Insight
Has Been Under the Effective Control From the Outbreak to the Global Pandemic 
,
Jim Mason1,2 
2 The HITAR Institute Canada, B.C. Canada
Author Correspondence author
International Journal of Clinical Case Reports, 2020, Vol. 10, No. 1
Received: 26 Apr., 2020 Accepted: 06 May, 2020 Published: 09 May, 2020
From the initial discovery at the end of 2019 to the global pandemic announced by WHO on March 11, 2020, has COVID-19, the disease unforeseeable by humans, been under effective control within the three months or were people having the exaggeration of keeping the disease under control and imagining its effectiveness? These will become the focal point of the debate about the global pandemic that did not appear for a century. This article systematically reviews the responsibility, professional role, and institutional supervision performed by doctors, hospitals, disease control centers, local governments, central governments, and international agencies in the COVID-19 global pandemic from the time of the initial discovery, to the outbreak, and to the point where it became a global pandemic. By examining numerous evidences, it is evident that COVID-19 has been under effective control from the outbreak to the stage of a global pandemic.
Since the outbreak of the new coronavirus (COVID-19) in December 2019, the disease became a global pandemic, infecting people in over 213 countries. Early manifestations of novel coronavirus pneumonia infection are similar to acute respiratory tract infection, and some patients develop rapidly into acute respiratory distress syndrome, which is aggravated in a short period of time, resulting in multiple organ failure (Chen et al., 2020). As of April 26, 2020, approximately 2.8 million people worldwide have been diagnosed with COVID-19, including more than 190 000 deaths, and the numbers are increasing rapidly.
From the initial discovery at the end of 2019 to the global pandemic announced by the WHO on March 11, 2020, has COVID-19, the disease unforeseeable by humans, been under effective control within the three months or are people having the exaggeration of keeping the disease under control and imagining its effectiveness? These will become the focal point of the debate about the global pandemic that did not appear for a century.
1. Initial Discovery and Early Warning – From December 26, 2019 to December 31, 2019
Since December 26, 2019 to December 31, 2019, within the time of a week, the cases of “pneumonia of unknown cause” was discovered by professionally trained expert doctors in China in the outpatient department of the hospital immediately after its first appearance. These doctors, following professional regulations and laws, conducted professional medical treatment and efficiently informed the infectious disease to the local government to receive execution of effective administrative control.
On December 26, 2019, Dr. Zhang Jixian, in the Hubei Provincial Hospital of Chinese and Western Medicine, found 4 patients with pneumonia – one of them is from the Huanan Seafood Market and the other three patients are a family.
Dr. Zhang Jixian performed the routine procedures taken for pneumonia patients, which included examinations related to symptoms of influenza A, influenza B, syncytial virus, adenovirus, rhinovirus, chlamydia, mycoplasma, etc.. The results of all the tests for the four patients were negative. Due to the fact that the 4 pneumonia patients all showed symptoms of fever, cough, and lung infection, but tested negative for the routine pneumonia examinations, the pneumonia was classified as “pneumonia caused by unknown virus”.
On the account of a doctor’s professional vigilance and sensitivity on the topic, Dr. Zhang Jixian hospitalized the family of three and set up an “isolated inpatient ward” and an “isolated area”. He alerted all health care members in the pneumology department and all his colleagues to wear face masks for self-protection. He also warned that N95 masks must be worn at all times when entering the “isolated area”. Furthermore, all medical supplies used by the three patients must not be mixed with other patients’ and their medical wastes should be treated separately.
On December 27, 2019, Dr. Zhang Jixian officially reported the four patients diagnosed with “pneumonia caused by unknown virus” to Dr. Xia Wenguang, the Dean of the Hubei Provincial Hospital of Chinese and Western Medicine, Office of Infection Response, and the Medical Department. The hospital immediately reported the cases to the Wuhan Jianghan Center for Disease Prevention and Control.
On December 28, 2019, the outpatient department of the Hubei Provincial Hospital of Chinese and Western Medicine admitted 3 more patients from the Huanan Seafood Market. They showed identical symptoms with the 4 patients admitted previously. Dr. Zhang Jixian considered the disease “as the disease that had not yet been discovered”. Then he immediately reported to the hospital again and suggested that multiple departments in the hospital should be convened for group consultation.
On December 29, 2019, Hubei Provincial Hospital of Chinese and Western Medicine convened a discussion meeting with all departments of the hospital at 1:00 in the afternoon. Doctors discovered that despite the fact that the six patients showed identical symptoms, they all have contact history with the Huanan Seafood Market. The hospital decided to report to the Hubei Provincial Center for Disease Control and Prevention, the Health Commission of the Hubei Province, the Wuhan Center for Disease Control and Prevention, and the Wuhan Municipal Health Commission about the six patients, in which 3 were showing mild symptoms and the other 3 were showing severe symptoms.
They were transferred to a hospital designated for infectious disease treatment.
On the same day, the expert group formed by the Wuhan Center for Disease Control and Prevention, the Wuhan Jinyintan Hospital, and the Wuhan Jianghan Center for Disease Prevention and Control formally settled in Dr. Zhang Jixian’s hospital and started epidemiological investigation.
On December 30, 2019, Wuhan Municipal Health Commission announced the Emergency Notice on the Treatment of Pneumonia of Unknown Cause.
On December 31, 2019, the National Health Commission of the PRC made arrangements in the early morning and dispatched working groups and expert groups to Wuhan to guide the epidemic situation and conduct on-site investigations. The Wuhan Municipal Health Commission issued the Report on the Current Situation of Pneumonia in Wuhan City on the official website and found 27 cases. The Wuhan Municipal Health Commission promoted the public to avoid closed, airless public places and places with concentrated population; masks should be worn when going out. From that day the Wuhan Municipal Health Commission issued information on the epidemic situation according to the law.
2. National Actions and Warnings – From January 1 to January 23.2020
On the last day of 2019 (December 31), the local government’s control applied to the “pneumonia caused by unknown virus” caught the attention of the central government. The Chinese government (National Health Commission of the PRC and Chinese Center for Disease Control and Prevention) immediately became took over the responsibility for the control and regulation of the “pneumonia caused by unknown virus” in Wuhan. From the first batch of working groups and expert groups entered the “pandemic area” for investigation and supervision in the early morning of January 1, 2020 to the announcement of the “lockdown” of Wuhan city in January 23, 2020 (about a 3-week period), the Chinese government has conducted effective professional handling and strong administrative supervision. Wuhan is a megacity with a registered population of 9.835 million and a floating population of 5.103 million. At the time of the most important holiday in China, the night before the Chinese New Year, the announcement of the “city lockdown” is an extremely difficult decision. However, the Chinese central government concluded to this difficult decision because the Wuhan “city lockdown” not only issued a serious warning to the rest of China, but also blew the most powerful whistle to the world (National Health Commission of the PRC, 2020, http://www.nhc.gov.cn/).
On January 1, 2020, despite the fact that New Year’s Day is a national public holiday, the National Health Commission of the PRC and the Chinese Center for Disease Control and Prevention sent a working group composed of internal staff and the epidemiology experts of the Chinese Center for Disease Control and Prevention as well as clinical experts on infectious diseases in key hospitals directly under the Commission to Wuhan for investigation and verification by first flight at 6:45 a.m. on January 1. The epidemiology experts of the Chinese Center for Disease Control and Prevention were selected along with the clinical experts of infectious diseases selected from the key hospitals by the National Health Commission of the PRC rushed to Wuhan to form an expert group for investigation and verification. The National Health Commission of the PRC set up an leading group for epidemic response and disposal, and thereafter held daily leading group meetings.
On January 2, 2020, the Chinese Center for Disease Control and Prevention and the Chinese Academy of Medical Sciences received the first batch of specimens of 4 cases from the Hubei province and immediately started pathogen identification. The National Health Commission of the PRC formulated the “Three Early” Prevention and Control Plan of Unidentified Viral Pneumonia.
On January 3, 2020, the National Health Commission of the PRC and the Health Commission of the Hubei Province enacted 9 documents, including the Diagnosis and Treatment Plan of Unidentified Viral Pneumonia (Trial). At the same time, the National Health Commission of the PRC, Chinese Center for Disease Control and Prevention, and 4 other scientific research institutions conducted parallel laboratory tests on case samples to further carry out pathogen identification.
On January 4, 2020, the National Health Commission of the PRC and Health Commission of the Hubei Province enacted the Manual for Medical Treatment of Unidentified Viral Pneumonia, which was issued to every medical and health institution in Wuhan and provided relevant training within Wuhan.
On January 5, 2020, the Wuhan Municipal Health Commission published the report of the information of the pneumonia caused by unknown virus on its official website, in which a total of 59 cases of pneumonia caused by unknown virus were found. According to laboratory test results, respiratory pathogens such as influenza, avian influenza, adenovirus, infectious atypical pneumonia, and Middle East respiratory syndrome are excluded from the list of potential diseases, which further confirmed it as a “pneumonia caused by unknown virus”.
On January 6, 2020, the National Health Commission of the PRC informed about the unknown pneumonia in Wuhan at the National Health Work Conference and requested that surveillance, analysis, and judgements be strengthened. The epidemic situation should be handled in a timely manner.
On January 8, 2020, the expert assessment team of the National Health Commission of the PRC initially confirmed that the epidemic was caused by a new coronavirus. The National Health Commission of the PRC sent a second group of experts to Wuhan.
On January 9, 2020, the expert assessment team of the National Health Commission of the PRC released the information about the pneumonia caused by unknown virus to the public – the pathogen has been initially confirmed as a new coronavirus – and updated the name “pneumonia caused by unknown virus” to the “new coronavirus-infected pneumonia”.
On January 13, 2020, the National Health Commission of the PRC convened a meeting to deploy and guide Wuhan city in the Hubei province to further strengthen social management and control measures, strengthen the body temperature detection of personnel at ports and stations, and reduce crowd gathering.
On January 14, 2020, the National Health Commission of the PRC held a national video and telephone conference to strengthen the epidemic prevention and control work in Wuhan, Hubei and prepare for national epidemic prevention and response.
On January 15, 2020, the National Health Commission of the PRC published the first version of the diagnosis and treatment plan, as well as the prevention and control plan for the new coronavirus-infected pneumonia.
On January 17, 2020, the National Health Commission of the PRC sent 7 supervision teams to the pandemic areas to guide the prevention and control of the epidemic.
On January 18, 2020, the National Health Commission of the PRC organized a high-level expert group on national medical and prevention and control led by Zhong Nanshan to Wuhan to investigate the epidemic prevention and control work (until the January 19). The National Health Commission of the PRC issued the second-edition of the diagnosis and treatment plan for new coronavirus-infected pneumonia.
On January 19, 2020, the National Health Commission of the PRC distributed nucleic acid testing reagents within the country.
On January 19, 2020, the National Health Commission of the PRC issue an announcement to classify the new coronavirus-infected pneumonia as a Class B infectious disease and to take the prevention and control measures of the Class A infectious diseases. At the same time the new coronavirus-infected pneumonia is included into the regulations and management of infectious diseases in the “Detailed Rules for the Implementation of the Frontier Health and Quarantine Law of the People’s Republic of China”. The National Health Commission of the PRC issued the “Prevention and Control Plan for the New Coronavirus-Infected Pneumonia (2nd Edition)”.
On January 21, 2020, the National Health Commission of the PRC started to post the epidemic situation of the previous day on the official website and the government’s new media platform every day. The English website was released simultaneously from February 3, 2020.
On January 22, 2020, the National Health Commission of the PRC issued the third edition of the new coronavirus-infected pneumonia diagnosis and treatment plan, detailing the relevant content of the Chinese medicine treatment plan. The weekly report of the Chinese Center for Disease Control and Prevention (English version) reported the epidemiology findings of the information about the new coronavirus in Wuhan for the first time. The information library developed by the China National Center for Bioinformation was officially launched, releasing the mutation analysis information about the new coronavirus genome in the world.
On January 23, 2020, the prevention and control headquarters issued a notice (No.1) about the new coronavirus-infected pneumonia in Wuhan. Starting from 10:00 on January 23, 2020, the city buses, subway, ferry, and long-distance passenger transportation will be suspended; citizens should not leave Wuhan without special reasons; airports, railway stations, and other passages to leave Wuhan would be temporarily closed; so far, Wuhan city is in “lockdown” (People’s Government of Hubei Provincial, 2020, http://www.hubei.gov.cn/zhuanti/2020/gzxxgzbd/zxtb/202001/t20200123_2014402.shtml).
3. WHO’s Duty and Actions – From January 5, 2020 to March 11, 2020
The World Health Organization (WHO) is the guardian of global health information and works with counties to improve the generation, sharing, and usage of high-quality knowledge resources. The WHO’s role in emergencies includes guiding and coordinating health response measures, providing support to countries, conducting risk assessments, setting priorities, formulating strategies, providing key technical guidance, supplying and funding, and monitoring health status. As an international and multinational organization, the WHO has been effectively fulfilling its roles and responsibilities since the outbreak of the “pneumonia caused by unknown virus” in Wuhan. It has played an outstanding role in the global fight against COVID-19 (World Health Organization, 2020, www.who.int).
On January 1, 2020, the World Health Organization formed an accident management support team at the three levels of the organization (headquarters, regional headquarters, and national headquarters). The organization entered a state of emergency.
On January 4, 2020, the WHO reported on social media that a group of pneumonia cases occurred in Wuhan, Hubei; no deaths occurred.
On January 5, 2020, the WHO released the first issue of the new coronavirus in the “Disease Outbreak News”. The status of patients with cluster pneumonia and public health measures in Wuhan were reported by China to the WHO.
On January 9, 2020, the World Health Organization website issued a statement on cases of cluster pneumonia in Wuhan, China, stating that the initial identification of a new coronavirus in a short period of time is a significant achievement.
On January 14, 2020, the head of the WHO’s outbreak response technology pointed out at the media stating that the coronavirus may have (with 41 confirmed cases) limited human-to human transmission, mainly through family members. Moreover, the person expressed that the a greater outbreak may be possible. The person in charge also said that considering our previous experience with SARS, MERS, and other respiratory pathogens, it is not surprising that interpersonal transmission occurs.
From January 20, 2020 to January 21, 2020, experts from the WHO Representative Office in China and the Western Pacific Reginal Office went to Wuhan to investigate the recent pneumonia outbreak caused by the new coronavirus infections. The WHO appreciates China’s initiative to report the epidemic information, to share viral gene sequence, and is willing to further share technical solutions, diagnostic reagents, primers for prevention and control, diagnosis and treatment, and etc.. The WHO said it will continue to strengthen cooperation with China and provide relevant technical support.
On January 22, 2020, the WHO delegation to China issued a statement saying that there is evidence that there is interpersonal communication in Wuhan, but more investigations are needed to understand the overall situation of the transmission.
On the same day, the World Health Organization held an emergency committee meeting of the International Health Regulations. The participating countries, the World Health Organization, and relevant experts shared information on the epidemic situation and conducted scientific research and judgment on the epidemic situation.
On January 23, 2020, in consideration of the “city lockdown” in Wuhan, China, after discussion, the World Health Organization Emergency Committee stated that it is too early to declare that the new coronavirus epidemic constitutes an international public health emergency because there are few and limited cases outside of China. Furthermore, the Chinese government has implemented a series of strong prevention and control measures.
On January 28, 2020, Tan Desai, the Director-General of the World Health Organization, visited Beijing and met with Ma Xiaowei , the Deputy Director of the National Health Commission of the PRC, to conduct in-depth discussion on the prevention and control of pneumonia outbreak caused by the new coronavirus. On the same day, the Director-General of the World Health Organization, Tan Desai, met with President Xi Jinping. During his stay in Beijing, Dr. Tan Desai agreed with the Chinese government leaders that an international team of first-class scientists would go to China to understand the specific situation, overall response measures, and exchange information and experiences.
On January 30, 2020 (Geneva local time), the World Health Organization announced that the new coronavirus disease epidemic is listed as a Public Health Emergency (PHEIC) of International Concern and issued a more serious warning. This is the sixth Public Health Event of International Concern declared by the WHO International Health Regulations went into effect in 2005.
On February 10, 2020, World Health Organization sent advance team members to Beijing.
On February 11, 2020, the Global Research and Innovation Forum on new coronavirus held in Geneva by the World Health Organization and the “Global Cooperative Organization of the Prevention and Control of infectious Diseases” (until the 12th) with more than 400 scientists in related disciplines, representatives of relevant countries and regions, and representatives of public health institutions worldwide.
The joint mission of the WHO and the National Health Commission of the PRC convened the first meeting. Preliminary consensuses were reached after the in-depth discussion with the principles members of the composition of the WHO-China joint expert inspection team about the key areas of investigation, the initial schedule.
Coronavirus disease was named Covid-19 by WHO. The virus itself had been designated SARS-CoV-2 by the International Committee on Taxonomy of Viruses (BBC News, 2020).
On February 17, 2020 (Geneva local time), the WHO held a press conference in Geneva to introduce the latest situation of the new coronavirus disease.
From February 16, 2020 to February 24, 2020 (Geneva local time), the WHO-China New Coronavirus Disease Joint Expert Investigation Team, including members from Canada, Germany, Japan, Nigeria, the Republic of Korea, Russia, Singapore, and the United States (CDC and National Institutes of Health) carried out on-site investigations in Beijing, Guangdong, Sichuan province, and Hubei province to understand the situation of the new coronavirus disease pandemic situation, prevention and control measures, medical treatment, community prevention and control, scientific research, entry and exit inspection, quarantine, passenger screening, wildlife sales management, and other works. After finishing the 9 day inspection in China, the WHO-China New Coronavirus Disease Joint Expert Investigation Team held a press conference in Beijing to introduce the inspection and the recommendations for the prevention and control of epidemics in China and the world. See the Report Of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19): https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf.
On February 27, 2020 (Geneva local time), the Director-General of the World Health Organization, Tan Desai, said in Geneva that the global prevention and control of the new coronavirus disease epidemic is at a “decisive” moment. All countries should formulate a “full-scale” epidemic prevention and control plan.
February, 28, 2020 (Geneva local time), the WHO Director General, Tan Desai, announced in Geneva that global risk level of new coronavirus disease is “very high”. Previously, the global risk level of the new coronavirus disease was at “high risk”. Tan Desai said that in view of the current pneumonia in many countries around the world, there are 4351 cases outside China and more countries are experiencing outbreaks. Therefore, the global risk level of new coronary pneumonia has been raised. Tan Desai said that China’s experience proves that as long as effective measures are taken as early as possible, there is still a chance to curb the spread of the virus and prevent it from becoming a pandemic.
February 28, 2020, Dr. Takeshi Kasai, WHO Reginal Director of the Western Pacific, held a special briefing on the community communication guidelines for the prevention of new coronavirus disease (COVID-19) in the Western Pacific Region. More than 40 people including ministerial-level representatives from Japan, South Korea, Vietnam, and other countries, senior officials and experts from member countries and regions of the region attended the meeting.
On March 2, 2020 (Geneva local time), the WHO Director-General, Tan Desai, said that the number of the new coronavirus disease outside China is not optimistic. South Korea, Italy, Iran, and Japan became concerning.
On March 4, 2020 (Geneva local time), the World Health Organization held a global emergency preparedness monitoring committee to respond to the new coronary pneumonia epidemic response telephone conference.
On March 5, 2020, in a recent interview with the US media Bruce Aylward, the head of the World Health Organization’s expert group on inspections of China, praised China’s measures to combat the new coronavirus disease epidemic and believed that China’s anti-epidemic model can be replicated.
On March 10, 2020 (Geneva local time), World Health Organization Director-General, Tan Desai, said that China’s recent number of confirmed cases has been on a clear downward trend. The international community should make full use of the “opportunity window” that China has sought to curb the spread of the new coronavirus.
On March 11, 2020 (Geneva local time), the World Health Organization (WHO) officially announced at a press conference that the new coronavirus disease (COVID-19), is listed as a global pandemic. The extent and severity of the shocking epidemic and shocking level of inaction became concerning and worrying. A group of more than 120 scientists, doctors, funders, and manufactures formed an expert group and made a public declaration that they will together work towards the development of the COVID-19 vaccine under WHO’s coordination on April 13, 2020 (Mason, 2020).
Conclusion
Form the initial appearance of the COVID-19, to the outbreak, to the global pandemic, from the professional roles performed by doctors, hospitals, disease control centers, local governments, central governments, and international agencies and the responsibilities of institutional supervision, a large number of facts have shown that COVID-19 has been under effective control from the outbreak to the lobal pandemic. As scholars from the Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT and the Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands published research papers in the New England Journal of Medicine (published on January 24, 2020, at NEJM.org), stating that “China responded quickly by informing the World Health Organization (WHO) of the outbreak and sharing sequence information with the international community after discovery of the causative agent. The WHO responded rapidly by coordinating diagnostics development; issuing guidance on patient monitoring, specimen collection, and treatment; and providing up-to-date information on the outbreak” (Munster et al., 2020).
Authors’ contributions
Luo Mengting was responsible for drafting, revising, and finalizing of the paper. Jim Mason participated in the revision, review, and finalization of the paper. All authors read and agree to the final text.
Acknowledgments
This study was co-funded by Hainan Institutes of Biotechnology and Cuixi Academy of Biotechnology “Management Strategy and Impact on Society of Nova Coronavirus Pneumonia” (Project No.20200123). The author is very grateful to Dr. Fang Xuanjun, from Institute of Life Science, Jiyang College of Zhejiang A&F University, for his careful review of the first draft of this paper, and puts forward very useful criticism and revision opinions on the paper.
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