Timeline of the COVID-19 pandemic in 2019
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This article documents the chronology and epidemiology of SARS-CoV-2 in 2019, 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, Hubei, China, in December.
The study of the origin of SARS-CoV-2 by comparing genetic sequences is complicated by its low evolutionary rate, due to proofreading by the viral exoribonuclease (ExoN), and the low sampling of early centers of infection in China, Iran, and Italy. Phylogenetics estimates that SARS-CoV-2 arose in October or November 2019. Evidence suggests that it descends from a coronavirus that infects wild bats and spread to humans through an intermediary wildlife host. 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.
A September 2020 review noted "The possibility that the COVID-19 infection had already spread to Europe at the end of last year is now indicated by abundant, even if partially circumstantial, evidence", including pneumonia case numbers and radiology in France and Italy in November and December.
RT-PCR (Reverse transcription polymerase chain reaction) testing of untreated wastewater samples from Brazil and Italy have suggested detection of SARS-CoV-2 as early as November and December 2019, respectively, but the methods of such sewage studies have not been optimised, many have not been peer reviewed, details are often missing, and there is a risk of false positives due to contamination or if only one gene target is detected.
Antibodies to SARS-CoV-2 receptor-binding domain were reported in 111 (11.6%) of 959 asymptomatic participants in a lung cancer screening trial in Italy from September 2019, which the authors claim may indicate an earlier start to the COVID-19 pandemic. The World Health Organization stated it was reviewing the results, seeking verification of the neutralization results, and that "the possibility that the virus may have silently circulated elsewhere cannot be ruled out". These seroprevalence tests are prone to false positives, possibly due to cross-reactivity with other coronaviruses, and need confirming; the journal published an expression of concern in March 2021 due to possible issues with the peer review.
Symptoms of the index case, or patient zero, began on 1 December. The man had not been to the Huanan Seafood Wholesale Market. His family was unaffected, and no epidemiological link was found between him and the other laboratory-confirmed cases as of 2 January. 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. On 26 February 2021, The Wall Street Journal reported that a purported patient zero of COVID-19 may have been infected by parents who visited a different food market than the Huanan Seafood Wholesale Market that has been thought to be the primary source of the infection earlier.
Symptoms of three more laboratory-confirmed cases began on 10 December. These patients are known because they became hospitalized and thus sampled. Two of these three had no direct exposure to the Huanan Seafood Wholesale Market, while the other did.
The fifth and sixth laboratory-confirmed cases first felt symptoms on 15 December. Both patients had direct exposure to the Huanan Market.
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) in Guangzhou, a private company specialising in metagenomic massive parallel sequencing analysis. 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.
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".
After having observed the elderly couple's CT (computerised tomography) 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. Another patient, a merchant from the Huanan Seafood Wholesale Market, 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.
Identification of Pathogen
Wuhan Central Hospital are told by phone by Vision Medicals that the BAL sample taken on 24 December contained a new kind of coronavirus (Chinese: …"一种新的冠状病毒。" ; …"a new kind of coronavirus"), and the patient was then quarantined. Vision Medicals also send a written report to the Chinese Academy of Medical Sciences. 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 Yongjun (李永军), the Wuhan Central Hospital and the local CDC.
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).
Respiratory samples from a man hospitalized in Paris, France were retrospectively diagnosed (study 14 April, published 3 May) as having SARS-CoV-2 virus present. He presented with advanced symptoms (chest CT of ground-glass opacities) and 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 August 2019), though his wife worked near to an airport. The epidemiological circumstances remain uninvestigated and it is possible the sample was contaminated. (Note: these findings do not appear in the statistics overview from the French Public Health Ministry.)
First novel disease report
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, however, the report of 22 January 2020 from the Chinese CDC seems to claim this contact falling on 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" 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. 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.
The Wuhan CDC staff found also additional patients with similar symptoms who were linked to the market. (The Wuhan 'Center for Disease Control and Prevention' (CDC) is part of Chinese Center for Disease Control and Prevention.)
Wuhan Central Hospital received a report from CapitalBio Medlab stating that their sample (obtained 27 December) contained SARS coronavirus. According to a Caixin news report and social media, this was a mistake. The same news report alleged 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.
Several doctors at Wuhan Central Hospital shared the test report on social media ("社交媒体") in discussions mainly aimed at colleagues. As referred to by Caixin Online, from the social media account of Li Wenliang, it is stated that there are seven cases of SARS at Wuhan Central Hospital, all connected to the Huanan Seafood Wholesale Market.
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".
First official messages
Wuhan Municipal Health Commission sent a hard-copy message to its affiliate institutions. containing guidelines in confronting a possible outbreak of infectious pneumonia. Two scanned copies also found their way, the same day, to the Weibo QQ service – a social media platform.
- 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.
First international alert
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. The ProMED reporting program, under auspice of the International Society for Infectious Diseases (ISID), reported on the situation in Wuhan. The full date is actually 30 December 23:59:00.
WHO may also have noticed the information coming out from Wuhan.
First public message
The Wuhan Municipal Health Commission released a briefing on its website about early signs of a pneumonia outbreak in the city. 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
The message on pneumonia of unknown etiology was picked up by news agencies, including the state television CCTV, local news agencies, such as Hubei Daily. and social media, such as the Weibo account of CCTV. People's Daily said the exact cause remained unclear, and it would be premature to speculate. Through the Weibo account "YangShiXinWen", CCTV also sent an alert about the unknown virus, adding that a team of experts from the National Health Commission would arrive in Wuhan.[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 learned of the pneumonia outbreak only 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?"
Inter-regional and international responses
In response to the announcement from Wuhan, Hong Kong's Centre for Health Protection tightened their inbound screening processes. They announced that various "surveillance measures at all boundary control points" have begun – including thermal imaging for checks on body temperature. 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. 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."
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.
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. The WHO China office then notified the WHO Western Pacific Regional Office about the notice from the Wuhan government.
The Taiwan Centers for Disease Control (CDC) implemented inspection measures for inbound flights from Wuhan. Deputy director Luo Yi-jun raised the alarm with his colleagues after reading about the outbreak on the PTT Bulletin Board System. Taiwan would end up having fewer than 500 total COVID-19 cases until September 2020.
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