Interview with the Second Expert Team Sent to Wuhan by Health Commission: Why Do We Fail To Find Human-to-human Transmission?

（Jennifer’s note: The following is the English translation of a report published by the Chinese media Caijing.com on Feb. 26, 2020. The report has been removed from Caijing’s website but is still available on some other sites. Here is an archive version of the original Chinese report. )

On January 20, 2020, Zhong Nanshan, the leader of the high-level expert group of the National Health and Medical Commission, an academician of the Chinese Academy of Engineering, and an expert in respiratory medicine, said in an interview with CCTV News program "1 + 1" that the novel coronavirus is "affirmed from human to human."

The discovery that novel coronavirus is "human to human" is of great significance to public protection and medical treatment, and January 20 also became an important time point for the prevention and control of the epidemic.

Since the "unknown cause of pneumonia" was publicly disclosed by the Wuhan Health and Medical Commission on December 31, 2019, whether the novel coronavirus has been passed down from person to person has been a topic of great concern. On the evening of January 18, 2020, 84-year-old Zhong Nanshan rushed from Guangzhou to Wuhan. Two days later, he disclosed the virus "human-to-human" information.

The outside world has learned that before Zhong Nanshan, there were two groups of experts who went to Wuhan to investigate on December 31, 2019 and January 8, 2020, but neither group of experts explicitly mentioned that the virus would be transmitted from person to person— —On January 4, 2020, the first group of members of the National Health and Medical Commission publicly stated that “at present, no obvious evidence of human-to-human transmission was found”; on January 10, the second group of members of the expert group told the media that according to the situation of patients' illness and spread, the overall epidemic is "preventable and controllable."

From the outbreak of the epidemic, the investigation results and public statements of the above two groups of experts may become one of the factors that delay the epidemic prevention and control. Therefore, the public has been asking questions in various ways: Why did the first two groups of experts fail to reach the important conclusion of "people-to-people" during the investigation in Wuhan?

A reporter from Caijing recently interviewed a member of the second group of experts. The expert arrived in Wuhan on January 8, 2020, and left in late January 2020. The expert asked to be interviewed anonymously, but did not object to Caijing's identifying him as a member of the second group of experts.

The expert emphasized to Caijing reporter that at that time the expert group had limited information and materials in Wuhan and could not reach the conclusion that coronavirus transmission was "human to human." He said, "If medical personnel was infected it must be human to human, and it shows that the virus is very contagious." With hindsight, there have been cases of infected medical staff in Wuhan at that time, but the expert said that the expert group did not have relevant information at that time.

"We are also trying to understand." The expert introduced that during the period in Wuhan, the expert group paid special attention to the medical staff for infection. "Everywhere I went, I asked whether the medical staff was infected." But the answers were " No". With hindsight, what the expert group learned at the time in Wuhan was not all the truth. However, it is not known who concealed the fact that some medical staff members were infected at the time from the expert group.

The expert also said that after the second group of experts arrived in Wuhan, a lot of information was not available. "We didn't see a formal report, including how the disease came, how it was discovered, what investigations were done, what the findings were, which cases were initially found ... these we didn't know. Later as we had no ways to find out, we basically were only responsible for clinical treatment. "

On January 16, 2020, the second group of experts returned to Beijing to organize a meeting. At that time, members of the expert group said that the outbreak was underestimated.

Even so, the public still questioned: Have the panel go to Wuhan done “its due diligence”, and tried its to find out the true situation?

The following is the content of this expert's exclusive interview with the reporter of Caijing.

Why didn't they find "people to people" transmission?

Caijing reporter: Why did the second group of experts fail to find "person-to-person" transmission?

Expert: To confirm infections within family and society, then to confirm person to person tranmission, there must be a clear chain, and it could also be joint exposure. But medical personnel are different, because they and the patient cannot have common exposure, and there is no need to analyze what kind of transmission chain there is. As long as the medical staff is infected, it must be "person-to-human" transmission, and it shows that the virus is still very contagious, because medical staff generally do not have particularly close contact with patients.

Why could Academician Zhong Nanshan declare "clear person to person transmission"? First, he already knew the transmission chain of the virus in Guangdong. There were two cases in Guangdong. They had not been to Wuhan, but their family members developed new coronavirus pneumonia when they went to Wuhan. Secondly, because Academician Zhong had mastered the transmission chain of the virus, he arrived in Wuhan and someone immediately reported to him that there was a medical staff infection.

In contrast, although the materials we had at the time also included two cases of family cluster infections, we did not know the chain of transmission and cases of medical care infections, so we could not draw the conclusion of "human to human transmission."

Caijing reporter: Regarding whether the novel coronavirus pneumonia will be "person-to-person", did the expert group discuss this issue?

Expert: Everyone is confused. Because in the early days, cases were mostly related to the South China Seafood Market, and often a family of traders worked in this market, or often went to this market. Therefore, after a family is infected, is it caused by co-exposure or "person-to-person transmission"? The question is ambiguous. At that time, someone in our expert group also asked the experts of the disease control system. The answer from the other party was that there was no way to determine "person to person transmission."

Caijing reporter: The second group of experts went to Wuhan to investigate. Is there no information on whether the medical staff was infected in the information provided by Wuhan?

Expert: No. Later, according to media reports, a case of medical staff infection had actually occurred at that time. Lu Jun, an emergency physician at Tongji Hospital, developed symptoms on January 5, 2020, was hospitalized on January 10, and was referred to Jinyintan Hospital on January 17. (Editor's note: According to the Beijing Youth Daily, on the evening of January 5, Lu Jun, a 30-year-old emergency doctor at Tongji Hospital, developed fever symptoms, was hospitalized with "viral pneumonia" on January 10, and transferred to January 17 ICU treatment at Jinyintan Hospital. Lu Jun said that he does not know the exact date of the diagnosis of new coronary pneumonia, but it must be confirmed before the transfer on January 17.)

We went to Tongji Hospital after January 10. The response we received at the time was that there was no medical staff infection. I think that the medical personnel's infection situation should be pursued one by one, to whom did the hospital report it, and where was this information reported eventually blocked?

Caijing reporter: Which hospitals did the second group of experts go to?

Experts: Jinyintan Hospital, Wuhan Pulmonary Hospital, Wuhan People's Hospital, Wuhan First Hospital, Union Hospital, Tongji Hospital. We mainly went to their fever clinics.

Caijing reporter: With all the hospitals you went to, did you personally ask if there was any medical infection?

Expert: We are particularly concerned about the infection of medical staff. We did have asked about this at every place. When we heard that any medical staff was infected, we would call one by one to ask, but in the end, we got information that there was no medical staff infection at all. We weren't shown the infected area of ​​the medical staff either. Who knows where they were then? How could we find out at such large hospitals?

Caijing reporter: Who was accompanying the expert group at the time?

Experts: People from the hospital and the health committee are all there.

Caijing reporter: Are people from the hospital directors, administrative staff, or doctors?

Expert: Some are the directors of the hospital, and some are the director of the medical service.

Caijing reporter: "Person to person transmission" is the core element in this infectious disease.

Expert: It is very critical. We have always suspected that there is "person-to-person transmission", but there was just no evidence.

Caijing reporter: Why wasn't there evidence? Was it because they did not provide it, or because what they provided was not enough?

Expert: They didn't tell us the truth. From the real situation now, they were lying.

The expert group did not know the real situation?

Caijing reporter: Has Wuhan fully informed the expert group of the information it had at the time?

Expert: Regarding the investigations of the first group of experts and Hubei and Wuhan, we did not see a formal report, including how the disease was discovered, what investigations were conducted, what the findings were, and which cases were initially found ... We did't have any of these. Later, as we had no way to find out, we basically were only responsible for clinical treatment.

Caijing reporter: Why was this happening?

Expert: They didn't cooperate at all. This was the main problem. For example, if the medical staff was infected, even if you reported only a medical staff infection, we would have realized that it is contagious.

Caijing reporter: Then you gave up the investigation later?

Expert: It was not that we gave up, but because we weren't allowed to step in. At that time, territorial management was required. After we went, we received instructions. The general content was: territorial management, local focus, and the expert group were only there to offer some help.

Later, Hubei and Wuhan each had their own expert teams, and they were mainly responsible for the treatment of patients. Our main task was to receive a delegation from Hong Kong, Macao, and Taiwan at the time, and the other was to go to a hot clinic for information.

Caijing reporter: They asked you to offer help? Did you end up offering any help?

Expert: That is the simplest thing: I asked you to report all the cases. Why didn't you report them?

Caijing reporter: Has Wuhan listened to your suggestions and opinions?

Expert: After the pathogen was found, before the news was released, members of the expert group and the local government had a meeting. What we were really talking about is how many cases are there? Among the case information provided by Wuhan, 41 cases were confirmed by laboratory test results. In addition to this batch of cases, there was a batch of suspected cases that had not been tested by the laboratory.

We had different opinions at the time about what kind of information about the cases should be released. The unanimous opinion of our expert group was that all suspects and confirmed diagnoses should be reported, and we clearly expressed that before leaving. But that was not the case the next day. When the news came out, only 41 cases were reported by the local government, just a group of people diagnosed by laboratory methods. I don't understand the things behind it. (Editor's note: Wuhan Municipal Health Commission issued a notice on January 11 stating that after the initial identification of the "unknown viral pneumonia" pathogen as a new type of coronavirus, the Wuhan Health Commission organized the testing of existing patient specimens, as of midnight on Jan 10, 41 cases of pneumonia with a new coronavirus infection were initially diagnosed, of which 7 were severe cases and 1 died. The remaining patients were in stable condition.)

Caijing reporter: How many suspected cases did you see at that time?

Expert: I can't remember the details. To be sure, the number of suspected cases I saw was greater than the number of confirmed cases.

Caijing reporter: If the suspected number had also been announced at the time, would the public be more vigilant?

Expert: yes, that would be the case.

Caijing reporter: Before you, the first expert group had been to Wuhan. Why did they organize the second group of experts to Wuhan?

Expert: They stayed too long. They spent New Year's Day there.

Caijing reporter: How did the second group of experts and the first group of experts transfer?

Expert: They briefed us on the situation, mainly about the cases. Everyone was briefed about the basic situation, and it was over. Our focus was to go to Jinyintan Hospital and Wuhan Pulmonary Hospital and guide them in treatment.

Caijing reporter: Was there a preliminary judgment on the novel coronavirus pneumonia virus at that time?

Expert: It was definitely not the same virus like SARS, because according to the information I had obtained, the two only had more than 70% homologous. So it was not right to classify it as SARS. In addition, the severe cases we saw at the time were indeed fewer than SARS. That was not wrong, and it is more confirmed now. In addition, there were deaths, but not many. One of the 41 confirmed cases at that time.

Caijing reporter: After that, how do you and the third group of experts transfer?

Expert: I didn't see Academician Zhong Nanshan. After the second group of experts returned, we went to a meeting of the National Health Commission to assess the epidemic. Some members said at the time that the outbreak was underestimated. In my impression, the attitude of the health and health committee changed the next day, and it has begun to attach importance to it.

Caijing reporter: Compared with the "person-to-person" issue, the "preventable and controllable" conclusion reached by the second group of experts at that time caused greater controversy.

Expert: The situation grasped by the expert group at that time was indeed preventable and controllable. Only 41 patients, can you say that it is not preventable and controllable? The main problem is not that we said it was preventable and controllable. The disease is definitely preventable and controllable even now. You should write this clearly. This disease IS preventable and controllable. However, we didn't say you should not prevent it or control it. Have we succeeded in containing and prevent it to this day? The problem is, we asked you to control and prevent it, but you did not prevent or control it, then whose responsibility is that? Can any disease be controlled if we don't make an effort to control and prevent it? Failing to control and prevent is what caused the disastrous consequences of today, not the concept that it is controllable and preventable. 

Caijing reporter: Looking at this issue today, why do you think they were hiding information?

Expert: Then I don’t know. You can to and ask them. Who knows? We do not guess others' intentions. 

I believe this is not the case in Beijing, nor in Guangdong, it may not be the case in other places. Look at the current prevention and control situation, then you'll know.

Caijing reporter: If they had told you the actual situation (medical infections) at that time, would the situation be different today?

Expert: If they said that the medical staff was infected, that was not limited "person-to-person", and it would have been defined as "person-to-person".

Caijing reporter: Why could the third group of experts see clear evidence of "people to people transmission" when they went there?

Expert: Things had reached to the point which they couldn't hide anymore. How could it not be exposed? From the speech of Academician Zhong, there was medical staff infection, which was very important evidence. If we had been told that there were medical staff infections, our judgment of epidemic situation would have definitely been different. 

Caijing reporter: At that time, Wuhan always claimed that there was no medical staff infection. As an expert group, did you ever doubt this?

Expert: Of course we doubted it, but this doubt was useless. When we heard about (medical infection), we contacted the hospital, because we didn’t know which doctor it was. After contacting them, they would not tell you or tell you the truth. There was nothing we could do because it had been made very clear to us that it was territorial management. The instruction we received was that we should mainly assist the local authorities, the national expert group could offer help, guidance, and assistance.

Caijing reporter: If you had doubts, why didn't you directly ask the local government or hospital?

Expert: When we discussed, we asked them to report truthfully. The leader of the health and health committee said on the spot. He said, "Did you doubt that I concealed the cases?" He asked us openly, and all the experts were present. If he was saying that, what else could we say?

Caijing reporter: After hearing that sentence, how did the expert group feel?

Expert: You should not look for us, you should look for that leadership to learn this. That health committee member has now been removed from office. (Note: On February 10, the Standing Committee of the Hubei Provincial Party Committee decided to remove Zhang Jin as the secretary of the Party Committee of the Hubei Health and Health Committee; Liu Yingzi was also removed from the position as the director of the Hubei Health and Health Committee; Wang Hesheng, member of the Standing Committee of the Hubei Provincial Party Committee, now holds the above two posts.)