May 12, 2020

OUTBREAK:

The Early Days of the Coronavirus Outbreak in Wuhan (Bernhard Zand und Veronika Hackenbroch, 12.05.2020, Der Spiegel)

More than four months after fish monger Chen became one of the very first people to come down with the respiratory illness later named COVID-19, there are a number of theories and opinions in circulation about the origins and spread of the illness. DER SPIEGEL has reconstructed events in Wuhan in an effort to learn how the outbreak could have happened and what took place in the early days in the city's hospitals and health agencies. And to learn whether the global pandemic could have been prevented if officials, doctors and politicians had behaved differently. In short, to learn who might share the blame for this pandemic.

This reconstruction is based on numerous discussions and meetings, on reporting in Wuhan itself but also on reporting by Chinese journalists. A complete picture can only be provided by an in-depth international investigation of the kind being demanded by experts and politicians around the world - an investigation that Beijing has thus far resisted. But it can already be said with certainty that mistakes were made in Wuhan - and that the global spread of the disease could, at the very least, have been slowed.

It isn't known when and where the first person became infected with SARS-CoV-2. But it is considered extremely likely that the precursor to the pathogen comes from bats - and based on genetic analysis, it is believed that the virus jumped to humans only one single time, at some point in fall 2019.

That is rather unusual. It is generally the case that a longer process of genetic adaptation is necessary before a virus that originates in animals can be passed from human to human. Generally, humans repeatedly become infected by animals before a pathogen mutates such that it can be passed from person to person. But SARS-CoV-2 followed a different path. Researchers believe that a specific genetic sequence is responsible, one that joined the genome that produced SARS-CoV-2 predecessor completely by chance. It is that sequence that has made it so easy for the virus to spread.

Researchers have two hypotheses for the beginning of the pandemic: Either this genetic sequence was added to the virus when it was still reproducing in its animal host - whether it be bats, pangolins or raccoon dogs - so that the first person who became infected was immediately able to pass it along. Or a precursor was circulating unnoticed for months, but wasn't particularly contagious before the new sequence was added.

Either way, close contact between humans and animals provide ideal conditions for viruses to jump to humans. And those conditions were present at a wildlife market in Wuhan.

On Dec. 26, the day when the fish monger Chen Qingbo checked into the Central Hospital of Wuhan, the pulmonologist Zhang Jixian, 54, had her first encounter with the virus at a different clinic in Wuhan. An elderly patient was suffering from a fever, a cough and breathing difficulties and tests for influenza and other, similar illnesses had all come back negative. Dr. Zhang ordered a CT scan of the patient's lungs and found that she was suffering from a severe and unusual form of pneumonia.

One day later, the neurological department asked Zhang for assistance with an elderly patient experiencing similar symptoms. His CT scan had also revealed severe pneumonia. The doctors soon figured out that the male patient and the female patient were married. "I realized that something wasn't right," Zhang would later tell the state-run news agency Xinhua.

The doctor learned that the son of the two patients had brought them to the hospital and she convinced him to submit to a CT scan of his own lungs. "He resisted initially," according to Zhang. "He had no symptoms and thought we wanted to get him to undergo an expensive procedure."

Once the scan was performed, though, it revealed the same lesions on the lungs that his parents had. For Zhang, it all pointed to a "contagious disease," and after a few more tests, she was convinced. "It wasn't a normal illness." That same day, she reported her findings to the authorities.

People suffering from the same symptoms were showing up at other hospitals in the city as well. Most had one thing in common: Like Chen Qingbo, they had been traders, suppliers or customers of the Huanan market.

Before it was closed down, the market consisted of two large halls separated by a broad road. Each hall contained dozens of stands and Chen's stand was in the eastern part of the market, where primarily fish and shellfish were on offer. In one corner of the larger, western half of the market, there were several stands that offered exotic wares like snake, fox and salamander meat along with scorpions, crocodiles, live hedgehogs (for the equivalent of 4.50 euros per kilogram), living wolf pups (3 euros) and civets (32 euros). Civets are thought to be the transmitter of the SARS coronavirus that began spreading in southern China in 2002.

In such markets, animals are crammed into cages in horrific conditions, and images taken from this part of the market in Wuhan before it was shuttered on Jan. 1 show dismal-looking stands with dire hygienic conditions. Even today, more than four months later, you can still smell the rotten stench if you approach the site, which has been completely cordoned off.

"They allegedly also sold pangolins there," says Chen Qingbo. "But I never saw them. I never went over to those stands. I find wild animals to be dirty and I'm afraid of them." The eastern part of the market, by contrast, was a completely normal Chinese market, says Qingbo. "Even the restrooms were OK. They were cleaned every day."

Posted by at May 12, 2020 1:44 PM

  

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