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Timeline of the COVID-19 pandemic in 2019

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See also: Timeline of the COVID-19 pandemic
Main article: COVID-19 pandemic

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This article documents the chronology and epidemiology in 2019 of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) and is responsible for the COVID-19 pandemic. The first human cases of COVID-19 were identified in Wuhan, China, in December.

Pandemic chronology

Semi-log plot of cumulative incidence of confirmed cases and deaths in China and the rest of the world.[1][2]
Semi-log plot of daily incidence (epidemiology) of cases by region: Hubei Province; mainland China excluding Hubei; the rest of the world (ROW); and the world total.[1][2]
Semi-log plot of coronavirus daily deaths by region: Hubei Province; mainland China excluding Hubei; the rest of the world (ROW); and the world total.[1][2]

October and November

Phylogenetic studies indicate that SARS-CoV-2 arose in October or November 2019.[3][4][5] Evidence suggests that it descends from a coronavirus that infects wild bats and spread to humans through an intermediary wildlife host.[6] It is not known whether the virus itself evolved in wildlife populations or if its distinctive spike proteins were selected for after zoonotic transfer to humans.[7][8][3][4]

According to ABC News and Israel's Channel 12, the US National Center for Medical Intelligence (NCMI) was aware of the virus by the second week of November and had published the details of the outbreak in Wuhan in an intelligence report.[9][10] The NCMI has denied that the report existed.[10]

1 December

Symptoms of the index case, or patient zero, began on 1 December.[11] The man had not been to the Huanan Seafood Wholesale Market. His family was unaffected, and no epidemiological link between him and the other laboratory-confirmed cases as of 2 January.[11] Wu Wenjuan, a senior doctor at Jinyintan Hospital, said the man was in his 70s, had Alzheimer's disease, lived several bus rides away from the market and had not left his home.[12][13]

13–16 December

Coronavirus disease 2019 antibodies were present in American Red Cross blood samples from California, Oregon, and Washington dating to as early as December 13–16, 2019. This was reported in a November 2020 study published by Clinical Infectious Diseases.[14]

As of February 2020, the first documented COVID-19 hospital admissions were dated to 16 December 2019.[11]

18 December

The Italian National Institute of Health looked at 40 sewage samples collected from wastewater treatment plants in northern Italy between October 2019 and February 2020. An analysis released in June 2020 said samples taken in Milan and Turin on 18 December showed the presence of SARS-CoV-2.[15]

24 December

An unresolved clinical case sparks off the first scientific involvement: a bronchoalveolar lavage fluid (BAL) sample was sent from Wuhan Central Hospital to Vision Medicals (广州微远基因科技有限公司) in Guangzhou, a private company specialising in metagenomic massive parallel sequencing analysis.[16][17]

26 December

An elderly couple with fever and coughs sought treatment at the Hubei Provincial Hospital of Integrated Chinese and Western Medicine (湖北省新华医院). Zhang Jixian, director of the Department of Respiratory and Critical Care examined the couple and made the preliminary diagnosis of their illness as something that "looked like flu or common pneumonia".[18][19]

27 December

After having observed the elderly couple's CT scans were abnormal, Zhang Jixian asked the couple's son to undergo a scan and found the same pattern. Zhang Jixian had been working as medical expert during the SARS outbreak in 2003, and was aware of the signs of a suspected outbreak of an infectious disease.[18][19] Another patient, a merchant from the Huanan Seafood Wholesale Market,[19] arrived at the hospital with fever and cough that day, and his CT scan showed the same characteristics. All blood tests from the four patients indicated viral infection and a further array of influenza-related tests came back negative. Zhang Jixian filed a report to her superiors and also took the precaution of making a provisional quarantine area.[18][19]

Wuhan Central Hospital received message from Vision Medicals that the BAL sample taken on 24 December contained a new kind of coronavirus, and the patient was then quarantined.[20] Also at Wuhan Central Hospital, yet another unresolved case caused a BAL sample to be taken, this time sent off to CapitalBio Medlab of Beijing (北京博奥医学检验所有限公司).[16]

Respiratory samples from a man hospitalized in Paris, France were retrospectively diagnosed as having SARS-CoV-2 virus present. The man presented with advanced symptoms (chest CT of ground glass opacities). His child had previously presented with influenza-like illness. The man had not traveled recently (his last travel outside of France had been to Algeria in Aug 2019). The study from 14 April was published 3 May and widely reported (ex. BFMTV, ABC News, Business Insider).[21][22][23] The epidemiological circumstances remain uninvestigated.[24] (Note: these findings do not appear in the statistics overview from the French Public Health Ministry.[25])

29 December

On this day and the previous, three similar cases arrived at Hubei Provincial Hospital of Integrated Chinese and Western Medicine, all associated with the seafood market. The health authorities had been informed, and medical experts from Wuhan JinYinTan Hospital, "a hospital designated to treat infectious diseases"[26] came to transfer six of the seven patients. Zhang Jixian took the further initiative to let doctors and nurses in the respiratory department wear face masks, and put out an order for 30 hospital coats of fine canvas.[18]

The Wuhan CDC staff found also additional patients with similar symptoms who were linked to the market.[27] (The Wuhan 'Center for Disease Control and Prevention' (CDC) is part of Chinese Center for Disease Control and Prevention.)

30 December

Wuhan Central Hospital received a test report from CapitalBio Medlab, claiming an occurrence of SARS.[16] According to social media, the test result was later found faulty.[20] Several doctors at Wuhan Central Hospital shared the test report on social media in discussions mainly aimed at colleagues.[16]

The first official messages in the pandemic

Wuhan Municipal Health Commission sent a message to its affiliate institutions.[28]

  • Supervising doctors shall hold fast on discipline and create specialised team-units.
  • General staff must be alert to the situation, especially keeping an eye out for patients with symptoms of infectious pneumonia.
  • Statistical material must be gathered ongoingly and send to Wuhan Municipal Health Commission and Hubei Province Health Committee.
  • Statistical material for the previous week, relating to patients with symptoms of infectious pneumonia, is to be sent to Wuhan Municipal Health Commission before 4 o'clock, this day.
  • Without permission from authorised personnel no one is allowed to spread information about the medical treatment.[29][30]

31 December

The first public message in the pandemic

The Wuhan Municipal Health Commission informed the city community about the early signs of a pneumonia outbreak.[31] The message conveys the impression of alertness, by summarising yesterday's orders to the city hospitals; emphasising ongoing scientific and clinical investigations and to seek hospital care when having persistent fever while showing symptoms of pneumonia; as well advising the public to wear face masks and to avoid enclosed public places and crowded areas.

Cases in total: 27
Serious cases: 7
Recovering: 2
As of now: no fatalities, no healthcare-workers infected, no signs of human-to-human transmission, cause of pneumonia infection still under investigation

Chinese government broadcaster China Central Television reported on viral pneumonia, and through the Weibo account "YangShiXinWen", also sent an alert about the unknown virus, adding that a team of experts from the National Health Commission would arrive in Wuhan.[32][33][better source needed]

Qu Shiqian, a vendor at the Huanan Seafood Wholesale Market, said government officials had disinfected the premises on 31 December and told stallholders to wear masks. Qu said he had only learned of the pneumonia outbreak from media reports. "Previously I thought they had flu," he said. "It should be not serious. We are fish traders. How can we get infected?"[34]

Inter-regional measures

According to the Hong Kong government Centre for Health, various "surveillance measures at all boundary control points" have begun – including thermal imaging for checks on body temperature.[35]

Events, reactions and measures

23–24 December

A BAL sample is sent from Wuhan Central Hospital to Vision Medicals. According to the GenBank record, the sample was obtained 23 December, whereas Ren et al.,Chin Med J, 2020 sets the date to 24 December 2019.[36][37]

27 December

Vision Medicals inform Wuhan Central Hospital, by phone, that the requested analysis of a BAL sample – obtained 24 December – show a new kind of coronavirus (Chinese: …"一种新的冠状病毒。" ; …"a new kind of coronavirus.").[16] Vision Medicals also send a written report to the Chinese Academy of Medical Science. The report tells of Chinese: …"样本里面确实有一个跟Bat SARS like coronavirus类似的新型病毒" ; …"a sample containing a new coronavirus similar to bat SARS coronavirus" and in the days that follow there is an intensified communication between the CEO of Vision Medicals Li Youngjun (李永军), the Wuhan Central Hospital and the local CDC.[20]

According to news reports in February 2020 – Workers Daily, Global Times  – at the Hubei Provincial Hospital of Integrated Chinese and Western Medicine and following the report from Doctor Zhang Jixian, the hospital immediately alerted the local CDC, Wuhan Jianghan Disease Prevention and Control Center,[19] however, the report of 22 January 2020 from the Chinese CDC seems to claim this contact falling on 29 December.[27]

29 December

The administration at Hubei Provincial Hospital of Integrated Chinese and Western Medicine convened an inter-departmental panel of doctors whose conclusions were the cases were unusual and required special attention, and also having learned of two similar cases in the city, decided to report their findings to the municipal and provincial health authorities, Wuhan Municipal Health Commission and Hubei Province Health Committee.[19]

30 December

Wuhan Central Hospital receives report from CapitalBio Medlab that their sample (obtained 27 December) contains SARS coronavirus.[16] According to a Caixin news report, this is a mistake. The same news report allege this sample was later sent on from CapitalBio Medlab to Vision Medicals, and that Vision Medicals could confirm the sample contained SARS-CoV-2, i.e. identical to the first sample Vision Medicals had received.[20]

The alleged faulty test-report went to the social media ("社交媒体"), where a couple of doctors from the hospital joined in with warnings and cautions to some of their colleagues. As referred in Caixin Online, from the social media account of Li Wenliang, it is stated that there are 7 cases of SARS at the Wuhan Central Hospital, all connected to the Huanan Seafood Wholesale Market.[16]

For Vision Medicals, too, these are hectic days (27–30 December) with the Chinese CDC requesting all results from Vision Medicals and from the Chinese Academy of Medical Science: "this was an urgent, secret and serious investigation".[20]

The first official messages in the pandemic

Wuhan Municipal Health Commission sends hard-copy messages to its affiliated institutions, containing guidelines in confronting a possible outbreak of infectious pneumonia.[28] Two scan-copies also found their way, the same day, to the Weibo QQ service – a social media platform.[29][30][38]

The first information reaching an international context

FluTrackers, an international disease tracking website established in 2006, was the first report reaching an international context on the situation in Wuhan on 30 December at 23:35:00 as recorded in the internet archive and reported by The Washington Post, Forbes, and CIDRAP. [39][40][41][42] The ProMED reporting program, under auspice of ISID, reported on the situation in Wuhan. The full date is actually 30 December 23:59:00.[28]

WHO may also have noticed the information coming out from Wuhan.[43]

31 December

The Wuhan Municipal Health Commission released a briefing on its website about a pneumonia outbreak in the city.[31] The message on pneumonia of unknown etiology was picked up by news agencies, including the state television CCTV,[32] local news agencies, such as Hubei Daily.[44] and social media, such as the Weibo account of CCTV.[33] People's Daily said the exact cause remained unclear, and it would be premature to speculate.[34]

International agencies also picked up on the reports, including Reuters,[45] Deutsche Welle[46] and the South China Morning Post.[34]

In response to the announcement from Wuhan, Hong Kong's Centre for Health Protection tightened their inbound screening processes. The centre appealed to the public to maintain hygiene, with detailed advice on washing hands and wearing a mask, and further precautions when travelling outside Hong Kong.[35] Hong Kong's Secretary for Food and Health Sophia Chan announced "[any suspected cases] including the presentation of fever and acute respiratory illness or pneumonia, and travel history to Wuhan within 14 days before onset of symptoms, we will put the patients in isolation."[34]

Tao Lina, a public health expert and former official with the Shanghai Center for Disease Control and Prevention, said, "I think we are [now] quite capable of killing it in the beginning phase, given China's disease control system, emergency handling capacity and clinical medicine support." No human-to-human infection had been reported so far and more pathological tests and investigations were underway, an official said.[34]

The World Health Organization office in China picked up the media statement from the website of the Wuhan Municipal Health Commission on cases of viral pneumonia.[47] The WHO China office then notified the WHO Western Pacific Regional Office about the notice from the Wuhan government.[47]

The US CDC claim to have "first learned of a 'cluster of 27 cases of pneumonia'" in Wuhan on this day.[48]

Claims of earlier cases

March 2019: Spain

Chavarria-Miró et al. (submitted) reported finding traces of potentially SARS-CoV-2 related genetic material in a sewage sample collected in Barcelona on 12 March 2019. The researchers suggest that this finding "indicates circulation of the virus in Barcelona long before the report of any COVID-19 case worldwide". However, other researchers have regarded the results with caution, pointing out that there is no evidence of increased respiratory infection in Barcelona around that time. It has been suggested that the results could be a false positive due either to contamination in the laboratory or to the imprecision of the test.[49][50][51]

August 2019: China

An unpublished study by a team of epidemiologists in Boston suggested that COVID-19 could have been spreading in China as early as August 2019. The study found increased traffic in parking lots of Wuhan hospitals that summer, coinciding with increased internet search traffic for terms such as "diarrhea". The authors hypothesized that these results were the result of early coronavirus cases, but cautioned that they could not directly verify such a link or rule out alternative explanations.[52][53] Other researchers expressed cautious interest in the study, while noting that the study lacked a control group.[53] Some researchers have criticised the study's methodology, noting that diarrhea is only the 7th most common symptom of COVID-19,[54] and that the study noted increased traffic to children's hospitals, even though children are generally much less affected to the virus.[55][53]

September 2019: Italy

Blood samples taken in Italy were later found to contain SARS-CoV-2 receptor-binding domain (RBD)–specific antibodies. According to a peer-reviewed, published study,[56] an analysis of 959 blood samples taken during a cancer-screening trial in Italy between September 2019 and March 2020 found antibodies in some of those samples. SARS-CoV-2-specific antibodies were detected in 111 of the samples (11.6%), and 14% of those samples with antibodies were taken during September 2019.[57] The study uses an in-house-designed RBD-based ELISA, namely, VM-IgG-RBD and VM-IgM-RBD, which purports to be of sufficient quality.[58] The summary states: "This study shows an unexpected very early circulation of SARS-CoV-2 among asymptomatic individuals in Italy several months before the first patient was identified, and clarifies the onset and spread of the coronavirus disease 2019 (COVID-19) pandemic."[56] The WHO said on 16 November 2020 that they were contacting the authors of the study for further information about this claim.[59]

27 November 2019: Brazil

A preprint posted online in June 2020 reported that two raw sewage samples collected independently on 27 November 2019 in Santa Catarina, Brazil, detected SARS-CoV-2 (100,000 copies per litre), 66 days in advance of the first confirmed COVID-19 case in the Americas. Subsequent samplings were positive on 11 December and 20 February. These samples show that SARS-CoV-2 could have been circulating in Brazil since late November 2019.[60]

See also

References

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  48. ^ Marisa Taylor (22 March 2020). "Exclusive: U.S. axed CDC expert job in China months before virus outbreak". Health News. Reuters. Archived from the original on 22 March 2020. Retrieved 25 May 2020.
  49. ^ Chavarria-Miró, Gemma; Anfruns-Estrada, Eduard; Guix, Susana; Paraira, Miquel; Galofré, Belén; Sáanchez, Gloria; Pintó, Rosa; Bosch, Albert (13 June 2020). "Sentinel surveillance of SARS-CoV-2 in wastewater anticipates the occurrence of COVID-19 cases" (PDF). MedRxiv. doi:10.1101/2020.06.13.20129627.
  50. ^ Zimmer, Carl; Minder, Raphael (26 June 2020). "Study Suggests Coronavirus Emerged Much Earlier Than Thought. Some Are Skeptical". The New York Times.
  51. ^ "Was coronavirus really in Europe in March 2019?". The Conversation. 28 June 2020.
  52. ^ Nsoesie, Elaine Okanyene; Rader, Benjamin; Barnoon, Yiyao; Goodwin, Lauren; Brownstein, John. "Analysis of hospital traffic and searchengine data in Wuhan China indicates early disease activity in the Fall of 2019" (PDF). Unpublished manuscript, Harvard DASH.
  53. ^ a b c "China, scientists dismiss Harvard study suggesting COVID-19 was spreading in Wuhan in August". Reuters. 11 June 2020. Retrieved 16 November 2020.
  54. ^ Song, Christopher Giles, Benjamin Strick and Wanyuan (15 June 2020). "Fact-checking claims coronavirus might have started earlier". BBC News. Retrieved 30 September 2020.{{cite news}}: CS1 maint: multiple names: authors list (link)
  55. ^ "Expert reaction to preprint looking at hospital traffic and search engine data in Wuhan in Autumn 2019". Science Media Centre. 9 June 2020. Retrieved 16 November 2020.
  56. ^ a b Apolone, Giovanni; Montomoli, Emanuele; Manenti, Alessandro; Boeri, Mattia; Sabia, Federica; Hyseni, Inesa; Mazzini, Livia; Martinuzzi, Donata; Cantone, Laura; Milanese, Gianluca; Sestini, Stefano; Suatoni, Paola; Marchiano, Alfonso; Bollati, Valentina; Sozzi, Gabriella; Pastorino, Ugo (11 November 2020). "Unexpected detection of SARS-CoV-2 antibodies in the prepandemic period in Italy". Tumori Journal. doi:10.1177/0300891620974755.
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