I was the Australian doctor on the WHO’s COVID-19 mission to China. Here’s what we found about the origins of the coronavirus


Dominic Dwyer, University of Sydney

As I write, I am in hotel quarantine in Sydney, after returning from Wuhan, China. There, I was the Australian representative on the international World Health Organization’s (WHO) investigation into the origins of the SARS-CoV-2 virus.

Much has been said of the politics surrounding the mission to investigate the viral origins of COVID-19. So it’s easy to forget that behind these investigations are real people.

As part of the mission, we met the man who, on December 8, 2019, was the first confirmed COVID-19 case; he’s since recovered. We met the husband of a doctor who died of COVID-19 and left behind a young child. We met the doctors who worked in the Wuhan hospitals treating those early COVID-19 cases, and learned what happened to them and their colleagues. We witnessed the impact of COVID-19 on many individuals and communities, affected so early in the pandemic, when we didn’t know much about the virus, how it spreads, how to treat COVID-19, or its impacts.

We talked to our Chinese counterparts — scientists, epidemiologists, doctors — over the four weeks the WHO mission was in China. We were in meetings with them for up to 15 hours a day, so we became colleagues, even friends. This allowed us to build respect and trust in a way you couldn’t necessarily do via Zoom or email.

This is what we learned about the origins of SARS-CoV-2.

Animal origins, but not necessarily at the Wuhan markets

It was in Wuhan, in central China, that the virus, now called SARS-CoV-2, emerged in December 2019, unleashing the greatest infectious disease outbreak since the 1918-19 influenza pandemic.

Our investigations concluded the virus was most likely of animal origin. It probably crossed over to humans from bats, via an as-yet-unknown intermediary animal, at an unknown location. Such “zoonotic” diseases have triggered pandemics before. But we are still working to confirm the exact chain of events that led to the current pandemic. Sampling of bats in Hubei province and wildlife across China has revealed no SARS-CoV-2 to date.

We visited the now-closed Wuhan wet market which, in the early days of the pandemic, was blamed as the source of the virus. Some stalls at the market sold “domesticated” wildlife products. These are animals raised for food, such as bamboo rats, civets and ferret badgers. There is also evidence some domesticated wildlife may be susceptible to SARS-CoV-2. However, none of the animal products sampled after the market’s closure tested positive for SARS-CoV-2.

We also know not all of those first 174 early COVID-19 cases visited the market, including the man who was diagnosed in December 2019 with the earliest onset date.

However, when we visited the closed market, it’s easy to see how an infection might have spread there. When it was open, there would have been around 10,000 people visiting a day, in close proximity, with poor ventilation and drainage.

There’s also genetic evidence generated during the mission for a transmission cluster there. Viral sequences from several of the market cases were identical, suggesting a transmission cluster. However, there was some diversity in other viral sequences, implying other unknown or unsampled chains of transmission.

A summary of modelling studies of the time to the most recent common ancestor of SARS-CoV-2 sequences estimated the start of the pandemic between mid-November and early December. There are also publications suggesting SARS-CoV-2 circulation in various countries earlier than the first case in Wuhan, although these require confirmation.

The market in Wuhan, in the end, was more of an amplifying event rather than necessarily a true ground zero. So we need to look elsewhere for the viral origins.




Read more:
Coronavirus: live animals are stressed in wet markets, and stressed animals are more likely to carry diseases


Frozen or refrigerated food not ruled out in the spread

Then there was the “cold chain” hypothesis. This is the idea the virus might have originated from elsewhere via the farming, catching, processing, transporting, refrigeration or freezing of food. Was that food ice cream, fish, wildlife meat? We don’t know. It’s unproven that this triggered the origin of the virus itself. But to what extent did it contribute to its spread? Again, we don’t know.

Several “cold chain” products present in the Wuhan market were not tested for the virus. Environmental sampling in the market showed viral surface contamination. This may indicate the introduction of SARS-CoV-2 through infected people, or contaminated animal products and “cold chain” products. Investigation of “cold chain” products and virus survival at low temperatures is still underway.




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Extremely unlikely the virus escaped from a lab

The most politically sensitive option we looked at was the virus escaping from a laboratory. We concluded this was extremely unlikely.

We visited the Wuhan Institute of Virology, which is an impressive research facility, and looks to be run well, with due regard to staff health.

We spoke to the scientists there. We heard that scientists’ blood samples, which are routinely taken and stored, were tested for signs they had been infected. No evidence of antibodies to the coronavirus was found. We looked at their biosecurity audits. No evidence.

We looked at the closest virus to SARS-CoV-2 they were working on — the virus RaTG13 — which had been detected in caves in southern China where some miners had died seven years previously.

But all the scientists had was a genetic sequence for this virus. They hadn’t managed to grow it in culture. While viruses certainly do escape from laboratories, this is rare. So, we concluded it was extremely unlikely this had happened in Wuhan.




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A team of investigators

When I say “we”, the mission was a joint exercise between the WHO and the Chinese health commission. In all, there were 17 Chinese and ten international experts, plus seven other experts and support staff from various agencies. We looked at the clinical epidemiology (how COVID-19 spread among people), the molecular epidemiology (the genetic makeup of the virus and its spread), and the role of animals and the environment.

The clinical epidemiology group alone looked at China’s records of 76,000 episodes from more than 200 institutions of anything that could have resembled COVID-19 — such as influenza-like illnesses, pneumonia and other respiratory illnesses. They found no clear evidence of substantial circulation of COVID-19 in Wuhan during the latter part of 2019 before the first case.

Where to now?

Our mission to China was only phase one. We are due to publish our official report in the coming weeks. Investigators will also look further afield for data, to investigate evidence the virus was circulating in Europe, for instance, earlier in 2019. Investigators will continue to test wildlife and other animals in the region for signs of the virus. And we’ll continue to learn from our experiences to improve how we investigate the next pandemic.

Irrespective of the origins of the virus, individual people with the disease are at the beginning of the epidemiology data points, sequences and numbers. The long-term physical and psychological effects — the tragedy and anxiety — will be felt in Wuhan, and elsewhere, for decades to come.




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The Conversation


Dominic Dwyer, Director of Public Health Pathology, NSW Health Pathology, Westmead Hospital and University of Sydney, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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‘I still cannot get over it’: 75 years after Japan atomic bombs, a nuclear weapons ban treaty is finally realised



Eugene Hoshiko/AP

Gwyn McClelland, University of New England

The UN Treaty on the Prohibition of Nuclear Weapons will finally come into force after the 50th country (Honduras) ratified it over the weekend. The treaty will make the development, testing, stockpiling and use of nuclear weapons illegal for those countries that have signed it.

This is an extraordinary achievement for those who have suffered the most from these weapons — including the hibakusha (survivors) of the bombings of Hiroshima and Nagasaki and the islanders who lived through nuclear weapons testing in the Pacific.

Since 1956, the hibakusha in Japan, South Korea, Brazil and elsewhere have been some of the most strident campaigners against the use of these weapons. Among them is a group of Japanese Catholics from Nagasaki whom I interviewed as part of my research collecting the oral histories of atomic bomb survivors.

A 92-year-old hibakusha of the atomic bombing of Nagasaki in 1945 and a brother in a Catholic order, Ozaki Tōmei, explained the significance of the treaty to survivors like him. He was orphaned from the bombing at 17 and never found his mother’s body.

The Germans made tools for war including poisonous gas, which was [eventually] banned […] However, when the USA made an atomic weapon, then they … wanted to try it out. It was a war […] they were human.

And so this is why we say we have to eliminate nuclear weapons […] They said they did it to end the war, but for the people who were struck, it was horrific […] there was no need to use it.

Lanterns with messages of peace are lit on the 75th anniversary of the Nagasaki bombing.
DAI KUROKAWA/EPA

Treaty does not have support of nuclear powers

The treaty was adopted at the United Nations in 2017 by a vote of 122 nations in favour, one against and one abstention.

Sixty-nine nations, however, have not signed it, including all of the nuclear powers such as the US, UK, Russia, China, France, India, Pakistan and North Korea, as well as NATO member states (apart from the Netherlands who voted against), Japan and Australia.

Since the treaty was adopted, it needed ratification by 50 countries to come into force. This will now happen in 90 days.

Shacks made from scraps of debris from buildings that were leveled in the aftermath of the atomic bomb that was dropped over Nagasaki.
AP

The campaign for the treaty has relied heavily on civil society and organisations such as the Nobel Peace Prize-winning International Campaign Against Nuclear Weapons (ICAN).

And from the beginning, it has exposed political fault lines. The United States has been particularly outspoken in its opposition to the treaty, warning last week the treaty “turns back the clock on verification and disarmament and is dangerous” to the 50-year-old Nuclear Nonproliferation Treaty (NPT).




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The NPT sought to prevent the spread of nuclear arms beyond the five original weapons powers (the US, Russia, China, UK and France). It has been signed by 190 countries, including those five nations.

The head of ICAN, Beatrice Fihn, says the new treaty banning nuclear weapons merely builds on the nonproliferation treaty.

There’s no way you can undermine the nonproliferation treaty by banning nuclear weapons. It’s the end goal of the nonproliferation treaty.

States like Japan and Australia have opposed the treaty on the grounds their security is boosted by the US stockpile of nuclear weapons. Japan’s former prime minister, Shinzo Abe, has said the treaty

was created without taking into account the realities of security.

Survivors of the Hiroshima atomic bomb await emergency medical treatment.
AP

The efforts of hibakusha in advocating for a treaty

Making the bomb illegal turns an old US justification for the weapon on its head. Harry Stimson, the former US war secretary, argued in 1947 the bombings of Hiroshima and Nagasaki were necessary to compel the Japanese to surrender at the end of the second world war.

The atomic bomb was more than a weapon of terrible destruction; it was a psychological weapon.

The damage from the bombings was colossal. It is unknown how many people were killed, but estimates range from 110,000 (the US army’s toll) to 210,000 (the figure accepted by ICAN and others).




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At the forefront of the campaign to support the nuclear weapons ban treaty have been the voices of hibakusha who experienced the carnage firsthand.

Another Catholic hibakusha, Nakamura Kazutoshi, told me the stockpiling of nuclear weapons enables states to carry out genocide.

In war, we are at a level below animals. Among monkeys, or chimpanzees, there are no animals who would carry out a genocide.

Nakamura Kazutoshi.
Author provided

A third hibakusha, 90-year-old Jōji Fukahori, told me about how he lost his mother and three younger siblings in the Nagasaki bombing.

His younger brother, Kōji, died an excruciating death around a week after the bombing, walking in the hot ash with no shoes and complaining to his brother, “I’m so hot!”

At the site where Fukahori’s brother was exposed, the temperature was about 1,000 degrees Celsius. Fukahori said,

You would have thought everyone would have turned into charcoal.

For Fukahori, the lasting effects of radiation exposure is a major reason why nuclear weapons must be banned. He continued:

the terror of radiation has to be fully communicated … The atomic bomb is unacceptable. I still cannot get over it.

Since 2009, Fukahori has been speaking out at the Nagasaki Atomic Bomb Museum and on the Peace Boat, a non-governmental organisation that organises cruises where passengers learn about the consequences of using nuclear weapons from hibakusha.

Jōji Fukahori telling his story.

Pressure building on Japan

The Japanese government is now under mounting pressure to ratify the treaty. Major Japanese financial institutions and companies have said they will no longer fund the production of nuclear weapons and nearly a third of all local assemblies have adopted proposals calling on the government to act.

The government, however, has been unmoved. In August, Abe gave a speech at a memorial service in Nagasaki, in which he suggested the effects of the bombings had been overcome.

Seventy-five years ago today, Nagasaki was reduced to ashes, with not a single tree or blade of grass remaining. Yet through the efforts of its citizens, it achieved reconstruction beautifully as we see today. Mindful of this, we again feel strongly that there is no trial that cannot be overcome and feel acutely how precious peace is.

Visitors pray for the atomic bomb victims at the Hiroshima Peace Memorial Park.
Koji Ueda/AP

A Japanese atomic researcher, who knows how Fukahori and other hibakusha have not been able to move on, told me Abe’s words don’t go far enough:

Rather than placing a ‘full-stop’ at the end of damages such as this, we have a necessity to make our claim that the damages are not finished.

The nuclear weapons ban treaty offers a moment of hope for all the hibakusha of Hiroshima and Nagasaki still with us after 75 years. It is certainly their hope the ratification of the treaty now moves us one step closer to a world free of nuclear war.




Read more:
Instead of congratulating ICAN on its Nobel Peace Prize, Australia is resisting efforts to ban the bomb


The Conversation


Gwyn McClelland, Lecturer, Japanese Studies, University of New England

This article is republished from The Conversation under a Creative Commons license. Read the original article.

WHO reform: a call for an early-warning protocol for infectious diseases


Peter Gluckman and Alexander Gillespie, University of Waikato

The World Health Organization (WHO) has come in for its share of criticism for its handling of the COVID-19 pandemic. While some faults are the responsibility of the WHO, others were caused by member states, which did not always act as quickly as they should have.

In our opinion, the fundamental problem was that the WHO’s current information sharing, response and organisational structure to deal with infectious diseases that may spread across borders quickly and dangerously is out of date.

We argue the global population deserves a better model — one that delivers information about the risk of emergent infectious diseases faster and in a way that is transparent, verifiable and non-politicised.

Preparing for the next pandemic

More than one million people have died of COVID-19, and that number could double before the pandemic is brought under control.

COVID-19 is not the first pandemic, nor will it be the last. The WHO was also criticised after the 2014 Ebola epidemic.




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Global responses to such threats have precedents dating back to 1851 and the development of stardardised quarantine regulations. The international initiatives that have since followed, punctuated by the formation of leading international bodies such as the WHO in 1946, represent incremental progress. The most recent iteration of work in this area is the International Health Regulations of 2005.

We suggest a new protocol should be added to the WHO. We have drafted a tentative discussion document, which is available upon request, based on the following six broad ideas.




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1. The WHO remains the central decision-making body

We want to strengthen the collection and sharing of information related to infectious diseases, but we believe the WHO must remain the international entity that interprets the material, raises alerts for the global community and organises responses.

Despite retaining the centrality of the WHO, we suggest a new protocol to provide the basis for the independent collection, sharing and transfer of information between countries and with the WHO. Fundamentally, we want the early-warning science to be divorced from the policy responses.

2. Obligation to issue risk warning

A clear and binding legal principle needs to be explicitly written into international law: namely, that there is an obligation to pass on, as quickly as possible, information about a hazardous risk discovered in one country that could be dangerous to others.

The international community first saw this thinking in the 1986 Convention on Early Notification of a Nuclear Accident, developed after the Chernobyl incident. We believe the same thinking should be carried over to the early notification of infectious disease threats, as they are just as great.

3. Independence in science

We need legally binding rules for the collection and sharing of information related to infectious diseases. These rules must be detailed, but have the capacity to evolve. This principle is already developing, beginning with innovative solutions to problems like regional air pollution, which separates scientists from decision-makers and removes any potential for partisan advice.

The core of this idea needs to be adapted for infectious diseases and placed within its own self-contained protocol. Signatories can then continually refine the scientific needs, whereby scientists can update what information should be collected and shared, so decision-makers can react in good time, with the best and most independent information at their fingertips.

4. Objectivity and openness

We must articulate the principle that shared scientific information should be as comprehensive, objective, open and transparent as possible. We have borrowed this idea from the Intergovernmental Panel on Climate Change (IPCC) but it needs to be supplemented by the particular requirement to tackle emergent infectious disease risks.

This may include clinical and genetic information and the sharing of biological samples to allow rapid laboratory, medical and public health developments. Incomplete information should not be a reason to delay and all information should be open source. It will also be important to add a principle from international environmental law of acting in a precautionary manner.

In the case of early notification about infectious diseases, we contend that even if there is a lack of scientific certainty over an issue, it is not a reason to hold back from sharing the information.

5. Deployment to other countries

We realise information sometimes needs to be verified independently and quickly. Our thinking here has been guided by the Chemical Weapons Convention and the use of challenge inspections. This mechanism, in times of urgency, allows inspectors to go anywhere at any time, without the right of refusal, to provide independent third-party verification.

In the case of infectious diseases, a solution might be that in times of urgency, if 75% of the members of the new protocol agree, specialist teams are deployed quickly to any country to examine all areas (except military spaces) from where further information is required. This information would then be quickly fed back into the mechanisms of the protocol.

6. Autonomy and independent funding

We suggest such a protocol must be self-governing and largely separate from the WHO, and it is essential it has its own budget and office.

This will increase the autonomy of the early-warning system and reduce the risks of being reliant on the WHO for funding (with all the vagaries that entails). If well designed, the protocol should provide a better way for state and non-state actors to contribute.

The goodwill and financial capacity of international philanthropy, transnational corporations and civil society will need to be mobilised to a much greater degree to fund the new protocol.


The authors worked with Sir Jim McLay, whose leadership contribution and input on the proposed protocol has been integral to the project.The Conversation

Peter Gluckman, Director of Koi Tū, the Centre for Informed Futures; former Chief Science Advisor to the Prime Minister of New Zealand and Alexander Gillespie, Professor of Law, University of Waikato

This article is republished from The Conversation under a Creative Commons license. Read the original article.