Tuesday, April 07, 2020

Who was patient zero? And does it matter?

Since the outbreak of the COVID-19 coronavirus there has been much speculation as to where it came from. Most scientists are in general agreement that the virus resulted from a process known as zoonosis whereby a virus jumps from animals to humans. But there has also been wild speculation, amongst netizens both in China and the West as to the specifics.

The original source

Bats are widely believed to be the original source of the COVID-19 coronavirus. Research carried out by at least one team, based at the Wuhan Institute of Virology, indeed seems to point to at least one species of bat, the horseshoe bat found and collected in two caves - Yanzi and Shitou in Yunnan province - as to being reservoirs of a multitude of coronaviruses, some of which bear strong similarities to COVID-19 [NCBI / NYT].

But what remains unclear at the moment is how the virus jumped from the bats to humans. Some scientists believe that the virus jumped from bats to a second animal which in turn was transported to the Wuhan wet market and from which it then crossed to humans.

This is of course entirely plausible. Whilst there are examples of people in China using bats in Traditional Chinese Medicine, the bats used are often sold dried and would be unlikely to harbour viruses for any length of time having been killed and dried. Therefore any zoonosis would likely require a live bat infecting another animal which in turn might be taken to market.

Intermediate host
 
A whole number of potential candidates exist, though there has been much focus on the pangolin, a rare, exotic and scaled mammal which is prised for its meat as well as its scales, which again are used in Traditional Chinese Medicine. However, less exotic animals such as pigs could also have facilitated the jump from bats to humans.

But there has been wild speculation that the virus might have leaked directly from the Wuhan Institute of Virology itself where the bats were being studied.

Conspiracy theories

One particular piece of information that has fuelled such rumours is the apparent disappearance of Huang Yanling [黄燕玲] who worked out of the laboratory. Whilst it is not denied that Huang Yanling once worked at the institute, official accounts insist she moved on from her post in 2015 [Xinhuanet - Chinese]

However there remains much suspicion about her potential involvement as much information about her has been scrubbed from the Internet. Nor has anyone managed to locate her.

Another anecdote that has also fuelled the theory that the virus came from the Wuhan Institute of Virology is a quote from one of the team who made significant discoveries about coronaviruses in bats.

Shi Zhengli [石正丽], a virologist at the WIV, and a world expert on bat viruses, and known as 'China's Bat Woman', wrote in Scientific American in March this year that when she was urgently contacted by the head of the Wuhan Institute of Virology on 31st December 2019 to investigate coronavirus samples found in two patients with atypical pneumonia, she remembers thinking "If coronaviruses were the culprit, could they have come from our lab?"

Of course, such thoughts might well run through the minds of a scientist working closely with coronaviruses that are later found to have been responsible for starting a pandemic. But feelings or concerns are not proof.

Denials

Shi was the focus of personal attacks in Chinese social media who claimed the Wuhan Institute of Virology was the source of the virus, leading Shi to post, "I swear with my life, [the virus] has nothing to do with the lab."

She went further in a follow up statement, saying, "The novel 2019 coronavirus is nature punishing the human race for keeping uncivilized living habits. I, Shi Zhengli, swear on my life that it has nothing to do with our laboratory."

Of course, it might be possible that Huang Yanling was infected whilst working at the laboratory and later infected people in and around the wet market in Wuhan only to be 'disappeared' in order to 'hide the truth'. The police action, early on in the outbreak, against a doctor who tried to bring attention to the new deadly virus does nothing to quell such conspiracy theories. Dr Li Wenliang had, in December 2019, attempted to bring attention to colleagues of a possible outbreak of an illness that resembled severe acute respiratory syndrome [SARS], later acknowledged as COVID-19. However, on 3rd January 2020, Wuhan police summoned and admonished him for "making false comments on the Internet." Li later died from complications after contracting the virus himself. 

Scapegoats and inaction

It is clear that the Communist Party of China manipulated information, silenced individuals and potentially risked more lives by not being upfront with both its own people and the world in general. But even if there were cover-ups, it was clear by mid to late January as stringent lockdowns were implemented and temporary hospitals were constructed, that the situation was serious. To blame China for the West's complacency is merely looking for a scapegoat.

Indeed many countries close to China reacted far swifter and decisively in the face of the spread of the virus. Taiwan, for example, employed temperature and other health checks on all people arriving early on, conducted widespread testing as well as contact tracing and quarantines. As such there are only a little over 300 cases in the region and only 5 deaths amongst a population of over 23 million. Similar procedures in Hong Kong, South Korea and Iceland has also kept the numbers of cases and deaths relatively low.

The first cases appeared in the UK on 31 January, but it was not until the 23rd of March that a lockdown was implemented following a closure of schools and an order that pubs, clubs, restaurants and other public places be shut. In that time there was no widespread testing, people arriving from abroad were not subject to temperature or health checks and there was little effort to perform contact tracing [Wikipedia].

The same was true of the US. On the 19th January 2020, a 35-year-old man presented himself to an urgent care clinic in Snohomish County, Washington having returned from Wuhan [NEJM / NYT]. Having seen a health alert from the US Centers for Disease Control and Prevention [CDC] about the novel coronavirus outbreak in China and suffering from a cough and fever he had decided to seek medical help. The man later recovered. However, it is likely that many others, perhaps asymptomatic, also arrived in the US around this time or before and began to spread the infection. Yet once again, the US dragged its feet in terms of checking arrivals from other countries, delaying testing, and failed to prepare for what later proved to be a major health emergency, though a ban on individuals travelling from China was implemented on the 31st of January.

Learning lessons

Whilst this pandemic is far from over, one can only hope lessons are learnt. All countries must prepare for any future pandemics. The WHO along with governments from all countries must draw up plans and procedures to curtail the spread early on. And information must be freely shared, not only between scientific bodies and governments, but also to the general population.

Many countries around the world are at fault concerning the spread of the COVID-19 coronavirus. China's ruling communist party failed to share and even stifled the flow of information. Many other countries failed to act quickly enough, despite warnings from China and the WHO as early as the 30th of January when the WHO declared a global health emergency.

First world countries in particular could be rightly criticised for maintaining their public health service and for mothballing preparations for future pandemics including the failure to maintain equipment and failing to store Personal Protection Equipment [PPE] appropriately.

As such, in many countries there is a clear shortage of ventilators, PPE and other important equipment, as well as a shortage of properly trained staff, nurses and doctors.

More pandemics to come

This won't be the last pandemic and as Dr Shi Zhengli says, "the mission must go on" to find and identify other coronaviruses. "What we have uncovered is just the tip of an iceberg."

Disease ecologist Peter Daszak, who has collaborated with Shi over many years, says there are as many as 5,000 coronavirus strains waiting to be discovered in bats globally. As far back as 2013 he warned that bats and other animals, through zoonosis, pose a risk to us all [Wired]. 

So who was patient zero?

So, was Huang Yanling patient zero? It is perhaps of little consequence. Whether she was the first person to begin the spread, or whether is was a pangolin or pig that was the first carrier, it is zoonosis that is the driving factor. 

Indeed, it is not the fault of a virology lab or its workers. It isn't the fault of the bats either per se. It is the fault of humans for failing to heed the warnings from scientists.

As Daszak said only this week, "We need to be thinking about pandemics in the same way we think about climate change – it's an existential threat to us, but it's one we can actually control, because we're the drivers of it." [SCMP]

"Bat-borne coronaviruses will cause more outbreaks," says Dr Shi, "We must find them before they find us."  

tvnewswatch, London, UK

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