Coronavirus: What do new questions about WHO and China cases mean?

The question about infection rates has plagued analysts of the data that the WHO and China have presented since January.

By SETH J. FRANTZMAN
People wearing masks pass by portraits of Chinese President Xi Jinping and late Chinese chairman Mao Zedong as the country is hit by an outbreak of the novel coronavirus, on a street in Shanghai, China February 10, 2020 (photo credit: REUTERS/ALY SONG)
People wearing masks pass by portraits of Chinese President Xi Jinping and late Chinese chairman Mao Zedong as the country is hit by an outbreak of the novel coronavirus, on a street in Shanghai, China February 10, 2020
(photo credit: REUTERS/ALY SONG)
The last week of March brought new information to world leaders about coronavirus. The US intelligence community produced a classified report that concluded China “concealed the extent of the coronavirus outbreak in its country,” according to reports.
The controversy reached US President Donald Trump on the first of April when he was asked about the numbers. “The numbers seem to be a little bit on the light side,” Trump said.
The question about infection rates has plagued analysts of the data that the WHO and China have presented since January. These questions raise concerns that many countries modeled their own strategy to fight the virus on information that may have led them to be too optimistic. This led to emergency measures, such as lockdowns, as the virus spread. It has meant many look with growing apprehension at the “curve” of infections and wonder when the predicted “flattening” will occur.
Understanding the problem is key to figuring out what might have gone wrong and also where we are today.
There are several key questions that reports have raised. First, we know that the leading experts who modeled the virus threat and presented their findings in mid-March to Western leaders were relying on data from China and later data from South Korea, Singapore and Japan. Even researchers at the Imperial College and others who published in the journal The Lancet Infectious Diseases had much to say about different scenarios and what interventions, such as social distancing and closing schools, would accomplish.
In short: The experts knew a variety of interventions could slow the virus and flatten a curve, but the curve would be different if the rate of infections were different and if existing data were wrong.
Foreign Policy in the US reported that “it is likely that Beijing is deliberately under-reporting the death toll in Wuhan, where the outbreak began, and the total number of cases across the country in February.” Late February and early March now look like key dates for when countries were lured into a false hope. A February 25 press conference by the World Health Organization sought to allay concerns, noting that 24 provinces in China had reported zero cases for a day and that just three weeks ago 31 provinces in China had reported infections. “All of these are as big as any one of the countries that have been in the news recently with their outbreaks,” the WHO said.
The WHO’s Bruce Aylward said on February 25 that the “unanimous assessment of the team” that went to China was that “they have changed the course of this outbreak. What was a rapidly escalating outbreak has plateaued and then come down faster than one would have expected.”
The WHO downplayed the idea that the virus was a pandemic in February, even as it spread rapidly to Italy, South Korea and Iran. A pandemic is defined as “worldwide spread” of a new disease. But the WHO waited until March 12 to label coronavirus a pandemic. There were already 11,000 people infected in Italy and 7,000 in South Korea and more than 1,000 in the US.
The world’s response changed rapidly in the wake of the pandemic declaration. But it now appears many countries acted too late. It also appears that they acted on problematic information, or at least incomplete information.
For instance, while testing data that is reported in many countries includes those who do not have symptoms, Reuters on April 1 said China would begin reporting asymptomatic cases. This information would have been good to know a month ago. But the media didn’t dig and report it, and officials with the WHO didn’t seem to discuss it either.
Only now, in April, are most Western media reporting that the “death toll could be astronomically higher,” relying on stories about cremations, funeral urns, cellphone data and US intelligence reports.
Another shocking report says 21 million cellphones “disappeared” during the pandemic in China. The details claim that 21 million cellphone accounts were canceled and 840,000 landlines closed in China in the last three months.
It’s unclear why those numbers would lead to conclusions that those users died or that they died of the virus. However, all these articles add to the growing list of concerns and questions.
The problem is that key weeks may have been wasted between February 25 and March 12 due to many governments not trying to independently verify what was happening in China and not being skeptical of the WHO information. This crisis has brought many questions about whether countries can rely on international organizations, even as we are being told we should invest more in them due to the pandemic. But should countries invest more when organizations don’t seem to be accountable or transparent about their information or even independently verify it?
The WHO, for instance, appears to have dismissed working with areas that are disputed, such as Taiwan or eastern Syria, Somaliland and other places. Viruses don’t recognize borders. But world health authorities do, and that can be a problem in an era where there are non-governed places, weak states or historic border disputes.
The problem for other governments and publics is not knowing what to rely on. “Asia may have been right about coronavirus masks,” CNN reported on Wednesday. The WHO in March told people not to wear masks unless they have coronavirus. Of course, in most countries it is hard to get tested, so it’s not clear what that means. Maybe it means they should wear them just in case.
US health officials are now reexamining the use of masks by the public after having told people not to wear them.
This pandemic has revealed several key gatekeepers to information that may have led to bad planning in March as the pandemic spread. There were only 100,000 cases reported worldwide as recently as March 6. On that date more than 3,400 people had died and there were new infections in seven countries, with the virus present in 90 countries. The WHO at the time still had not declared it a pandemic. On Thursday, cases were poised to top one million, with 50,000 deaths.
The gatekeepers of information are multifold. First there are the countries that report their own data, apparently with different standards of reporting symptomatic or asymptomatic cases, and also reporting how people died. For instance, there are questions as to whether some countries over-report deaths by people who have the virus but die of other illnesses, or whether other countries under-report by purposely coding deaths as due to other illnesses. Without one standard, how can one make a model?
The next question relates to the models themselves. Experts talk about a “curve,” but the actual results have varied widely. For instance, many countries appeared to level off before adding numerous new cases, such as Iran, Sweden, Denmark, India and Japan. Others appeared to have a perfect curve going to near-zero, like China, only to begin increasing again. Others, such as the US and Turkey, appear to be rapidly increasing the number of cases without flattening. And then there are all the countries with very low numbers of cases or a flattened curve, such as Malaysia, Singapore, South Korean, Greece, Thailand, Saudi Arabia, Finland and Egypt. However, some of these charts could be based on bad information by states that don’t test or report cases differently. What looks like a pristine story is foggier.
Israel appears to have relied on its own concerns in February regarding this outbreak. Israel instituted gradually increasing lockdowns. Like most countries, it does not know when it will “flatten” the curve because it has to continue testing areas where there are alleged growing outbreaks. It has no answer about the economic toll and the quarter of the workforce now unemployed.
However, what we have learned in the last weeks is not only how rapidly the virus can spread in a place like the US, but also how our own knowledge about masks and infection rates must be questioned as policies change and information is gathered.
This raises serious questions about the WHO and whether there will be an accounting or independent study of what happened in late February and early March, key dates when time may have been crucial and was squandered by countries who based their modeling on information that is now being called into question.