clear picture of happened in terms of [central] decisions in China from Jan. 14 to Jan. 20, less so in between Jan. 5 and 14.

It may be lost in the long quote above, but the fact that one of the China CDC's own investigators (sent from Beijing) himself came backs sick with Covid-19 from a Jan 8 visit to Wuhan, but this wasn't apparently detected until Jan 16 is probably suggestive that China CDC wasn't very cognizant of the true extent and danger of what was going on before that date. (Them being apparently taken by surprise by the Thai case report on Jan 13 is also indicative.)

As an ECDC report on Jan 17 went into more detail (than the WHO or the US CDC) as to what the evidentiary basis from China was at that point

As of 17 January 2020, a total of 44 laboratory-confirmed cases infected with 2019-nCoV have been reported, 41 from Wuhan, China and three travel-associated to Thailand (2) and Japan (1). [...]

In China, 763 close contacts have been identified and monitored. Of these, 644 have completed the observation period, while 119 remain under medical observation. So far, none has tested positive for 2019-nCoV [7,10].

The main ref cited for that is a "Wuhan City Health Committee. Wuhan Municipal Commission of Health and Health on pneumonia of new coronavirus infection 2020 - update [16 January 2020]." which is still on-line and seems to confirm that data/report (through Google Translate.)

That is a pretty striking finding, and I think not quite explained insofar, although there are some correlates later with Chinese virus tests not being very reliable (or at least hard to use properly in the field) even at much later dates. Since the early tests were apparently all routed through Beijing, it's also not implausible the samples were mishandled in transport etc.

The NEJM paper which later retrospectively diagnosed quite a few more cases in that early period (putting the figure to 248 before Jan 11 just in Wuhan) also says:

Confirmed cases could more easily be identified after the PCR diagnostic reagents were made available to Wuhan on January 11, which helped us shorten the time for case confirmation.

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A few more details of those early days were released more recently, as reported by CNN (May 17):

Dr. Zhong Nanshan, the Chinese government's senior medical adviser and the public face of the country's fight against Covid-19, also confirmed in an exclusive interview with CNN on Saturday that local authorities in Wuhan, the city where the novel coronavirus was first reported in December, had suppressed key details about the magnitude of the initial outbreak. [...]

[Heading:] "They didn't like to tell the truth"

Zhong is known as the "SARS hero" in China for combating the severe acute respiratory syndrome epidemic in 2003. This time around, he has led the country's coronavirus response -- especially in the critical early stages of the outbreak. On January 20, it was Zhong who confirmed on state broadcaster CCTV that the coronavirus can be transmitted between people, after Wuhan health authorities had maintained for weeks that there was no clear evidence for human-to-human transmission, and that the outbreak was "preventable and controllable."

Heading a team of experts dispatched by the NHC to investigate the initial outbreak, Zhong visited Wuhan on January 18. He said that upon his arrival, he received many calls from doctors and former students, warning him that the situation was much worse than the official reports had claimed. "The local authorities, they didn't like to tell the truth at that time," Zhong said. "At the very beginning they kept silent, and then I said probably we have (a larger) number of people being infected." Zhong said he became suspicious when the number of officially reported cases in Wuhan remained at 41 for more than 10 days -- despite infections emerging overseas. "I didn't believe that result, so I (kept) asking and then, you have to give me the real number," he said. "I suppose they are very reluctant to answer my question."

In Beijing two days later, on January 20, he was told the total number of cases in Wuhan was now 198, with three people killed and 13 medical workers infected.

In a meeting with central government officials, including Chinese Premier Li Keqiang, that same day, he proposed to lock Wuhan down to contain the virus' spread.

The move was unprecedented. The central government placed Wuhan under lockdown on January 23, canceling all flights, trains and buses in and out of the city, and blocking major highway entrances. The Wuhan lockdown was eventually lifted 76 days later. [...]

While Zhong acknowledged that the number of infections were initially under reported in Wuhan, he rejected accusations that China's official statistics remained unreliable even after the central government took control of the country's coronavirus response in late January.

But Zhong said the Chinese government had learned lessons from SARS 17 years ago, when it covered up "some of the outbreak... for two or three months."

This time, he said, the central government announced that "all the cities, all the government departments, should report the true number of diseases -- so if you do not do that, you will be punished."

"So since ... the 23rd of January, I think all the data ... will be correct," he added.

Also a bit of some interest (from that interview), albeit about the related US accusations that the virus originated in a lab accident:

Zhong said that in early February, China's disease control authorities spent two weeks investigating Shi [Zhengli]'s lab for wrongdoing. They didn't find anything, he added.

As far the blame game goes, on the other hand some of those local Wuhan officials [had] blamed the lack of disclosure on the lack of authorization from the center:

In an interview with CCTV on January 27, Wuhan mayor Zhou Xianwang admitted that his government did not disclose information on the coronavirus to the public "in a timely fashion," saying, "as a local government, we can only disclose information after being authorized."