Covid’s First Patient Was Not Who WHO Thinks, Scientist Says

A scientist who analyzed public reports of the first cases of Covid-19 in China reported on Thursday (18) that a major investigation by the WHO (World Health Organization) had probably misplaced the initial chronology of the pandemic. The new analysis suggests that the first known patient to contract the coronavirus was a saleswoman at a large animal market in Wuhan, not an accountant who lived many miles away.

The report, published on Thursday (18) in the prestigious journal Science, will rekindle, although it certainly cannot resolve, the debate over whether the pandemic started with a transmission of wild animals sold on the market, a leak from a virology laboratory in Wuhan or otherwise. The search for the origins of the biggest public health catastrophe in a century has fueled geopolitical battles, with few new facts emerging in recent months to resolve the issue.

Scientist Michael Worobey, one of the leading experts in tracking virus evolution at the University of Arizona, found discrepancies in the chronology by sifting through what had already been published in medical journals, as well as video interviews on a Chinese news channel with people who would be the first two identified with the infection.

Worobey says the seller’s links to the Huanan Seafood Wholesale Market, as well as a new analysis of early hospitalized patients’ connections to the market, strongly suggest that the pandemic started there.

“In this city of 11 million people, half of the first cases are related to a place the size of a football field,” says Worobey. “It is very difficult to explain this pattern if the outbreak has not started in the market.”

Several experts, including one of the WHO’s chosen pandemic investigators, said Worobey’s detective work was solid and that Covid’s first known case was most likely a fish seller.

But some of them also said the evidence was still insufficient to decisively answer the larger question of how the pandemic started. They suggested that the virus likely infected “patient zero” sometime before the seller’s case, and then reached critical mass to spread widely on the market. Studies of changes in the virus’s genome — including one made by Worobey himself — suggested that the first infection happened around mid-November 2019, weeks before the seller became ill.

“I don’t disagree with the analysis,” says Jesse Bloom, a virus expert at the Fred Hutchinson Cancer Research Center. “But I don’t agree that any of the data is strong or complete enough to say anything with much confidence, except that the Huanan fish market was clearly an overspread event.”

Bloom also noted that this was not the first time that the WHO report, done in collaboration with Chinese researchers, had been found to contain errors, including those involving potential early patients’ links to the market.

“It’s kind of unbelievable that in all these cases there are still inconsistencies about when this happened,” he says.

“The error is there”

In late December 2019, doctors at several hospitals in Wuhan noticed mysterious cases of pneumonia arising in people working in the Huanan Seafood Wholesale Market, a humid, poorly ventilated space where fish, poultry, meat and wild animals were sold. . On Dec. 30, public health officials told hospitals to report any new cases linked to the market.

Fearing a recurrence of Severe Acute Respiratory Syndrome (SARS), which surfaced in Chinese animal markets in 2002, local authorities ordered the Huanan market closed and Wuhan police closed it on January 1, 2020. Despite these measures, new cases multiplied in the city.

Wuhan authorities said on January 11, 2020 that the cases began on December 8th. In February, they identified the first patient as a Wuhan resident with the surname Chen, who fell ill on December 8 and had no connection with the market.

Chinese authorities and some outside experts suspected that the initially high percentage of market-linked cases may have been a statistical flaw known as identification bias. They argued that authorities’ Dec. 30 request to report market-related illnesses may have led doctors to neglect other cases without such links.

“At first, we assumed that the seafood market could have the new coronavirus,” said Gao Fu, director of China’s Centers for Disease Control and Prevention, in May 2020, according to the China Global television network. “But now we find that the market is one of the victims.”

In the spring of 2020, senior members of the Trump government promoted another scenario for the pandemic’s origin: that the virus had escaped the Wuhan Institute of Virology, which has a campus about 12 kilometers from Huanan Market, across the river Yangtze.

In January of this year, researchers chosen by the WHO visited China and interviewed an accountant who reportedly developed symptoms on 8 December. His influential March 2021 report described it as the first known case.

But Peter Daszak, an EcoHealth Alliance disease ecologist who was on the WHO team, said he was convinced by Worobey’s analysis that they were wrong.

“The December 8 date was a mistake,” said Daszak.

The WHO team did not ask the accountant for the date his symptoms began, he says. Instead, they were given the December 8 date from doctors at Hubei Xinhua Hospital, who handled other initial cases but did not dedicate themselves to Chen. “So the error is there,” he says.

For WHO experts, according to Daszak, the interview was a dead end: the accountant had no apparent links to an animal market, a laboratory or a conglomeration of people. He said that he enjoyed spending time on the Internet and running, and that he didn’t travel much. “It was as ‘normal’ as you could imagine,” says Daszak.

If the team had identified the fishmonger as the first known case, Daszak explained, they would have asked more direct questions, such as which stall she worked in and where her products came from.

While doctors at Hubei Xinhua Hospital said the onset of the accountant’s illness had occurred on December 8, a senior doctor at Wuhan Central Hospital, where Chen was treated, told a Chinese media outlet that he developed symptoms around the time. December 16th.

Asked about Chen’s case, China’s National Health Commission said it supports the comments made by Liang Wannian, leader of the Chinese side of the WHO-China investigation, who conducted the interview with doctors at Hubei Xinhua Hospital. Liang told a news conference in February this year that Covid’s first case showed symptoms on December 8 and “was not connected” to the Huanan market.

Errors and inconsistencies

In their report, WHO experts concluded that the virus likely spread to people from animals, but they could not confirm whether the Huanan market was the source. In contrast, they said a lab leak was “extremely unlikely”.

In May, two months after the publication of the WHO and China report, 18 leading scientists, including Worobey, responded with a letter in Science complaining that the WHO team paid little attention to the laboratory leak theory. Much more research would be needed, they argued, to determine whether one explanation was more likely than the other.

An expert on the origins of flu and HIV, Worobey tried to piece together the early days of Covid’s pandemic. Reading a May 2020 study of the first cases written by local doctors and Wuhan health officials, he was intrigued to see a description that sounded like Chen: a 41-year-old man with no contact with the Huanan market. But the study authors dated her symptoms on December 16, not December 8.

Then Worobey found what appeared to be a second independent source for the later date: Chen himself.

“I had a fever on the 16th, during the day,” said a man identified as Chen in a March 2020 video interview with The Paper, a Shanghai-based publication. The video indicates that Chen is a 41-year-old man who worked in a company’s finance office and has never been to the Huanan market. Official reports said he lived in the Wuchang district of Wuhan, miles from the market.

The New York Times was unable to independently confirm the identity of the man in the video.

Along with the fever on December 16, Chen said he felt tightness in his chest and went to the hospital that day. “Even without any strenuous exercise, with a minimum of effort, like talking to you right now, I was breathless,” he said.

Worobey said the medical records shown in the video may contain clues as to how the WHO-China report ended up with the wrong date. One page described the surgery Chen needed to extract teeth. Another was a December 9 prescription for antibiotics, referring to a fever the day before—possibly the day of the dental surgery.

In the video, Chen speculated that he may have acquired Covid “when I went to the hospital” — possibly a reference to dental surgery.

obscure connections

In Worobey’s revised chronology, the oldest case is not that of Chen, but that of a fish seller named Wei Guixian, who developed symptoms around December 11th. (Wei said in the same video published by The Paper that her severe symptoms began on December 11, and she told The Wall Street Journal that she started feeling unwell on December 10. The WHO-China report listed one case of 11 December linked to the market.)

Worobey found that hospitals reported more than a dozen probable cases before Dec. 30, the day authorities in Wuhan warned doctors to look out for links to the market.

He determined that Wuhan Central Hospital and Hubei Xinhua Hospital each recognized seven unexplained cases of pneumonia before December 30, which would be confirmed as Covid-19. In each hospital, four out of seven cases were related to the market.

By focusing only on these cases, Worobey argued, he could rule out the possibility that the identification bias skewed the results in favor of the market.

Still, other scientists said there was no certainty that the pandemic started on the market.

“He did an excellent job of reconstructing what he could from the available data, and it’s as reasonable a hypothesis as any,” said Dr. W. Ian Lipkin, a virus specialist at Columbia University’s Mailman School of Public Health. “But I don’t think we’ll ever know what’s going on because that was two years ago and it’s still unclear.”

Alina Chan, a postdoctoral fellow at the Broad Institute in Cambridge, Massachusetts, and one of the strongest advocates of investigating a laboratory leak, said only new details about previous cases — dating back to November — would help scientists pinpoint the source.

“The main problem this points out,” he says, “is that data is lacking and there are errors in the WHO-China report.”

Translated by Luiz Roberto M. Gonçalves