Takeaways from internal documents on China’s virus response

On Jan. 14, China’s top health agency told provincial officials that they were facing a likely epidemic from a new coronavirus — but didn’t alert the public for six days.
Internal documents obtained by The Associated Press show the National Health Commission ordered secret pandemic preparations, even as they downplayed the outbreak on national television.
President Xi Jinping warned the public on the seventh day, Jan. 20. By then, more than 3,000 people had been infected during nearly a week of silence, according to retrospective infection data.
Takeaways from the internal documents:

THAILAND JOLTS CHINA AWAKE
For almost two weeks, China’s Center for Disease Control did not register any cases from local officials, internal bulletins obtained by the AP confirm. Yet during that Jan. 5-17 period, hundreds of patients were appearing in hospitals not just in the city of Wuhan but across the country.
Doctors and nurses in Wuhan say there were many signs the coronavirus could be transmitted between people by late December. But officials muzzled medical workers who tried to report such cases. They required staff to report to supervisors before sending information higher. And they punished doctors who warned about the disease.
The muffling of warnings left top leaders in the dark. It took the first confirmed case outside China, in Thailand on Jan. 13, to jolt leaders in Beijing into recognizing the possible pandemic before them. An internal memo cites China’s top health official, Ma Xiaowei, as saying the situation had “changed significantly” because of the possible spread of the virus abroad.

‘THE MOST SEVERE CHALLENGE SINCE SARS’
The memo, on a secret Jan. 14 teleconference held by Ma, shows that Chinese officials were deeply alarmed and had come to a much grimmer assessment than they were letting on in public.
For weeks, officials had stuck to the line that there was “no clear evidence of human-to-human transmission,” calling the disease “preventable and controllable.” But during the teleconference, Ma said that “clustered cases suggest human-to-human transmission is possible.”
“The epidemic situation is still severe and complex, the most severe challenge since SARS in 2003, and is likely to develop into a major public health event,” the memo cites Ma as saying.
After the teleconference, officials adjusted their language slightly, but continued to downplay the threat.
“We have reached the latest understanding that the risk of sustained human-to-human transmission is low,” Li Qun, the head of China CDC’s emergency center, told Chinese state television on Jan. 15.

PANDEMIC PREPARATIONS
Before the teleconference, health authorities had focused narrowly on Wuhan, the central China city where the outbreak started.
They searched for visitors to a market that dealt in live game, believing the virus was largely transmitted from animals to humans. But rattled by the case in Thailand, Chinese leaders launched a nationwide hunt to find cases, the documents show.
The memo warned the risk of transmission was higher with many people traveling for the upcoming Lunar New Year holiday. “All localities must prepare for and respond to a pandemic,” it said.
Officials distributed test kits and ordered health officials across the country to screen patients. They ordered hospitals to open fever clinics, and doctors and nurses to don protective gear. They instructed officials in Hubei province, where Wuhan is located, to begin temperature checks at transportation hubs and cut down on large public gatherings.
They did it all without telling the public. Even as the new measures began to turn up hundreds of cases across the country, tens of thousands of people dined at a mass Lunar New Year banquet and millions traveled through Wuhan.
‘EMPHASIZE POLITICS’
The documents show how political considerations may have shaped China’s response to the outbreak.
In the memo, Ma demanded officials unite around Xi. It made clear that social stability was a key priority during the long lead-up to China’s two biggest political meetings of the year in March.
“Emphasize politics, emphasize discipline, emphasize science,” the memo cites Ma as saying.
While the documents do not spell out why Chinese leaders waited six days to make their concerns public, the meetings may be one reason. They were later indefinitely postponed.
The memo said the health commission was acting in accordance with “important instructions” from Xi and other top officials. It referred to a Jan. 7 meeting chaired by the vice premier in charge of public health and attended by Xi. But it did not make explicit what those instructions were.

REWRITING HISTORY
By late January, boiling public anger over China’s initial handling of the outbreak put the leadership on the defensive. Health experts accused Wuhan’s leaders of a cover-up, and Beijing fired local officials.
National leaders began to publicize directives they had earlier made in secret in apparent attempts to demonstrate they had acted decisively from the beginning. On Feb. 17, President Xi revealed he had led the response as early as Jan. 7, two weeks before his first public comment on the virus. Days later, the National Health Commission published a notice revealing its confidential teleconference, dated to Jan. 14.
The public notice omitted sections of the internal memo showing how alarmed officials had been at the time. It added lines suggesting that commission leaders were responding proactively to what then seemed a minor outbreak.
“Respond to small probability events with high probability thinking,” the altered notice read. “Seek truth from facts, and propagate scientific knowledge on epidemic prevention to avoid causing panic among the masses.” AP