Open this photo in gallery Medical staff transfer a patient of a highly suspected case of a new coronavirus at the Queen Elizabeth Hospital in Hong Kong, China January 22, 2020. STRINGER/Reuters

As Chinese authorities widened a massive urban lockdown and flew large numbers of medical personnel to Wuhan, the epicentre of a new SARS-like virus, medical authorities provided new indications that weeks of inaction had allowed the virus to spread widely before serious measures were taken.

Chinese authorities had initially reported that the new 2019-nCoV coronavirus had most seriously affected the elderly and those left vulnerable by pre-existing health conditions.

But an academic study published by Chinese researchers in The Lancet on Friday found that of the first 41 confirmed cases of the virus, which causes pneumonia-like symptoms, “less than half had underlying diseases.” Nearly half were 49 years of age or younger. And a third had not been exposed to the wild-animal market identified as the source of the virus, suggesting that even from the earliest days, it had begun to leap between people.

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Fifteen per cent of those first 41 people died.

“We are concerned that 2019-nCoV could have acquired the ability for efficient human transmission,” warned the paper’s authors, who included dozens of doctors from hospitals in Wuhan and major state institutes for infectious-disease research.

The first of the patients was admitted to hospital on Dec. 16, more than a month before Chinese authorities began to lock down Wuhan and neighbouring cities in Hubei province.

On Sunday, President Xi Jinping said China was facing a “grave situation” as the country more than 2,000 confirmed cases and the death toll rose to 56, overshadowing celebrations of the Lunar New Year that began on Saturday.

Nearly all of Hubei, with a population of 58 million, was under some form of lockdown, with authorities halting most forms of transportation and barring entry to and exit from at least 15 cities. New cases have also been confirmed in Canada, Malaysia, Australia, Nepal, France, Singapore and the U.S.

The growing reach of the virus comes after weeks of inaction in Wuhan, where 2019-nCoV is believed to have originated at a market selling wild animals. Though China has been credited for an unusual degree of transparency in the past week, virologists have faulted the country for acting too slowly in the early days of the virus’ spread, allowing infected people to travel widely inside and outside Wuhan.

Now, new evidence is emerging that officials in Wuhan deliberately downplayed the virus, even after formally notifying the World Health Organization on Dec. 31 about what the WHO described as “a cluster of cases of pneumonia of unknown cause.”

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But the Wuhan government took a “refrigerating strategy” in the early days of the viral spread, a doctor at Wuhan Union Hospital told China News Weekly. Medical staff were banned from speaking publicly about what was taking place or accepting media interviews, the doctor said.

Police in Wuhan also said in early January that they had arrested eight people for spreading “rumours” about what was then a little-understood pneumonia affecting a growing number of people.

Another person claiming to be a Wuhan physician wrote to the National Health Commission this week claiming that doctors in the city were told not to report “viral pneumonia” in their imaging reports between Jan. 12 and Jan. 16 – a period during which local officials delivered sunny reports on a local situation under control. That meant that, during a crucial period in which cases were accumulating, local health-care workers were unable to properly raise the alarm, the person wrote. The Globe and Mail was unable to independently verify the report, which was widely circulated in China and not refuted by state media.

A doctor at Wuhan’s Hubei Xinhua hospital has now died from the virus, state media reported Saturday morning. The death of Liang Wudong, 62, comes amid widespread reports of a large number of unreported cases of medical staff infected by the virus, and accusations that an improper dissemination of information kept those treating the ill from taking proper precautions themselves.

A second paper published in The Lancet on Friday provided evidence that the virus can be transmitted from a person who is not showing symptoms of being ill.

The early weeks of limited action in Wuhan stand in contrast to the response China has launched in the past three days, an unprecedented and heavy-handed campaign to isolate most of a Hubei population the size of Italy.

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China announced plans to build two rapid-construction medical facilities to respond to the virus in Wuhan, one with 1,000 beds and a second with 1,300. Military transport jets and civilian aircraft were used to fly 1,230 medical reinforcements, including military medics, to assist overwhelmed hospitals and take over from health-care workers who have themselves become sick.

Only Tibet remains officially unaffected by the virus. Major cities and provinces across much of the rest of China have raised their states of medical alert to their highest levels.

In Beijing, authorities suspended long-distance bus service and official churches and mosques suspended services. The capital city also began temperature screening at subway stations and for all arriving passengers at the city’s two international airports.

Shanghai ordered public-transit staff to wear masks, barred schools from holding large events and said officials would not approve marriage registrations on Feb. 2, a popular date because it creates a palindrome when written in numeric form.

Hong Kong suspended all trains and flights from Wuhan, where authorities said they would ban the use of all vehicles outside except free buses and official traffic beginning Sunday. Hong Kong has also cancelled Lunar New Year celebrations and will keep schools closed until mid-February.

In China’s Hainan province, a popular winter tourist destination, all tourists arriving from Hubei province, where Wuhan is the capital, will be subject to medical observation for 14 days.

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Didi, the Uber-like ride-sharing service in China, required all drivers to wear masks.

But even top officials with the Communist Party acknowledged that their efforts have yet to halt the progression of the virus.

The virus “has not been blocked, and it is spreading,” Sun Chunlan, a Politburo member who is deputy prime minister of the State Council, the country’s cabinet, said in remarks reported by state media. She called for an even greater “sense of responsibility and urgency.”

With a report from Reuters