Who should be crowned in the novel cronovirus battle

During the traditional spring festival, the whole Chinese nation has her people tied down in their homes in order to most effectively deter the spread of 2019-nCoV, except the medical professionals, law enforcement and other disease control civil servants who are still fighting on the front line with the active virus among an increasingly larger group of infected or potentially infected. As a country, we have a painful memory of the 2002-2004 SARS outbreak and naturally had learned enough lessons to act with extreme caution toward such demons, or so we thought.
2020年的春节，全中国——除了那些奋战于还在扩展的疫情第一线的医护、公安和疾控人员——都闭门锁户宅在家里过年，因为这是目前最有效隔绝新冠病毒蔓延的策略。 2002-2004年间肆虐的非典肺炎留下了深痛的记忆， 于是我们以为已经吸取了太多深重的教训而不敢不万分小心的从事任何传染病监测与预防工作。 至少，我们起初是这么以为的。

Governance lapses became an ongoing hot topic in this war against the pandemic. It all started from a terrible feeling of awaking to a nightmare: January 20th of 2020, the highly respected Dr. Zhong Nanshan, a member of the Chinese Academy of Science, emphasized on state news that the Wuhan cronovirus-infected pneumonia could pass from human to human. Having remembered Mr.Zhong as a hero in the 2003 SARS battle for his outspokenness, integrity and his disease-control expertise, the country trusted Zhong’s words more than Wuhan or Hubei’s official notice, which by that time hadn’t made any outstanding correction to the old claim “there was no clear evidence to indicate human-to-human transmissibility”, except lightly touching on the fact“some of the infected had no history of visiting the Huanan wet market”（wild-animal meat sold on Huanan wet market is believed to be the primary origin of this virus). It must have been truly difficult for the Wuhan government to simply state “It is contagious between people, so cut down travel , wear your facemask at all times and stop gathering all together!”
这几天对于疾病预防治理是否有重大纰漏民间议论纷纷。这些议论开始于2020年1月20日的”梦醒时分“：这一天受全国人民尊敬爱戴的钟南山院士在央视新闻上称武汉的新冠肺炎是可以人传染人的。钟南山院士是2003SARS疫情中以直言不讳和英明远见一战成名的英雄，人们相信他的话更胜过相信武汉卫健委的通报。钟院士此言一出可谓平地一声雷，因在此之前人们在武汉卫健委的通报中看到的都是”未有明确的人传人的证据“ “有限的人传人的可能性”， 顶多在后期轻描淡写地提到“某些患者没有接触华南海鲜市场的历史”（华南海鲜市场是目前为止流行病学调查认为最可能的病毒来源），但从未明确修正过传染性上的说法。 要让武汉政府直接了当地说 “无法排除人传人的可能” ”请立即取消集会，尽量避免出门和出行，在外不要摘下口罩“，看来是太难了。

It would still have been too late to make such a strong warning though, exactly 13 days late, actually. On January the 5th, Wuhan Municipal Health Commission put up the notice “so far we had 59 cases of the pneumonia with unknown etiology” , and after a strange 5-day quiet, on January 11, it announced that” there has been an accumulation of 41 confirmed cases infected with the recently identified novel cronovirus” (why a reduction in the accumulative confirmed cases? We could attribute it to the recently established diagnosis procedure that probably ruled out the rest for other causes or it came out not before some patients got healed and released or died). Then an interesting thing happened, between Jan 11 to Jan 18, they reported zero increase of confirmed cases. So that means, from January 5 to January 18, this highly contagious virus decided to inflict no more patients but patiently waited for 13 days to act up again with an almost explosive outbreak ever since the 18th?
可是即使是武汉卫健委”早在“1月20日发出这样强硬的警告，也还是太迟了，不多不少迟了13天。1月5日，武汉卫健委通报”目前有59例未知病原的肺炎“， 接着沉寂了5天，又在1月11日通报 ”目前共有41例新冠病毒确诊“ （为什么病例反而减少了？这是因为1月8-10日这段日子才刚刚分离了病毒植株、将其命名为2019新冠型病毒、推出常规检测方法， 新确立的检测方法排除了某些疑似病例，亦或者某些病例在此之前就治愈或者死亡了）然后更耐人寻味的事情出现了：1月11日到18日之间，次次通报0新增病例。这也就意味着从1月5日到18日，这个高度传染性的冠形病毒”决定“暂且收手，在武汉人类中默默潜伏了13天到了18日早上才正式大发作？
What happened during that time? It turned out Wuhan held its Two Conferences (the municipal-level people’s congress and political consultation conference) between January 6 to 10（the next day their first epidemic notice in 5 days) and Hubei province held its Two Conferences between January 12-17 (precisely the next day there started to be an increase in the reported confirmed cases) . We have to conclude that this virus of a Wuhan origin is superbly politically sensitive. To this, the Wuhan government answered that it took five days to complete a laboratory test for etiology confirmation. Let’s give them the benefit of the doubt here a bit: after all, it was only until January 10th that the diagnostic PCR reagents and testing procedure were developed. But what about the subsequent 6 days? New admission to hospitals with similar symptoms never stopped, so how odd the number stalled for a streak of 13 days considering the backed-up cases could get tested at a faster rate with the new PCR reagents distributed.

那段时间内到底发生了什么？原来武汉在1月6到10之间召开了两会，偏偏11日一早就发出了五天内的第一次通报。湖北紧锣密鼓地于12-17日之间召开了省的两会，而恰恰第二日18号一早的疫情通报中有了两周以来第一次病例新增。一起一落，辗转圆合，密不透风。我们只能认定这个病毒是一个极其贴心、政治敏感的带冠小王子。对于这方面的质疑，武汉卫健委的回答是不明病原体肺炎病毒样本检测是需要5天才能完成的。好吧，我们就采取这个说法给其5天时间，毕竟1月10日才建立了系统的靶向检测新冠病毒的程序，之前的沉寂或有情可原。那么接下来的几天呢？根据后来发表的诸多论文来看，这一周（1月11到17）每天都有新发病例，按几率来说每天都有大量发热门诊病人出现，且加上前几天因无标准试剂从而堆积的待测样本，怎么也不该每天零新增确诊还保持此清水记录十三天？
The rest is history. The whole country started then (about Jan 18) to pay some attention to the apparently still local outbreak(with one or two international exceptions) but few outside Wuhan were really worried, because of the downplaying tone of those official notices so far issued by the Wuhan Government. How about locally? You would expect to see a lot more alertness. Yet, on the 19th of January, in one of the districts the city government hosted a Thousands-of-Families-Dinner event, and on January 21th, the provincial government still celebrated the end of the lunar year at its New-Spring Gala (the relevant news site is now 404).

剩下的你都知道了。 全国于一月18日这天开始或多或少关注起了这个当时看来还是局限于武汉市的一场瘟疫（偶有国际病例发作，如流星划过，转瞬即忘），不过武汉之外很少有人为此真的忧心，毕竟武汉卫健委的疫情通报里对人传人的可能性尽可能轻描淡写。 那武汉当地呢？不如临大敌也要高好几个级别地警惕度了吧：1月19日武汉一个区主持了万家宴的活动，而1月21日，湖北省政府照例举行了新春团拜会。
There is something seriously wrong in the work of epidemiological report and prevention here. But who exactly did what or failed to do what? The possibilities are: 1) the municipal government of Wuhan was ordered down in terms of making public the real severity of the virus by their provincial superiors. 2) the central CDC of China did not inform the local governments on the real severity and transmissibility of the virus. 3) The local governments having been informed by the CDC experts didn’t think it was their obligation to announce the outbreak.
这场疫情的预报工作恐怕是问题严重。那问题究竟出在哪里？谁做了什么或者谁没有做到什么？ 这里有三个可能性：1）武汉市政府被上峰命令不准对公众通报病毒的严重性。2）疾控中心专家没有将疫情的严重状况告知政府。 3）当地两级政府虽可依据专家们提供的信息与疾控专业建议，也上报了国务院卫健委，但认为主动透明通报疫情不是自己的责任。

A recently published (January 30th) NEJM article Early Transmission Dynamic in Wuhan, China, of CronoVirus-Infected Pneumonia written by a group of Chinese CDC doctors, Wuhan medical professionals and WHO experts began to circulate among netizens. Chinese people raged citing some of the content in the article against the authors - the front-line epidemiological researchers of this virus, calling them “irresponsible” “failing to inform the public in time about the human-to-human transmissibility” . Some people who read the article understood that the CDC people have long recognized the full medical picture but didn’t inform, or at least didn’t press hard the local government to spill the beans early enough.
最近有一篇1月30日于《新英格兰医学杂志》上刊出的由中国疾控中心学者、武汉当地医生以及几个世界卫生组织干事联合作者的题为“中国武汉新冠病毒肺炎早期传播态势“的学术文章在网民之间开始传阅。很多人被此文中的一些内容激怒而对作者们发起了指责，认为这些学者不负责任，”只知道抢发论文“，”明明早知人传人却还给’无明确人传人证据’的官方说法背书”。

Such allegations coincided with words uttered by the mayor of Wuhan a couple of days earlier on the 27th during an interview in reply to people’s anger toward Wuhan’s hiding-the-fire behavior. He said “People just don’t understand, even with the information given, we need to be authorized to release it to the public, in accordance with the Law of the PRC on the Prevention and Treatment of Infectious Diseases”.
这些民间指控和1月27日武汉市长在央视新闻上针对人们“武汉政府知情不报”等质疑进行回应时的一些说法可以合起来看。周市长说”人们就是不理解，我们得到了信息但也要得到授权才能发布疫情，要遵从《中华人民共和国传染病防治法》的。“

Here you might be wondering: who call the shots on the brink of a pandemic in a region? The local government with the actual outbreak, the state government, or the CDC who are not a department of the government, at least not one with direct administrative powers? Let’s examine the relevant law mentioned by Wuhan’s mayor to find out who should shoulder the main responsibility in informing the public.
这里你可能要问了：那到底谁在一场区域疫情中执行主要的行政权力？疫情源地的政府、疾控中心（并不算政府的一部分，至少没有直接的行政权力做通报或者调度）还是国务院？我们就从武汉市长所提到的中华人民共和国传染病防治法看起。

Here the words are “Upon an outbreak, the state department may authorize provincial-level governments to notify the public their region’s epidemic status“. Is it the Wuhan mayor’s insinuation that the state department did not authorize the Hubei province (his superiors) to release the information? But they did put out their first notices on the 31st of December 2019, which means they got the authorization then. Does the authorization have to come each time they make a notice on their local government site about the ongoing outbreak? Or the authorization is limited to some extent of the truth? Otherwise, why did they obviously withhold information for 13 days between January 5th to 18th and when they did release any information, for example on the 5th and 11th, they knowingly erroneously stressed that ” there has been no evidence of human-to-human transmissibility” ? Is this kind all dictated in the law or was he actually hinting at some upper-level meddling in his own scope of responsibility?
黄色高亮的第三十八条有关疫情通报的规定里说”传染病暴发流行时…. 国务院可以授权省、自治区、直辖市人民政府卫生行政部门向社会公布本行政区域的传染病疫情信息。“那么武汉市长是不是暗示其上峰省政府并未从国务院那里得到授权全面通报疫情？但是武汉市卫健委2019年12月31日就首次通报了不明病毒原肺炎的疫情，这就意味着他们还是得到了某种授权的。那这个授权是不是得每次通报之前都要去申请？不指令不发话？还是说这个授权对信息发布的程度以及范围有限制？不然的话，怎么1月5日到18日之间基本上任何有意义的信息都没有得到发布（没有授权？）而且有发布的日子，说话也不尽不实，掩耳盗铃地说”没有人传人的明确证据“，这些做法都是传染病防治法里面规定的么？还是武汉市长在暗示省级政府或者国务院对他的职责范围内的事情有所干预？

On the other hand, have the CDC doctors really put their need to publish papers before their immediate obligations in terms of advising the government, as some think demonstrated in the swift publication of their famous article “Early Transmission Dynamic… “, where there was a revelation that CDC knew about the severity and transmissibility way before the official announcement of such info? Take a look at one chart in the article in question.
另一方面，这些疾控中心的医学专家们是不是如人们所想象的，把自己的职业发展需求摆在公众利益之上，疫情当前只顾抢数据发论文？毕竟论文透漏出了一个真相：他们早就知道了传染性和疫情的严重性为什么没有即使通报政府、至少没有促使政府作出及时、准确的通报。 先看看新发病例的时间分布图。

Surely onsets were not discovered at the time of their happening due to the the necessary delay between a person’s onset of symptoms and his initial hospital visit as a result of the symptoms, not to mention a further period needed for diagnosis and data collection. So how long does it take for a case to be confirmed after their onset of symptoms? Let’s now look at the “frequency of cases” versus “days needed” charts below, particularly C.
当然了症状新发的日子肯定不是病例被”发现“（诊断和记录）的日子，毕竟大多数人们并不总是一有症状就去医院的 ，更何况去了医院得到检测诊断也必需一段时间。 那究竟从一个病例新发到确诊需要多长时间？我们再看看下面需时的几率分布图，重点关注C。

Assuming samples for case definition were taken on the day of their initial visits and assuming a five-day period for a NCIP ( Novel Cronovirus Infected Pneumonia) working definition (before the 2019 nCoV was identified and named, the working definition took after the SARS and MERS-CoV guidelines) to be confirmed，it would take 6 days for a case to be confirmed counting from the day of onset. That means, a January 2nd onset is mostly likely to be confirmed as a NCIP case not much later than January 8th. Henceforth given all these onsets (later confirmed) happening each day between Jan 3 -18 (The January 5th official notice by the Wuhan government reported no increase since Jan 3), chances are slim that none of them showed up on the radar during that time. It is equally unlikely that the CDC doctors who arrived at Wuhan on December 30 of 2019 didn’t have their hands full testing all the pouring-in cases and backed-up cases, especially once they had figured out the pathogen. And they came to the result of “ nil increase “ of the number of cases in the middle of an outbreak?
假设这些去门诊的病人都在当天被取样，并假设新冠病毒NCIP最初的暂行确诊程序（在新冠病毒分离命名并有了靶向核酸试剂之前，对新冠病毒的测试遵照世卫组织有关SARS和中东呼吸综合症两种冠状病毒标准测试 )需要5天完成，那么从一个人发病到确诊需要六天。也就是说，一个1月2日新发的病例很可能在1月8日之前就能得到确认为此次的冠状病毒病患。那么根据此顶级医学杂志的论文数据来看一月门诊病例每日都有，绝大多数六天之内就该得到确诊，那么从1月3日（卫健委1月5日的通报中提到3号后无新感染病例）到1月18日这十五天内没有任何新病例得到确诊的可能性太小了。 那么这些作者们12月31日到达武汉后，恐怕每天得废寝忘食地做检测或者做研究，新数据不愁太少只愁太多，怎么还能背书一个疫情爆发前期整整13日无新增的结论？

That was just one of the two major mishaps. The other information gap was on the transmissibility of the disease. Look at the table above. Among the 47 cases with onsets before January 1, 12 were found to be not related to wet markets or other persons with influenza symptoms, a.k.a, they probably had contracted the virus from other NCIP infected. Let’s assume it took at least a week (a bit too long) to figure out the travel history of all 47 cases and they were all admitted before January 3rd (the day the first official notice by Wuhan in 2020 came out), by January 10, it should have been clear then among the CDC experts that the human-to-human transmissibility cannot be ruled out. It would fall under their jurisdiction to stress this to the local government and strongly advise the administration to not take it too lightly. That’s what they should have done. But what really happened? A 13-day hiatus on reported increase in the number of cases and a long period of reticence concerning the real probability of the feared transmissibility.
日新增病例问题还只是两个”瞒报“类问题之一。另一个信息虫洞是有关传染性。 由上图可以看出2020元旦之前发病的47病例中12个并没有任何与海鲜市场或者其他流感类病人接触的历史，也就是说这12个人很可能是从其他新冠病例传染致病的。我们假设这47个病例都是1月3日收治（新年武汉卫健委的第一次通报，病例数字是大于47的，所以此假设合理）并且医院查询所有47人的接触史需要7天的时间（这个数据收集空挡给的够大吧？），那么完全有理由认为疾控中心的人最晚1月10日就能得出”人传人可能性无法排除”的结论。那么将此结论告知并且强调性告知给武汉政府，由武汉政府上报省政府及国务院的责任是不是就落在疾控中心的肩上了呢？ 这个过程快进到最后，我们看到的事实就是整整十三天毫无波澜水平无比的新增病例线以及对长达几乎三周对人传人可能性避重就轻的官方口气。

Yet wuhan’s mayor’s own words have given it away that the Wuhan government was informed in time. Once informed by the CDC, it would be their job to report up to the provincial government of Hubei as well as the National Health Commission of the PRC (part of the state department). Then we can only assume the authorization would come directly from the Hubei provincial government regarding releasing regional epidemic information to the public, for the state department won’t and can’t pass over the provincial government to direct a city government. But we still have one remaining question after all these investigative readings, did the Hubei government tie up Wuhan government’s hands in terms of a full and transparent release of information? Before we attempted to answer that question, one other theory we have to get out of the way: some foreign media insinuated that the state department, the highest level of the Chinese government, looked the other way when an authorization for full release of information was due or that they even intentionally directed the local governments to cover it up, but we know better not to dignify such insinuations by over pondering it because it is plain stupid to say the state department ignores the law stipulating accuracy and timeliness in reporting about any epidemics, when they are called on to make executive orders. Yet in the whole mayhem of CDC reporting to the Wuhan government about their findings and the local government communicating with their superiors on what steps to take, some people in certain positions had somehow decided it was best to keep the public in the dark for 13 straight days and to keeping the public mind free of worries of the risk of contracting the virus from other people.
不过武汉市长原话倒也替疾控中心撇清了 ”我们就是拿到信息也需要授权才能公布”。当地政府的责任是依据专家的传染病疫情通报上报省级政府及国务院卫健委。接下来省级政府将是直接授权或者不授权武汉政府公布武汉当地疫情的部门，因为毕竟国务院是不能也不会越级去授权或者阻挠市政府工作的。那么问题就剩下了一个：湖北省政府是不是阻挠了或者有条件性地授权了武汉市政府的全面公布疫情？【另外，我们注意到有外媒BBC 美国之音等比较露骨地指责中国中央政府在给与当地政府全面通报疫情授权这件事上故意拖延甚至直接干预以意图遮掩疫情，但这是无稽之谈，难道一国的国务院是傻的么？明明法律写的明明白白需要及时准确通报疫情，在行政程序需要他们授权的时候，他们明显故意违法？我们不劝人善良，就劝某些人提高点智商再来骂国家】
佛系地综上所述，在整个疾控中心通报武汉政府，武汉政府请示省政府是否公布的这整个过程里发生了些奇妙的事情：某些位置的某些人认为缓说疫情十三天是必要的，是最佳策略，能够防止恐慌，能够让人们心情放松地外出社交。