Thread by @MichaelWorobey

"Chinese Scientist Hits Back at [my ] Wuhan market coronavirus origin paper"

Dr. Liang Wannian, the lead scientist on the WHO-China study on SC2's origin, has badly misunderstood or misrepresented the science here. Some thoughts in a 🧵, 1/33

scmp.com/news/china/sci…

What is clear to me from Liang's comments is that the Chinese regime is *deeply* fearful of the strong evidence that places the origin of the pandemic at Huanan Market. But first it is incumbent upon me to acknowledge that he raises one important point. 2/

Although it was a tangential point in my paper in @ScienceMagazine (see below), Liang asserts that the earliest known case *was* a Mr Chen, an accountant with no connection to Huanan Market, with symptom onset of Dec 8, not 16. 3/
science.org/doi/10.1126/sc…

I had noted the discrepancy between the Dec 8 onset reported in the WHO-China report and the Dec 16 onset reported in this scientific paper on the patient and several others early cases. 4/
journals.lww.com/cmj/Fulltext/2…

Along with testimony from Chen himself in a video interview saying that:

“I started having a fever on the 16th, and I would experience tightness in the chest and shortness of breath”. (see the timeline in the supplemental materials of my paper). 5/

Chen also points to a dental diagnosis and treatment plan in what may or may not be his medical chart, which a friend transcribed for me as follows: 6/

既往史：否认特殊病史
查体：51颊侧倾生，11萌出，6萌出深窝沟
辅助检查结果:
诊断：1. 乳牙滞留
治疗建议：建议51拔除，6行窝内封闭术
处理：6行窝沟封闭术，局麻下51拔除，嘱常规医嘱，不适随诊。
1. 盐酸奥布卡因凝胶 30mg:10ml/支 * 1支外用
用法： 30mg 外用 临时医嘱
医师：田巍 7/

Google Translate:
"Past history: Denial of special medical history
Physical examination: 51 buccal leaning, 11 erupting, 6 erupting deep pits and fissures
Auxiliary inspection results:
Diagnosis: 1. Retention of primary teeth 8/

"Treatment recommendations: 51 removal is recommended, 6 lines of intra-socket closure surgery are recommended
Treatment: 6 lines of pit and fissure sealing, 51 removal under local anesthesia, regular doctor's order, follow-up if unwell. 9/

"1. Obucaine Hydrochloride Gel 30mg: 10ml/bottle * 1 bottle for external use
Usage: 30mg for external use, temporary medical advice
Doctor: Tian Wei (Phone number also provided)." 10/

I wrote the following explanation of how I believed this dental problem may have led to an erroneous Dec 8 onset date. 11/

I included in the timeline figure the following:
" Dec 8 - Reported symptom onset of 41-YO man from Jiangxia District (S2, S3) (see Dec 16, below). Apparently due to a dental problem involving baby teeth retained into adulthood, with fever Dec 8-9 (S4)" 10/

And I asserted in the paper the following: 12/

Liang suggests in the SCMP article that the dental issues noted in the patient chart were not those of Mr Chen, but a family member. And @Drinkwater5Reed has made what is, I think, a very strong argument that the dental record was from a child... 13/

https://twitter.com/Drinkwater5Reed/status/1469937908148838402

...because it mentions "erupting" teeth. I had imagined that the translation here meant infected, but it now seems quite clear to me that "erupting" refers to adult teeth emerging, which aside from wisdom teeth (they're not) indicates this is a child. 14/

Note that both @Drinkwater5Reed and @franciscodeasis have earlier argued that Mr Chen *did* get ill with COVID on Dec 16, not Dec 8. 15/

https://twitter.com/Drinkwater5Reed/status/1428772298358730752

https://twitter.com/franciscodeasis/status/1397227238764990469

Indeed, @Drinkwater5Reed didn't leave room for doubt: 16/

I think the jury is still out. But I think the idea that the Dec 8 date came from Mr Chen having a dental problem is very likely incorrect, and I will be in touch with Science to correct the record. 17/

There are lots of remaining questions. Why did a journal article and multiple doctors and hospitals report Chen's COVID onset date as Dec 16 if it was actually Dec 8?

If the dental record is from a child, and the rest from Mr Chen, why are they in the same patient handbook? 18/

Are the medical records from Dec 9 and 11 Mr Chen's? As noted in my paper:
***
December: a medical record from 9 December, shown in reference S4, states that the patient “has had a fever for one day” and prescribes two antibiotics, cefmetazole, and piperacillin sodium.
***
19/

If so, were these antibiotics for a respiratory infection? And why does Liang say "he also started experiencing cold-like symptoms such as headaches and dizziness on December 8", but not mention a fever or antibiotic treatment? 20/

Why does Chen say that his fever "began" on Dec 16, if this Dec 8/9 fever was his and due to COVID?

And what about the time between onset and ICU admission, which is *very long* 22 days if Chen became ill with COVID on Dec 8 (From Ren et al, cited in my support materials):
/21

Note that the 4 other patients in the study had onset-to-ICU of 7 or 8 days.

Similarly, 22 days from onset to positive sample is quite long, for Chen. Not impossible, but long. /22

But the key thing - media coverage focusing on Mr Chen notwithstanding - is that WE SHOULD NOT CONFUSE THE EARLIEST KNOWN CASES WITH THE VERY FIRST CASES. Before discussing the Dec 8 or 16 onset of Mr Chen, and the Dec 10 onset of Ms Wei, a Huanan vendor... /23

...I wrote this:

"Additionally, the earliest known cases should not necessarily be expected to be the first infected or linked to Huanan Market: They probably postdated the outbreak’s index case by a considerable period (10)..."
24/

Even if Mr Chen got sick on Dec 8, two days before Ms Wei, there's almost no chance that either is the primary case of the pandemic. Ref 10, above, is a paper I co-authored with @jepekar and Joel Wertheim:

25/

science.org/doi/10.1126/sc…

We showed that the first human case in Wuhan likely occurred around mid-Nov. Crucially - and this has been missed or ignored by Liang Wannian and many strong believers in a lab origin of the pandemic - our median simulation showed just *nine* infections by Dec 1. Nine!
26/

So this idea in vogue with lab origin aficionados that the Chinese authorities are hiding droves of cases before December is just nonsense. And whether Ms Wei was the 1st or 2nd known patient...
27/

...what is remarkable is the evidence of cases so early among vendors in a soccer field-sized live wildlife market building. There were perhaps a few hundred such individuals, versus 11 million inhabitants in Wuhan.
28/

The possibility that one of the 11 million or so people who did not work at the market may (or may not) have edged out a market worker by 2 days in symptom onset is not surprising if the outbreak started at the market. As I noted in the paper.
29/

What *would* be astounding is finding so many early cases linked to this market if the virus had moved from the community to the market rather than vice versa.
30/

And you can't explain away this pattern by arguing that so many Huanan-linked cases were discovered because that's just where people were looking. That is not true. And that was the main point of the paper.
31/

The other key point, which too has upset Liang Wannian because it is true, is that early cases *unlinked* to the market tended to live around and near to the market. That points very strongly toward a market origin and community spread beginning around the market.
32/

For Liang to dismiss that point simply shows that he doesn't understand it. And, in case it is not obvious, I made that argument with Liang's *own* data from the WHO-China report, which I understand must be especially aggravating.
33/

What is bemusing is the idea that Chinese authorities hid a bunch of earlier cases so that they could...publish a report that contains strong evidence implicating a live-wildlife market origin of SARS-CoV-2!
34/