COVID-19: What Went Wrong?

Illustrated by: Yixuan Chen

Many things have happened since the discovery of the SARS-Cov-2 and the appearance of Coronavirus disease 2019 (COVID-19) in Wuhan, China. As of 24:00 on Feb 20, there are 75,465 identified cases of COVID-19 nationally, 62,662 of which are in Hubei province. Wuhan with more than 9 million residents is completely shut down. Panic and xenophobia are spreading across the border.

China fights hard in a so-called “People’s War”, which describes the nationwide actions against the epidemic. As a veteran of a public health crisis, China has been running a national surveillance system for Pneumonia of Unknown Etiology (PUE) since the severe acute respiratory syndrome (SARS) outbreak in 2003 [1].The Chinese Center for Disease Control and Prevention (CCDC) sent high-profile virologists and public health experts to Wuhan by the end of December. Gene sequencing of the virus was done in early January. More than 4.5 billion yuan ($645 million) of financial aid has been distributed directly to the Hubei province by the National Ministry of Finance [2][3]. A number of 21,569 healthcare workers and 189 medical teams have been relocated to Hubei by February 12th. 

However, the situation in Wuhan and Hubei is a disaster. Though both the public and central government are pouring countless donations and supplies to Hubei, medical supplies are running low in almost all major hospitals in Wuhan. The public has questioned the disproportionate and delayed allocation of public donations by one of the government-designated dispensers, the local Red Cross charter [4]. Medical workers are exposed to the hazardous environment usually with insufficient protective gear and lack of knowledge, resulting in 1716 cases of infections and 6 deaths by February 14th including one of the whistleblowers, Dr. Li Wenliang. Wuhan municipal government has shut down public transport since January 23rd, and at least 48 cities in China have implemented certain lockdown policies.

This public health crisis continues to escalate as this article is written, while the local government and even the central government remain unable to control the situation. So, what went wrong?

Are scientists to be blamed?

Interestingly, all of the leading virologists and public health experts in China have faced harsh criticism on the internet. One popular opinion is that they had prioritized publishing their research results in high-caliber international academic journals rather than working to contain the disease, which allows them to reap the benefits of bolstered academic credentials while paying no attention to the people’s safety in Wuhan. An inferno of controversy struck social media when the director-general of CCDC, virologist George F. Gao, co-authored an article analyzing the early transmission patterns of COVID-19 on January 27th in the New England Journal of Medicine. This academic accomplishment was treated as evidence of his malfeasance. A document published by the Ministry of Science and Technology on January 29th seemed to support this argument by asking scientists “not to focus on publications until epidemic prevention and control tasks are completed.”

It appeared that scientists were indeed the ones to blame. However, that is simply not true.

In fact, the CCDC is an agency under the National Health Commission (NHC) with no authorization to make or override policies or administrative decisions made by the local government [5]. Think about it as a government-sponsored think tank that provides important intelligence support but is not entrusted with decision making. Furthermore,  if the municipal government in Wuhan decides to down the city, they are changing the lives of countless people. The Wuhan government needs to consult specialists in not only medicine but commerce, finance, and manufacture to optimize their decision. Drawing from the data procured by the CCDC, local government and party branches can act to contain this public health crisis.

The assumption that scientists should do everything also neglects the specificity of expertise. Scientists may be virologists and epidemiologists by training but are not familiar with policymaking and administrative procedures. Therefore, they can help in the decision-making process but not redirect society to contain the disease with administrative orders.

The scientific community around the world recognizes the outstanding contributions of medical experts in China who rapidly responded to the emergency. A team of scientists in the CCDC released the genome sequence of the novel coronavirus online on January 10th [6]. Dr. Shi Zheng-li and her team, who successfully tracked the origin of SARS coronavirus in 2017, published their research about the possible origin and functioning mechanism of the SARS-CoV-2 on January 23rd. By sharing the data and research results, they fostered global collaboration to combat the public health crisis. 

Is COVID-19 hard to treat in clinical practices?

In short, yes.

On a molecular level, the virus SARS-CoV-2 shares many similarities with the 2003 SARS-CoV. The novel coronavirus, SARS-CoV-2, matches 79.5% of the sequences identified in SARS-CoV. They both use spike (S) glycoprotein to bind a cell entry receptor called angiotensin-converting enzyme 2 (ACE2) in order to enter the host cell. However, SARS-CoV-2 has a higher affinity to the receptors, which possibly contributes to its strengthened ability to spread amongst humans.

In clinical practice, things get trickier: there is no known effective anti-virus treatment. The virus may trigger a severe immune overreaction called a cytokine storm, which results in acute respiratory system responses and life-threatening symptoms. It takes time to figure out how exactly a novel virus triggers a cytokine storm. Dr. Wang Leyao, a virologist by training and a specialist for human microbiome and lung diseases in Washington University School of Medicine, expressed her concerns. “Normally, viral respiratory infections can be self-controlled…there is no solid study yet on the pathology of this disease. It is long-term research to go.”

Unlike bacteria, there is no medicine available to hunt down the virus without hurting all other cells. However, some medications for viral infections may prove useful. The treatment plan issued by the CCDC [7] recommends Lopinavir/ritonavir, which is a combination of drugs used for HIV/AIDS. Clinical trials have been launched in Wuhan and Beijing to investigate the efficacy of Remdesivir, an antiviral drug developed for Ebola and MERS that “incorporates into nascent viral RNA chains and results in premature termination” [8]. It takes time to figure out the effectiveness of treatments.

What should we be concerned about in addition to medicine?

The National Health Commission (NHC) has been running a bottom-up surveillance system of Pneumonia of Unknown Etiology (PUE) since 2004. The procedures require all clinicians to directly report PUE online, which may stop the local government from concealing the actual situation of PUE. Though many researchers expressed concerns about the effectiveness and the awareness of the system among clinicians, it did work [9]. The surging number of patients with COVID-19 was noticed by the CDC on different levels by the end of December [10]

But after the first week of January, they lost control. Suspiciously, no new cases were confirmed by the Wuhan Municipal Health Commission (WMHC)for five days from January 11th to 15th, when Lianghui, the two most important political conferences in Hubei, took place [11][12]. Then, the number surged. Government officers in Wuhan and Hubei were late at every step of the way as anticipated due to the top-down accountability philosophy. They tend to prioritize the satisfaction of their superiors rather than the well-being of their citizens, implementing campaign-style extreme policies to prove their ability to control the situation. Additionally, the lack of civic participation resulted in a spectacle on social media. Therefore, the lack of civic engagement in China deserves more attention. 

Currently on Washington University’s campus, COVID-19 does not impose health concerns. As of January 27th, no cases of COVID-19 have been identified in Missouri.  There’s no need to wear disposable surgical masks or even N95 medical masks, as Dr. Henry Huang in the Department of Microbiology of Washington University School of Medicine clarifies. “If it’s a raging epidemic like inside China, then [wearing masks] makes some sense,” Dr. Huang says, “there’s a very limited and defined role of the masks.” Masks may catch certain percent of pathogens when someone sneezes on you, while most people neither have the skills to safely take off a N95 mask. In general, washing hands is helpful in terms of flu prevention considering how often we touch our faces and eyes with our pathogen-carrying hands.

After all, a tragedy is happening in China. Every single life counts. Every single family counts. Please join me in remembering what is happening in Wuhan, concerning Chinese citizens, and mourning the loss of lives. 

Edited by: Morgan Leff
Illustrated by: Yixuan Chen


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