Wednesday, 6 May 2020

Covid-19: stretching the time-line

In a post on Facebook some time ago I speculated that Italy's surge of Covid-19 infections was unlikely to have been caused by just the two Chinese tourists diagnosed in February while they were in the country. That supposition was supported by clinical evidence towards the end of the month. As the Guardian reported:
Massimo Galli, professor of infectious diseases at the University of Milan and director of infectious diseases at the Luigi Sacco hospital in Milan, said preliminary evidence suggested the virus could have been spreading below the radar in the quarantined areas.
“I can’t absolutely confirm any safe estimate of the time of the circulation of the virus in Italy, but … some first evidence suggest that the circulation of the virus is not so recent in Italy,” he said, amid suggestions the virus may have been present since mid-January.

Now we have evidence from France that a man who recovered from pneumonia (apparently) over Christmas had actually contracted Covid-19.
Dr Cohen, head of emergency medicine at Avicenne and Jean-Verdier hospitals near Paris, said the patient was a 43-year-old man from Bobigny, north-east of Paris. He told the BBC's Newsday programme that the patient must have been infected between 14 and 22 December, as coronavirus symptoms take between five and 14 days to appear. The patient, Amirouche Hammar was admitted to hospital on 27 December exhibiting a dry cough, a fever and trouble breathing - symptoms which would later become known as main indications of coronavirus.

This was four days before the WHO's China country office was informed of cases of pneumonia of unknown cause being detected in the Chinese city of Wuhan.

- and three days before the Wuhan accidental whistle-blower, opthalmologist Li Wenliang, correctly surmised that a patient had been infected with a virus similar to SARS. A further six cases came to light. It should also be noted that Dr Li remarked that all these patients had links to Huanan Seafood Market (not the Wuhan laboratory).

The Wikipedia entry continues:
On 8 January, Li contracted the coronavirus when he came into contact with an infected patient at his hospital. The patient suffered from acute angle-closure glaucoma and developed a fever the next day. Li then began to suspect that the patient might have a coronavirus infection. Li developed a fever and cough on 10 January, which soon became severe. Doctor Yu Chengbo, a Zhejiang medical expert sent to Wuhan, told media that although most young patients do not tend to develop severe conditions, the glaucoma patient whom Li saw on 8 January was a storekeeper at Huanan Seafood Market with a high viral load, which could have exacerbated Li's infection.

So it is likely that Covid-19 was established in continental Europe in December at the latest, and probably from more than one source. Chinese who made their money in "wet markets" could have visited tourist attractions and ski resorts both in Italy and France, in the latter case passing through Charles de Gaulle airport, whence  the Bobigny patient may have caught it via an asymptomatic wife. Another possibility is that a French trader with links to former colonies in south-east Asia may have visited a wet market there. French efforts to find their own "Patient Zero" continue.

On the other side of the Atlantic, Mike Pompeo continues to blame the Chinese for the fact that Covid-19 is running wild in the USA. He states, correctly, that on the 3rd January the authorities in Wuhan suppressed Dr Li's evidence and threatened him with criminal action over the leak on scoial media of his warnings to medical colleagues. What Pompeo did not add - thus implying that the Chinese government has continued to be obstructive - was that on 11th and 12th January the China national health authority gave detailed information to WHO about the outbreak and have continued to cooperate with the world body since. Local officials who allowed the virus to spread were sacked or censured.

The rigid centralised communist system in China is at fault in one respect, I suggest. Control is exercised from the top. Information flows from top to bottom, less from bottom to top and clearly not horizontally. The Wuhan laboratory could publish in scientific journals world-wide, but would surely be in trouble if it issued warnings against wild animal trade inside the country. Politics militates against science. The Wuhan officials were more concerned about keeping intimations of trouble away from the media and, more importantly, their party bosses. Even if they knew about the science  - which is unlikely - they believed that keeping up the pretence that all was for the best in their socialist city was more important than saving the lives of a few pneumonia sufferers.

In Western democracies, lateral transmission of information is relatively easy. However, there is a countervailing threat, the attitude of populist leaders to "experts". The reliance on gut instinct, remedies learned at mother's knee and "common sense" not only delays seeking expert opinion until there is a crisis but also deters scientists from volunteering warnings, knowing that they will be disregarded.

Boris Johnston likes to compare himself with Winston Churchill. As has been pointed out here before, a major difference is that, for all his faults, Churchill was faithful to the British people and did not single any section of the public out for contempt. Another great difference - and one that was crucial to our survival in the second world war - was his respect for scientists and love of technology.

At least our leaders have not plumbed the depths of the US leadership - yet.

PS - On 5th March, Matt Hancock, the Health Secretary, said that shutting schools and universities because of the corona virus outbreak would have no clinical benefit. There were no plans to cancel large events. That was based on a political interpretation of the scientific advice, and a policy that was to be reversed when the scale of the deaths resulting from it became obvious.

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