Timely information about the health of medical workers is key to understanding the transmission patterns and developing strategies aimed at containing outbreaks.
But it was not until Feb. 14 – more than a month into the crisis – that China disclosed that about 1,700 front-line medical workers were infected at the time. The figure – which has since grown – was published in a research paper, not reported directly to the World Health Organization (WHO).
In response to questions from The Washington Post, the WHO said it has repeatedly asked Chinese officials for “disaggregated” data – meaning specific figures broken out from the overall numbers – that could shed light on hospital transmission and help assess the level of risk front-line workers face.
“We received disaggregated information at intervals, though not details about health care workers,” said Tarik Jasarevic, a spokesman for the Geneva-based organization.
The comment, in a Saturday email to The Post, was one of the first instances that the U.N. health agency had directly addressed shortcomings in China’s reporting or handling of the coronavirus crisis.
It could renew that Beijing is unable or unwilling to share all of the information that scientists and public health experts need to understand the virus as it spikes in places such as South Korea, Italy and Iran.
Details about front line worker infections are “critical for developing preparedness plans in countries around the world,” said Jennifer Nuzzo, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security.
“Giving that information to the World Health Organization is also important from a credibility standpoint,” she said.
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WHO’s credibility is also on the line. After China’s attempts to coverup the 2002 severe acute respiratory syndrome (SARS) epidemic, the rules governing international outbreaks were updated with an eye to accountability.
But in recent weeks, as evidence mounted that China had silenced whistleblowers and undercounted cases, WHO has continued to heap praise on Beijing.
Getting information from member countries in crisis always requires coaxing. But public health experts worry the laudatory tone has gone too far.
“China should be transparent and WHO should be transparent with the broader community,” said Lawrence Gostin a professor of global health law at Georgetown University who also provides technical assistance to the WHO.
“This is health communication 101,” he continued. “Tell us everything you know, tell us what you don’t know and tell us what you are doing to find out what you don’t know.”
It is not clear whether political sensitivities shaped Chinese reporting on sick doctors and other health-care professionals. It is possible that data gaps simply reflect the challenge of gathering information in the middle of a crisis, experts said.
What is clear is that China is not sending details that WHO officials and other experts expect and need.
“China has learned at least one lesson from SARS. They’re cooperating with WHO just enough to stave off accusations that they are not cooperating,” said Mara Pillinger, an associate in global health policy and governance at Georgetown’s O’Neill Institute for National and Global Health Law.
“This partial collaboration makes it politically tricky for WHO to publicly contradict or go around the Chinese government,” Pillinger said, “because WHO needs to do everything it can to encourage stronger cooperation from China.”
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This breakdown of trust was not supposed to happen – again.
Post-SARS measures require countries to quickly report emerging infectious diseases and give WHO broader power to investigate threats.
The response to the coronavirus suggests that some of those measures have been successful and others not.
China has been praised by WHO for quickly reporting an emerging threat in Wuhan, for instance. But there is evidence that some officials, particularly at the local level, worked to obscure what was going on – and that doctors were censored.
In late December, Li Wenliang, an ophthalmologist at Wuhan Central Hospital, told a group of fellow doctors in a private chat that seven people had contracted a SARS-like virus.
After the messages started circulating online, Li was detained and a propaganda campaign against rumor-spreading was launched. As soon as he was released, he returned to his hospital, where he contracted the virus. He died Feb. 7.
His death turned Li into a symbol of Beijing’s failures, spurring an unusual show of support – and a swift response from China’s censors.
The party-controlled press has since tried to co-opt the narrative, highlighting the brave work of front line workers without discussing censorship or offering many details about hospital transmission.
For now, WHO seems to be doubling down on its public support for China and its leaders.
On Tuesday, a WHO official wrapping a mission to China, Bruce Aylward, told reporters in Beijing that other countries could learn from China’s “rigorous approach.”
At a lengthy WHO news conference the next day, Aylward called China’s response “impressive,” “stunning,” “extraordinary,” “striking,” “disciplined” and “successful.”
“They know what they’re doing,” he said, “and they’re really, really good at it.”
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The Washington Post’s William Wan contributed to this report.