At one minute to midnight, US East Coast time, on the last day of 2019, there was a brief ‘request for information’ on ProMED-mail, an online newsletter that monitors unofficial sources to gather intelligence about new disease outbreaks affecting people and animals. It read, simply: ‘Undiagnosed pneumonia: China (Hubei).’
Dr Marjorie Pollack, the deputy editor of ProMED-mail, had been alerted by a Taiwanese colleague to a message on WeChat, the Chinese social-media site, sent by an ophthalmologist in Wuhan named Dr Li Wenliang: ‘Seven cases of SARS have been diagnosed at the Huanan Fruit and Seafood Market, quarantined in our hospital’s emergency department.’
Li had learned of this from a colleague, Dr Ai Fen, the director of the emergency department of the Wuhan Central Hospital, who had sent samples from her latest pneumonia patient for testing. The results came back on the afternoon of 30 December: ‘SARS coronavirus’, a shocking diagnosis not seen in China for 15 years. Ai circled the word ‘SARS’, photographed it and copied it to a friend at a different hospital.
Dr ‘George’ Fu Gao, the head of the Chinese Centre for Disease Control in Beijing, saw the WeChat message. Just a few weeks before, he had made a rather bold claim: ‘SARS-like viruses can appear at any time. However, I am very confident to say that “SARS-like events” will not occur again, because the infectious-disease surveillance network system of our country is well established, and such events will not happen again.’
So Gao was especially alarmed to hear about an outbreak of a SARS-like virus not through the official surveillance network, but through social media. He raised the alarm with China’s health minister. Liang Wannian, head of the National Health Commission, was despatched to Wuhan on 31 December. Immediately on arrival he took the decision to close down the Huanan Seafood Market, despite the fact that Ai’s latest patient had no connection to the market.
The local officials were already acting fast – but not to stop the disease, only to stop the news of it spreading. Within hours of his WeChat post, at 1.30am on 31 December, Li Wenliang was summoned to an interrogation by the Wuhan Municipal Health Commission. He was made to wait until 4am before being interviewed and forced to sign a humiliating confession of sharing ‘untruthful information’. Six weeks later, he would die of Covid.
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Shi Zhengli, head of the Centre for Emerging Infectious Diseases at the Wuhan Institute of Virology, was at a conference in Shanghai. On 30 December she was ordered by the head of the WIV to drop whatever she was doing, abandon the conference and catch a train back to the lab to examine samples that had been sent there from the hospital.
I wondered if [the municipal health authority] got it wrong’, she later told a journalist. ‘I had never expected this kind of thing to happen in Wuhan, in central China.’ She then recalls worrying: ‘Could they [the viruses] have come from our lab?’
Well might she worry. In the preceding 20 years, her lab had been responsible for tracking down the source of the SARS outbreak of 2003. To do this, they had sampled animals and people from all over China, zeroing in on horseshoe bats in southern Yunnan near the border with Laos, from where thousands of bat faeces and blood samples had been sent a thousand miles north to Wuhan. Her lab contained more SARS-like viruses in its freezers than the rest of the world put together: none came from Wuhan itself. These included the closest known relative of what would soon be called SARS-CoV-2. Quite a coincidence.
But it was worse than that. Shi had supervised a team, led by Ben Hu, to do a series of experiments with these bat viruses, swapping their spike genes between strains, infecting human cells with them and infecting mice with human genes. In one experiment, the virus had gained a 10,000-fold increase in infectivity. Some of these experiments had been done at inappropriately low biosafety levels. The risk of a scientist falling ill with a human-trained version of a SARS-like virus was high.
Still more worryingly, the previous year Shi had worked on a plan to insert a feature called a furin cleavage site, known to increase infectivity in human beings but not bats, into a SARS-like virus for the first time. SARS-CoV-2 is still today the only SARS-like virus known with a furin cleavage site.
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The authorities excluded from testing all potential cases that had no connection or proximity to the seafood market. They insisted the virus could only be caught from animals, despite nurses and doctors falling sick. They went ahead with a huge banquet for the Chinese New Year and encouraged people to travel abroad. By mid January at the latest, the virus was already in a dozen countries, every index case tracing back to a traveller from Wuhan.
