A chronology of the COVID-19 outbreak in Wuhan, China [timeline]

In Wuhan: How the COVID-19 Outbreak in China Spiraled Out of Control, Dali L. Yang scrutinizes China’s emergency response to the COVID-19 outbreak in Wuhan, delving into the government’s handling of epidemic information and the decisions that influenced the scale and scope of the outbreak. This timeline, adapted from the book, walks through the day by day chronology of the initial outbreak and explores how both the virus and information spread.

This detailed approach gives visibility on some of the themes that came to define the Chinese response. The development of an emergency response involving local and national response teams frequently worked at odds with the media strategy that sought to control the spread of information. Mapping when Xi Jinping learned key details and what he chose to do with that information is also illuminating. It also becomes possible to see how the science and communication around the role of the Huanan Seafood Market and the possibility of human-to-human transmission evolved.

8 December 2019

• First officially recorded COVID-19 case begins to show pneumonia symptoms. (This is the disease onset and recorded retrospectively.) More retrospective cases visit different hospitals in the following days and weeks.

27 December 2019

• Clinicians and hospital administrators in several Wuhan hospitals are publicly known to have filed reports of pneumonia of uncertain etiology (PUE) cases to local centers for disease control (CDCs).
• Vision Medicals in Guangzhou identifies novel coronavirus in a sample taken from a patient at Wuhan Central Hospital.

29 December 2019

• Dr Zhang Jixian and the Hubei Provincial Hospital of Integrated Chinese and Western Medicine reports seven PUE cases to the Hubei Provincial Health Commission and the Wuhan Municipal Health Commission (WMHC).
• The first three are a family cluster with no known connection to the Huanan Seafood Market.

30 December 2019

• A joint investigation team submits its report on the outbreak of viral PUE cases. The report includes the following case definition: “Individuals with exposure to the Huanan Seafood Market and their family members who have been diagnosed as pneumonia cases in hospitals since 1 December 2019.”
• WMHC issues emergency notices to major Wuhan hospitals asking for submission of PUE cases while demanding secrecy.
• China CDC director general (George) Gao Fu learns of the Wuhan outbreak from social media sources late in the evening and dispatches emergency response teams to Wuhan.

31 December 2019, New Year’s Eve

• NHC and China CDC expert and emergency response teams are on the ground in Wuhan.
• With national approval, WMHC issues the first official advisory on the outbreak and discloses 27 viral PUE cases in the afternoon. No mention is made of novel coronavirus detection.

1 January 2020, New Year’s Day

• Wuhan Huanan Seafood Market is shut down. China CDC emergency operations team leads in the collection of samples.
• Wuhan Public Security (police) announce punishment of eight “rumormongers” for disseminating information saying pneumonia outbreak was caused by SARS (severe acute respiratory syndrome) or SARS-like coronavirus.
• NHC official direct Wuhan Institute of Virology not to release “all testing and experimental data plus results and conclusions related to this outbreak.”

2 January 2020

• China Central Television broadcasts punishment of “rumormongers” about the pneumonia outbreak in Wuhan.

3 January 2020

• Wuhan University Zhongnan Hospital clinicians and laboratory staff identify a family of three infected with SARS-like coronavirus. None of the three had been to the Huanan Seafood Market.

4 January 2020

• The WMHC Command for Responding to PUE oversees and manages the transfer of so-called viral PUE patients to the Wuhan Jinyintan Hospital for treatment. Only patients with a history of exposure to the Huanan Seafood Market are given permission for the transfer. Patients with similar clinical symptoms but no history of exposure to the Huanan market are excluded and left in the general hospitals.

5 January 2020

• WMHC discloses that there are 59 viral PUE cases, of which seven are announced as severe cases. “No clear evidence of human-to-human transmission.”
• Zhang Yongzhen’s team at Shanghai Public Health Clinical Center obtains the whole genome of SARS- CoV- 2 from a sample collected at Wuhan Central Hospital. Zhang submits a report to the NHC to warn of danger from the novel coronavirus.

6 January 2020

• China CDC activates Level II emergency response (which is not publicly announced).

7 January 2020

• General Secretary Xi Jinping makes “requirements” on handling the outbreak in Wuhan at a Politburo Standing Committee meeting. (No details of the requirements have been made public.)
• A 67-year-old male patient dies of suspected novel coronavirus infections at Jinyintan Hospital. An expert panel can only agree the deceased died of pneumonia but does not rule it a case of novel coronavirus infection in the absence of a diagnostic test.

9 January 2020

• NHC uses a Xinhua interview with academician Xu Jianguo to make a low-key announcement that a novel coronavirus (then named “2019-nCoV”) was identified as the causative pathogen of the PUE outbreak in Wuhan.
• Wuhan University Zhongnan Hospital (Medical Affairs Department) uses the national disease reporting system to submit reports of two so-called viral PUE cases. The system indicates that the submission was successful, but the submitted cases were disappeared from the system.

10 January 2020

• Start of the Lunar New Year peak travel season.

11 January 2020

• Dr Wang Guangfa of Second NHC Expert Team said the outbreak is “preventable and controllable.”
• WMHC begins to refer to pneumonia cases with novel coronavirus infections and announces 41 laboratory-confirmed cases as of 10 January. WMHC states that investigations by national, provincial, and municipal experts “have not found any newly infected patients after 3 January 2020” and “have not found clear evidence of human-to-human transmission.”

12 January 2020

• The Beijing Municipal Health Commission arranges for the transfer of two suspected novel coronavirus cases, a husband and wife, to Beijing Ditan Hospital for treatment.
• The two patients had visited Wuhan for a wedding around 7-9 January but had no exposure to the Huanan Seafood Market.

13 January 2020

• Thailand confirms the first COVID-19 case outside China and notifies the World Health Organization (WHO). The patient, a traveler from Wuhan, was first admitted to hospital with fever on 8 January 2020. WHO states that the case in Thailand confirms its earlier concern that the novel coronavirus would spread beyond China.

14 January 2020

• NHC leadership led by Ma Xiaowei convenes a confidential national working teleconference on novel coronavirus pneumonia “prevention and control” (fangkong).

15 January 2020

• NHC confidentially distribute fangkong documents totaling 63 pages to provincial health authorities for immediate attention and action within 5 hours of reception.
• China CDC activates Level I emergency response (which is not publicly announced).
• WMHC releases a question-and-answer dated 14 January: “No clear evidence of human-to-human transmission has been found; limited human-to-human transmission cannot be ruled out, but the risk of sustained human-to-human transmission is low.” NHC provides the same information to WHO, which shares it with the rest of the world.

16 January 2020

• Professor Yuen Kwok-yung of Hong Kong University sends urgent messages to China CDC director general Gao Fu and Guangdong Provincial CDC with supporting evidence for person-to-person transmission.

18 January 2020

• WMHC discloses four new confirmed cases (as of 16 January) and one case each identified in Thailand and Japan.
• NHC confidentially issues updated second edition of the fangkong documents, that state cases that lack a history of exposure to the Huanan market are growing and admit that the outbreak is spreading. These documents are not disclosed to the public until 22 January, 2020

20 January 2020

• Dr. Zhong Nanshan appears on China Central Television in the evening to inform the public of novel coronavirus human-to-human transmission, including 14 medical staff infections.

21 January 2020

• Hubei Province activates Level II Emergency Response for novel coronavirus pneumonia. Hubei leaders attend Lunar New Year gala.

22 January 2020

• In the afternoon, Xi Jinping approves “the strict closure of exit channels,” or cordon sanitaire, for Wuhan and the rest of Hubei Province.

23 January 2020

• At about 2:30 a.m., the Wuhan Municipal leadership, in the name of the Wuhan Municipal Command for the Prevention and Control of Novel Coronavirus Pneumonia, announces the cordon sanitaire would be in effect at 10 a.m. About 500,000 people are able to leave Wuhan between this announcement and 10 a.m.
• Wuhan is “sealed off” from the rest of China at 10 a.m.

25 January 2020, Lunar New Year’s Day

• General Secretary Xi Jinping convenes the Politburo Standing Committee on the epidemic and declares that the epidemic poses an existential threat to “the whole picture” and vows to “win the epidemic fangkong battle.”
• Led by the national leadership, China mobilizes a total of 344 medical teams from the armed forces and every provincial unit to offer medical assistance to Wuhan/Hubei. This national campaign, with more than 44,000 health workers, is the largest ever medical assistance mission in China’s history.

29 January 2020

• The novel coronavirus is detected in all provincial units in China. Tibet declares Level I response emergency.

30 January 2020

• WHO declares the coronavirus outbreak that started in Wuhan a Public Health Emergency of International Concern (PHEIC).

5 February 2020

• The 1,600-bed Jianghan Fangcang Hospital (located in the Wuhan International Convention Center) and the 800-bed Wuchang Fangcang Hospital (housed in the Hongshan Sports Stadium) are opened.

10 February 2020

• General Secretary Xi Jinping makes his first public appearance since the Wuhan lockdown, visiting the Anhuali community in Chaoyang District, Ditan Hospital, and the Chaoyang District CDC in Beijing.

11 February 2020

• The International Committee on Taxonomy of Viruses names the novel coronavirus SARSCoV-2 and WHO names the disease COVID-19 (coronavirus disease 2019).

• As of today, Wuhan has 1,103 infected healthcare workers confirmed, while the rest of Hubei has another 400.

11 March 2020

• WHO declares COVID-19 a pandemic.

_{Featured image by Amir Arabshahi via Unsplash.}