Health·CBC Investigates

Why some experts are questioning China's coronavirus claims

China has taken unprecedented steps to stop COVID-19, locking down 60 million people. But questions remain about whether authorities initially concealed the severity and spread of the outbreak.

Lack of transparency, dubious numbers recall effort to downplay SARS outbreak

A resident wears a makeshift protective face shield at a residential compound in Wuhan, the epicentre of the novel coronavirus outbreak, in China's Hubei province. Experts are raising questions about how the country's leadership handled the first few weeks of the crisis. (Reuters)

This year's broadcast started with a six-minute celebration of China's international Belt and Road infrastructure projects — as interpreted via ethnic dance

Then came the traditional musical salute to the Lunar New Year, with women waving feathered fans and men dressed like caped superheroes. A pair of comedians took the stage, followed by a boy band-style rendition of Wild Wolf Disco, one of the country's top hits.

Finally, a half-hour in, things got serious. String music swelled and TV screens across China filled with images of gowned and masked hospital workers in Wuhan, bravely attending to victims of the COVID-19 virus outbreak. And the six hosts of state television's annual Spring Festival Gala stood in a line before the camera, doing their best to soothe the fears of the estimated 1.3 billion people watching at home.

"The central government is doing all they can to succeed!" one proclaimed. 

"We are quarantining the virus, but not quarantining love," said another. 

"Please believe China, all will be better!" promised a third.

Men wearing face masks sit on a bench with a cat underneath, at a park in Beijing on Friday. China remains in the grips of the novel coronavirus outbreak. (Reuters)

A month after that Jan. 24 broadcast, it's clear that such optimism was at best, premature. The number of novel coronavirus cases in China has expanded dramatically, with 77,042  people having contracted the disease as of Sunday, according to the World Health Organization, and 2,445 deaths — a 3.0 per cent mortality rate. 

And while there are indications the rate of infection within the country might be slowing, the flu-like illness continues its spread in Japan, South Korea, Singapore, Iran and beyond, with 1,769 cases and 17 associated deaths across 28 countries. Canada accounted for eight of those confirmed illnesses, with a ninth presumptive case, but none of the fatalities.

This, against a backdrop of unprecedented measures to contain the disease. A staggering 60 million people in Hubei province remain on lockdown, largely confined to their homes, with schools and businesses closed. A total of 780 million people across China are under strict travel restrictions. And almost two dozen airlines have severely curtailed, or flat-out cancelled, their flights in and out of the country. 

But questions now swirl about what the Chinese knew during the first, crucial few weeks of the outbreak, and if information about the severity and spread of the disease was being suppressed instead of shared. A possible repeat of what happened during the early days of the SARS crisis in 2002-03, when the country's Communist leadership downplayed a similar illness that eventually moved around the world, infecting more than 8,000 people, and killing 774, including 44 in Canada.

"They promised transparency, they promised everything would change, they promised a new rule book," says Laurie Garrett, a Pulitzer-Prize winning journalist and author who has tracked global outbreaks and epidemics for decades. 

Garrett, who was based in Beijing during the SARS outbreak, says China's COVID-19 statistics have given her a strange case of déjà vu. 

"When you started seeing this long period where the numbers either didn't budge, or even one day went backwards, to me that just looked like completely fabricated figures," she says. "There was absolutely no reason to believe that was true, especially if this was a SARS-related virus."

Yanzhong Huang, a professor of global health studies at Seton Hall University in New Jersey and senior fellow at the Council on Foreign Relations, agrees that China's early reports on the illness were severely flawed.

"It seems very clear that either local government officials or the health authorities messed up in their response to the outbreak," he says. Low-balled case numbers and inaccurate information about how the disease was spreading meant that health-care workers failed to take adequate precautions to isolate patients or even protect themselves, he says.

"When the preparation fails, you are guaranteed to see how a small outbreak evolves into an epidemic and takes a heavy toll on the economy and a society," he says. "At least two weeks were squandered."

A changing timeline

There has been widespread outrage in China over the case of Dr. Li Wenliang, a Wuhan ophthalmologist who was among the first to report a cluster of strange, SARS-like pneumonia cases at a local hospital. After Li shared his observations in an online chat group with his medical school classmates on Dec. 30, he was questioned by police, and ultimately forced to sign a statement declaring that his insights were "incorrect" and "illegal." 

Li's death on Feb. 7 from the very virus he had been accused of fabricating touched off public mourning and expressions of dissent on social media, and many consider him a martyr to both science and free expression. 

However, we now know that Li was not the only one to sound the alarm. 

A report from another Wuhan doctor, Zhang Hong, published in The Lancet medical journal earlier this month, revealed that seven other area physicians were cautioned by police after flagging suspicious pneumonia cases in early December. 

And while China did inform the World Health Organization (WHO) about the unexplained illnesses on Dec. 31 — blaming animal-to-human transmission at a local market — it took authorities almost three weeks more to disclose other major developments such as the first confirmed person-to-person transmission on Jan. 3, the spread of the sickness to health-care workers on Jan. 7, and the initial COVID-19 death on Jan. 9.  

The Chinese public was also kept in the dark. Local papers in Wuhan reported sparingly on the illness in early January, mostly denying that it existed, or was in any way related to SARS. The People's Daily, the country's national newspaper, made no mention of the outbreak whatsoever until Jan. 21, the day President Xi Jinping finally acknowledged the problem, decreeing that the virus "must be taken seriously," in remarks reported by state television.

Travellers are seen at the Shanghai Hongqiao Railway Station on Tuesday, what should have been the last day of the Spring Festival travel rush. (Aly Song/Reuters)

And the timeline of who knew what, when, keeps changing. 

Last week, official Chinese media reported on a speech Xi gave at the beginning of February in which the president claimed he had demanded measures to "prevent and control" the coronavirus during a Jan. 7 gathering of the Politburo Standing Committee, the country's highest authority. 

Some observers of Chinese politics suggest the speech has been highlighted in an effort to portray Xi as a take-charge leader and insulate him from domestic criticism over his government's handling of the crisis. But the disclosure raises other questions. 

"The official story to the outside world and the rest of China was, 'It's all under control,'" says Laurie Garrett. "[Xi] clearly knew that was a false narrative because, you know, a small outbreak of 40 people in one city, all connected to an animal market does not warrant an intervention by the head of state — in any country."

Global consequences

If the Chinese were concealing the true extent of the coronavirus outbreak through the first weeks of January, they didn't do the rest of the world any favours.

When the WHO met on Jan. 22 and 23 to debate whether to declare a global health emergency, it was understood that there were 571 confirmed cases with 17 fatalities in China, and 10 more illnesses across seven other territories and countries. 

The WHO committee held off on the emergency — a label that frees up funds and international assistance — because of the relatively small number of reported infections and China's aggressive lockdown in Hubei.

In retrospect, it may have been a costly deferral. By the time the declaration was ultimately made on Jan. 30, the number of coronavirus illnesses in China had grown to 7,736 confirmed and 12,167 suspected cases, with 170 deaths. And the disease had spread to 18 countries, with 82 people having fallen sick.

Tedros Adhanom Ghebreyesus, director general of the World Health Organization, has praised China for its response to the outbreak. (Denis Balibouse/Reuters)

Tedros Adhanom Ghebreyesus, the WHO's director general, has been effusive in his praise for the "extraordinary measures" that China is taking to combat COVID-19.

"The speed with which China detected the outbreak, isolated the virus, sequenced the genome and shared it with WHO and the world are very impressive, and beyond words. So is China's commitment to transparency and to supporting other countries," he said shortly after the emergency was declared. "In many ways, China is actually setting a new standard for outbreak response. It's not an exaggeration."

But medical workers on the front lines in Hubei have publicly complained about shortages of face masks, goggles and other vital protective gear, and the Chinese government has been slow to accept outside assistance — the first WHO advance team, led by Canadian expert Bruce Aylward, was finally allowed into the country on Feb. 10.

And there are continued questions about the country's case numbers as authorities keep changing the diagnosis criteria, making it difficult to tell how much progress is actually being made in the battle against the coronavirus. 

The politics of fear

Kelley Lee, the director of global health studies at Simon Fraser University, has studied and followed the WHO since the 1990s. She says the crisis is highlighting the "disconnect" between a body that was created in 1948, and the realities of a transnational epidemic in a modern, inter-connected world. 

"It's during an outbreak like this that we find out if our political institutions and our politicians are helping or hindering," says Lee.

Chinese President Xi Jinping inspects the novel coronavirus prevention and control work at the Anhuali Community in Beijing on Feb. 10. (Xinhua via Reuters)

The WHO doesn't have the authority to tell Xi Jingping what to do, let alone take over the fight on the ground. All it can do is engage in what is known as disease diplomacy, and try to convince China that its interests and the world's concerns are completely aligned.

"In some ways the SARS outbreak taught the WHO that you have to have the country that is most affected — the epicentre of the outbreak — on its side. It can't risk alienating the Chinese," says Lee. "I'm sure they know that they're not getting full co-operation, but they're still trying to encourage that."

However, that baked-in skepticism about the Chinese numbers is being harnessed and exploited by other actors. 

A conspiracy theory suggesting the novel coronavirus actually originated in a Chinese bioweapons laboratory has been making the rounds online, amplified by people like U.S. President Donald Trump's former adviser, Steve Bannon. Earlier this month, Sen. Tom Cotton, raised the idea — flatly discredited by experts — during a Fox News appearance.

"We don't have evidence that this disease originated there," said the Arkansas Republican. "But because of China's duplicity and dishonesty from the beginning, we need to at least ask the question to see what the evidence says, and China right now is not giving evidence on that question at all."

A similar, and equally false, online claim suggests the COVID-19 virus was stolen by Chinese spies working at the National Microbiology Lab in Winnipeg. 

A staff member is seen inside a Wuhan pharmacy with disinfectants placed at its entrance. (Reuters)

Where this all leads China and the world remains impossible to predict. But the fears associated with a spreading and deadly disease have a way of lingering long after the outbreak peters out. 

Journalist Ian Young, a former international editor of the South China Morning Post, thinks of the legacy of SARS in Hong Kong. 

"It was a psychologically shaping event for a lot of Hongkongers because it changed the way a lot of people lived their lives," he says. "It ended up killing about 300 people. It doesn't sound like a vast toll, but in the early stages of the outbreak, we had no idea exactly how deadly it was going to be — how transmittable it was going to be and there were massive levels of fear."

Young likens it to what happened in North America with the Sept. 11 attacks, when governments shifted to a war footing in the course of a single morning and air travel changed forever as terrorism went from being a distant threat to a live-on-TV reality.

"It changes people's behaviours and perceptions of the world. And perceptions of risk," he says. 

Making COVID-19 just the latest twist on the old saw about history repeating.

  • Watch: Terence McKenna's documentary report on the lessons to be learned from China's handling of the coronavirus crisis on CBC TV's The National, Monday night.



Jonathon Gatehouse

CBC Investigative Journalist

Jonathon Gatehouse has covered news and politics at home and abroad, reporting from dozens of countries. He has also written extensively about sports, covering seven Olympic Games and authoring a best-selling book on the business of pro-hockey. He works for the national investigative unit in Toronto.

With files from Matthew Pierce