By Daniel R. Lucey M.D., MPH, FIDSA
After China initially reported 41, then ~ 46, and then ~ 100 laboratory-confirmed cases in December 2019, a total of 124 confirmed cases in December was reported by China July 31 but for some reason only posted on the WHO website Nov. 5.
First posted on the WHO website Nov. 5 the July 31 terms of reference for the WHO-convened Joint China-WHO team investigating the origins of SARS-CoV2 provided this new valuable data on page 5 of 9: “Retrospective review of cases identified a total of 124 confirmed cases with onset date in December 2019, 119 of whom were from Wuhan and 5 others from Hubei or other provinces, but all with travel links to Wuhan during the period of exposure. A study of 41 initially identified confirmed cases showed that 70% of the cases had a link to the Huanan market (Huang et al, 2020), but detailed exposure factors within the market and elsewhere remain unclear.”
Five key questions arise regarding these 124 patients:
- Who are these 124 cases, and how many were linked to the Seafood Market and other specific locations in Wuhan?
- Where were the 5/124 cases who were not from Wuhan?
- What is the timeline for the day-by-day illness onset for each patient?
- How many “isolated” cases are known from before December even if no “unusual clusters” were reported?
- How many, if any, additional cases (more than124) are known in December, and before December (back at least to Nov. 17, 2019 as reported by Josephine Ma, in the South China Morning Post March 13, based on “Government records”)?
The number of reported confirmed cases in December has steadily increased from:
- Jan. 24 (Huang et al Lancet): 40 cases in December (i.e., date of onset of illness)
- Jan. 29: (Qun et al NEJM): ~46 cases in December (my count from graph)
- Feb. 17: (Zhang et al China CDC Weekly): ~ 100 cases in December (my count)
- July 31/posted Nov. 5: WHO-China document: 124 confirmed cases in December.
The above “Huang et al, 2020” reference is to a Lancet paper online Jan. 24 in which 41 confirmed patients (40 illness onset in December and one illness onset on Jan. 1). The ”70%” with a link to the Seafood Market were shown chronologically in the paper’s Figure 1B.
Five days later, on Jan. 29, the New England Journal of Medicine published a paper on 425 confirmed patients through Jan. 22. Figure 1 in that paper provided the timeline of illness onset for 46 patients in December.
On Feb. 17 the China CDC weekly published a detailed epidemiologic study of the epidemic with 44, 672 confirmed cases through Feb. 11. In Figure 2B here:
the China CDC joint team showed ~100 confirmed cases with date of onset in December.
If the pattern of increasing numbers of confirmed cases in December 2019 holds, then more cases and data should be anticipated from December, and some cases from November 2019.
Daniel Lucey, M.D. MPH, FIDSA, FACP, is a Clinical Professor of Medicine (Teaching) at Dartmouth Geisel School of Medicine, adjunct Professor at Georgetown Medical Center, senior scholar at Georgetown Law, Anthropology Research Associate at the Smithsonian Museum of Natural History and a member of the Infectious Diseases Society of America Global Health Committee. He served as a volunteer to outbreaks overseas including patient care in Sierra Leone and Liberia (MSF) during Ebola 2014, SARS 2003, MERS 2013, Plague 2017 as well as H5N1, Zika, and Yellow Fever. Since Jan. 6 he has contributed more than 50 posts to Science Speaks on COVID-19 and traveled to China Feb. 11. With career experiences, he proposed and helped design the 2018-2022 Smithsonian Exhibition on Epidemics.