THREAD: I read the @WHO’s 40-page report from a recent visit to assess the #COVID19 situation in China so you don’t have to. Here are some key points: who.int/docs/default-s…
@WHO The Joint Mission consisted of 25 experts from China, Germany, Japan, South Korea, Nigeria, Russia, Singapore, the U.S., and the WHO. It was co-headed by Dr. Bruce Aylward of the WHO and Dr. Liang Wannian of China.
@WHO The team visited hospitals, clinics, community centers, transport hubs, research institutes, health commissions, and medical supply warehouses in Beijing, Chengdu, Guangzhou, Shenzhen, and Wuhan, meeting with officials, scientists, medical personnel, and community workers.
@WHO The report says lung samples were collected from a Wuhan pneumonia patient on Dec. 30, gene-sequenced, and found to bear 96% similarity to a SARS-like coronavirus. (For the record, @caixin said gene-sequencing happened at least a few days earlier.) caixinglobal.com/2020-02-28/in-…
Stats from the complete dataset of nearly 56,000 confirmed cases reported by Feb. 20:
- median age is 51
- 51.1% are male
- 77.0% are from Hubei province
- 21.6% are farmers or laborers
- median age is 51
- 51.1% are male
- 77.0% are from Hubei province
- 21.6% are farmers or laborers
COVID-19 is a zoonotic virus. Bats (or possibly pangolins) appear to be the reservoir host, but an intermediate host has not yet been identified. vox.com/science-and-he…
Droplets (e.g. coughing/sneezing in close contact with another person) are believed to be the major mode of transmission, while the airborne and fecal-oral routes appear to be ineffective in spreading the virus.
Human-to-human transmission is mostly occurring in families.
Human-to-human transmission is mostly occurring in families.
Based on the Join Mission’s observations, everyone should be considered susceptible to COVID-19, though additional risk factors may increase susceptibility.
It has yet to be determined whether people who recover from the virus are resistant to subsequent infections.
It has yet to be determined whether people who recover from the virus are resistant to subsequent infections.
The report praises the Jan. 23 lockdown of Wuhan without ever using this word: Instead, the lockdown is referred to as “strict traffic restrictions” (lol) and “the cordon sanitaire” (double lol).
The authors said transmission was “less intense” in Wuhan’s neighboring cities of Xiaogan, Huanggang, Jingzhou and Ezhou without visiting these places (or if they did, it’s not in the disclosed itinerary).
The report acknowledges infections at medical facilities, prisons, and “other closed settings” but says “they do not appear to be major drivers of the overall epidemic dynamics” …
prison clusters: sixthtone.com/news/1005226/o…
mental hospital cluster: sixthtone.com/news/1005191/c…
prison clusters: sixthtone.com/news/1005226/o…
mental hospital cluster: sixthtone.com/news/1005191/c…
The report downplays concerns of nosocomial (hospital-acquired) infection, saying many of the reported infections among medical staff occurred in the early stages of the epidemic—when knowledge of effective defenses was minimal—and at home rather than in public health settings.
The most common symptoms of COVID-19 include: fever (87.9%), dry cough (67.7%), fatigue (38.1%), sputum production (33.4%), shortness of breath (18.6%), sore throat (13.9%), headache (13.6%), myalgia or arthralgia (14.8%), chills (11.4%), nausea or vomiting (5.0%).
People typically develop symptoms 5-6 days after infection (meaning 5-6 day incubation period, with a range of 1-14 days).
The maximum of 14 days highlights why many companies and governments are imposing 2-week quarantine periods on at-risk individuals.
The maximum of 14 days highlights why many companies and governments are imposing 2-week quarantine periods on at-risk individuals.
Around 80% of lab-confirmed cases had mild-to-moderate symptoms, 13.8% had “severe” symptoms, and 6.1% were “critical” (respiratory failure, septic shock, multiple organ failure, etc.)
High-risk groups include people over 60 with underlying medical problems (hypertension, diabetes, cardiovascular disease, chronic respiratory disease, cancer), while children and teens are low-risk, accounting for only a small percentage of total cases.
This graph of case fatality ratio over time is encouraging, and suggests an evolving standard of care, according to the authors: 
The report lauds China’s epidemic response measures — but note that the authors steer clear of late-December / early-January dates that might implicate the party’s initial mismanagement of the crisis.
Here’s an actual sentence that appears in the report, shattering any illusion of objectivity:
“In the face of a previously unknown virus, China has rolled out perhaps the most ambitious, agile and aggressive disease containment effort in history.”
“In the face of a previously unknown virus, China has rolled out perhaps the most ambitious, agile and aggressive disease containment effort in history.”
The fawning tone only gets worse, as the ensuing paragraphs are peppered with words like “remarkable,” “invaluable,” “striking,” “uncompromising,” “relentless,” “exceptional,” etc.
Makes you wonder whether a publicity department official had to sign off on the final report…
Makes you wonder whether a publicity department official had to sign off on the final report…
One thing we can probably all agree on though:
“At the individual level, the Chinese people have reacted to this outbreak with courage and conviction.”
“At the individual level, the Chinese people have reacted to this outbreak with courage and conviction.”
The report’s recommended improvements: 1) eliminate bureaucracy that impedes swift action on early alerts, 2) scale up facilities for isolation and treatment, 3) better protect frontline medical workers, 4) more clearly communicate with the international public health community.
Key quote:
“The COVID-19 virus is unique among human coronaviruses in its combination of high transmissibility, substantial fatal outcomes in some high-risk groups, and ability to cause huge societal and economic disruption.”
“The COVID-19 virus is unique among human coronaviruses in its combination of high transmissibility, substantial fatal outcomes in some high-risk groups, and ability to cause huge societal and economic disruption.”
The report suggests other countries can learn from China’s “unprecedented” and “rather unique” public health response to COVID-19 — though it says they’re probably not prepared to take such bold actions.
The authors praise the role of China’s “extremely proactive surveillance” in detecting COVID-19 cases quickly…
Do they realize how this sounds, I wonder?
Do they realize how this sounds, I wonder?
Note here the authors’ 5th “major recommendation” to China, which is essentially: “Do a better job of sharing your data and research.”
“COVID-19 prevention and control mechanisms were initiated immediately after the outbreak was declared.”
Really? Because reports about a pneumonia of unknown etiology in Wuhan were being censored as late as Jan. 2
Really? Because reports about a pneumonia of unknown etiology in Wuhan were being censored as late as Jan. 2
“Payment of health insurance was taken over by the state, as well as the work to improve accessibility and affordability of medical materials.”
But how effectively has this top-down mechanism been implemented at the local level? sixthtone.com/news/1005178/w…
But how effectively has this top-down mechanism been implemented at the local level? sixthtone.com/news/1005178/w…
Wearing face masks, washing hands, and social distancing are the most important “non-pharmaceutical control measures,” though further research is needed to quantify the impact of each, according to the report.
In conclusion: I get that it’s important for the @WHO to maintain a good relationship with China — the second-biggest donor to the UN after the U.S. — but it’s hard to take its obsequious missives on the COVID-19 situation in China seriously these days. wsj.com/articles/the-w…
oops, make that *Joint* Mission's
Have to say I'm incredibly humbled by the number of people who appreciated this and took the time to say so. Thank you 🙏
