Apollo's Arrow

In the late fall of 2019, an invisible virus that had been quietly evolving in bats for decades leaped in an instant to a human being in Wuhan, China. It was a chance event whose most subtle details we will probably never know. Neither the person to whom the virus gravitated nor anyone else was fully aware of what had transpired. It was a tiny, imperceptible change.

Scientists later came to suspect that this initial move by the virus might have happened at the Huanan Seafood Wholesale Market in Wuhan, because many of the first recorded patients were vendors or visitors there. But the picture was confusing. Huanan is known as a wet market because, as at many other markets throughout the world, one can buy fresh produce, fish, meat, and live animals there, and sometimes even wildlife (such as hedgehogs, badgers, snakes, and turtledoves). Some of these animals are butchered in the market, on the spot. Unlike the antiseptic supermarkets many of us are accustomed to, the pavements in such places are hosed down during the day to keep them clean. Hence, the markets are "wet."1

As far as we know, bats were not for sale at Huanan, though bats are consumed in China.2 In a prescient article published a year before the virus slipped unseen into our species, scientists suggested that "bat-animal and bat-human interactions, such as the presence of live bats in wildlife wet markets and restaurants in Southern China, may lead to devastating global outbreaks."3

The first person with a confirmed case of the disease that would come to be known as COVID-19 developed symptoms of severe acute respiratory syndrome (SARS) on December 1, 2019. There may have been other patients earlier; we do not know. However, this patient (and a few other early cases) did not have contact with bats or wildlife or the Huanan market. This has led to concerns that perhaps the virus initially leaped to humans in some other way, such as through researchers in Wuhan who collected samples of the virus directly from wild bats and analyzed them in laboratories with inadequate protective procedures.4 The Wuhan Center for Disease Control and Prevention, which does research with bat viruses, is just a few blocks from the Huanan market, and the Wuhan Institute of Virology is also a few miles away from it. However, Chinese authorities have claimed that there was no chance the virus leaked from these facilities.5

Notwithstanding the mysterious origin of the virus, 66 percent of the first forty-one people to contract the disease, during the month of December, did indeed have a direct connection to the Huanan market as shoppers, traders, or visitors.6 If the market was not the place where the virus first found its way to humans, it was the place where it first became easy for us to detect. The market, with its densely packed stalls and large number of people, provided a fertile environment for the virus to spread rapidly and easily, generate a localized cluster of cases, and therefore come to our attention.7

One of the first doctors to sound the alarm about the disease was Dr. Jixian Zhang of the Hubei Provincial Hospital of Integrated Chinese and Western Medicine. On December 26, 2019, she noticed seven cases of atypical pneumonia; three patients were in the same family, and four were from the Huanan market and knew each other. She reported them to the Wuhan Center for Disease Control the next day.8 Eventually, as part of an effort to cover up their initial inaction as the pandemic took root, the authorities gave her a merit award for reporting the cases.9 But later investigation revealed that there had been other cases of atypical pneumonia earlier in December, above the threshold for notifying the central Chinese Center for Disease Control in Beijing, that had gone unreported. Precious time to contain the outbreak was lost. In fact, a later analysis documented that there were 104 cases and 15 deaths during the month of December.10

The authorities began to realize what was happening and shut down the market on January 1, 2020.11 By then, the initial patients, dispersed to various hospitals, were being collected and transferred to a specially designated facility, Jinyintan Hospital.12 On January 27, 2020, analyses released by the Chinese CDC (and later regarded by some as possible misinformation) noted that 33 of 585 environmental samples (such as swabs of surfaces) collected at Huanan from January 1 to January 12 contained the RNA of a novel coronavirus, later named SARS-CoV-2. The positive samples were highly concentrated on surfaces in the western part of the market, where the wild animals were sold.13

On December 30, 2019, two days before the market was shut down, a thirty-three-year-old ophthalmologist, Dr. Wenliang Li, became aware of the emerging cluster of cases after reading an alarming report by one of his colleagues. Dr. Ai Fen, the head of the emergency department at Wuhan Central Hospital, had received a lab report for a patient with atypical pneumonia indicating that the patient had SARS.14 On a private WeChat group with a few medical-school classmates, Li spread the alarm. "There are seven confirmed cases of SARS at Huanan Seafood Market," he said. "The latest news is, it has been confirmed that they are coronavirus infections, but the exact virus strain is being subtyped. Protect yourselves from infection and inform your family members to be on the alert."15

By January 3, 2020, local authorities caught wind of Li's communications. There was a Chinese Communist Party meeting scheduled for later in the month, on January 12, and news of a local outbreak, much less a serious one, was not welcome. Indeed, until at least January 11, the public was wrongly assured that no new cases had been observed in Wuhan.16 Li was called to meet with the police and accused of "rumor-mongering" and "making false statements on the internet." He was forced to retract what he had said and sign a letter promising that he would not engage in "illegal activities."17 This was not the last time that the truth about COVID-19 would be suppressed or ignored as the pathogen spread around the world.

Of course, Dr. Li was completely correct. Later, the authorities would publicly apologize, and he would become a hero to ordinary Chinese people tired of constraints on free expression and disillusioned by misinformation from their leaders.18 Alas, as eventually happened to many other health-care workers in China (and in many other countries), Li died of COVID-19, on February 7.19 He had contracted the disease on January 8 while taking care of a glaucoma patient. That patient was a shopkeeper at the Huanan market.

The Chinese became aware fairly quickly that the disease could spread from person to person and was not independently and repeatedly acquired from a fixed animal reservoir. This worrisome fact was confirmed in a report about the first forty-one known cases published online in the British medical journal The Lancet on January 24.20 The Chinese were also aware that the disease was serious. Of these first patients, six (15 percent) died. The article concluded that the virus "still needs to be deeply studied in case it becomes a global health threat."

The virus spread—first slowly, then quickly—through Wuhan and then through all of Hubei Province, home to fifty-eight million people. By January, while the overall percentage of infected people in Wuhan was still tiny, it was high enough that when large numbers of people left the city, some of them carried the pathogen with them.

The virus had announced itself with extremely unfortunate timing, right at the start of the annual chunyun (春运) migration in China that was taking place in the run-up to the Lunar New Year festival, on January 25, 2020. During this period, over three billion trips are typically made, a mass movement that puts the annual Thanksgiving travel in the United States to shame.21 To make matters worse, Wuhan is a central transportation hub for China. Nearly twelve million trips were taken through Wuhan in January (as research in my lab, in collaboration with Chinese scientists, later documented), thus carrying the virus throughout China by the middle of February.22 The more people from Wuhan who went to a particular destination, as shown in figure 1, the worse the SARS-2 outbreak at that destination would later be. The initial "imported" cases set off local outbreaks via cascades of what epidemiologists term community transmission.

Authorities initially silenced voices like Li's, but later they abruptly yielded to reality and changed course—as other politicians in dozens of other countries would also eventually do. China scrambled to contain the outbreak, and more honest reporting was now encouraged. As Chinese president Xi Jinping said in his first public statements regarding the situation, on January 20: "It's necessary to release epidemic information in a timely manner and deepen international cooperation."23 The Communist Party's central political and legal affairs commission, a group not known for encouraging transparency, offered its own stern warning on a popular social media site in China: "Whoever deliberately delays and conceals reports will forever be nailed to history's pillar of shame." The post was later deleted.24

On January 17, nine days after Dr. Wenliang Li contracted SARS-2, seventy-two-year-old Dr. Lanjuan Li, a well-known physician and epidemiologist at Zhejiang Medical University in Hangzhou, one of China's oldest medical schools, learned from private communications that some medical personnel in Wuhan had fallen ill with a new kind of pneumonia.25 That day, she contacted the National Health Commission in Beijing seeking permission to go to Wuhan, and the next day, China sent her there as part of a six-member team. Also on the team was Dr. Nanshan Zhong, an eighty-three-year-old pulmonologist renowned for his role in identifying the nature and severity of the prior SARS viral outbreak in 2003. Both Li and Zhong enjoyed tremendous respect in China and around the world. Dr. George Fu Gao, the head of the Chinese CDC in Beijing, had been alarmed at what was happening in Wuhan (since hearing of informal reports in late December, he had been prodding local authorities to be more forthcoming), and he also joined the mission.26

On January 19, the team visited hospitals, the Wuhan Center for Disease Control and Prevention, and the Huanan market. The city's health-care system was already inundated. In a few days, China would begin construction of a 645,000-square-foot field hospital with thirty intensive care units and a thousand beds to supplement the existing infrastructure in Wuhan. Construction would be completed in ten days.27 On the evening of January 19, the team returned to Beijing and briefed the National Health Commission. Their report was alarming. At eight thirty a.m. the next day, January 20, the six experts took part in a cabinet meeting in Zhongnanhai, the Chinese leadership compound adjacent to the Forbidden City. Because the disease could spread from person to person, the team advised the government to implement stronger control measures, and they recommended closing off Wuhan. The Wuhan government announced at two a.m. on January 23 that it would impose a lockdown at ten o'clock that morning. A lockdown of the whole surrounding province of Hubei followed almost immediately.28

By January 25, nearly all of China was shut down.29 According to an analysis conducted by one of my Chinese students soon afterward, 934 million people lived in provinces that were subject to new rules, described as "closed-off management" (封闭管理). The scale of the practices, reminiscent to some extent of the degree of social control under Chairman Mao, was breathtaking. It was the largest imposition of public health measures in human history.

"Closed-off management" involved many features.30 People were required to shelter in their homes and were given permission to leave only once or twice a week for essentials. Shoppers waited in lines and kept six feet of separation between themselves and others—a development that stunned both local and foreign observers familiar with the usual press of bodies in China. And simply everyone wore a mask in public. Movement of people and vehicles was checked with special exit-entrance permits in every area, often down to the neighborhood level. Collectivist slogans made a reappearance everywhere, from little notations on these permits ("It is everyone's responsibility to fight the virus") to huge red banners in the streets. Every person's temperature was checked at the entrance to every community. Schools were moved online for millions of pupils. Vehicles and public places were regularly disinfected. Food and other essentials were carefully delivered on an enormous scale. The Chinese authorities encouraged delivery companies to distribute goods, and the companies vouched, via the ubiquitous apps used to place orders, that their drivers were wearing masks and did not have fevers.

The rules were enforced by block captains, local officials, and Communist Party members.31 This was made easier by the authoritarian government and collectivist norms in China, and enforcement of this new regime was not just top-down. For instance, rural residents set up crude roadblocks of felled trees to keep outsiders out, and they interrogated visitors in local dialects in order to detect interlopers.32

This control sometimes came with modern twists. In February, a state-run military electronics company released an app that allowed citizens to enter their names and ID numbers and be informed of whether they might have come into contact with a carrier of the virus while using planes, trains, or buses. This technology struck many people in countries around the world as creepy, yet similar ideas would soon strike them as desirable, even normal.33

The Chinese government began to gingerly lift some of these restrictions in some parts of the country in late March, but the Chinese continued to implement many other procedures on a large scale.34