By Daniel R. Lucey MD, MPH, FIDSA
By July 31, 2020 the World Health Organization and China had agreed in writing to a highly-consequential document with long-term implications titled “WHO-convened Global Study of the Origins of SARS-CoV-2: Terms of References for the China Part”. This title, as well as multiple statements in the text such as “under the framework of global tracing for the origins of SARS-CoV-2” (page 2 of 9), raises the question of where in the world the next WHO international team will travel on this global study. WHO has stated that the coming week of March 15 they will make public the full report from the WHO-China joint team working in Wuhan Jan.14-Feb. 9. It is hoped that:
- A comprehensive “look back” information (see Science Speaks, Jan. 25, 2020: An evidence-based hypothesis, Science, Jan. 26, 2020: Wuhan seafood market may not be source of novel coronavirus , and New York Times, July 8, 2020: 8 Questions from a Disease Detective on Pandemic’s Origins) will be included on both the human and animal side of China’s epidemiological investigations back at least to the earliest reported case in Hubei province November 17, 2019 (of a total 266 patients in 2019) according to a government report seen by the South China Morning Post and cited in an article one year ago March 13, 2020.
- No assessments will be included that the laboratory origin hypothesis is “extremely unlikely”, given that this hypothesis was obviously not included in the final WHO-China “Terms of References for the China Part,” nor were experts in laboratory biosafety or gain-of-function research listed in the international “team composition” (p. 8 of 9). Given these facts, neither a scientific nor legal basis is evident (from these WHO-China Terms of References) for the WHO team leader at the Feb. 9 press conference in Wuhan to declare the lab origin hypothesis “extremely unlikely.”
It can be anticipated that one or more locations in Southeast Asia will be the next in an aspirational series of “terms of references” for the “WHO-convened Global Study of the Origins of SARS-CoV-2, given questions regarding coronaviruses in bats and pangolins. Likewise, given questions related to mink, sewage samples, human cases, and China’s focus on (potential) cold-chain transmission by imported food and/or food packaging, then Europe and the Americas are also likely on this aspirational list with Southeast Asia.
The one best summary from China of these questions, with an accompanying diagram titled “Possible SARS-CoV-2 transmission studies”, appeared in the Jan. 8, 2021 Science in an article by Dr. Peng Zhou and Dr. Zheng-Li Shi, at the Wuhan Institute of Virology and Fudan University in Shanghai titled “SARS-CoV-2 spillover events.”
Foreshadowing of such studies outside China is clear from the above July 31, 2020 “WHO-convened Global Study of the Origins of SARS-CoV-2: Terms of References for the China Part.” A few examples found in each of the text pages 2-8 include:
- Page 2: “In addition, the international team will also develop study frameworks and materials that may set the ground for origin tracing work elsewhere. The global origin tracing work is therefore not bound to any location and may evolve geographically as evidence is being generated, and hypotheses evolve.”
- Page 3: “Findings from origin studies in China will advance origins tracing in other countries and may lead to similar work elsewhere.”
- Page 4: “A number of outbreaks in mink farms in the Netherlands, Denmark and Spain have shown that minks can spread the disease in farm environment and could potentially establish a new animal reservoir in mink populations for SARS-CoV-2 if not efficiently controlled. These preliminary results demonstrate that different animal species in regular contacts with humans are susceptible to infection with SARS-CoV-2 and could serve as intermediate animal host species…”
- Page 5: “While there is currently no evidence that food is a likely source or route of transmission for the virus,it is necessary to coordinate and cooperate globally to share data and evidence to further clarify the potential role of food in the spread of COVID-19 virus.”
- Page 6: “The framework and methodological approaches implemented in China could also be used to study the virus origins elsewhere, if warranted. For example, methods for serological surveys among population groups potentially exposed to animal hosts can be standardized for comparison.”
- Page 7: “Testing of frozen sewage samples for evidence of circulation prior to December 2019…The international team will ensure that the scientific framework developed in China can be applicable and replicated in other settings, should there be a need to do so.”
- Page 8: “Regular interaction will be maintained to share scientific findings related to origin tracing from China and elsewhere.”
Daniel Lucey, M.D. MPH, FIDSA, FACP, is a Clinical Professor of Medicine at Dartmouth Geisel School of Medicine, Infectious Disease 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 hands-on Ebola patient care in Sierra Leone and Liberia (Doctors without Borders) 2014, MERS 2013, SARS 2003, as well as HIV, H5N1, Zika, yellow Fever, and pneumonic plague 2017 (with WHO/USAID/CDC). Since Jan. 6, 2020 he has contributed over 75 posts to Science Speaks on COVID-19 and traveled to China in February 2020. He initially proposed, then fundraised and helped design the content for 2018-2022 Smithsonian Exhibition on Epidemics due to zoonotic viruses. From 1982-1988 he trained at University of California San Francisco and Harvard and was an attending physician at the NIH (NIAID) in the 1990s while in the US Public Health Service.