Timeline of the COVID-19 pandemic in December 2019
This article documents the chronology and epidemiology of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the COVID-19 pandemic, which was first detected in Wuhan, China. Some developments may become known or fully understood only in retrospect.
From late January 2020 onwards a series of studies from different research teams published results ascertaining the clinical situation, and, as well providing preliminary analysis for characterizing the early evolutionary progress of SARS-CoV-2. Key technical terms in the genetic research are 'most recent common ancestor', or MRCA, and comparative studies of genomes using massive parallel sequencing or second-generation sequencing (NGS), both of which facilitated the discovery.
The early Chinese laboratory-confirmed cases have been determined in retrospect.
- November 2019
According to an early preliminary study using phylogenetic analysis, the expert estimate suggested the most recent common ancestor (MRCA) evolved between 22 and 24 November 2019. As of May 2020 this estimate was corroborated with a larger dataset, setting the date interval to "6 October 2019 – 11 December 2019". Also, although near-conclusive evidence points to bats as the natural reservoir host for the virus, the path of transmission to humans - the zoonotic origin - most likely occurred via an intermediary wildlife host. It was assumed and further evidenced that the novel coronavirus uses ACE2, the same entry receptor as SARS-CoV. It is possible that the ability for human-to-human transmission has evolved after the zoonotic transfer.
A clinical study documents the index case, or patient zero - his symptoms started on 1 December. The study summarized the laboratory-confirmed cases as of 2 January 2020, and although not explicit on every single case, it was noted the first case was male, had not been to the Huanan Seafood Wholesale Market of Wuhan, that his family was unaffected and that no epidemiological link between him and the other cases was found. The BBC Chinese Service later confirmed that they had received information from Wenjuan Wu, one of the authors from the article in Lancet and who was one of Wuhan's JinYinTan Hospital's senior doctors, that this first man was in his 70s, had Alzheimer's disease, lived several bus rides away from the market and did not venture out from his home.
The first documented admission to a hospital.
An unresolved clinical case sparks off the first scientific involvement: A bronchoalveolar lavage fluid (BAL) sample is sent from Wuhan Central Hospital to Vision Medicals (广州微远基因科技有限公司) in Guangzhou - a private company specializing in metagenomic massive parallel sequencing analysis.
An elderly couple, both suffering from fever and coughs, sought treatment at the Hubei Provincial Hospital of Integrated Chinese and Western Medicine (湖北省新华医院). Zhang Jixian, director of the Department of Respiratory and Critical Care examined the couple and made the preliminary diagnosis of their illness as something that "looked like flu or common pneumonia".
After having observed the elderly couple's CT scans were abnormal, Zhang Jixian asked the couple's son to undergo a scan and found the same pattern. Zhang Jixian had been working as medical expert during the SARS outbreak in 2003, and was aware of the signs of an suspected outbreak of an infectious disease.
Another patient, a merchant from the Huanan Seafood Wholesale Market, arrived at the hospital with fever and cough that day, and his CT scan showed the same characteristics. All blood tests from the four patients indicated viral infection and a further array of influenza-related tests came back negative. Zhang Jixian filed a report to her superiors and also took the precaution of making a provisional quarantine area.
Wuhan Central Hospital received message from Vision Medicals that the BAL sample taken on 24 December contained a new kind of coronavirus, and the patient was then quarantined. Also at Wuhan Central Hospital, yet another unresolved case caused a BAL sample to be taken, this time sent off to CapitalBio Medlab of Beijing (北京博奥医学检验所有限公司).
On this day and the previous, three similar cases arrived at Hubei Provincial Hospital of Integrated Chinese and Western Medicine, all associated with the seafood market. The health authorities had been informed, and medical experts from Wuhan JinYinTan Hospital, "a hospital designated to treat infectious diseases" came to transfer six of the seven patients. Zhang Jixian took the further initiative to let doctors and nurses in the respiratory department wear face masks, and put out an order for 30 hospital coats of fine canvas.
The Wuhan CDC staff found also additional patients with similar symptoms who were linked to the market. (The Wuhan 'Center for Disease Control and Prevention' (CDC) is part of Chinese Center for Disease Control and Prevention.)
Wuhan Central Hospital received a test report from CapitalBio Medlab, claiming an occurrence of SARS. According to social media the test result was later found faulty, but, back then, multiple doctors at Wuhan Central Hospital shared the test report on social media, foremost addressed to the collegial circle.
The first official messages in the pandemicEdit
Wuhan Municipal Health Commission sends a message to its affiliate institutions.
- Supervising doctors shall hold fast on discipline and create specialized team-units.
- General staff must be alert to the situation, especially keeping an eye out for patients with symptoms of infectious pneumonia.
- Statistical material must be gathered ongoingly and send to Wuhan Municipal Health Commission and Hubei Province Health Committee.
- Statistical material for the previous week, relating to patients with symptoms of infectious pneumonia, is to be send to Wuhan Municipal Health Commission before 4 o'clock, this day.
- Without permission from authorized personnel no one is allowed to spread information about the medical treatment.
The first public message in the pandemicEdit
The Wuhan Municipal Health Commission informed the city community about the early signs of a pneumonia outbreak. The message conveys the impression of alertness, by summarizing yesterday's orders to the city hospitals; emphasizing ongoing scientific and clinical investigations and to seek hospital care when having persistent fever while showing symptoms of pneumonia; as well advising the public to wear face masks and to avoid enclosed public places and crowded areas.
Chinese state television CCTV channel 13 in their daily news broadcasts, and through the Weibo account "YangShiXinWen", also sent an alert about the unknown virus, adding that a team of experts from the National Health Commission would arrive in Wuhan.
Qu Shiqian, a vendor at the Huanan Seafood Wholesale Market, said government officials had disinfected the premises on 31 December and told stallholders to wear masks. Qu said he had only learned of the pneumonia outbreak from media reports. "Previously I thought they had flu," he said. "It should be not serious. We are fish traders. How can we get infected?"
SARS-CoV-2 outside WuhanEdit
NB! Findings reported in this section do not appear in the statistics overview from the French Public Health Ministry.
On 2 December, a man was admitted to Hôpital Albert Schweitzer in France. His thoracic scan was part of suspicious scans identified by the hospital, the earliest of these suspicious scans being on 16 November.
In May 2020 mainstream media (ex. BFMTV, ABC News, Business Insider) reported of the case of a SARS-CoV-2 infected patient in France. The epidemiological circumstances remain uninvestigated.
Events, reactions and measuresEdit
A BAL sample is sent from Wuhan Central Hospital to Vision Medicals. According to the GenBank record, the sample was obtained 23 December, whereas Ren et al.,Chin Med J, 2020 sets the date to 24 December 2019.
Vision Medicals inform Wuhan Central Hospital, by phone, that the requested analysis of a BAL sample - obtained 24 December - show a new kind of coronavirus (Chinese: …"一种新的冠状病毒。" ; English: …"a new kind of coronavirus."). Vision Medicals also send a written report to the Chinese Academy of Medical Science. The report tells of Chinese: …"样本里面确实有一个跟Bat SARS like coronavirus类似的新型病毒" ; English: …"a sample containing a new coronavirus similar to bat SARS coronavirus" and in the days that follow there is an intensified communication between the CEO of Vision Medicals Li Youngjun (李永军), the Wuhan Central Hospital and the local CDC.
According to news reports in February 2020 - Workers Daily, Global Times - at the Hubei Provincial Hospital of Integrated Chinese and Western Medicine and following the report from Doctor Zhang Jixian, the hospital immediately alerted the local CDC, Wuhan Jianghan Disease Prevention and Control Center, however, the report of 22 January 2020 from the Chinese CDC seems to claim this contact falling on 29 December.
The administration at Hubei Provincial Hospital of Integrated Chinese and Western Medicine convened an inter-departmental panel of doctors whose conclusions were the cases were unusual and required special attention, and also having learned of two similar cases in the city, decided to report their findings to the municipal and provincial health authorities, Wuhan Municipal Health Commission and Hubei Province Health Committee.
Wuhan Central Hospital receives report from CapitalBio Medlab that their sample (obtained 27 December) contains SARS coronavirus. According to a Caixin news report, this is a mistake. The same news report allege this sample was later sent on from CapitalBio Medlab to Vision Medicals, and that Vision Medicals could confirm the sample contained SARS-CoV-2, i.e. identical to the first sample Vision Medicals had received.
The alleged faulty test-report went to the social media ("社交媒体"), where a couple of doctors from the hospital joined in with warnings and cautions to their colleagues. As referred in Caixin Online, from the social media account of Li Wenliang, it is stated that there are 7 cases of SARS at the Wuhan Central Hospital, all connected to the Huanan Seafood Wholesale Market.
For Vision Medicals, too, these are hectic days (27-30 December) with the Chinese CDC requesting all results from Vision Medicals and from the Chinese Academy of Medical Science: "this was an urgent, secret and serious investigation".
- The first official messages in the pandemic
Wuhan Municipal Health Commission sends hard-copy messages to its affiliated institutions, containing guidelines in confronting a possible outbreak of infectious pneumonia. Two scan-copies also found their way, the same day, to the Weibo QQ service - a social media platform.
- The first information reaching an international context
WHO may also have noticed the information coming out from Wuhan.
- The first public message in the pandemic
The Wuhan Municipal Health Commission released a briefing on its website about the pneumonia outbreak in the city. The message on finding pneumonia of unknown cause was circulated through news agencies, including the state television CCTV, local news agencies (ex. 湖北日报网 [Hubei Daily Online]) and social media (ex. Weibo account "央视新闻" [ed. "YangShiXinWen", China Central Television News]). The People's Daily said the "exact cause remained unclear and it would be premature to speculate."
Information was picked up by international news agencies Reuters and Deutsche Welle as well as Hong Kong based South China Morning Post:
- Hong Kong takes emergency steps as mystery 'pneumonia' infects 27 in Wuhan
- China investigates SARS-like virus as dozens struck by pneumonia
- Chinese officials investigate cause of pneumonia outbreak in Wuhan
- Inter-regional reactions
In response to a Wuhan authority announcement on the "pneumonia of unknown cause", Hong Kong immediately tightened their inbound screening processes as a result. Hong Kong Secretary for Food and Health Sophia Chan Siu-chee announced "[any suspected cases] including the presentation of fever and acute respiratory illness or pneumonia, and travel history to Wuhan within 14 days before onset of symptoms, we will put the patients in isolation."
Tao Lina, a public health expert and former official with the Shanghai Center for Disease Control and Prevention, said, "I think we are [now] quite capable of killing it in the beginning phase, given China's disease control system, emergency handling capacity and clinical medicine support." No human-to-human infection had been reported so far and more pathological tests and investigations were underway, an official said.
- Information reaching an international context
According to the World Health Organisation, WHO China Country Office officially received information from the Chinese health authorities concerning the situation in Wuhan. Taiwan also notified WHO.
Retrospective studies consider the SARS-CoV-2 to have evolved in November 2019. Scientific comprehension of this new kind of SARS-like coronavirus took place at Vision Medicals, located in Guangzhou province, between 24–27 December 2019. Clinical apprehension of a pending epidemic started at Hubei Provincial Hospital of Integrated Chinese and Western Medicine in Wuhan almost the same time, in the days between 27 and 29 December 2019. At 31 December 2019 the Wuhan Health authorities issued a case statistic. At that day information reached WHO through official channels and the U.S. CDC as well.
- "Coronavirus disease 2019". World Health Organization: WHO. Archived from the original on 22 February 2020. Retrieved 27 January 2020.
- "疫情通报" (in Chinese). National Health Commission of the People's Republic of China. Archived from the original on 26 January 2020. Retrieved 9 February 2020.
- "Tracking coronavirus: Map, data and timeline". BNO News. 1 April 2020. Archived from the original on 2 April 2020. Retrieved 21 April 2020.
- See p. 498 in Huang et al.,Lancet, 2020
- Li, Xingguang; Zai, Junjie; Zhao, Qiang; et al. (27 February 2020). "Evolutionary history, potential intermediate animal host, and cross‐species analyses of SARS‐CoV‐2". Journal of Medical Virology. Wiley. 92 (6): 602–611. doi:10.1002/jmv.25731. PMC 7228310. PMID 32104911.(print:June 2020)
- Andersen, Kristian G.; Rambaut, Andrew; Lipkin, W. Ian; et al. (17 March 2020). "The proximal origin of SARS-CoV-2". Nature Medicine. 26 (4): 450–452. doi:10.1038/s41591-020-0820-9. PMC 7095063. PMID 32284615 – via www.nature.com.(print:April 2020)
- See p. 6 in van Dorp, Lucy; Acman, Mislav; Richard, Damien; et al. (5 May 2020). "Emergence of genomic diversity and recurrent mutations in SARS-CoV-2". Infection, Genetics and Evolution. Elsevier: 104351. doi:10.1016/j.meegid.2020.104351. PMC 7199730. PMID 32387564.(preproof)
- Zhou, Peng; Yang, Xing-Lou; Wang, Xian-Guang; et al. (3 February 2020). "A pneumonia outbreak associated with a new coronavirus of probable bat origin". Nature. 579 (7798): 270–273. doi:10.1038/s41586-020-2012-7. PMC 7095418. PMID 32015507.(preprint: 22 January biorxiv.org Archived 24 January 2020 at the Wayback Machine)(print:12 March 2020)}}
- Wu, Fan; Zhao, Su; Yu, Bin; et al. (3 February 2020). "A new coronavirus associated with human respiratory disease in China". Nature. 579 (7798): 265–269. doi:10.1038/s41586-020-2008-3. PMC 7094943. PMID 32015508.(preprint 25 January 2020 biorxiv.org Archived 9 May 2020 at the Wayback Machine)(print:12 March 2020)
- See p. 499 Fig.1B & p. 500 in Huang et al.,Lancet, 2020
- Huang, Chaolin; Wang, Yeming; Li, Xingwang; et al. (24–30 January 2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". The Lancet. 395 (10223): 497–506. doi:10.1016/S0140-6736(20)30183-5. PMC 7159299. PMID 31986264 – via www.thelancet.com.
- Duarte, Fernando (24 February 2020). "Who is 'patient zero' in the coronavirus outbreak?". BBC Future. BBC. Archived from the original on 8 March 2020 – via www.bbc.com.
- 汪宜青 [Wāng Yí Qīng] (18 February 2020). "模糊不清的"零号病人"与新冠病毒来源争议" [The shadowy debate on "Patient Zero" and the origins of SARS-CoV-2]. BBC News 中文 (in Chinese). BBC. Archived from the original on 2 March 2020. Retrieved 1 May 2020 – via www.bbc.com.
- See p. 499 Fig.1B in Huang et al.,Lancet, 2020
- 高昱 [Gāo Yù]; 彭岩锋[Péng Yán Fēng]; 杨睿 [Yáng Ruì]; et al. (26 February 2020). "独家 | 新冠病毒基因测序溯源：警报是何时拉响的" [Exclusive | Tracing the New Coronavirus gene sequencing: when did the alarm sound]. 财新网 [Caixin Online] (in Chinese). Caixin. Archived from the original on 27 February 2020. Retrieved 1 March 2020 – via china.caixin.com.
- " "Vision Medicals | Crunchbase". www.crunchbase.com. Cruncbase Inc. " Archived from the original on 8 April 2020. Retrieved 2 May 2020.
- Yao, Yuan; Ma, Yujie; Zhou, Jialu (16 April 2020). "Xinhua Headlines: Chinese doctor recalls first encounter with mysterious virus". Xinhua. Archived from the original on 23 April 2020. Retrieved 23 April 2020 – via xinhuanet.com.
- Wei, Fan; Cheng, Yang; Meng, Cui (7 February 2020). "Ringing the alarm". Global Times. Archived from the original on 7 February 2020. Retrieved 18 April 2020 – via www.globaltimes.cn.
- 张翀 [Chong, Zhang] (8 February 2020). "她最早发现新冠肺炎疫情苗头 立即上报可疑病例" [She first discovered the signs of a new coronary pneumonia epidemic and immediately reported suspicious cases]. 民生 [Society]. 工人日报 [Worker's Daily] (in Chinese). Archived from the original on 16 April 2020.
- Gāo Yù et al.,Caixin Online, 2019 referring to Weibo account "XiaoShanGou".
- Yao et al.,Xinhuanet, 2020
- The 2019-nCoV Outbreak Joint Field Epidemiology Investigation Team; Li, Qun (22 January 2020). "An Outbreak of NCIP (2019-nCoV) Infection in China". China CDC Weekly. Chinese Center for Disease Prevention and Control. 2 (5): 79–80. ISSN 2096-7071. Archived from the original on 28 January 2020. Retrieved 8 February 2020 – via weekly.chinacdc.cn.
- Marjorie P. Pollack (Mod.MPP), ed. (30 December 2019). "UNDIAGNOSED PNEUMONIA - CHINA (HUBEI): REQUEST FOR INFORMATION". International Society for Infectious Diseases – via promedmail.org.
- 许雯 [Xǔ Wén] (31 December 2019). "武汉疾控证实：当地现不明原因肺炎病人，发病数在统计" [Wuhan CDC confirm: pneumonia infections of unknown cause has appeared in the local area, the number of infected people is being calculated]. 国内 [Inland]. 新京报网 [Beijing News Online] (in Chinese). 新京报 [Beijing News]. Archived from the original on 31 December 2019 – via www.bjnews.com.cn.
- Chinese Human Rights Defenders (ed.). "关于做好不明原因肺炎救治工作的急通知" [Urgent notice on best practice for the medical treatment of pneumonia of unknown cause] (PDF) (in Chinese). Archived (PDF) from the original on 17 February 2020. Retrieved 14 February 2020 – via www.nchrd.org.
- "武汉市卫健委关于当前我市肺炎疫情的情况通报". Wuhan Municipal Health Commission (in Chinese). Archived from the original on 9 January 2020. Retrieved 24 January 2020.
- "[新闻直播间]湖北武汉发现不明原因肺炎 国家卫健委专家组已抵达武汉" [Hubei Wuhan detect pneumonia of unknown cause, National Health Committee expert team soon to arrive in Wuhan]. CCTV-13 (in Chinese). 央视网(cctv.com). 31 December 2019. Archived from the original on 18 April 2020 – via tv.cctv.com.
- 湖北日报网 [Hubei Daily Online], ed. (31 December 2019). "武汉发现不明原因肺炎，国家卫健委专家组已达武汉" [Wuhan detect pneumonia of unknown cause, National Health Committee expert team soon to arrive in Wuhan] (in Chinese). Retrieved 30 April 2020 – via py.cnhubei.com.
- Mandy Zuo; Lillian Cheng; Alice Yan; et al. (31 December 2019). "Hong Kong takes emergency steps as mystery 'pneumonia' infects 27 in Wuhan". Politics. South China Morning Post. Archived from the original on 14 January 2020. Retrieved 8 February 2020 – via www.scmp.com.
- "Tableau de bord COVID-19 Suivi de l'épidémie de COVID-19 en France". Santé publique France. Archived from the original on 14 May 2020. Retrieved 22 May 2020 – via dashboard.covid19.data.gouv.fr.
- "Coronavirus : Un premier cas de Covid-19 remontant au 2 décembre confirmé en Alsace". 7 May 2020. Archived from the original on 8 May 2020. Retrieved 19 May 2020.
- "Coronavirus : Un premier cas dès le mois de novembre en Alsace". 7 May 2020. Archived from the original on 20 May 2020. Retrieved 19 May 2020.
- Hugo Septier (3 May 2020). "Coronavirus: le professeur Cohen affirme qu'il y avait un cas de Covid-19 en France dès le 27 décembre". Santé. BFMTV (in French). NextRadioTV. Archived from the original on 4 May 2020. Retrieved 16 May 2020 – via bmftv.com.
- Maria Cheng; John Leicester; James Keaten (5 May 2020). "French doctors: First virus case may have been in December". ABC News. Archived from the original on 6 May 2020. Retrieved 16 May 2020 – via abcnews.go.com.
- Morgan McFall-Johnsen; Isaac Sher; Hilary Brueck (7 May 2020). "New evidence suggests the coronavirus was likely spreading in the US and France as early as December". Business Insider. Insider Inc. Archived from the original on 8 May 2020. Retrieved 16 May 2020 – via www.businessinsider.com.
- Deslandes, A; Berti, V; Tandjaoui-Lambotte, Y; et al. (3 May 2020). "SARS-COV-2 was already spreading in France in late December 2019". International Journal of Antimicrobial Agents. Elsevier: 106006. doi:10.1016/j.ijantimicag.2020.106006. PMID 32371096.(preproof)
- Ren, L.; Wang, J.; Jin, Q.; et al. (4 February 2020), "Severe acute respiratory syndrome coronavirus 2 isolate BetaCoV/Wuhan/IPBCAMS-WH-01/2019, complete genome", Nucleotide, GenBank, National Center for Biotechnology Information, GenBank Accession number: MT019529.1
- See p. 4 Table 1 inRen, Li-Li; Wang, Ye-Ming; Wu, Zhi-Qiang; et al. (11 February 2020). Hao, Xiu-Yuan; Wei, Pei-Fang (eds.). "Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study". Chinese Medical Journal. doi:10.1097/CM9.0000000000000722. PMC 7147275. PMID 32004165.
- 杨小刚 [Yáng Xiǎo Gāng], ed. (31 December 2019). "武汉不明原因肺炎已做好隔离 检测结果将第一时间对外公布". 第一财经 [First Finance] (in Chinese). Archived from the original on 31 December 2019 – via www.yicai.com.
- Borger, Julian (18 April 2020). "Caught in a superpower struggle: the inside story of the WHO's response to coronavirus". The Guardian. Washington. Archived from the original on 23 April 2020. Retrieved 23 April 2020 – via www.theguardian.com.
- Wuhan Municipal Health Commission (ed.). "武汉市卫健委关于当前我市肺炎疫情的情况通报" [Wuhan Municipal Health Department's message about our city's present pneumonia situation]. wjw.wuhan.gov.cn (in Chinese). Archived from the original on 9 January 2020. Retrieved 24 January 2020.
- "刚刚，武汉市卫健委通报肺炎疫情：尚未发现人传人现象" [Now ; Wuhan Municipal Health Commission announce situation on pneumonia: as yet no sign of human-to-human transmission]. News Center - Public Announcements. 湖北日报网 [Hubei Daily Online] (in Chinese). 31 December 2019. Archived from the original on 28 April 2020. Retrieved 30 April 2020 – via news.cnhubei.com.
- "China investigates SARS-like virus as dozens struck by pneumonia". Deutsche Welle. 31 December 2019. Archived from the original on 1 January 2020. Retrieved 8 February 2020 – via www.dw.com.
- "Chinese officials investigate cause of pneumonia outbreak in Wuhan". Reuters. 31 December 2019. Archived from the original on 2 January 2020. Retrieved 8 February 2020 – via www.reuters.com.
- "CHP closely monitors cluster of pneumonia cases on Mainland". Press Releases. The Government of the Hong Kong Special Administrative Region. Archived from the original on 7 February 2020. Retrieved 8 February 2020 – via www.info.gov.hk.
- "WHO | Pneumonia of unknown cause – China". WHO. 5 January 2020. Archived from the original on 7 January 2020. Retrieved 21 April 2020.
- Marisa Taylor (22 March 2020). "Exclusive: U.S. axed CDC expert job in China months before virus outbreak". Health News. Reuters. Archived from the original on 7 April 2020. Retrieved 23 March 2020 – via www.reuters.com.
- "China publishes timeline on COVID-19 information sharing, int'l cooperation - CCTV News". Xinhua. 7 April 2020. Archived from the original on 10 April 2020. Retrieved 10 April 2020 – via english.cctv.com.