The outbreak of 2019-nCoV, originated in Wuhan since early December, the capital of China's Hubei Province, has caused a huge impact in Mainland China. The outbreak was first manifested by a cluster of mysterious pneumonia in Wuhan since early December 2019. Since 30 December when the local Health Commission's internal circular about the mysterious pneumonia was made public on Weibo, one of China's major social networking services, the potential outbreak soon drew nationwide attention, including that of the National Health Commission (NHC) in Beijing, who sent experts to Wuhan to make further investigation on the following day (31 December). The investigation came to a conclusion that the pneumonia was caused by a new coronavirus on 8 January 2020.[1] The quick isolation, identification and publication of the new virus by Chinese scientists and other measures taken by China were widely praised by many including the World Health Organization[2] and US[3] and German[4] officials. China's response appeared to be more transparent, especially when compared to how the country responded to SARS in 2003.[3][5]
However, delayed and controversial responses by the Wuhan and Hubei authorities failed to contain the outbreak in the early stage. On 29 January, Tibet announced its first confirmed case, a male who travelled from Wuhan to Lhasa by rail on 22-24 January[6], which marked that the virus had been spread to all parts of Mainland China.[7][8][9] By 2 February, more than 300 had died of the coronavirus infection-associated pneumonia and 14,380 were confirmed to be infected. In Hubei alone, there were 9074 infections and 224 deaths due to the virus.[10] The World Health Organization had declare the outbreak as a “public health emergency of international concern over the global outbreak of novel coronavirus”,[9] for fear that the virus spread beyond China to where there is no robust healthcare system, despite its confidence in China's efforts.[11]
Huanan Seafood Market in Wuhan, a possible origin of the outbreak, had been shut down since 1 January 2020, which did not stop more infections. The city of Wuhan announced a sudden lockdown on 23nd, which was followed by other Hubei cities. As Xiangyang became the last Hubei city to declare lockdown on 27th, all Hubei cities had been quarantined, with local access to airports, roads and railways temporarily shut down. [12] To arrest the transmission of the virus, starting from 1 February, Hubei city of Huanggang introduced a curfew law, which allows only one member of a local family to shop on the streets for every two days, making the city the first to restrict people from going outdoors.[13] Similar approach has been taken by Zhejiang city of Wenzhou, which is second largest epicenter after Hubei.[14]
President of China Xi Jinping warned a 'grave situation' facing China[15] and held a Politburo meeting which guaranteed resources and experts for treatment and supplies to Hubei,[16] as more and more cases of the viral infection, mostly exported from Wuhan, became confirmed in other cities in Hubei[7] and multiple parts in Mainland China.[17] By 29th, all regions of Mainland China, following by Guangdong and Zhejiang, had initiated Class 1 Response to Public Health Emergency, the highest response level, after Tibet upgraded its response level on the day.[18] Chinese New Year celebrations were cancelled in many cities. Passengers were checked for their temperatures to see whether they had a fever. [19] By 27th, 19 provinces had halted inter-province bus services. [20] Railway services connecting Hong Kong and Mainland China were suspended. [21]
With the increasing reported cases of infections, fear upgraded along with regional discrimination in China and racial discrimination beyond China, despite calls for stopping the discrimination by many governments. [22][23] Rumors circulated across Chinese social media, along with counter-rumor efforts by multiple Chinese media and governments[24][25], while the Supreme Court defended 8 "rumors" who were summoned by Wuhan police for they claimed there was SARS cases in Wuhan. As the Court pointed out in a WeChat article, delay and intransparency in public information are the root of fake news and the information that is mostly factual and not subjectively malicious, and causes no objectively severe consequences should be tolerated. [26]
Hubei Province
Early response by Wuhan
On 27 December 2019, Zhang Jixian, a ICU doctor at Hubei Hospital of Integrated Traditional Chinese and Western Medicine in Wuhan, discovered unusual changes in the lungs of her 4 patients, which were different from those in any known viral pneumonia. One of these patients were from Huanan Seafood Market. She reported her discovery to her hospital and the hospital soon informed Jianghan District's Centre for Disease Control and Prevention (CDC). On the following two days, three more patients with similar conditions came to the clinic of the hospital, all of whom were from Huanan Seafood Market. The hospital then notified the provincial and municipal health commission. The health commissions appointed Wuhan and Jianghan CDC and Jinyintan Hospital to make epidemiological research for the 7 patients on 29th. 6 of them were then transferred to Jinyintan, a specialized facility for infectious diseases. Only one patient refused the transfer. [28]
Since the evening of 30th, two emergent notice letters from the Municipal Health Commission of Wuhan began to circulate on the Internet, which was soon confirmed by Wuhan CDC on the following day. The letters required all hospitals in Wuhan to report any pneumonia patients with unknown causes and related to Huanan Seafood Market and asked the hospitals to give proper treatment to these patients. Wuhan CDC told The Beijing News the investigation was still underway and that experts from the National Health Commission were on the way to help the investigation. [29]
On 1 January 2020, the seafood market was closed down by Jianghan District's Health Agency and Administration for Market Regulation due to a "environment improvement." According to China Business, workers in hazmat suits were inspecting all around the market and collecting samples. Storekeepers at the market said they did not know what the people were collecting and detecting.Urban Management officers and police officers were on the spot to ask the storekeepers to wrap up and leave the market. [30] Several doctors were warned by Wuhan police of "spreading misinformation" and 8 "rumorer" were summoned by police on 3 January.[31][32]
Human-to-human transmission
Despite the expert-led investigation and early signs of human-to-human transmission, including a nosocomial infection case confirmed on 10 January according to Caixin[33], the local government of Wuhan denied any case of nosocomial infection and kept saying that there was no clear sign of human-to-human transmission until 15th when the Municipal Health Commission (MHC) said on its website that "the result of present investigations show no clear evidence of human-to-human transmission, but it does not the possibility, and the its risk of continuous human-to-human transmission is low."[34] The reported case number froze at 41 during the Hubei Lianghui and Wuhan Lianghui, the local parliamental sessions between 6-17 January, which the local authorities of Hubei and Wuhan claimed to be due to lack of test kits for the new virus.[35] On 20th, he number of reported case soared to 136. On the same day, Zhong Nanshan, one of the NHC experts sent to Wuhan who was well-known , exemplified the risk with a cluster of 14 hospital-acquired infections in Wuhan and two familial cases in Guangdong on 20 January.[36]
Lockdown and cerfew
The city of Wuhan announced a sudden lockdown on 23nd, which was followed by other Hubei cities. Yet, by 23rd, as stated by Zhou Xianwang, Mayor of Wuhan, 5 million Wuhan citizens had left the city for the Chinese New Year vacation, while 9 million remained in the city.[37] As Xiangyang, the last Hubei city to declare lockdown of city, all Hubei cities had been quarantined by 27th, with local access to road and railway networks temporarily shut down. Multiple major Hubei hospitals began to request for medical supplies, including surgical masks and other protective equipment, via social media almost at the same time when Wang Xiaodong, Governor of Hubei, promised to the people that there would be no shortage of supplies after lockdown in a press conference. [38]
Starting from 1 February, Hubei city of Huanggang introduced a curfew, which allows only one member of a local family to shop on the streets for every two days, making the city the first to restrict people from going outdoors.[13]
Other provinces
President of China Xi Jinping warned a 'grave situation' facing China[15] and held a Politburo meeting which guaranteed resources and experts for treatment and supplies to Hubei,[16] as more and more cases of the viral infection, mostly exported from Wuhan, became confirmed in other cities in Hubei[7] and multiple parts in Mainland China.[17] On 29 January, Tibet announced its first confirmed case, a male who travelled from Wuhan to Lhasa by rail on 22-24 January[6], which marked that the virus had been spread to all parts of Mainland China.[7][8] Ahead of the Hubei authorities[17], Class 1 Response to Public Health Emergency, the highest response level, were announced by mainland provinces of Guangdong and Zhejiang on 23th; by 29th, all parts of Mainland had initiated Class 1 Response, after Tibet upgraded its response level on the day.[18]
Chinese New Year celebrations were cancelled in many cities. Passengers were checked for their temperatures to see whether they had a fever. [19] People with travel history to Hubei, especially Wuhan were closely watched and quarantined. As the epidemic accelerated, more authorities followed Hubei and Guangdong to announce not wearing a mask in public places illegal. The mainland market saw a shortage of face masks, which will not be relieved until late February when most workers return from the New Year vacation according to Lei Limin, an expert in the industry.[39]
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