Empty streets in WuhanPexelbay

When we welcomed in 2020, few of us could imagine how our world was about to change. We awoke on the 1st of January to a heady mix of hangovers and hope for a new year and a new decade. What promised to be a celebration of our technological advances would soon dissipate in an almost surreal realization of our complete and utter vulnerability. Nature was about to deliver a masterclass in supremacy, leaving no one in doubt as to who really rules our little cosmic ball.

Not everyone was out celebrating though. A handful of Asian epidemiologists had identified a potential viral pandemic in the making and their attention was firmly focused on China. As new year’s day unfolded, frantic emails were being exchanged between Taiwanese epidemiologists based in Asia, the WHO, and their colleagues in the West, describing worrying pneumonia of unknown origin that was rapidly getting out of hand in a city in China. Human to human transmission was strongly suspected and these experts recognized the danger signals. Many harbored well-founded concerns of an impending disaster and decided to yell, “Houston, we have a problem”.

Houston, or in this instance the World Health Organization (WHO) dragged their feet. We may never know the real chain of events that unfolded in the WHO offices between the receipt of those first Taiwanese emails sounding the alarm in early January and the initial acknowledgment and warning they issued in late January, directed at the global community. Whatever the politics, it was too little, too late.

The biggest threat that was to emerge over December 2019 and January 2020 wasn't Wuhan itself or the virus. Wuhan is a transportation hub of China, a densely populated city with a population of more than 14 million in 2019. Enter the Wuhan Tianhe International Airport (IATA: WUH, ICAO), a large airport on the outskirts of Wuhan. Tianhe is an international airport and serves the area of Hubei, China. Most importantly, this airport serves non-stop passenger flights to 103 destinations in 8 countries and 92 domestic flights inside China.

Had the coronavirus outbreak occurred elsewhere, not in close proximity to an international airport, we wouldn't, in all likelihood, be having this discussion right now. Mankind would have dodged another viral bullet. Or would we?

Having this international airport located at the center of a potential pandemic outbreak with confirmed cases of human to human transmission shouldn't just have sounded a warning bell, it should have set off every siren the medical world possessed.

Instead, the world was offered a watered-down warning, written in typical medical parlance, language we call medi-speak, that avoids any specifics and remains as vague as possible to allow for wiggle room. The WHO, who was called on seriously, in a way their services had never been called on before, failed miserably to fulfill their basic mandate to humanity. They failed to warn us and they failed to protect us.

Vague, non-specific, and indecisive warnings and advisories were issued. In the early weeks of January 2020, as the world tried to figure out what the WHO was actually saying, the coronavirus quietly and unobtrusively did what viruses do best. It continued to spread, making its way to almost every corner of the globe, carried invisibly across borders by its hosts. Us.

Wuhan earns its place in pandemic history. or does it?

Wuhan had just cemented its place in pandemic history and rumors quickly began circulating online that sought to explain the origins of the virus in various ways. Experts and virologists initially pointed to the wet markets in Wuhan, specifically the Huanan Seafood Wholesale Market, as the most likely source of infection. It didn't take long for the wheels to come off this theory, as only environmental contamination was found at the market. Horseshoe bats breathed a cumulative sigh of relief and then the blame game kicked off, big time.

China blamed America for introducing the virus to Wuhan during the October 2019 World Military Games. Americans responded by developing a promoting their own crazed theories, the favored one suggesting that the new novel coronavirus was in actual fact a Chinese manufactured pathogen, created in the Wuhan Institute of Virology, a biosafety level 4 (BSL-4) lab in China relatively close (25 to 35 kilometers [15 to 22 miles]) to the Wuhan live-animal market at the epicenter of China’s outbreak. The only common thread shared by all the theories, crazed or otherwise, that emerged as the coronavirus continued to spread in early 2020 was this one single and apparently immutable fact. Wuhan was ground zero.

While we were all at odds to decide exactly how it had happened, we were all certain of one fact,. Wuhan was the source of SARS-CoV2.

But was it?

Research begins to paint another picture

On the 13th of January, 2020, South Cina Morning Post confirmed Thailand had recorded the first case of coronavirus outside of China, a Chinese individual, not attached to the Huanan Seafood market. The woman, 61, was identified as a Chinese tourist from the city in central Hubei province. She received treatment in a hospital in Nonthaburi near Bangkok, where she was first admitted on January 8. This appeared to be the first known publicly recorded case of the virus escaping China’s borders. Many followed in short succession.

Data, in the first year of the pandemic, was dealt with in real-time as scientists battled to combat the virus. Almost without exception, data were drawn from patients infected with the coronavirus, post-January 2020. We had no reason or driving motivation to examine cases that predated this or to even consider the question. We were overwhelmed with too much real-time information flowing from pandemic hotspots across the globe to bother with 2019.

Scientists and researchers are, however, by nature, inquisitive creatures and it was only a question of time before people started to ask questions. One of these was a simple, but controversial one. What if the coronavirus had been around for a lot longer than we originally surmised? To confirm the presence of the virus in the population you need serological samples taken from a broad swathe of people, Samples that you can easily test for markers associated with the coronavirus.

Italy and France were in possession of just such samples and exhibited sufficient scientific curiosity to pursue the question.

Was the Genie already out of the bottle?

By January of 2020, according to emerging data, the coronavirus had already made its way around the globe. Now, research in the West indicates confirmed infections in Europe that predate the Wuhan outbreak by months. Patients in Italy and France had contracted the virus as early as September, October, and November of 2019. France provides an interesting perspective on this, with blood samples taken from pneumonia patients in December of 2020. One of the cases was identified as being Covid. The particulars of this case and the timing are of interest.

Paris, France

The Paris-based hospital collected samples from 24 patients (over December 2019 and January 2020) presenting with pneumonia. to detect influenza using PCR tests, the same genetic screening process used to detect the presence of the novel coronavirus in patients infected at the time the sample is collected. One was identified as being Covid positive.

The patient, a man, had been admitted on the 27th of November and had not traveled to China. The man’s wife worked alongside a Sushi stand, close to colleagues of Chinese origin and although the man had infected both his children, the wife remained asymptomatic. Yves Cohen, head of resuscitation at the Avicenne and Jean Verdier hospitals in the northern suburbs of Paris, where the patient was hospitalized was quoted at the time in an interview.

“Of the 24, we had one who was positive for COVID-19 on Dec. 27. Each sample was retested several times to ensure there were no errors.”

It may be easy to dismiss this article and the hospital's findings as an anomaly perhaps attributable to cross-contamination of samples. It happens as we’re far from perfect. The desire to pinpoint China as the source of the epidemic has also been overwhelming and any evidence to the contrary tends to be dismissed out of hand.

An article published in The French magazine, The Connexion, highlights the findings of another French study. National health research body Inserm said:

“The first identified cases of COVID-19 were detected on December 8, 2019, in Wuhan, China; and the first documented case in Europe was reported retrospectively in France… on December 27”.

But, it added, new research “suggests early circulation of SARS-CoV-2 in Europe” going back to at least November 2019 in France, and even earlier in Italy. You can read the paper which highlights later retesting from the CONSTANCE cohort here. It validates findings that suggest infections of coronavirus in France as early as November of 2019. According to the original article;

In the study, scientists analysed 9,144 blood samples taken from a pool of 200,000 male and female adult participants, living in all regions of mainland France. The samples had been collected between November 4, 2019, and March 16, 2020. They were first analysed using a rapid Elisa test to detect Covid-19 antibodies and the virus was found in 353 participants.
To discount false positives, a second highly specific test was then done on these samples. This showed 13 of the samples taken between November 5, 2019 and January 30, 2020 came back “SN positive” meaning the Covid-19 virus had been detected.

Professor Fabrice Carrat, director of the study, told Le Monde:

“These results suggest that as early as November and December of 2019, the rate of contamination among people in France was already around one case per 1,000 people. We seem to have found cases sporadically, all over the country.”

What really caught our eye though was a newer article that examined blood samples taken from a cancer cohort in late 2019 in Italy.

Italy sees France and raises the stakes

Entitled “Unexpected detection of SARS-CoV-2 antibodies in the pre-pandemic period in Italy,” the paper was published in November of 2020. You can read the entire paper by following the link. We’ll provide a basic overview below.

First, a little context. The first laboratory-confirmed Italian COVID-19 case was identified in Lombardy on February 20, 2020, in a 38-year-old man who had no history of possible contacts with positive cases in Italy or abroad. Within a few days, additional cases of COVID-19 and critically ill patients were recorded in the surrounding area. Soon several cases were identified in other Italian regions, mostly in the northern area. Lockdowns were first applied in 2 critical areas of Lombardy and Veneto and were rapidly enforced regionally and nationwide starting on March 8.

Italy’s first two known cases of COVID-19 disease were recorded on January 30, 2020, when two tourists from China tested positive for SARS-CoV-2 in Rome.

On the basis of the first case identification, it was hypothesized that the virus had been circulating in Italy since January 2020. However, the rapid spread, the large number of patients requiring hospital admission and treatment in intensive care units, as well as the duration of the pandemic suggest that the arrival of the virus and its circulation in Italy in a less symptomatic form could be anticipated by several months.

What the authors of the paper needed was a serological sample to test from earlier in 2019. They were in luck. Their eventual cohort was a population enrolled from September 2019 to March 2020 through the SMILE trial (Screening and Multiple Intervention on Lung Epidemics; ClinicalTrials.gov Identifier: NCT03654105), a prospective lung cancer screening study using low-dose computed tomography and blood biomarkers. They had their samples and set about testing them. What they found verified their suspicions.

Frequency of immunoglobulin M (red columns) and immunoglobulin G (blue columns) receptor-binding domain (RBD)–positive cases in respect tohttps://doi.org/10.1177/0300891620974755

The first surge of positive cases was identified in September–October 2019, a full three months before the Wuhan cluster. Evaluation of anti–SARS-CoV-2 functional NAbs identified positive samples in CPE-based microneutralization tests already collected in October 2019. Given the temporal delay between infection and antibody synthesis, these results indicate that the virus circulated in Italy well before the detection of the declared index patient in February 2020. In addition, most of the first antibody-positive individuals lived in regions where the pandemic started.

Reviving an old conspiracy

It’s time to wheel out one of the rumor mill’s favorite conspiracies, the World Military Games. We’re left with little choice at this point as the confirmed presence of the SARS-CoV2 virus in Europe in September of 2019 casts serious doubt on Wuhan being the center of origin. As insufficient data exists at this stage, hopefully, a situation that will be remedied in the coming months as we attempt to track down the real ground zero for the virus, we are going to make a few reasonably safe assumptions.

1. Italy and France were not the only countries infected with the novel coronavirus in late 2019. Logic dictates that if it was present in two large and well-traveled European populations, that it had already spread globally as early as September or October of 2019.
2. Testing has only been performed retroactively on samples collected from September of 2020. It is very likely that the presence of the SARS-CoV2 virus in our populations may predate this period by months, escaping detection as it gradually evolved to develop its current strains.
3. Wuhan, was almost certainly not the point of origin, merely the first population to develop an infectious cluster of the mutated virus, establishing a pattern soon to be repeated across the globe.

All of which brings us back to the question of the World Military Games, officially known as the 7th CISM Military World Games. Almost every country was in attendance at the event hosted in Wuhan in October of 2019. Stretching from the 18th to the 27th of October, it was the largest military sports event ever to be held in China, with nearly 10,000 athletes from over 100 countries competing in 27 sports.

Many of the athletes complained of Covid like symptoms during their stay in Wuhan, among them French athlete Élodie Clouvel, who speculated that an illness she and her fellow athlete, Valentin Belaud experienced, may have been COVID-19. Around 230,000 volunteers were recruited for the event and with so many potential global carriers of the virus assembled together, this event may very well have served as the catalyst for the subsequent outbreak seen in Wuhan in December of 2019.

Given what we know and with the promise of emerging data from research currently underway, every single nation on the planet is a suspect. Any could potentially have served as the source of origin for the SARS-CoV2 virus. We will have absolutely no way of determining this until further research is done. We do however know enough now to be able to safely say that Wuhan is looking less and less likely by the day. Its population of 14 million merely served as the first large petri dish for the virus's more ambitious plans.

Keep in mind that one of the major sources of the outbreak of the Great Flu was a military encampment in the US. Poor hygiene in the camp and proximity to animals, in particular waterfowl and swine, had been suggested as the possible catalyst for animal-to-human transition in the 1918 pandemic.

The longer we continue to allow massive encampments of impoverished, homeless seas of humanity to persist globally, we encourage the opportunity for new viral crossover events. Refugee and migrant camps aren't merely an afront to a civilized world, they may also spell our end. These camp cities house hundreds of thousands of people in squalid conditions with no sanitation or freshwater. It is a recipe for future disasters.

So where does that leave us?

Aah, the million-dollar question. This new data is potentially far more worrying than any version of scaremongering the world could dream up over Wuhan. What it tells us is this.

We have no defense mechanisms that can function effectively against new, highly infectious, emergent viral strains and we may never develop any. These data tell us that new viral strains can move about freely in our populations, undetected for extended periods, offering the virus the time and opportunity needed to hone its attack. To mutate. Our responses will always be too little, too late. It is the nature of the combatant we are engaged with.

Viruses predate man and they will most certainly outlive us. In our self-induced technological arrogance, we assume mastery of everything we survey. The actual truth is far removed from this fictional view of our reality. We are as much a part of nature as any other organism on the planet and our species poses a very real threat to the ecosystem we inhabit. Nature has a way of ensuring balance and we lose sight of this at our own peril.

While you digest that you may consider issuing an apology to your Chinese friends. They are merely victims of an unpleasant pandemic, affected in exactly the same way we’ve all been.