Airborne precautions, such as a fit-tested N95 respirator, and other personal protective equipment are strongly recommended. Serum antibodies should be tested among health-care workers before and after their exposure to 2019-nCoV for identification of asymptomatic infections.

“By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Of the 41 patients…27 had been exposed to Huanan seafood market.”

Source: “How the Virus Got Out,”The New York Times (Mar. 22, 2020), available at: https://www.nytimes.com/interactive/2020/03/22/world/coronavirus-spread.html?action=click&module=Spotlight&pgtype=Homepage

Many of these travelers went not only to other parts of China, but spread out across the globe.

China “went ahead with New Year celebrations despite the risk of wider infections” and let “some five million people leave Wuhan without screening.”

1/1: Because of the Lunar New Year travel, “[t]he timing of the outbreak could not have been worse.”

1/1: On January 1 without any investigation into where the virus originated from, the Wuhan seafood market was closed and disinfected. Source: 8

1/1: WHO: “No evidence of significant human-to-human transmission. Does not recommend any specific measures for travelers.” Source: 5

, which had already determined that the novel virus was similar to SARS, to stop testing samples and to destroy existing samples. Source: 3

eight doctors who had posted information about the illness on WeChat.

12/31: On December 31, Chinese authorities started censoring news of the virus from search engines, deleting terms including “SARS variation, “Wuhan Seafood market” and “Wuhan Unknown Pneumonia.” Source: 8

12/31: “…Yet officials in Taiwan raised concerns (of person to person transmission) as early as December 31…” Source 8

the World Health Organization’s China office about the cases of an unknown illness. Source: 3

12/31: Wuhan health officials confirm 27 cases of illness and close a market they think is related to the virus’ spread.

hospitals of a “pneumonia of unclear cause” and orders them to report any related information. Source: 3

Wuhan doctor Li Wenliang also shares information on WeChat about the new SARS-like virus. He is called in for questioning shortly afterward.

on WeChat about the new virus. She was reprimanded for doing so and told not to spread information about it.

The hypothetical disease quickly spreads among the colleagues of the family members and medical workers who treated them. In response, the team of experts at the Korea Centers for Disease Control and Prevention (KCDC) developed an algorithm to find the pathogen and its origin, as well as testing techniques.

12/17: Two dozen leading South Korean infectious diseases specialists tackled a worrying hypothetical scenario: a South Korean family contracts pneumonia after a trip to China, where cases of an unidentified disease had arisen.

but resistant to anti-flu drugs. Staff later learned he worked at a wildlife market connected to the outbreak. Source: 3

12/6: Five days after a man linked to Wuhan’s seafood market presented pneumonia-like symptoms, his wife contracts it, suggesting human to human transmission.

12/1: The symptom onset date of the first patient identified was Dec 1, 2019. None of his family members developed fever or any respiratory symptoms. No epidemiological link was found between the first patient and later cases.

by Chinese doctors from Wuhan’s Jin Yin-tan Hospital refers to the first patient in the study occuring on Dec. 1, 2019.

“Some of the cases were likely backdated after health authorities had tested specimens taken from suspected patients,” the newspaper reports. “Interviews with whistle-blowers from the medical community suggest Chinese doctors only realised they were dealing with a new disease in late December.” From the 55-year-old patient on November 17 onwards, one to five new cases of COVID-19 are reported each day, according to the government records.

by the South China Morning Post (in March), show that Chinese government investigators found an earlier case of COVID-19 on November 17. It is not clear that Chinese authorities knew that they were dealing with a new virus at the time.

1/2: A tweet from the Global Times states: “Police in Central China’s Wuhan arrested 8 people spreading rumours about local outbreak of unidentifiable #pneumonia. Previous online posts said it was SARS.” This had the intended effect of silencing other doctors who may have been inclined to speak out. Source: 8

1/2: New York Times reports that individual animals and cages were not swabbed “eliminating evidence of what animal might have been the source of the coronavirus and which people had become infected but survived”. The Hubei health commission ordered genomics companies to stop testing for the new virus and to destroy all samples. Source 8

NOTE: There are no primary sources referenced in this article.

The alleged cover-up continued when representatives from the US Centers for Disease Control and Prevention on Jan. 8 visited Wuhan, where officials intentionally withheld information that hospital workers had been infected by patients — a telltale sign of contagion.

Researchers alerted Beijing of their findings — and on Jan. 3, received a gag order from China’s National Health Commission, with instructions to destroy the samples.

In late December, several genomics companies tested samples from sick patients in Wuhan — the center of the coronavirus outbreak — and noticed alarming similarities between their illnesses and the 2002 SARS virus.

1/3: Chinese scientists knew about the coronavirus and its deadly effects as early as December — but were ordered by government officials to suppress the evidence.

Director Redfield emails and speaks on the phone with Dr. George Gao, Director of the China Center for Disease Control and Prevention. Source: 9

1/3: CDC Director Robert Redfield sent an email to the director of the Chinese CDC, George Gao, formally offering to send U.S. experts to China to investigate the coronavirus. Source: 6

the sequence with the WHO until Jan. 12. That was one day after a Chinese lab published the genome sequence on virological.org without authorization by authorities, AP reported. WHO chief Tedros Adhanom Ghebreyesus later lauded the regime’s efforts in sharing the virus sequence as “very impressive, and beyond words.”

Although a state-affiliated lab had documented the full virus genome by Jan. 2, the Chinese regime didn’t

the new coronavirus’ complete genetic information. This information is not made public until Jan. 9. Source: 3

1/3: China’s leading health authority, the National Health Commission, ordered Wuhan pneumonia samples be moved to designated testing facilities or destroyed, while instructing a no-publication order related to the unknown disease. Source: 8

Osterholm said it is critical to establish — or share, if one has been established — a case definition. That’s the tool public health officials use to rule in and out possible cases in an outbreak. Source:

“This much information this early into an outbreak is a very positive thing,” Osterholm said. “I feel confident at this point that the appropriate public health measures are being taken to both investigate the outbreak and to contain it as much as possible…. And I think hopefully over the next several days it will become much clearer what the [causative] agent is.”

1/6: Michael Osterholm from the University of Minnesota, an internationally recognized expert in infectious disease epidemiology, praises the Chinese authorities for the information they have made public so far.

a “level 1 travel watch — the lowest of its three levels — for China’s outbreak,” according to the University of Minnesota’s Center for Infectious Disease Research and Policy. The CDC said the “cause and the transmission mode aren’t yet known, and it advised travelers to Wuhan to avoid living or dead animals, animal markets, and contact with sick people.” The CDC also offered to send a team to China, but China

1/5: CDC Director Redfield sent another email to the Chinese CDC Director, George Gao, formally offering to send U.S. experts to China to investigate the coronavirus outbreak Source: 6

1/4: Director Redfield emails Dr. Gao again offering CDC assistance, stating, “I would like to offer CDC technical experts in laboratory and epidemiology of respiratory infectious diseases to assist you and China CDC in identification of this unknown and possibly novel pathogen.” Source: 9

as it is highly possible that the illness is spreading from human to human.” Source: 2

“the city should implement the strictest possible monitoring system for a mystery new viral pneumonia that has infected dozens of people on the mainland

1/4: The head of the University of Hong Kong’s Centre for Infection

1/4: “Yet officials in Taiwan raised concerns (of person to person transmission) as early as December 31, as did experts in Hong Kong on January 4.” Source 8

This report was denied by China the following day.

However, the analysis of Der Spiegel pointed out that the German government is reluctant to escalate the conflict with China, because: Germany needs protective equipment produced in China. After German Chancellor Angela Merkel and Xi Jinping called, there was a special coordination in Beijing ’s Ministry of Commerce Contact person for related material transportation. In exchange, Chinese leaders demanded to show people in a helpful image. In a report to the Bundestag Foreign Affairs Committee last week, a diplomat pointed out that Beijing hopes that after each mask or protective clothing arrives in the receiving country, the local will host an event that will cause a public effect. Governments in some European countries reportedly cooperated well.

The German weekly said that the German Federal Intelligence Agency estimated that due to China ’s information policy, the world lost four to six weeks to fight the virus.

According to another report from Der Spiegel, the German Federal Intelligence Agency has shown that after the outbreak, China urged the World Health Organization to postpone the issuance of a global warning at the highest level.

1/21: REPORT: China asked WHO to delay report that virus can be spread person to person.

1/21: WHO: “There is possibility of ‘sustained’ human-to-human transmission of new virus in China” Source: 5

that “anyone who deliberately delays and hides the reporting of [virus] cases out of his or her own self-interest will be nailed on the pillar of shame for eternity.” Source 3

and Xi’s actions to fight it for the first time. China’s top political commission in charge of law and order

“In coming weeks, we anticipate sharing these tests with domestic and international partners” she said. “… we continue to believe of this novel coronavirus to the American public at large remains low at this time.” Source: Washington Post 4/18 “Contamination at CDC lab delayed virus tests’ rollout”

1/21: CDC’s Dr. Nancy Messonier “announced that a few days earlier the CDC had ‘finalized development’ of its test and used it to confirm the first coronavirus infection in the US, a man in Washington State who had traveled from the Wuhon region.”

1/20: The WHO held an emergency call, attended by many HHS officials, during which it advised that “the outbreak is a big problem.” After the call, Dr. Bright and his team discussed the need to make HHS leadership aware of the urgent necessity for funding to combat the virus. By email dated January 20,2020, Dr. Robert Johnson, Director of BARD A Division of Influenza and Emerging Infectious Diseases, asked Dr.Bright:“ Is the ASPR (and hopefully through him) the [Secretary Azar aware of just how BARDA’s hands are tied due to lack of funding, and precious time being lost?”

1/20: Dr. Fauci announces the National Institutes of Health is already working on the development of a vaccine for the coronavirus. Source: 6

“The World Health Organisation does the same. Yet officials in Taiwan raised concerns as early as December 31, as did experts in Hong Kong on January 4.” Source 8

“Despite evidence of human-human transmission from early December, PRC authorities deny it until January 20,” it states. Source 8

1/20: Zhong Nanshan, a top Chinese doctor who is helping to coordinate the coronavirus response, announces the virus can be passed between people. Source: 3

1/19: WHO hedges: “Not enough is known to draw definitive conclusions about how it is transmitted, the clinical features of the disease, the extent to which it has spread, or its source, which remains unknown.” Source: 2

1/18: The Wuhan Health Commission announces four new cases. Also, Annual Wuhan Lunar New Year banquet.

1/17: CDC announces that 3 airports in the United States will begin screening incoming passengers from China: SFO, JFK, and LAX. Two more airports were subsequently added before the 1/28 announcement of an additional 15. Source: 1

1/15: The patient who becomes the first confirmed U.S. case leaves Wuhan and

1/15: The House of Representatives votes to send articles of impeachment to the Senate. Pelosi and House Democrats celebrate with a signing ceremony featuring commemorative pens. Source: 10

1/14: PRC National Health Commission chief Ma Xiaowei privately warns colleagues the virus is likely to develop into a major public health event. Source: 8

, internal Chinese documents show that government officials acknowledged likely human-to-human transmission of coronavirus, and said they were following orders from the president of China to keep it under wraps. Source: 2

, “Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel coronavirus (2019-nCoV) identified in Wuhan, China.” Meanwhile, according to

1/13: First coronavirus case reported in Thailand, the first known case outside China. Source: 3

“Now the question is, if the market opens up again, what will happen. We need an understanding of what, in fact, was the source, and if that source is likely to come back into contact again with humans?”

“Panic never works period,” he says. “To me it appears that if anything, [the outbreak] is under control… it seems to be over [in Wuhan] as we haven’t seen any secondary transmission.

1/13: While public health officials should remain vigilant, there is no need for undue alarm, Osterholm said, emphasizing that the focus should be on learning from this outbreak to prepare for future ones.

1/12: Professor Zhang Yongzhen’s lab in Shanghai is closed by authorities for “rectification”, one day after it shares genomic sequence data with the world for the first time. Source 8

1/11: Michael T. Osterholm, PhD, MPH, said he’s pleased to see that health officials and scientists in China have released as much information as they have. The main focus now turns toward identifying the animal species that transmitted nCoV to humans and determining Based on the current reports, there’s no obvious evidence of human-to-human spread yet, Osterholm said, noting that red flags, for example, would be infections in patients’ family members who weren’t at the market and infections in healthcare workers.

1/10: PRC official Wang Guangfa says the outbreak “under control” and mostly a “mild condition”. Source 8

1/9: CDC and FDA begin collaborating on a diagnostic test for the novel coronavirus. Source: 9

1/8: CDC distributes an advisory via the Health Alert Network, which communicates to state and local public health partners, alerting healthcare workers and public health partners of the outbreak. Source: 9

1/8: CDC alerts clinicians to be on the look-out for patients with respiratory symptoms and a history of travel to Wuhan, China. Source: 1

, “Preliminary identification of a novel virus in a short period of time is a notable achievement and demonstrates China’s increased capacity to manage new outbreaks.” Source: 2

1/7: The CDC established a coronavirus incident management system to better share and respond to information about the virus. Source: 6

1/21: The Wuhan Institute of Virology, part of the China Academy of Sciences, has applied to patent the use of Gilead Sciences ’ remdesivir to treat the current coronavirus outbreak. The Wuhan Institute submitted the patent application jointly with the Military Medicine Institute of the People’s Liberation Army Academy of Military Science. Researchers with both organizations noted in a paper published in Nature’s Cell Research this week that both remdesivir and chloroquine, used to treat malaria, may be effective in stalling the coronavirus.

The Wuhan Institute indicated it filed the patent application on January 21, but also noted it would temporarily drop the patent claims if it had the opportunity to collaborate with foreign biopharma companies to battle the epidemic.

Source: https://www.biospace.com/article/china-s-wuhan-institute-files-to-patent-the-use-of-gilead-s-remdesivir-for-coronavirus/

Related: Gilead’s remdesivir is an experimental drug that isn’t licensed or approved anywhere in the world. It is being rushed into clinical trials in China. Gilead’s chief medical officer, Merdad Parsey, told Bloomberg that the drug could enter clinical trials in China as early as next week in patients with moderate and severe symptoms. China can manufacture chloroquine and currently wants access to remdesivir. Bloomberg points out that the country’s decision to seek a patent “instead of invoking the heavy-handed ‘compulsory license’ option that lets nations override drug patents in national emergencies, underscores the delicate balancing act before China as it signals commitment toward intellectual property rights alongside curbing the virus outbreak.” “The fact that they have applied for a patent means there’s growing awareness about this in the country,” said Wang Yanhu, a senior partner at Albright Law Offices in Beijing. “The government is compelled to avoid using the compulsory license because it has been making efforts to show China respects intellectual property rights and the abuse of compulsory licensing will draw international criticism.” Gilead is presently shipping enough doses of the drug to China to treat 500 patients and is increasing its supply in case the clinical trials are effective. Source: https://www.biospace.com/article/china-s-wuhan-institute-files-to-patent-the-use-of-gilead-s-remdesivir-for-coronavirus/



1/21: WHO R&D Blueprint for experimental therapeutics As of 20 January 2020, 278 confirmed cases were reported in China, including 51 severe cases, 12 in critical condition and 6 deaths.Among the 278 confirmed cases, 15 are reported to be healthcare workers. During the call, 4 additional cases were reported to have occurred in Shanghai and that have been hospitalized.In addition, 2 separated exported cases were reported in Thailand, 1 in Japan and 1 in S. Korea.

RCT to determine whether lopinavir/ritonavir is safe and effective in treating patients infected with nCoV has been recruiting patients in Wuhan and is close to complete enrolment. (Not Remdesivir)

Source: https://apps.who.int/iris/bitstream/handle/10665/330695/WHO-HEO-RDBlueprintnCoV-2020.5-eng.pdf?sequence=1&isAllowed=y

1/22: Biden Advisor Ron Klain: Wuhan is the 7th largest city in China — as San Antonio is in the US. Also, it is probably too late for this to be effective, and tens of thousands — if not hundreds of thousands — of people have left this city for other parts of China. Source: https://twitter.com/RonaldKlain/status/1220058103288344576?s=20

1/22: Trump responds to whether he’s concerned about a possible pandemic, “No. Not at all. And we have it totally under control. It’s one person coming in from China, and we have it under control. It’s going to be just fine.” Trump was referring to a resident from Snohomish County, Wash., who came back from China on Jan. 15 and was diagnosed with the coronavirus. Source: 2

1/22: Trump says the U.S. and China will be “closer” after a recently-signed trade deal and praises President Xi as “a man who truly loves his country. Much more to come!” Source: https://justthenews.com/video/bad-worse-tit-tat-timeline-deteriorating-us-china-relations

1/22: WHO: “I was very impressed by the detail and depth of China’s presentation.” Source: 5

1/22: An interagency diagnostics working group is set up by the Office of the Assistant Secretary for Preparedness and Response (ASPR), which includes, BARDA, CDC, FDA, NIH, and the Department of Defense (DOD). Source: 10

1/22: The Post reports Mike Bowen, owner of the largest surgical face mask producer in the US — Prestige Ameritech in Texas — contacted top officials in the Department of Health and Human Services. Source: https://www.vox.com/covid-19-coronavirus-us-response-trump/2020/5/10/21253689/covid-19-masks-trump-white-house-prestige-ameritech

1/22: Shock Video: Scores of people are trying to leave Wuhan, China, before the city of 11 million is put on lockdown to prevent the spread of coronavirus Source: https://twitter.com/BNONews/status/1220156684947132417?s=20

1/23: China barred people from leaving or entering Wuhan beginning in a surprise middle-of-the-night announcement and expanded that to most of the province in succeeding days. Trains and flights were canceled and checkpoints set up on roads into the central province. Source: https://time.com/5808736/china-ends-hubei-coronavirus-lockdown/

“That was like, whoa,” a senior U.S. official involved in White House meetings on the crisis told the Washington Post. “That was when the Richter scale hit 8.” Source 4

1/23: WHO: “There is now more evidence 2019-nCoV spreads from human-to-human transmission.” Source: 5

1/23: Vox publishes an article stating that travel bans to fight viruses “don’t work.” The article initially referred to the “Wuhan coronavirus,” before being edited weeks later. The article’s URL remains unchanged. Source: 2

1/23: China seals off Wuhan , cancelling plane, train and bus travel. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, says in a Journal of the American Medical Association podcast that the U.S. wouldn’t implement shutdowns of cities like what was occurring in China: “There’s no chance in the world that we could do that to Chicago or to New York or to San Francisco, but they’re doing it. So, let’s see what happens.” Source: 2

1/23: The CDC sought a “special emergency authorization” from the FDA to allow states to use its newly developed coronavirus test. Source: 6

1/23: ASPR convenes a Disaster Leadership Group (DLG) to coordinate strategies and countermeasures government-wide. The Trump administration begins discussions with manufacturers of N95 masks about more than doubling usual production. Source: 10

1/24: WHO publishes R&D Blueprint As of 24 January 2020, a total of 846 confirmed cases of a novel coronavirus (2019-nCov,hereafter referred to as nCoV) have been reported, of which 830 cases were reported from China. Other confirmed cases were reported outside of China in six countries (see https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200124-sitrep-4-2019-ncov.pdf?sfvrsn=9272d086_2). Of the 830 cases, 177 cases have been reported as severely ill and 25 deaths have been reported to date. The number of reported confirmed cases of 2019-nCoV has increased by 265 cases since the last situation report published on 23 January 2020, including China which reported additional 259 confirmed cases. The strategic objectives of the response are to interrupt the transmission of the virus from one person to another in China, to prevent exportation of cases from China to other countries and territories, and to prevent further transmission from exported case if they were to happen. This can be achieved through a combination of public health measures, such as rapid identification, diagnosis and management of the cases, identification and follow up of the contacts, infection prevention and control in healthcare settings, implementation of health measures for travellers, awareness raising in the population, risk communication. Note: Error in situation reports published on 23,24 and 25 January as originally published, which incorrectly summarized the risk for global level to be moderate. Details of each nation’s response that has had an infected person

It was agreed that candidate therapeutics that are still in preclinical phase of evaluation should not be prioritized over more advanced candidates with available clinical safety and efficacy data, as the purpose would be to identify products that could be ready for testing at the earliest.

Among the different therapeutic options, Remdesivir was considered the most promising candidate based on the broad antiviral spectrum, the in vitro and in-vivo data available for coronaviruses and the extensive clinical safety database(in particular coming from the Ebola virus disease clinical trial and MEURI) in eastern Congo). Further, studies in mice using Remdesevir showed superior efficacy over Kaletra + IFNbeta. A clinical trial is being planned in China to evaluate the safety and efficacy of Remdesivir in association with optimized standard of care.

Among the repurposed drugs, the investigation of the antiretroviral medicine (HIV protease inhibitors), lopinavir/ritonavir, either alone or in combination with IFNbeta1b, which is a combination currently investigated in the Kingdom of Saudi Arabia for the treatment of MERS-CoV(MIRACLE trial), was considered a suitable second option for rapid implementation in clinical trials.

Among the products that should not be prioritised, there was consensus that Ribavirin does not appear like a candidate worth further investigating, based on the available evidence.The experience with its evaluation in SARS in Canada in 2003 may have resulted in higher mortality than in other countries. It also reduced haemoglobin concentration-a side effect that is undesirable in patients with respiratory disorders.

Immunosuppressants and immunostimulators (e.g. corticosteroids/steroids) were also identified as products to be deprioritised as there is not enough information when the treatment should be given,and they may possibly be harmful in the context of mild illness, although there is evidence of efficacy in the setting of severe illness. This again underlines the importance of differentiating between mild and severe disease.

Chloroquine was also mentioned as a product for which there is insufficient evidence to support its further investigation.

Source: https://apps.who.int/iris/bitstream/handle/10665/330680/WHO-HEO-RDBlueprint%28nCoV%29-2020.1-eng.pdf

1/24: Trump tweets in praise of China’s “ transparency .” “China has been working very hard to contain the Coronavirus,” tweets the President. “The United States greatly appreciates their efforts and transparency. It will all work out well. In particular, on behalf of the American People, I want to thank President Xi!” Source 4

(On April 1 , the Biden campaign mocked the president for the tweet, and claimed Biden “publicly” warned Trump not to trust China.) Source: 2

1/24: Politico reports that the Trump administration held a briefing on the coronavirus for senators, but it was “sparsely attended” in part because it “was held on the same day as a deadline for senators to submit their impeachment questions.” “The initial thought from the Dems, I think, is that we were trying to distract from impeachment,” a GOP Senate aide told Politico. The outlet added that a White House official “recalled feeling surprised at the ‘incredibly’ poor attendance, noting that it came ‘even though the amount of concern expressed then was rather intense.’” Source: 2

1/24–30: China celebrates the Lunar New Year holiday. Hundreds of millions of people are in transit around the country as they visit relatives. Source: 3

1/24: China extends the lockdown to at least 13 cities covering 36 million people and starts to rapidly build a new hospital in Wuhan. From this point, very strict measures continue to be implemented around the country for the rest of the epidemic. Source: 3

1/24: 2nd travel related case (Illinois) Source: 1

1/24: Chinese inspection records (SEE 4/2) show the beginning influx of massive acquisition (hoarding) of 2 billion face masks and other medical protective gear purchased from multiple nations. Source: https://www.news.com.au/lifestyle/health/revealed-china-stockpiled-2-billion-face-masks-and-25m-medical-items/news-story/5304e5a5080bd4087e4a9be9de210b97

1/24: Officials in Beijing prevent the Wuhan Institute of Virology from sharing sample isolates with the University of Texas. Source 8

1/24: The Lancet publishes a study that finds a 10-year old boy in China was “shedding [the] virus without symptoms,” raising concerns of asymptomatic carriers. Source 4

1/25: Mr. Bowen wrote Dr.Bright and Dr. Wolf that his company was getting lots of requests from China and Hong Kong” for masks. https://int.nyt.com/data/documenthelper/6930-rick-bright-complaint/2a40b07e589ad4c5357b/optimized/full.pdf

1/25: As per the China National Health Commission, at this point China only had 1,298 cases. Source: https://www.bbc.com/news/world-asia-china-51363132

1/26: “The American people should not be worried or frightened by this. It’s a very, very low risk to the United States,” Fauci says on The CATS Roundtable . “It isn’t something that the American public needs to worry about or be frightened about.” Source: 2

1/26: Additional travel related cases (1st case in California) Source: 1

1/26: 1st case in Arizona (national case #5) Source: 1

1/26: CNN- China’s health minister Ma Xiaowei made a startling statement Sunday about the Wuhan coronavirus: He said people can spread it before they become symptomatic. (asymptomatic) “This is a game changer,” said Dr. William Schaffner, a longtime adviser to the US Centers for Disease Control and Prevention.

It’s much harder to contain a virus — to track down a patient’s contacts and quarantine them immediately — if the patient was spreading the disease for days or weeks before they even realized they had it.

“It means the infection is much more contagious than we originally thought,” said Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. “This is worse than we anticipated.”

Ma didn’t explain why he thinks the virus can be spread before someone has symptoms. If the Chinese health minister is right — and there are those who doubt him — that means the five confirmed cases in the United States might have been infectious while traveling from Wuhan to Arizona, California, Illinois and Washington state, even if they had no symptoms at the time.

On Sunday, Dr. Nancy Messonnier, director of the US Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, said the risk to the American public for contracting this virus continues to be low.

“We at CDC don’t have clear evidence that patients are infectious before symptom onset, but we are actively investigating that possibility,” Messonnier said. “We need to be preparing as if this is a pandemic, but I continue to hope that it is not,” she added.

US health officials believe the Wuhan virus has an incubation period of about two weeks, CDC officials said Friday during a media briefing.

“Based on what we know now about this virus, our concern for transmission before symptoms develop is low, so that is reassuring,” Dr. Jennifer Layden, an epidemiologist with the Illinois Department of Health, said at the Friday briefing.

The update on Sunday from the Chinese health minister should encourage health officials to change that thinking, some infectious disease experts told CNN.

“Assuming that Ma is correct, we’re going to have to re-evaluate our strategy, that’s for sure,” Schaffner said.

Dr. Paul Offit, another longtime CDC adviser, said given Ma’s news, he thinks health officials should alert people on the flights that the three US patients took from Wuhan that they might have traveled with someone who was infectious. “I think the conservative thing to do would be to cast a wider net,” he said.

The United States’ top infectious disease doctor wants a team of CDC disease detectives to go to China and check on these crucial questions about how the Wuhan coronavirus is spreading.

But there’s something stopping them: China first has to invite the CDC. “Up to now, to my knowledge, we have not been invited,” Dr. Anthony Fauci

The implications of Ma’s statement that the coronavirus is transmissible before symptoms are so important “that in my mind it’s absolutely critical that we ourselves see the data, because what goes on over there has implications for what happens here,” Fauci said. He added that to his knowledge, the Chinese did not tell US health authorities that the virus could spread before someone is symptomatic, a crucial aspect of any disease investigation. He said he learned about it after reading a CNN reporter’s email. Fauci said that CDC disease detectives would need to see precisely how Chinese health authorities have gathered their data and how they came to their conclusion. “To my knowledge, we have not seen the precise minute, granular data and how they collected it,” he said. “We need to get to the real bottom line of how they collected their data and see if it’s valid.”

“The Chinese have good people. I don’t want to impugn their capabilities,” Fauci added. “But when it’s something as important as this, our people who are trained epidemiologists need to go over their data and the best way to do that is go there and see how they’re collecting it.”

CDC’s Messonnier said Sunday the CDC has staff in China, but the team is not directly involved in the Wuhan coronavirus response. The agency hopes to have “additional engagement” on the outbreak in China in the coming days, she said.

In a tweet on Sunday, WHO Director-General Tedros Adhanom Ghebreyesus said, “I am on my way to Beijing, [China] to meet with the Government & health experts supporting the #coronavirus response. My @WHO colleagues & I would like to understand the latest developments & strengthen our partnership with [China] in providing further protection against the outbreak.”

Some experts are skeptical because of the lack of data from China.

“I seriously doubt that the Chinese public officials have any data supporting this statement,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “I know of no evidence in 17 years of working with coronaviruses — SARS and MERS — where anyone has been found to be infectious during their incubation period.”

“My gut says we’re going to be able to contain this real quick — we’re going to be able to put a moat around this fire,” said Offit, a pediatric infectious disease expert at the Perelman School of Medicine at the University of Pennsylvania. “I think this is going to be much more like SARS or MERS than the movie ‘Contagion.’” “But then,” the Philadelphia-based doctor said, “I’m an Eagles fan, so I tend to be optimistic about things.”

Source: https://www.cnn.com/2020/01/26/health/coronavirus-spread-symptoms-chinese-officials/index.html

1/26: ASPR holds first meetings of healthcare resilience, medical countermeasure development, and supply chain task forces, which continue several times a week or daily in the coming weeks. Source: 9

1/26: Kobe Bryant helicopter crash.

1/27: WHO: “Does not recommend any evaluation at the points of entry regarding this event, nor any restrictions on travel or commerce.” Source: 5

1/27: The Biden campaign, including its top coronavirus adviser Ron Klain, praise China for being “transparent” and “candid.” Speaking to Axios, Klain asserts: “I think what you’d have to say about China is, it’s been more transparent and more candid than it has been during past outbreaks, though still there’s problems with transparency and candor.” Even as he says there were “many” areas in which China hasn’t been transparent, Klain asserts that China had helpfully released a “sequence of the virus.” Klain goes on to say there isn’t “any reason” for anyone to postpone essential travel to anywhere except the Wuhan area. In fact, China reportedly destroyed virus samples rather than release them. Source: 2

1/27: Three days before Trump closes off most travel from China, Klain says he opposes that measure. “That’s premature.” Source: 2

1/27: Secretary Azar shares that HHS is “proactively preparing for the arrival of the novel coronavirus on our shores,” noting that “the novel coronavirus is a rapidly changing situation, and we are still learning about the virus.” “While the virus poses a serious public health threat, the immediate risk to Americans is low at this time,” Azar says, noting that he spoke on the morning of January 27 with China’s Minister of Health and WHO Director-General Tedros speak to discuss the novel coronavirus. Source: 9

1/27: CDC hosts a tele-briefing with Dr. Nancy Messonnier, who notes that new travel recommendations are coming and that “there may be some disruptions” to Americans’ lives as a result of the public health response, but that “this virus is not spreading in the community” in the U.S. Source: 9

1/27: CDC and State Department issue Level 3 “postpone or reconsider travel” warnings for all of China. Source: 9

1/27: FDA begins providing updates about processes for approval and authorization to developers of vaccines, therapeutics, diagnostics, and other countermeasures for the novel coronavirus. Source: 9

1/27: CDC’s Deputy Director for Infectious Diseases, Jay Butler, holds a call with the nation’s governors on the novel coronavirus. Source: 9

1/27: Biden Op-Ed in the USA Today “…in favor of reactionary travel bans that would only have made things worse. He advocated abandoning exposed and infected American citizens rather than bringing them home for treatment.”

“That’s how we broke the infection curve on Ebola. In September 2014, CDC projections warned that over 1 million people could be infected if we failed to act. By February 2015, thanks to the leadership of our administration, the number of new Ebola cases was fewer than 400 . A few months later, the epidemic was essentially extinguished .”

Source: https://www.usatoday.com/story/opinion/2020/01/27/coronavirus-donald-trump-made-us-less-prepared-joe-biden-column/4581710002/

1/27: The White House Coronavirus Task Force starts daily meetings to help monitor and contain the spread of the virus and provide updates to the President. Source: 6

1/27: Secretary Azar discusses the coronavirus situation with China’s Minister of Health and World Health Organization Director-General Tedros Source: 10

1/27: WHO R&D Blueprint Unfortunately, Dr. Zheng-Li Shi (“Bat Woman) from the Wuhan Institute of Virology,the lead investigator on the initial report of the nCoV isolated from 5 patientsin Wuhan, China (Zhou et al, 2020), was unable to join this initial consultation but has been in touch with the Blueprint Team and will join subsequent calls.

Dr. Zheng-Li Shi’s laboratory is successfully growing virus isolated from patients in Wuhan, China. They have published their culture methods in their initial report (Zhou et al, 2020). It is not yet clear how or when (if at all) this virus will be made available for distribution.The US CDC is also growing virus isolated from a patient in the United States. While the Chinese scientists do not report any difficulties growing their virus isolate,scientists from the US CDC reports that their virus isolate is quite slow-growing, hampering efforts to grow a large batch to make available for distribution. For the time being, there are no other known sources of virus isolates, but this may change as new cases are reported in other countries.

nCoV virus isolate is urgently needed to properly address the question of cross-reactivity. The US CDC is willing to share an isolate but these efforts are hampered bythe slow-growing nature of their isolate under the culture conditions being used. Investigators from the Wuhan Institute for Virology are encouraged to engage with US CDC scientists to see if they can assist in optimizing culture conditions.

https://www.who.int/blueprint/priority-diseases/key-action/24_01_2020_NFR_WG_CrossReactivity_with_other_CoV.PDF?ua=1

1/28: CNBC Interview with Biden Advisor Ron Klain Concerned, not fearful

8,000 arrive every day from China

Lots of unknowns

Can people spread without symptoms? There are reports.

Differences from Ebola Level of people coming from China v W Africa Differences are greater than similarities

Premature to ban travelers. It’s important for trade, tourism. 250,000 have already come from China since it broke out.

China’s been more candid and transparent. Case count seems low. Lots to be doubted.

Models say there are several hundred thousand cases.

No cars are leaving, but there are long line of trucks into Wuhon bringing supplies.

We have the best experts and great leadership.

Huge investment in preparing 60 US specialty infectious disease hospitals.

Help state and local governments. The burden is on them.

WHO should have declared a global health emergency. Not sure why the committee voted it down.

Source: https://www.cnbc.com/video/2020/01/28/still-a-lot-of-unknowns-with-coronavirus-former-ebola-czar.html

1/28: Dr. Carter Mecher, a senior medical adviser at the Department of Veterans Affairs, emails dozens of his colleagues in government and at universities about the coronavirus. “The chatter on the blogs is that WHO and CDC are behind the curve. I’m seeing comments from people asking why WHO and CDC seem to be downplaying this. I’m certainly no public health expert (just a dufus from the VA), but no matter how I look at this, it looks to be bad,” he warns in the email chain later leaked to the N.Y. Times . “The projected size of the outbreak already seems hard to believe, but when I think of the actions being taken across China that are reminiscent of 1918 Philadelphia, perhaps those numbers are correct. … Any way you cut it, this is going to be bad . You guys made fun of me screaming to close the schools. Now I’m screaming, close the colleges and universities. ”

The email chain, dubbed the “the Red Dawn String” by its members based off the 1984 movie about a group of Americans trying to save the United States from a foreign invasion, later includes: Dr. Jerome Adams (Surgeon General of the United States), Dr. Larry G. Padget (State Department), Dr. Anthony Fauci (NIH), Dr. Robert Kadlec (HHS), Dr. Robert Redfield (HHS), Col. Matthew Hepburn (DARPA, DOD), nine other senior officials at the Department of Health and Human Services, eight senior officials from the Department of Homeland Security, among other academics, private sector employees, former government officials and state officials. Source: 4

1/28: HHS hosts press briefing by Secretary Azar, Dr. Fauci, Director Redfield, and Dr. Messonnier. Azar says , “Americans should know that this is a potentially very serious public health threat, but, at this point, Americans should not worry for their own safety.” He underscores, “This is a very fast moving, constantly changing situation…. Part of the risk we face right now is that we don’t yet know everything we need to know about this virus. But, I want to emphasize, that does not prevent us from preparing and responding.” Source: 9

1/28: WHO: “Confident in China’s epidemic and control ability.” Source: 5

1/28: U.S. Department of Health and Human Services (HHS) announced that 15 additional U.S. airports (bringing the total to 20) would begin screening incoming travelers from China. LAX, SF, O’Hare, JFK, Atlanta, Houston, DFW, SD, SeaTac, Honolulu, Anchorage, MN-St. Paul, Detroit, Miami, Dulles, Philly, Newark, Boston, El Paso, San Juan. Source: 1

1/28: United Airlines announced it would cut 24 flights between the U.S. and China for the first week of February. Source: 1

1/28: CDC Director Robert Redfield to colleagues: “While we believe the 2019-nCoV poses a very serious health threat, the virus in not spreading in the US at this time and the CDC believes the immediate health risk from 2019-nCoV to the general American public is low.” Also indicates Chinese authorities have identified person to person spread.

Source: https://twitter.com/phillyrich1/status/1247132550730047488?s=20

1/29: Trump announces Coronavirus Task Force Source: https://www.whitehouse.gov/briefings-statements/statement-press-secretary-regarding-presidents-coronavirus-task-force/

1/29: WH Advisor Peter Navarro Memo to NSC entitled: “Should the White House Order a Travel Ban to Combat a Potential Coronavirus Pandemic?” The Jan. 29 memo set out two stark choices: “Aggressive Containment versus No Containment.” Created a matrix of risk/reward based on scenarios.

Navarro compared cost estimates for the choices and wrote that the Council of Economic Advisers’ estimates for stopping travel from China to the U.S. would be $2.9 billion per month. If the virus turned out to be a pandemic, that travel ban could extend 12 months and cost the U.S. $34.6 billion.

Doing nothing (the “No Containment” option) could range from “zero economic costs” to $5.7 trillion depending on the lethality of the virus.

On the high end, he estimated a scenario in which the coronavirus could kill 543,000 Americans.

Source: https://www.axios.com/exclusive-navarro-deaths-coronavirus-memos-january-da3f08fb-dce1-4f69-89b5-ea048f8382a9.html

1/29: American Airlines announced it would suspend flights from Los Angeles to Shanghai and Beijing from Feb. 9 through March 27, 2020. It will maintain its flight schedules (10 daily A/R) from Dallas-Fort Worth to Shanghai and Beijing, as well as from Los Angeles and Dallas-Fort Worth to Hong Kong. Source: 1

1/29: Shock Video: Zeke Emanuel, later added to Biden Task Force “I do think we need to put this somewhat into context. Which is… its likely to spread… it’s gonna get worse before it gets better. And we know that there will be people that unfortunately die from this. But, is this likely to break out into some major pandemic around the world? Unlikely. We’re likely to be able to contain it. Obviously it would have been better if we had done some containment earlier on and the Chinese had been a little more open earlier on. But these kinds of things are often hard to figure out about what the right measure is, especially when you don’t know how severe it’s going to be right at the start. But I would put in context we have tens of thousands of people in the United States who die every year from the flu…. Whatever this Coronavirus is, its very, very, very unlikely to be that severe. And yet our response, because its new and novel, tends to be much more histrionic I think than it is… We live with the flu, it’s just the flu but it also kills a lot of people. It may not kill at the same high rate but it does kill tens of thousands of Americans and your chance of getting it from colleagues is low.”

Source: https://noqreport.com/2020/04/01/april-fools-lie-joe-scarborough-rewrites-coronavirus-history-with-dr-ezekiel-emanuel/

1/29: CDC hosts a tele-briefing with Dr. Messonnier, who notes that “despite an aggressive public health investigation to find new cases [in the U.S.], we have not.” Source: 9

1/29: CDC posts infection prevention and control recommendations for novel coronavirus patients in healthcare settings, updated regularly in the coming months. Source: 9

1/29: The Chinese government sends email to HHS acknowledging offer of U.S. expert assistance; HHS begins soliciting nominees for mission from across the department. Source: 9

1/29: ASPR, CDC, FDA, NIAID, and DOD host a listening session with industry—1,468 participants—on medical countermeasure development, health system preparedness, supply resilience, and medical surge needs. Source: 9

1/29: The first repatriation flight from Wuhan, China arrives at March Air Reserve Base in California, beginning the safe repatriation of Americans and marking the first use of federal quarantine power in more than 50 years. The operation eventually totals more than 3,000 repatriations, with citizens from Wuhan and passengers from cruise ships. Repatriated Americans praise the work of the quarantine teams—including a couple who spent an extended honeymoon at Lackland Air Force Base in Texas. Source: 9

1/29: According to an account in the Wall Street Journal, Secretary Azar told President Trump that the coronavirus epidemic was under control and that the U.S. government had never mounted a better interagency response to a crisis. https://int.nyt.com/data/documenthelper/6930-rick-bright-complaint/2a40b07e589ad4c5357b/optimized/full.pdf

1/30: WHO: Declared a global health emergency over the new virus “I left in absolute no doubt about China’s commitment to transparency, and to protecting the world’s people.” Source: 5

1/30: President Trump states that the U.S. has the virus “under control” and hosts a campaign rally in Iowa. “We think we have it very well under control,” states President Trump. “We have very little problem in this country at this moment — five. And those people are all recuperating successfully. But we’re working very closely with China and other countries, and we think it’s going to have a very good ending for it. So that I can assure you.” Source: 4

1/30: CNN publishes a piece by Brandon Tensley, “Coronavirus task force another example of Trump administration’s lack of diversity.” Tensley, who claims to cover the “intersection of culture and politics,” was unable to offer medical analysis in the article. Source: 2

1/30: US State Dept issues a Level 4: Do not travel to China Alert (the highest level of Alert) Source: 1

1/30: CDC confirms 1st person to person case (Illinois, national case #6) Source: 1

1/30: CDC: “Given what we’ve seen in China and other countries with the novel coronavirus, CDC experts have expected some person-to-person spread in the US,” said CDC Director Robert R. Redfield, M.D. “We understand that this may be concerning, but based on what we know now, we still believe the immediate risk to the American public is low.” For the general public, no additional precautions are recommended at this time beyond the simple daily precautions that everyone should always take. It is currently flu and respiratory disease season, and CDC recommends getting vaccinated, taking everyday preventive actions to stop the spread of germs, and taking flu antivirals if prescribed. Right now, CDC recommends travelers avoid all nonessential travel to China. Source: 1

1/30: Declaration by WHO that the coronavirus outbreak is a Public Health Emergency of International Concern. Source: 1

1/30: The Trump Administration hosts a call with Secretary Azar, Director Redfield, Dr. Fauci, and others with the nation’s governors to present the Administration’s action plan on responding to the outbreak. Source: 9

1/30: In an appearance on Fox News, Secretary Azar notes that, whether the WHO declares a public health emergency of international concern (declared January 31), “That doesn’t change anything about what we are doing here in the United States. … The President is ensuring that we are proactively preparing and also taking the necessary steps to prevent or mitigate any potential further spread here in the United States.” Source: 9

1/30: Trump Administration budget officials begin discussions about funding needed for development of vaccines and therapeutics, purchases of Personal Protective Equipment (PPE) for the Strategic National Stockpile, surveillance and testing, and state and local support. Source: 9

1/30: ASPR launches a coronavirus portal to receive market research packages and meeting requests from industry stakeholders interested in developing or manufacturing medical countermeasures. Source: 9