COVID-19: The Authoritative Chronology, December 2019-March 2020 - Background paper 2a The Independent Panel for Pandemic Preparedness and ...

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COVID-19: The Authoritative Chronology, December 2019-March 2020 - Background paper 2a The Independent Panel for Pandemic Preparedness and ...
COVID-19: The Authoritative Chronology,
     December 2019–March 2020
                           Background paper 2a
       The Independent Panel for Pandemic Preparedness and Response
                                  May 2021
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 2 of 48

Glossary and abbreviations

AFCOR—Africa Task Force for Novel Coronavirus                         GOARN—WHO Global Outbreak Alert and Response                             Rt and Re—R at time t, effective reproduction number,
                                                                      Network                                                                  estimates how many other cases one infected individual
AFR—WHO African Region                                                                                                                         is likely to cause at a specific time, considering immunity
                                                                      HCWs—health care workers                                                 and public health measures
AMR—WHO Region of the Americas
                                                                      h-to-h—human-to-human                                                    RaTG13—a type of bat coronavirus
AP—Associated Press
                                                                      HQ—headquarters                                                          RCCE—Risk Communication and Community
Article 6—International Health Regulations section
regarding Member State notifications to the World                     IASC—Inter-agency Standing Committee                                     Engagement
Health Organization about a potential international                                                                                            SARS—severe acute respiratory syndrome
health threat                                                         IDVI—Infectious Disease Vulnerability Index
                                                                      IFRC—International Federation of Red Cross                               SARS-CoV-2—severe acute respiratory syndrome-
Article 10—International Health Regulations section                                                                                            coronavirus-2, the virus that causes COVID-19 disease
regarding Member State verification of emerging                       and Red Crescent Societies
disease threat information                                            IHR—International Health Regulations                                     SCMP—South China Morning Post
AU—African Union                                                      ILO—International Labour Organization                                    SEAR—WHO South-East Asian Region
CCDC—Chinese Center for Disease Control                               Mean serial interval—indicates the length of time                        STAG-IH—WHO Strategic and Technical Advisory Group
                                                                      between symptom onset of an initial case and any                         for Infectious Hazards
COVID-19—the disease caused by SARS-CoV-2
                                                                      subsequent cases                                                         UN—United Nations
DG—WHO Director-General
                                                                      nCoV—novel coronavirus                                                   UNHCR—UN High Commissioner for Refugees
Dispersion factor k—describes how a disease clusters
                                                                      PCR—polymerase chain reaction                                            UK—United Kingdom
EB—WHO Executive Board
                                                                      R&D—research and development                                             US—United States
ECDC—European Centre for Disease Prevention
and Control                                                           PHEIC—Public Health Emergency of International                           US CDC—United States Centers for Disease Control
                                                                      Concern                                                                  and Prevention
ED—Executive Director
                                                                      PPE—personal protective equipment                                        WASH—Water, Sanitation, and Hygiene
EEA—European Economic Area
                                                                      ProMED—Program for Monitoring Emerging Diseases                          WHO—World Health Organization
EMR— WHO Eastern Mediterranean Region
                                                                      PUO—pneumonia of unknown origin                                          WPRO—WHO Western Pacific Regional Office
EU—European Union
                                                                      R0—R naught, basic reproduction number, estimates                        2019-nCoV—novel coronavirus 2019
EUR—WHO European Region                                               how many other cases one infected individual is likely
                                                                      to cause prior to institution of public health measures or
G7—Group of Seven                                                     development of immunity
G20—Group of Twenty
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 3 of 48

                                                                 CHRONOLOGY LEGEND

                                                                          SUB-CATEGORY
                                                                Headline
                                                                Author/Actor
                                                                Published: 

                                                                Caption

                                                                Source
                                                                Links to other sources e.g. news release

                                                               Time zones
                                                               CST – China Standard Time
                                                               CET – Central European Time

                                                                      International actions

                                                                      Country actions

                                                                      Real-time evidence

                                                                      Retrospective evidence

                                                                      Annotations

                                                                      Key events

                                                                      Private document

                                                                      Public document

                                                                      WHO action

                                                                      Strength of research

                                                                      1 - low quality pre-print

                                                                      2 - medium peer reviewed

                                                                      3 - high quality top tier journal
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 4 of 48

INTERNATIONAL
COUNTRY
REAL-TIME EVIDENCE

                           pre-Dec 2019                               01 Dec 2019                                08 Dec 2019                               15 Dec 2019                                mid-Dec 2019
                                      SCIENCE                                     CASES
                                                                    Patient with COVID-like                                                                                                                       SCIENCE
                         Assumed spillover from animals
RETROSPECTIVE EVIDENCE

                                                                    symptoms identified                                      CASES                                                                  SARS-CoV-2 could have infected
                         to humans                                                                                                                                    SCIENCE
                         van Dorp L, Acman M, et al.                Huang C, Wang Y, et al.                    First identified COVID-19 patient                                                    people in the US in mid-Dec
                         Published: 5 May 2020                      Published: 24 Jan 2020                     becomes ill                               R0 increased during Dec. 2019              Basavaraju S, Patton M, et al.
                         Analysis of genomic diversity over 62-year-old man developed                          Joint WHO-China mission                   Lai A, Bergna A, et al.                    Published: 30 Nov 2020
                                                                    symptoms of a respiratory illness          Published: 30 Mar 2021                    Published: 25 Feb 2020
                         time found that all sequences                                                                                                                                              Blood samples in the United States
                         share a common ancestor towards on this date. He was identified                       “The case with the earliest onset         The analysis of 52 viral genomes           (US) were found to have cross-
                         the end of 2019, suggesting this           by some as the first patient with          date reported to the Chinese              from different countries                   reactive antibodies to SARS-
                         as the period when SARS-CoV-2              eventual laboratory confirmed              National Notifiable Disease               determined that R0 increased               CoV-2, suggesting that the virus
                         spilled over to a human host.              COVID-19. Subsequent evidence              Reporting System became ill on            from 0.8 to 2.4 during Dec. 2019,          could have infected people there
                                                                    suggests he was infected later in          December 8”.                              with a mean doubling time of               as early as Dec. 2019.
                         Infection, Genetics and Evolution, Nature,
                         WHO-convened Global Study of the           December.                                  WHO-convened Global Study of the          around 4 days.                             Clinical Infectious Diseases, Wall Street
                         Origins of SARS-CoV-2                      The Lancet, WHO, WHO-convened Global       Origins of SARS CoV-2                     Journal of Medical Virology                Journal
                                                                    Study of the Origins of SARS-CoV-2
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 5 of 48

INTERNATIONAL
COUNTRY
REAL-TIME EVIDENCE

                           16 Dec 2019                                18 Dec 2019                                21 Dec 2019                                                                          24 Dec 2019

                                  16 Dec 2019–02 Jan 2020                                                                               21 Dec–30 Dec 2019                                                    NEWS REPORT
                                       CASES                                                                                               CASES
RETROSPECTIVE EVIDENCE

                                                                                                                                                                                                    Wuhan doctors sent lung fluid
                         Patients with PUO admitted to                                                         Three patients with PUO identified in Wuhan (later                                   sample to commercial lab for
                         Wuhan hospital (later confirmed                          SCIENCE                      confirmed as SARS-CoV-2)                                                             testing
                         as SARS-CoV-2)                             Sewage samples in Italy possibly           Zhu N, Zhang D, et al.                                                               Published: 05 May 2020
                         Huang C, Wang Y, et al.                    positive for SARS-CoV-2                    Published: 24 Jan 2020
                                                                                                                                                                                                    Wuhan doctors noticed
                         Published: 24 Jan 2020                     La Rosa G, Mancini P, et al.               Three patients with PUO were identified in Wuhan                                     pneumonia patients were not
                         41 patients with pneumonia of              Published: 15 Aug 2020                     from 21 Dec. onwards. Lung fluid samples collected                                   responding to usual treatments
                         unknown origin (PUO) were                  Sewage samples from 18 Dec. in             30 Dec. during hospital admission later confirmed                                    and sent a test sample to Vision
                         admitted to a Wuhan hospital               Milan and Turin were found to be           SARS-CoV-2. One patient was a retailer at the Huanan                                 Medicals (commercial lab) for next
                         between 16 Dec.-2 Jan. Confirmed           positive for SARS-CoV-2, but may           Seafood Market, another a frequent market visitor.                                   generation sequencing/testing.
                         as SARS-CoV-2 in Jan. 2020.                be false positives.                        One died 9 Jan. 2020, the others were discharged.                                    Chinese Medical Journal, PBS Frontline,
                         The Lancet                                 Science of the Total Environment           New England Journal of Medicine                                                      Caixin
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 6 of 48

INTERNATIONAL

                                                                                                 First reported suspected cluster                                              ACTION
                                                                                  ACTION                                            ACTION
                                                                                                                                                                  Wuhan CDC collects samples
                                                                    Suspicious cases admitted to                  Additional suspicious cases                     from PUO patients
                                                                    Wuhan hospital                                identified at Wuhan hospital,                   Wuhan CDC
                                                                    Dr. Zhang Jixian                              cluster reported
COUNTRY

                                                                                                                                                      Wuhan CDC visits Hubei Hospital
                                                                                                                  Dr. Zhang Jixian
                                                                    One female with fever and dry                                                     of Integrated Chinese and Western
                                                                    cough symptoms is identified                  Staff at Hubei Hospital of          Medicine to collect lung fluid and
                                                                    by Dr. Zhang Jixian in Hubei                  Integrated Chinese and Western      blood samples from three PUO
                                                                    Hospital of Integrated Chinese                Medicine realize that the two       patients (husband, wife, son) for
                                                                    and Western Medicine. Her                     cases are a couple, and transfer    more investigation. Dr. Zhang
                                                                    husband is admitted to a different            the husband to the same             Jixian reports to Wuhan CDC that
                                                                    department of the hospital on                 department as his wife. Their son, she is “concerned about human-
                                                                    the same day. The results of the              who is asymptomatic, is also CT     to-human (h-to-h) transmission.”
                                                                    diagnostic work-ups are different             scanned, which reveals that he has Dr. Zhang Jixian notes “Wuhan
                                                                    than normal pneumonia cases.                  similar lung abnormalities as his   CDC didn’t dismiss my thoughts
                                                                    The female reports close contact              parents. Dr. Zhang Jixian reports   nor did they confirm them, but
REAL-TIME EVIDENCE

                                                                    with the Huanan Seafood Market,               the three cases to the Jianghan     said they needed to confirm
                                                                    while her husband reports no                  District Center for Disease Control through lab investigations.”
                                                                    contact with the market.                      and Prevention (CDC).               Interview and correspondence with
                                                                    Interview and correspondence with             Interview and correspondence with               Dr. Zhang Jixian, Journal of Nuclear
                                                                    Dr. Zhang Jixian, Journal of Nuclear          Dr. Zhang Jixian, Journal of Nuclear            Medicine, IHR Review Committee Report
                                                                    Medicine, WHO-convened Global                 Medicine, IHR Review Committee Report
                                                                    Study of the Origins of SARS-CoV

                           25 Dec 2019                                26 Dec 2019                                   27 Dec 2019
                                                                              NEWS REPORT                                                                                                                          NEWS REPORT
                                                                    Chinese lab identified SARS-like                                                                                                      Private lab in China pieced most
                                   NEWS REPORT                      virus in samples                                                                                                                      of genome
RETROSPECTIVE EVIDENCE

                         Senior director at Wuhan hospital                                                                                       SCIENCE
                                                                    Published: 01 Feb 2020                                                                                                                Published: 26 Feb 2020
                         heard of possible spread                                                                 Respiratory sample from hospitalised patient in
                                                                    An account published in multiple                                                                                                      Private lab shared next generation
                         Published: 28 Jan 2020                     Chinese news sites by an                      France positive for SARS-CoV-2                                                          sequence data of potential new
                         Dr. Lu Xiaohong, head of                   anonymous lab technician, said his            Deslandes A, Berti V, et al.                                                            virus with homology to SARS-like
                         gastroenterology at City Hospital          company had received samples                  Published: 03 May 2020                                                                  coronavirus with Wuhan officials
                         No. 5, told China Youth Daily that         from Wuhan and determined on                  A hospital in the north of Paris retrospectively tested                                 and the Chinese Academy of
                         on 25 Dec. she heard unexplained           26 Dec. they contained a new                  respiratory samples from patients admitted to the                                       Medical Sciences. First reported
                         viral pneumonia was spreading              coronavirus with 87% similarity               intensive care unit with influenza-like illness in Dec.                                 by Chinese finance publication
                         among health care workers                  to Severe Acute Respiratory                   2019. The sample from a patient admitted on 27 Dec.                                     Caixin; independently confirmed
                         (HCWs).                                    Syndrome (SARS).                              was found to be positive for SARS-CoV-2.                                                by the Associated Press (AP).
                         China Youth Daily, NY Times                Washington Post, Caixin                       International Journal of Antimicrobial Agents, Reuters                                  Caixin, Associated Press
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 7 of 48

INTERNATIONAL

                                30 Dec 2019 – 15:10 CST/08:10 CET               18:50 CST/11:50 CET
                                       ALERT                                        ALERT
                         Wuhan issues a first “urgent                 Wuhan issues a second “urgent
                         notice” to health institutions               notice” to health institutions
                         Wuhan Municipal Health Commission            Wuhan Municipal Health Commission
                         The Wuhan Municipal Health                   The Wuhan Municipal Health                                                                                                               12:16 CST/05:16 CET
                                                                                                                             ACTION
                         Commission issues an “urgent                 Commission issues a second                                                                                                                 REQUEST
                         notice” to health institutions about         notice to health institutions,           Wuhan Institute of Virology
                         cases of PUO linked to the Huanan            with instructions not to disclose        receives PUO samples                                                                 Taipei CDC IHR Point of Contact
                         Seafood Market. The notice is                information to the public without        Wuhan Institute of Virology
                                                                                                                                                                                                    emails WHO via IHR
                         shared in online chat groups,                authorisation. The “urgent                                                                                                    Taipei CDC IHR Point of Contact
COUNTRY

                                                                                                               Wuhan Institute of Virology
                         including by ophthalmologist Dr.             notice” includes the following           receives samples from seven                                                          Taipei CDC IHR Point of Contact
                         Li.                                          three headings: Strengthening            patients with PUO. The samples                                                       emails WHO via the International
                         Wuhan Municipal Health Commission            Responsibility and Guidance,             are sent by staff at Wuhan                                                           Health Regulations (IHR) system
                         archived document, WHO internal              Regularizing Medical Care, and           Jinyintan Hospital.                                                                  and requests information about
                         documents, Associated Press, PBS Frontline   Strict Reporting Information                                                                                                  cases, referring to recent news
                                                                      System.                                  Interview and correspondence with
                                                                                                               Dr. Zhengli Shi , Nature                       31 Dec 2019 – 10:16 CST/03:16 CET     reports. WHO Headquarters (HQ)
                                      SCIENCE                         Wuhan Municipal Health Commission
                                                                                                                                                                    NEWS REPORT                     acknowledges the request.
                                                                      archived document, WHO internal
                         Private laboratory sequences                                                                                                                                               WHO internal documents, Taiwan Centers
                                                                      documents, The Guardian, Associated                                                First report of cases in Chinese           for Disease Control
                         genome of novel coronavirus                  Press                                                                              media
                         Vision Medicals                                                                                                                 Published: 31 Dec 2019
REAL-TIME EVIDENCE

                         Scientists at private lab report                                                                                                Finance Sina publishes the first
                         genome sequencing results as                                                                                                    report in Chinese media on cases
                         “highly suspicious of SARS”. This is                                                                                            of PUO in Wuhan. Other media
                         shared with the hospital that sent                                                                                              articles are published shortly after
                         the samples.                                                                                                                    in Beijing News, Central News
                         Pre-print                                                                                                                       Agency, Taiwan and South China
                                                                                                                                                         Morning Post (SCMP).
                                                                                                                                                         Finance Sina, WHO internal documents

                           30 Dec 2019                                                                                                                     31 Dec 2019

                                                                                                                                                                                                                  CASES
RETROSPECTIVE EVIDENCE

                                                                                                                                                                                                    55% of cases linked to Huanan
                                                                                                                                                                                                    Seafood Market
                                                                                                                                                                    NEWS REPORT                     Li Q, Guan X, et al.
                                                                                                                                                                                                    Published: 29 Jan 2020
                                                                                                                                                         China CDC visited Huanan
                                                                                                                                                         Seafood Market                             A study of the first laboratory
                                                                                                                                                                                                    confirmed patients in Wuhan
                                                                                                                                                         Published: 2 Nov 2020                      with COVID-19 found a link to the
                                                                                                                                                         China CDC visited Huanan                   Huanan Seafood market in 55 % of
                                                                                                                                                         Seafood Market and took samples            cases with onset of disease before
                                                                                                                                                         before the market was closed.              1 Jan.
                                                                                                                                                         NY Times                                   New England Journal of Medicine
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 8 of 48

                                     12:17 CST/05:17 CET                                                                                                            13:55 CST/06:55 CET                     16:57 CST/09:57 CET
                                    REQUEST                                                                                                                         ACTION                                    REQUEST
                         WHO China Country Office                                                                                                      WHO China takes note of public             WHO HQ requests information
                         receives query from Beijing                                                                                                   bulletin and notifies WPRO                 from WHO WPRO IHR Focal Point
INTERNATIONAL

                         bureau of New York Times                                                                                                      WHO China Country Office                   WHO HQ
                         WHO China Country Office
                                                                                                                                                       WHO China Country Office sees              Having detected ProMED signal,
                         WHO China Country Office                                                                                                      online public bulletin from Wuhan          WHO HQ surveillance team
                         receives a query from the Beijing                                                                                             Municipal Health Commission                requests more information
                         bureau of New York Times                                                                                                      and immediately notifies the WHO           from the WHO WPRO IHR Focal
                         regarding cases in Wuhan.                                                                                                     WPRO IHR Focal Point by email,             Point, who provides a machine
                         WHO internal documents                                                                                                        and specifies no IHR notification          translation of the Wuhan
                                                                                                                                                       has been issued.                           Municipal Health Commission
                                                                                                                                                       WHO staff interview, WHO internal          public bulletin. On the same day,
                                                                                                                                                       documents                                  WHO receives requests for more
                                                                                                                                                                                                  information from the United
                                                                                                                                                              BORDER MEASURES                     Kingdom (UK) and the European
                                                                                                                                                       Taiwan (China) starts screening            Centre for Disease Control
                                                                                                                                                       airline passengers                         (ECDC).
COUNTRY

                                                                                                                                                                                                  WHO internal documents
                                                                                                                                                       Taiwan (China)
                                                                                                                                                       Taiwan (China) starts screening                   BORDER MEASURES
                                                                                                                                                       airline passengers from Wuhan for
                                                                                                                                                       fever.                                     Hong Kong SAR (China) makes
                                                                                                                                                                                                  public health announcement
                                                                                                                                                       Taiwan Today, JAMA
                                                                                                                                                                                                  Hong Kong SAR (China)
                                                                                                                                                                                                  Hong Kong SAR (China) makes
                                                                            12:59 CST/05:59 CET                         13:38 CST/06:38 CET                                                       public health announcement
                                                                                ALERT                                       CASES
                                                                                                                                                                                                  related to cluster of PUO cases in
                                                                                                                                                                                                  Wuhan, and underscores thermal
                                                                  ProMED reports cases in Wuhan              Wuhan releases public bulletin
REAL-TIME EVIDENCE

                                                                                                                                                                                                  imaging systems are in place at
                                                                  ProMED                                     about PUO cases                                                                      borders to screen for possible
                                                                  WHO HQ Epidemic Intelligence               Wuhan Municipal Health Commission                                                    cases.
                                                                  from Open Sources detects                  27 cases of PUO are confirmed                                                        Government of the Hong Kong Special
                                                                  signals of outbreak on Program             by Wuhan Municipal Health                                                            Administrative Region
                                                                  for Monitoring Emerging Diseases           Commission in public bulletin.
                                                                  (ProMED).                                  State Council Information Office of the
                                                                  ProMED, WHO staff interview, WHO           People’s Republic of China
                                                                  internal documents, IHR Review Committee
                                                                  Report
                          31 Dec 2019, cont.
RETROSPECTIVE EVIDENCE
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 9 of 48

                               01 Jan 2020 – 10:35 CST/03:35 CET                                                         16:54 CST/09:54 CET                          01 Jan – 23:05 CET                          10:45 CST/03:45 CET
                                      REQUEST                                                                              REQUEST                                    02 Jan – 06:05 CST                          REQUEST
                                                                                                                                                                      REQUEST
                         WHO WPRO IHR Focal Point                                                              WHO Representative to China                                                          WHO China Country Office
                         requests information                                                                  emails Chinese NHC                        WHO HQ requests WHO WPRO to                contacts WPRO
INTERNATIONAL

                         WHO WPRO                                                                              WHO Representative to China               trigger Article 10 of IHR                  WHO China Country Office
                                                                                                                                                         WHO HQ
                         WHO WPRO IHR Focal Point                                                              WHO Representative to China                                                          Replying to the email from WHO
                         requests information about                                                            emails the Chinese National               In an email, WHO HQ requests               HQ, WHO Country Office repeats
                         the cluster of cases from the                                                         Health Commssion to offer                 WHO WPRO to activate Article               request to WPRO to follow up with
                         Chinese National Focal Point, who                                                     support and repeats the requests          10 of the IHR and issue a formal           the Chinese National Focal Point.
                         acknowledges request one hour                                                         for information.                          request for verification. The              WHO internal documents
                         later. WHO WPRO IHR Focal Point                                                       WHO internal documents                    Incident Management System
                         sends a more detailed request for                                                                                               is activated and an Incident
                         information shortly afterward.                                                                                                  Management Support Team
                                                                              13:05 CST/06:05 CET
                         WHO Timeline, WHO internal documents,                                                              ACTION                       established.                                              ACTION
                         IHR Review Committee Report                            REQUEST
                                                                                                               Huanan Seafood Market closed              WHO internal documents, WHO Timeline       Wuhan Institute of Virology
                                                                    Singapore National Focal Point             Wuhan local health authority                                                         sequences the virus
                                                                    contacts WHO WPRO                                                                                                               Wuhan Institute of Virology
                                                                    Singapore National Focal Point
                                                                                                               The Huanan Seafood Market is                                                         Published: 29 Jan 2020
COUNTRY

                                                                                                               closed, cleaned, and disinfected.
                                                                    The Singapore National Focal               People’s Daily, WHO
                                                                                                                                                                                                    Using next-generation
                                                                    Point contacts WHO WPRO,                                                                                                        sequencing, Wuhan Institute of
                                                                    requesting information about                                                                                                    Virology decodes the sequence
                                                                    the cases in Wuhan. WHO WPRO                                                                                                    of the virus genome, except the
                                                                    replies four hours later.                                                                                                       5’ and 3’ terminus. The Institute
                                   NEWS REPORT                      WHO internal documents                                                                                                          sequences the full genome by 7
                         Media reports WHO is in contact                                                                                                                                            Jan.
                         with Chinese authorities                                                                                                                                                   Interview and correspondence with Dr.
                                                                                                                                                                                                    Zhengli Shi, Wuhan Institute of Virology,
                         Published: 01 Jan 2020                                                                                                                                                     Associated Press
                         South China Morning Post
REAL-TIME EVIDENCE

                         reports that “The World Health
                         Organisation said it is in ongoing
                         contact with authorities in China
                         over an unidentified outbreak of
                         viral pneumonia in the central
                         city of Wuhan, amid concern it
                         may have been transmitted from
                         animals.”
                         South China Morning Post

                           01 Jan 2020                                                                                                                                                                02 Jan

                                                  NEWS REPORT
RETROSPECTIVE EVIDENCE

                         Eight doctors questioned by Wuhan police
                         Published: 01 Feb 2020
                         The doctors questioned include ophthalmologist Li
                         Wenliang, who had sent a private chat message to
                         colleagues about a new SARS-like virus. The incidents
                         were reported on the Chinese newscast “Xinwen
                         Lianbo”, watched by millions. The police followed up
                         with a warning in the Xinhua News Agency and “call
                         on all netizens to not fabricate rumors, not spread or
                         believe rumors.”
                         Washington Post, The Lancet
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 10 of 48

                                     16:00 CST/09:00 CET                          21:00 CST/13:00 CET                     REQUEST                                   03 Jan – 11:15 CST/04:15 CET               16:00 CST/09:00 CET
                                     MEETING                                      MEETING                                                                           REQUEST                                    MEETING
                                                                                                             WHO Representative to China
                         First three-level teleconference          WHO and GOARN teleconference              writes formal letter to China              WHO WPRO contacts China,                   First technical briefing between
                                                                                                                                                        triggering Article 10 of IHR               China and WHO
INTERNATIONAL

                         WHO Incident Manager Support Team         WHO and GOARN                             WHO Representative to China
                                                                                                                                                        WHO WPRO                                   WHO Country Office
                         WHO Incident Manager Support              WHO and WHO Global Outbreak               WHO Representative to China
                         Team holds its first three-level          Alert and Response Network                writes a letter to the National            WHO WPRO requests information              First of three technical briefings
                         teleconference. In a context              (GOARN) hold a teleconference             Health Commission, offering                from the Chinese National Focal            between WHO China Country
                         of increasing requests for                about the outbreak. China CDC             support and urging the                     Point under Article 10 of IHR. The         Office and the Chinese National
                         information from several Member           does not join the call.                   Commission and the China                   Focal Point replies five hours             Health Commission. China gives
                         States, specifics of activating IHR       WHO internal documents, WHO Timeline      IHR National Focal Point to                later and confirms information             WHO information matching
                         to obtain further information from                                                  respond urgently to requests for           issued by Wuhan Municipal Health           the public bulletin, issued one
                         China are discussed.                                                                information.                               Commission.                                hour later. A WHO three-level
                         WHO internal documents                                                              WHO internal documents, WHO Timeline       WHO internal documents, IHR Review         teleconference is held immediately
                                                                                                                                                        Committee Interim Progress Report          following the meeting.
                                     REQUEST                              BORDER MEASURES                                                                                                          WHO internal documents, WHO Timeline
                                                                                                                                                              BORDER MEASURES
                         Countries ask WHO for                     Hong Kong SAR (China) to add
                         information                               “mystery Wuhan pneumonia” to                                                         Thailand implements screening
                                                                   notifiable infectious diseases list                                                  of patients travelling from
COUNTRY

                         Countries
                                                                                                                                                        Wuhan
                                                                   Hong Kong SAR (China)
                         Several Member States, including                                                                                               Government of Thailand
                         Malaysia and the Republic of              Hong Kong SAR (China) announces
                         Korea, request further information        that they will add “mystery Wuhan                                                    Thailand implements measures
                         about the outbreak from WHO.              pneumonia” to a list of notifiable                                                   for screening patients travelling
                         WHO internal documents                    infectious diseases, allowing the                                                    from Wuhan at four airports, and
                                                                   authorities to place patients in                                                     steps up surveillance at public and
                                                                   quarantine.                                                                          private hospitals.
                                                                   South China Morning Post                                                             Euro Surveillance, WHO
REAL-TIME EVIDENCE

                           02 Jan, cont.                                                                                                                  03 Jan
                                                  SCIENCE
                         Sampling at Huanan Seafood Market showed the
RETROSPECTIVE EVIDENCE

                         virus was present in the environment, not in animals
                         Joint WHO-China mission
                         Published: 31 Jul 2020
                         Of 336 samples collected from animals at Huanan
                         Seafood Market, none was positive by polymerase
                         chain reaction (PCR) for SARS-CoV-2. 69 out of 842
                         environmental samples were positive by PCR for SARS-
                         CoV-2. Three genetic sequences of SARS-CoV-2 from
                         environmental samples at Huanan Seafood Market
                         eventually were published on the Global Initiative on
                         Sharing All Influenza Data.
                         WHO-Convened Global Study of the Origins of SARS-CoV-2
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 11 of 48

                                                                           04 Jan – 11:22 CST/04:22 CET                 13:27 CST/06:27 CET                           04 Jan – 19:13 CET                      PUBLICATION
                                                                               REQUEST                               ANNOUNCEMENT                                     05 Jan – 02:13 CST
                                                                                                                                                                ANNOUNCEMENT                       WHO reports 44 cases in Disease
                                                                  WHO WPRO requests more                     WHO WPRO tweets China has                                                             Outbreak News
                                                                  information; advises IHR state             reported a cluster of PUO cases            WHO HQ tweets China has
INTERNATIONAL

                                                                                                                                                                                                   WHO
                                                                  parties will be notified                   WHO WPRO
                                                                                                                                                        reported a cluster of pneumonia
                                                                  WHO WPRO
                                                                                                                                                        cases                                      Based on Chinese data, WHO
                                                                                                             “#China has reported to WHO                WHO HQ                                     reports the 44 cases identified
                                                                  WHO WPRO IHR Focal Point                   regarding a cluster of pneumonia                                                      by 3 Jan. in Disease Outbreak
                                                                  acknowledges the information               cases in Wuhan, Hubei Province.            “#China has reported to WHO                News, and states that there is “no
                                                                  received under Article 10 of IHR           The Govt has also met with our             a cluster of #pneumonia cases              evidence of significant human-to-
                                                                  and requests more information              country office, and updated @              —with no deaths— in Wuhan,                 human transmission”.
                                                                  from the Chinese National Focal            WHO on the situation. Govt actions         Hubei Province. Investigations are
                                                                                                                                                                                                   WHO Disease Outbreak News
                                                                  Point. WHO WPRO advises that               to control the incident have been          underway to identify the cause of
                                                                  IHR state parties will be notified.        instituted and investigations into         this illness.”
                                                                  The Focal Point replies one hour           the cause are ongoing.”                    WHO Twitter
                                                                  later.                                     WHO WPRO Twitter
                                                                  WHO internal documents
COUNTRY

                                                                                                                                                                                                            ANNOUNCEMENT
                                                                                                                                                                                                   Wuhan issues third public
                                                                                                                                                                                                   bulletin confirming 59 PUO cases
                                                                                                                                                                                                   Wuhan Municipal Health Commission
                                   17:00 CST/10:00 CET                                                                                                                                             Published: 5 Jan 2020
                                      CASES                                                                                                                                                        Wuhan Municipal Health
                                                                                                                                                                                                   Commission issues a third bulletin,
                         Wuhan issues second public
REAL-TIME EVIDENCE

                         bulletin confirming 44 PUO cases                                                                                                                                          reporting 59 cases, seven in
                                                                                                                                                                                                   serious condition, no deaths. The
                         Wuhan Municipal Health Commission                                                                                                                                         bulletin reports that preliminary
                         Wuhan Municipal Health                                                                                                                                                    studies have not shown any sign
                         Commission issues second public                                                                                                                                           of h-to-h transmission, and that
                         bulletin, confirming 44 PUO cases,                                                                                                                                        no health care workers have been
                         of which 11 are severely ill and 33                                                                                                                                       infected.
                         are in stable condition.                                                                                                                                                  Wuhan Municipal Health Commission,
                         WHO                                                                                                                                                                       Center for Infectious Disease Research and
                                                                                                                                                                                                   Policy

                          03 Jan, cont.                             04 Jan                                                                                                                           05 Jan
RETROSPECTIVE EVIDENCE

                                                                                                                                                                                                               01 Jan-09 Jan 2020
                                                                                                                                                                                                                 SCIENCE
                                                                                                                                                                                                   Re estimated at 3.54 in China
                                                                                                                                                                                                   Hao X, Chen S, et al.
                                                                                                                                                                                                   Published: 16 Jul 2020
                                                                                                                                                                                                   Re estimated at 3.54 (3.4-3.67) in
                                                                                                                                                                                                   China for the period 1 Jan.-9 Jan.,
                                                                                                                                                                                                   suggesting rapid spread.
                                                                                                                                                                                                   Nature
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 12 of 48

                                        ALERT                                                                                                                                                                  NEWS BRIEFING
                         WHO alerts Member States via                                                                                                                                                 WHO briefs UN journalists
                         IHR                                                                                                                                                                          WHO
INTERNATIONAL

                         WHO
                                                                                                                                                                                                      WHO participates in a regular UN
                         WHO shares information about                                                                                                                                                 Geneva press briefing to give an
                         the cluster of cases through the                                                                                                                                             update on the cluster of cases.
                         IHR Event Information System                                                                                                                                                 WHO internal documents
                         accessible to all WHO Members
                         States and advises countries to
                         take precautions to reduce the risk
                         of acute respiratory infections.
                         WHO Timeline, IHR Review Committee
                         Report
COUNTRY

                                                                                                                                                                                                                   SCIENCE
                                                                                                                                                                                                      China CDC isolates the virus
REAL-TIME EVIDENCE

                                                                                                                                                                                                      China CDC
                                                                                                                                                                                                      The National Institute for Viral
                                                                                                                                                                                                      Disease Control and Prevention
                                                                                                                                                                                                      of the China CDC succeeds in
                                                                                                                                                                                                      isolating the first novel coronavirus
                                                                                                                                                                                                      strain.
                                                                                                                                                                                                      Interview: Dr. George Gao 25 Nov. 20, State
                                                                                                                                                                                                      Council Information Office of the People’s
                                                                                                                                                                                                      Republic of China

                           05 Jan, cont.                                                                          06 Jan                                                                                07 Jan
                                                                                   SCIENCE
                                                                     Shanghai group submit genome
RETROSPECTIVE EVIDENCE

                                       SCIENCE                       to GenBank
                                                                                                                          NEWS REPORT                                NEWS REPORT
                         Wuhan Institute of Virology                 Zhang YZ, Wu F et al.
                         isolates virus                              Published: 11 Jan 2020                     China CDC raised emergency                 WHO was concerned that not
                                                                                                                level                                      enough data was shared                               NEWS REPORT
                         Wuhan Institute of Virology                 A consortium of researchers from                                                                                                 Chinese top leaders discussed
                         Published: 29 Jan 2020                      the Shanghai Public Health Center          Published: 02 Jun 2020                     Published: 02 Jun 2020
                                                                                                                                                                                                      the outbreak
                         The Wuhan Institute of Virology             sequenced the novel coronavirus            China CDC raised emergency level           “We’re currently at the stage
                                                                     and uploaded the sequence to               to second highest. Staff isolated          where they’re giving it to us 15           Published: 09 Jun 2020
                         confirmed the isolation of
                         the novel coronavirus with                  GenBank on 5 Jan. The submitted            the virus, drafted lab testing             minutes before it appears on               Chinese top leaders, including the
                         immunofluroscence and                       sequence was subsequently                  guidelines, and designed test kits.        CCTV (China Central Television),”          President, discussed the outbreak
                         quantitative PCR assays.                    published on 11 Jan. and updated           The agency has no authority to             said WHO Representative to                 at a meeting of the Politburo
                         Interview and correspondence with Dr.       on 14 Jan. and 17 Jan.                     issue public warnings.                     China.                                     Standing Committee.
                         Zhengli Shi, Wuhan Institute of Virology    GenBank submission, Nature                 Associated Press                           Associated Press                           BBC
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 13 of 48

                                                                                   REQUEST                                   09–12 Jan 2020                              ANNOUNCEMENT                          PUBLICATION
                                                                                                                      INTERIM GUIDANCE
                                                                      WHO requests detailed case                                                             WHO announces China has                Risk for introduction to the EU
                                                                      information from China                   WHO issues a series of guidance               identified new coronavirus             considered low
                                                                                                               tools
INTERNATIONAL

                                                                      WHO                                                                                    WHO China                              ECDC
                                                                                                               WHO HQ                                                                               Published: 9 Jan 2020
                                                                      WHO writes to the China IHR              Published: 9 Jan 2020                         ”Chinese authorities have made
                                                                      National Focal Point and requests                                                      a preliminary determination of         Three EU airports have direct
                                                                      urgent confirmation of the               WHO issues a series of guidance               a novel (or new) coronavirus,          flights to Wuhan. As there is no
                                                                      discovery of the novel coronavirus,      tools related to national capacities          identified in a hospitalized person    indication of h-to-h transmission
                                                                      and detailed information on its          (9 Jan.), disease commodities (9              with pneumonia in Wuhan.”              and no cases detected outside
                                                                      etiology, clinical presentation,         Jan.), infection prevention and                                                      Wuhan, the European Centre for
                                                                                                                                                             WHO Statement, IHR Review Committee
                                                                      additional laboratory findings,          control (10 Jan.), laboratory testing         Report                                 Disease Prevention and Control
                                                                      including sequencing, and the            (10 Jan.), risk communication and                                                    (ECDC) considers the likelihood
                                                                      containment measures put in              community engagement (10 Jan.),                                                      of introduction to the European
                                                                      place.                                   surveillance case definitions (11                                                    Union (EU) to be low, but it can’t be
                                                                                                               Jan.), and clinical management (12                                                   excluded.
                                                                      WHO internal documents
                                                                                                               Jan.).                                                                               ECDC
                                                                                                               WHO guidance
COUNTRY

                                                                                NEWS REPORT
                                                                      Chinese scientists identify new
                                                                      coronavirus
REAL-TIME EVIDENCE

                                                                      Published: 08 Jan 2020
                                                                      Ahead of anyone, the Wall Street
                                                                      Journal reports that Chinese
                                                                      scientists investigating a mystery
                                                                      illness that has sickened dozens in
                                                                      central China have discovered a
                                                                      new strain of coronavirus.
                                                                      Wall Street Journal

                           07 Jan, cont.                                08 Jan                                   09 Jan

                                                                                                                                                                          CASES
                                                                                                                              CASES
RETROSPECTIVE EVIDENCE

                                                                                                                                                             First death occurs
                                    NEWS REPORT                                                                Unobserved cases due to h-to-h                Wuhan Municipal Health Commission
                                                                                                               transmission in China estimated               Published: 11 Jan 2020
                         Mayor of Wuhan reported to the                                                        to be 52,381
                         People’s Congress of Wuhan                                                                                                          The first pandemic-related death
                                                                                                               Mizumoto K, Kagaya K, and Chowell G.          occurred on 9 Jan. — a 61-year-
                         Published: 01 Feb 2020, updated 7 Feb 2020                                            Published: 2 Jun 2020
                                                                                                                                                             old male with liver disease who
                         In his address to the People’s                                                        Unobserved cases due to human-                frequented the Huanan Seafood
                         Congress of Wuhan, the Mayor                                                          to-human transmission were                    Market. The immediate cause
                         of Wuhan focused on new                                                               estimated to be 52,381 from 8 Dec.            of death was respiratory and
                         infrastructure, didn’t mention the                                                    2019 to 9 Jan. 2020. R0 estimated             circulatory failure.
                         outbreak.                                                                             to 2.37.                                      Wuhan Municipal Health Commission,
                         NY Times                                                                              International Journal of Infectious Disease   Bloomberg
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 14 of 48

                                     MEETING                                   REQUEST                                    MEETING                                     ADVICE                                     MEETING
                         WHO convenes global experts              WHO requests PCR primer and                First meeting of the STAG-IH               WHO recommends no specific                   GCM for R&D Preparedness
                         WHO                                      genome sequence                            WHO STAG-IH                                health measures for travellers               and Scientific Advisory Group
                                                                                                                                                                                                     of the R&D Blueprint hold first
INTERNATIONAL

                         WHO begins convening expert              The Executive Director of the WHO          WHO Strategic and Technical                WHO HQ
                                                                                                                                                                                                     teleconference
                                                                  Health Emergencies Programme                                                          Published: 10 Jan 2020
                         panels including clinicians and                                                     Advisory Group for Infectious
                                                                  writes to China’s National IHR                                                        WHO publishes advice for                     WHO
                         experts on diagnostics and                                                          Hazards (STAG-IH) discusses the
                         laboratory guidance.                     Focal Point requesting China share         situation in Wuhan and provides a          international travel and trade,              The Global Coordination
                         WHO internal documents, WHO Timeline
                                                                  the diagnostic PCR primer and full         risk analysis. WHO convenes R&D            recommends caution while                     Mechanism for R&D Preparedness
                                                                  genome sequence.                           experts as well.                           traveling in or from Wuhan.                  and the Scientific Advisory Group
                                                                  IHR Review Committee Report                WHO STAG-IH
                                                                                                                                                        Advises against travel or trade              of the R&D Blueprint hold their first
                                                                                                                                                        restrictions on China based on               teleconferences on the novel
                                                                                                                                                        currently available information.             coronavirus.
                                                                                                                                                        WHO HQ                                       GCM teleconference meeting minutes,
                                                                                                                    BORDER MEASURES                                                                  WHO timeline
                                                                                                             Areas impose international travel
                                                                                                             screening and/or controls
                                                                                                             Various countries
COUNTRY

                                                                                                             By 10 Jan., Hong Kong SAR (China),
                                                                                                             Japan, Macao SAR (China), Taiwan
                                                                                                             (China), Singapore, Turkmenistan,
                                                                                                             Viet Nam, Malaysia, and the
                                                                                                             Philippines all implement some
                                                                                                             border measures.
                                                                                                             Our World in Data, Viet Nam, Malaysia,
                                                                                                             Philippines
REAL-TIME EVIDENCE

                          09 Jan, cont.                                                                        10 Jan
                                                                                                                                                                      SCIENCE
                                                                                                                                                        PCR diagnostic reagent
RETROSPECTIVE EVIDENCE

                                                                                                                                                        developed and tested
                                                                                                                          SCIENCE                       China CDC
                                                                                                                                                        Published: 29 Jan 2020
                                                                                                             R0 initially estimated at 2.2 in
                                                                                                             China                                      PCR diagnostic reagent was
                                                                                                                                                        developed and tested in China,
                                                                                                             Li Q, Guan X, et al.
                                                                                                             Published: 29 Jan 2020                     allowing for accurate identification
                                                                                                                                                        and diagnosis of SARS-CoV-2
                                                                                                             Initial estimates of transmission          infection. Reagent was distributed
                                                                                                             dynamics in Wuhan indicated R0             to Wuhan the next day.
                                                                                                             to be 2.2 (1.4-3.9) and a doubling
                                                                                                                                                        New England Journal of Medicine, State
                                                                                                             time of 7.4 days.                          Council Information Office of the People’s
                                                                                                             New England Journal of Medicine            Republic of China
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 15 of 48

                                      MEETING                                                                            PUBLICATION                                                                              ACTION
                         Second technical briefing                                                            WHO reports 41 cases and one                                                          Scientists publish first protocol
                         between China and WHO                                                                death                                                                                 for RT-PCR test
INTERNATIONAL

                         WHO                                                                                  WHO                                                                                   WHO
                                                                                                              Published: 12 Jan 2020                                                                Published: 13 Jan 2020
                         Second of three technical briefings
                         between WHO China Country                                                            WHO issues a Disease Outbreak                                                         WHO publishes the first protocol
                         Office and the Chinese National                                                      News update, based on                                                                 for a reverse transcription
                         Health Commission. The list of                                                       information from China’s National                                                     polymerase chain reaction (RT-
                         cases shared confirm there are                                                       Health Commission. It reads “WHO                                                      PCR) assay for detection of the
                         cases not linked to the Huanan                                                       is reassured of the quality of the                                                    novel coronavirus, developed by
                         Seafood Market.                                                                      ongoing investigations and the                                                        partner laboratories.
                         WHO internal documents                                                               response measures implemented                                                         Charité Virology
                                                                                                              in Wuhan..”
                                                                                                              WHO Disease Outbreak News
COUNTRY

                                       CASES
                         Wuhan reports 41 cases using
                         updated case definition and the
                         first death
                         Wuhan Municipal Health Commission                      SCIENCE
                         The Wuhan Municipal Health                Research consortium publishes
                         Commission publishes its fourth           draft genome
                         bulletin coinciding with the second       Chinese researchers
                         technical briefing between China                                                                                                                                                          CASES
                         and WHO. The total number of              A consortium of researchers led                                                                                                  Thailand: First reported case
                         cases is revised down to 41, based        by Professor Yong-Zhen Zhang
REAL-TIME EVIDENCE

                         on a new case definition. The first       from the Shanghai Public Health                                                                                                  First reported case in Thailand,
                         death is reported. The bulletin           Clinical Center publishes a draft                                                                                                imported from Wuhan (see
                         also states that no new cases have        genome of the newly discovered                                                                                                   retrospective entry on 12 Jan.).
                         been reported since 3 Jan., and           coronavirus suspected of causing                                                                                                 WHO Dashboard and Situation Reports
                         “no clear evidence of human-to-           the outbreak on GenBank.
                         human transmission” has been              The genome was submitted
                         found.                                    to GenBank on 5 Jan. (see
                                                                   retrospective entry on 5 Jan.).
                         Wuhan Municipal Health Commission,
                         WHO internal documents                    Science Magazine, Post by Edward
                                                                   Holmes, Caixin, Twitter
                           11 Jan                                                                               12 Jan                                                                                13 Jan
                                                                                                                             CASES
                                                                                                              First case outside China detected
RETROSPECTIVE EVIDENCE

                                                                                                              in Thailand
                                                                                                              Okada P, Buathong R, et al.
                                    NEWS REPORT                                                               Published: 27 Feb 2020

                         Crowds gather at Wuhan events                                                        Air traveler who arrived
                                                                                                              from Wuhan on 8 Jan. was
                         Published: 01 Feb 2020
                                                                                                              identified through airport                               CASES
                         Holiday shopping fairs and other                                                     thermosurveillance and was
                         events continued. Without clear                                                                                                 China: 1,723 estimated cases
                                                                                                              diagnosed in hospital on 12 Jan.
                         government warnings, people                                                          Virus was genetically identical to         Estimated cases of COVID-19 were
                         kept travelling within and beyond                                                    30 Dec. strains in Wuhan.                  1,723 based on data looking at
                         China.                                                                               Euro Surveillance, IHR Review Committee    probability of exportation.
                         Washington Post                                                                      Report                                     Imperial College
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 16 of 48

                                    MEETING                                     ANNOUNCEMENT                                                                        ACTION
                         WHO teleconference on                    WHO seemingly gives conflicting                                                      WHO reaches agreement with
                         diagnostics strategy                     information on h-to-h                                                                China to visit Wuhan
                                                                  transmission
INTERNATIONAL

                         WHO                                                                                                                           WHO
                                                                  WHO HQ
                         WHO holds a teleconference with                                                                                               WHO China Country Office
                         the diagnostics and laboratories         WHO scientist in press briefing:                                                     reaches agreement with China to
                         global expert network to discuss         “From the information that we                                                        visit Wuhan. The visit takes place
                         a diagnostics strategy. The              have it is possible that there                                                       from 20-21 Jan.
                         teleconference includes members          is limited human-to-human                                                            WHO internal documents
                         from WHO Global Laboratories             transmission”. WHO tweet:
                         Alliance for the Diagnosis of High       “Preliminary investigations
                         Threat Pathogens.                        conducted by the Chinese
                         WHO internal documents                   authorities have no clear evidence
                                                                  of human-to-human transmission
                                                                  of the novel coronavirus (2019-
                                                                  nCoV) identified in Wuhan, China”.
                                                                  WHO Twitter, Reuters, IHR Review
                                                                  Committee Report
COUNTRY

                                                                                SCIENCE                                                                                                                      NEWS REPORT
                                                                  Travel data predict cities most                                                                    CASES                        Japan and Thailand report
                                                                  connected to Wuhan                                                                   Japan: First reported case
                                                                                                                                                                                                  coronavirus cases
                                                                  Bogoch II, Watts A, et al.                                                                                                      Published: 15 Jan 2020, updated 21 Jan 2020
REAL-TIME EVIDENCE

                                                                  Published: 14 Jan 2020                                                               First reported case in Japan,
                                                                                                                                                       imported from Wuhan.                       Japan’s Health Ministry says
                                                                  Travel data is used to produce a                                                                                                patient had not visited any
                                                                                                                                                       WHO Dashboard and Situation Reports
                                                                  list of top 20 passenger destination                                                                                            seafood market in China. “It is
                                                                  cities from Wuhan, with the                                                                                                     possible that the patient had close
                                                                  majority being in Asia. Infectious                                                                                              contact with an unknown patient
                                                                  Disease Vulnerability Index (IDVI)                                                                                              with lung inflammation while in
                                                                  scores are calculated for each                                                                                                  China.”
                                                                  destination.                                                                                                                    NY Times
                                                                  Journal of Travel Medicine

                          13 Jan, cont.                             14 Jan                                                                               15 Jan
RETROSPECTIVE EVIDENCE

                                                                                          NEWS REPORT
                                                                 China’s top health official ordered the country to
                                                                 prepare for a pandemic
                                                                 China CDC
                                                                 Published: 02 Jun 2020
                                                                 In a confidential teleconference, China’s top health
                                                                 official ordered the country to prepare for a pandemic.
                                                                 China CDC internally declared level one emergency.
                                                                 Chinese officials still said that the chance of sustained
                                                                 h-to-h transmission was low.
                                                                 Associated Press, PBS Frontline
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 17 of 48

                                                                                                                               ALERT                                   MEETING                               ANNOUNCEMENT
                                                                                                               PAHO issues Epidemiological                Third technical briefing between           WHO WPRO: no clear evidence of
                                                                                                               Alert                                      WHO and China                              h-to-h transmission
INTERNATIONAL

                                                                                                               PAHO                                       WHO                                        WHO WPRO
                                                                                                                                                                                                     Published: 16 Jan 2020
                                                                                                               The Pan American Health                    The third in-person technical
                                                                                                               Organization (PAHO) issues an              briefing between WHO China                 WHO WPRO tweets that
                                                                                                               Epidemiological Alert about the            Country Office and Chinese health          “According to the latest info we
                                                                                                               novel coronavirus recommending             authorities occurs. China National         have, there is no clear evidence
                                                                                                               Member States ensure health                Health Commission provides the             of sustained human-to-human
                                                                                                               workers have access to                     first “line list” of cases.                transmission and there are no
                                                                                                               information, are familiar with             WHO internal documents                     infections reported among health
                                                                                                               principles and procedures, and                                                        care workers.”
                                                                                                               trained to ask about patient travel                                                   WHO WPRO Twitter
                                                                                                               history. Screening at entry points
                                                                                                               and restrictions on travel and
                                                                                                               trade are not recommended.
                                                                                                               PAHO
COUNTRY

                                       CASES
                         First US COVID-19 patient seeks
                         care
REAL-TIME EVIDENCE

                         US CDC
                         Published: 21 Jan 2020
                         A man from Seattle seeking care
                         for illness is later confirmed on 21
                         Jan. as the first US COVID-19 case.
                         US Centers for Disease Control and
                         Prevention

                           15 Jan, cont.                              mid Jan                                    16 Jan
RETROSPECTIVE EVIDENCE

                                                                                     CASES
                                                                    Virus potentially circulated in
                                                                    Italy                                                    SCIENCE
                                                                                                                                                                      10 Jan–22 Jan 2020
                                                                    Alteri C, Cento V, et al.                  Rt estimated at 2.35 in China
                                                                                                                                                                        SCIENCE
                                                                    Published: 19 Jan 2021                     Kucharski AJ, Russel TW, et al.
                                                                    Analysis of early Italy cases              Published: 11 Mar 2020                     Re estimated at 3.32 in China
                                                                    suggests the virus was already             Rt estimated at 2.35 in China one          Hao X, Chen S, et al.
                                                                    circulating in the community prior         week before travel restrictions            Published: 16 Jul 2020
                                                                    to first confirmed case, as early as       were put in place on 23 Jan. It fell       Re estimated at 3.32 (3.19-3.44) in
                                                                    mid-January.                               to 1.05 one week later.                    China for the period 10 Jan.-22 Jan.
                                                                    Nature                                     The Lancet Infectious Diseases             Nature
ANNOUNCEMENT
                                           COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 18 of 48
                                                                                                             WHO WPRO tweets: Evidence of
                                     MEETING                                                                 limited h-to-h transmission                             MEETING                                   20 Jan–21 Jan 2020
                                                                                                             WHO WPRO                                                                                            ACTION
                         First meeting of analysis and                                                       Published: 19 Jan 2020
                                                                                                                                                        Second meeting of the STAG-IH
                         modelling group                                                                                                                WHO STAG-IH
                                                                                                                                                                                                    WHO China Country Office visits
                                                                                                             “According to the latest info                                                          Wuhan
INTERNATIONAL

                         WHO
                                                                                                             received and WHO analysis, there           STAG-IH experts discuss the                 WHO China Country Office
                         WHO holds the first meeting of the                                                  is evidence of limited human-to-           epidemiological situation, clinical
                         analysis and modelling working                                                      human transmission... While there          features, the development of                WHO China Country Office has
                         group for the novel coronavirus.                                                    is currently no clear evidence             a technical package (interim                its first mission to Wuhan since
                         WHO internal documents, WHO timeline                                                of sustained human-to-human                guidance), research and                     the outbreak. The team visits the
                                                                                                             transmission, we do not have               development (R&D) Blueprint                 Wuhan Tianhe Airport, Zhongnan
                                                                                                             enough evidence to evaluate the            landscape analyses (diagnostics,            hospital and the Hubei provincial
                                                                                                             full extent of human-to-human              vaccines, and therapeutics). The            CDC, including the Biosafety Level
                                                                                                             transmission.”                             R&D Blueprint Scientific Advisory           3 laboratory handling coronavirus
                                                                                                                                                        Group and Global Coordination               specimens.
                                                                              18 Jan–19 Jan 2020             WHO WPRO Twitter
                                                                                                                                                        Mechanisms also meet that day.              WHO staff interview, WHO Timeline, IHR
                                                                                ACTION                                 NEWS REPORT                                                                  Review Committee Report
                                                                                                                                                        WHO STAG-IH
                                                                  Prof. Nanshan Zhong leads                  China announces intention
                                                                  mission to Wuhan                           to step up efforts to contain                                                                    NEWS REPORT
                                                                  The Chinese National Health                outbreak                                            NEWS BRIEFING                      President Xi Jinping says China
COUNTRY

                                                                  Commission sends a mission to              Ahead of the Lunar New                     China medical expert confirms               will curb outbreak
                                                                  Wuhan, led by Prof. Nanshan                Year, China’s National Health              h-to-h transmission                         “People’s lives and health should
                                                                  Zhong.                                     Commission says it will step up            Prof. Nanshan Zhong                         be given top priority and the
                                                                  National Health Commission                 prevention and control measures.           National Health Commission                  spread of the outbreak should be
                                                                                                             Wuhan’s deputy mayor says he will          delegation led by Prof. Nanshan             resolutely curbed,” state media
                                                                                                             strengthen oversight of big events         Zhong announces on state                    quote President Xi Jinping.
                                                                                                             and reduce public gatherings.              TV cases involving h-to-h                   Reuters
                                                                                                             Reuters                                    transmission, that medical staff
                                   NEWS REPORT                                                                                                                                                                    CASES
                                                                                                                           CASES                        have been infected, and that
                         US reports it will screen                                                                                                      there are two cases in Guangdong            Republic of Korea: First reported
                         passengers on Wuhan flights                                                         China reaches 198 reported cases                                                       cases
REAL-TIME EVIDENCE

                                                                                                                                                        Province. The delegation suggests
                         The US will begin screening                                                         Wuhan Municipal Health                     people don’t travel in and out of           First reported cases in the
                         efforts at three US airports to                                                     Commission announces 198 cases             Wuhan.                                      Republic of Korea, imported from
                         detect travelers from Wuhan who                                                     of nCoV-2019 and four deaths,              National Health Commission, Reuters,        Wuhan.
                         might have symptoms of a new                                                        as of 19 Jan. In Wuhan Jinyintan           Chinese Ministry of Education, IHR Review
                                                                                                                                                                                                    WHO Dashboard and Situation Reports
                         respiratory virus. Many countries                                                   Hospital, a doctor reports 150             Committee Report
                         follow suit in the days to come.                                                    cases based on a clinical case
                         Reuters                                                                             definition.
                                                                                                             Wuhan Municipal Health Commission,
                                                                                                             Report: Prof. Nanshan Zhong 10 Nov 2020

                           17 Jan                                    18 Jan                                    19 Jan                                     20 Jan
RETROSPECTIVE EVIDENCE
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 19 of 48

                                                                                                                            ANNOUNCEMENT
                                                                                                               Clear evidence of h-to-h
                                                                                                               transmission according to WHO
                                                                                                               WPRO tweet
INTERNATIONAL

                                                                                                               WHO WPRO
                                                                                                               Published: 21 Jan 2020
                                                                                                               “It is now very clear from the
                                                                                                               latest information that there is
                                                                                                               at least some human-to-human
                                                                                                               transmission of #nCoV2019.
                                                                                                               Infections among health care
                                                                                                               workers strengthen the evidence
                                                                                                               for this.”
                                   CONTACT TRACING                          SCHOOL CLOSURES                    WHO WPRO Tweet
                         Singapore implements                        China closes schools
                         comprehensive contact tracing               Ministry of Education
                         Government of Singapore
                                                                     China begins school closures.
COUNTRY

                         Singapore is the first country              EdSurge
                         other than China in the Western
                         Pacific Region (WPR) to implement
                         comprehensive contact tracing.
                         Our World in Data

                                    NEWS REPORT                                                                          NEWS REPORT                                    CASES                                      CASES
                         Risk to UK very low                                                                   WHO expects further spread        China: Cases spread to 14                           Multiple medical staff in Wuhan
                                                                                                                                                 provinces                                           infected
REAL-TIME EVIDENCE

                         “Based on the available evidence,                                                     “More cases should be expected in
                         the current risk to the UK is very                                                    other parts of China and possibly 309 cases are reported in China,                    Wuhan Municipal Health Commission
                         low,” says Dr. Nick Phin, deputy                                                      other countries in the coming     spread across 14 provinces/                         Wuhan Municipal Health
                         director of the National Infection                                                    days,” says WHO spokesman Tarik municipalities.                                       Commission reports 15 medical
                         Service (NIS). “We are... keeping                                                     Jasarevic.                        WHO Situation Report                                staff confirmed as cases of
                         the situation under constant                                                          Reuters                                                                               pneumonia caused by new
                         review.”                                                                                                                                                                    coronavirus infection in Wuhan.
                         Reuters                                                                                                                                                                     China Daily

                           20 Jan, cont.                                                                         21 Jan
RETROSPECTIVE EVIDENCE
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 20 of 48

                                                                                                                                                                    22 Jan–23 Jan 2020                          22 Jan–23 Jan 2020
                                                                                                                                                                      MEETING                                     MEETING
                                                                                                                                                          WHO’s IHR Emergency                       WHO’s IHR Emergency
                                                                                                                                                          Committee starts first meeting            Committee ends meeting.
INTERNATIONAL

                                                                                                                                                          WHO                                       No PHEIC declared
                                                                                                                                                                                                    WHO
                                                                                                                                                          WHO’s IHR Emergency Committee
                                                                                                                                                          starts its first COVID-19-related         The IHR Emergency Committee
                                                                                                                                                          meeting. On this day, WHO                 does not recommend the outbreak
                                                                                                                                                          reports 314 cases, with 310 cases         a Public Health Emergency of
                                                                                                                                                          in 14 provinces and municipalities        International Concern (PHEIC), but
                                                                                                                                                          within China, and four confirmed          urges countries to be prepared for
                                                                                                                                                          cases in three countries outside          additional spread. The Committee
                                                                                                                                                          China, all with direct connections        agrees to meet again within 10
                                CONTACT TRACING                             CONTACT TRACING                              MASK USAGE                       to Wuhan.                                 days. By this day, cases have
                         Germany implements                          Costa Rica introduces                     France recommends mask                     IHR Committe Statement, WHO Situation     increased to 581, with 571 cases in
                         comprehensive contact tracing               comprehensive contact tracing             wearing                                    Report                                    24 provinces and municipalities
                                                                                                                                                                                                    within China, and 10 cases in
                         Government of Germany                       Government of Costa Rica                  Government of France
                                                                                                                                                                                                    four countries outside China, all
COUNTRY

                         Germany is the first country in the         Contact tracing for all COVID-19          France recommends mask                                                               connected to Wuhan.
                         WHO European Region (EUR) to                cases is introduced in Costa              wearing, the first country in EUR                                                    IHR Committe Statement, WHO Situation
                         implement comprehensive contact             Rica, the first country in the WHO        to do so.                                                                            Report
                         tracing.                                    Region of the Americas (AMR) to           Our World in Data
                         Our World in Data                           do so.
                                                                     Our World in Data                                                                                                                       LOCKDOWN/
                                   NEWS REPORT                                                                                                                                                         STAY-AT-HOME MEASURES

                         China reports 15 samples from                                                                                                                                              First lockdown in Wuhan
                         Huanan Seafood Market contain                                                                                                                                              Chinese Centre for Disease Control and
                         virus                                                                                                                                                                      Prevention
                         Published: 22 Jan 2020                                                                                                                                                     Lockdown initiated in Wuhan.
REAL-TIME EVIDENCE

                         It is unclear whether the virus                                                                                                                                            China CDC
                         is shed by humans or animals.                                                                                                                                              Cases per million
                         Chinese scientists publish the                                                                                                                                             China: 0.45
                         genetic sequence from some
                         samples, but the information                                                                                                                                                               CASES
                         provides no clues to the virus’                                                                                                                                            Singapore: First reported case
                         origins.
                         China CDC, NY Times                                                                                                                                                        First reported case in Singapore.
                                                                                                                                                                                                    WHO Statement

                           22 Jan                                                                                                                                                                      23 Jan
RETROSPECTIVE EVIDENCE

                                                                                                                                                                                                                    CASES
                                                                                                                                                                                                    China: 18,700 estimated cases,
                                                                                                                                                                                                    R0 at 5.7
                                                                                                                                                                                                    Sanche S, Lin Y, et al.
                                                                                                                                                                                                    Published: July 2020
                                                                                                                                                                                                    18,700 estimated cases in China.
                                                                                                                                                                                                    Transmission dynamics of early
                                                                                                                                                                                                    Wuhan spread were possibly as
                                                                                                                                                                                                    high as R0 5.7, with a doubling
                                                                                                                                                                                                    time of 2.3-3.3 days.
                                                                                                                                                                                                    Emerging Infectious Diseases
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 21 of 48

                                                                                                                         PUBLICATION                                    ADVICE                                         MEETING
                                                                                                               Molecular assays to diagnose               WHO recommends no restrictions                 Informal consultation on
                                                                                                               COVID-19                                   on international traffic                       therapeutics
INTERNATIONAL

                                                                                                               WHO HQ                                     WHO                                            WHO HQ
                                                                                                               Published: 24 Jan 2020                     Published: 24 Jan 2020                         Published: 24 Jan 2020
                                                                                                               WHO publishes an overview                  WHO updates advice                             WHO R&D Blueprint initiates
                                                                                                               of assays that have applied to             for international traffic,                     an informal consultation on
                                                                                                               Foundation for Innovative New              recommending against                           prioritization of candidate
                                                                                                               Diagnostics for participation in its       restrictions, but supporting airport           therapeutic agents for use in novel
                                                                                                               assay assessment work.                     exit screening and suggesting                  coronavirus 2019 infection.
                                                                                                               WHO HQ                                     possible entry screening.                      WHO HQ
                                                                                                                                                          WHO

                               BORDER MEASURES                                                                        CONTACT TRACING
                         21 countries/areas have                                                               Nepal introduces comprehensive
                         international screening in place                                                      contact tracing
                         National governments                                                                  Government of Nepal
COUNTRY

                         Officials across the globe from                                                       Contact tracing for all cases of
                         Africa to South America begin                                                         COVID-19 introduced in Nepal, the
                         containment measures.                                                                 first country in SEAR to do so.
                         Our World in Data                                                                     Our World in Data                                            Jan 24: Key scientific articles published in the Lancet
                                                                                                                                                                       SCIENCE                                          SCIENCE
                                                                                                                                                          Clinical characteristics, severity,            Family cluster suggests h-to-h
                                                                                                                                                          and mortality published                        transmission and asymptomatic
                                                                                                                                                          Huang C, Wang Y, et al.                        infection
                                                                                                                                                                                                         Chan JF-W, Yuan S, et al.
                                                                                                                                                          Common symptoms: cough,
                                                                                                                                                          fever, short breath, and myalgias.             Study describes a family cluster
                                                                                                                                                          Approximately 17-42% developed                 where h-to-h transmission
REAL-TIME EVIDENCE

                                                                                                                                                          acute respiratory distress                     and asymptomatic infection is
                                                                                                                                                          syndrome, 23-32% admitted to                   documented.
                                                                                                                                                          intensive care units, and 11-15%               The Lancet
                                                                                                                                                          died. Of the 41 first laboratory-
                                                                                                                                                          confirmed patients 27/41(66%)
                                                                                                                                                          were found to be exposed to
                                                                                                                                                          Huanan Seafood Market.
                                                                                                                                                          The Lancet

                           23 Jan, cont.                                                                         24 Jan

                                                                                                                                                          “Because of the pandemic potential
RETROSPECTIVE EVIDENCE

                                                                                                                                                          of 2019-nCoV, careful surveillance
                                       CASES                                       CASES                                                                  is essential to monitor its future host
                                                                                                                                                          adaption, viral evolution, infectivity,
                         Vast majority of early infections          Travel restrictions in China                                                          transmissibility, and pathogenicity.”
                         in China undetected                        significantly reduced spread
                         Li R, Pei S, et al.                        Wells CR, Sah P, et al.
                         Published: 16 Mar 2020                     Published: 13 Mar 2020
                         Researchers estimate that 86%              Researchers estimate that travel
                         of all infections were undetected          restrictions enacted in China after
                         prior to the lockdown of Wuhan on          23 Jan. reduced the average daily
                         23 Jan., leading to rapid spread.          rate of case exportations by 81.3%.
                         Science                                    PNAS
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 22 of 48

                                                                                                                         ACTION
                                                                                                            WHO grades outbreak as level
                                                                                                            three emergency
INTERNATIONAL

                                                                                                            The SARS-CoV-2 outbreak is
                                                                                                            elevated to the highest level of
                                                                                                            emergency. WHO HQ takes over
                                                                                                            emergency management from the
                                                                                                            regional office.
                                                                                                            WHO internal documents

                                                                                                                                                                                                             MASK USAGE
                                                                                                                                                                                                 First mask mandates in
                                                                                                                                                                                                 Guangdong, China
                                                                                                                                                                                                 The Guangdong Provincial Headquarters
                                                                                                                                                                                                 Office for the Prevention and Control
                                                                                                                                                                                                 of Pneumonia Infected by the Novel
COUNTRY

                                                                                                                                                                                                 Coronavirus
                                                                                                                                                                                                 Mask wearing in public places
                                                                                                                                                                                                 made mandatory in Guangdong
                                                                                                                                                                                                 province.
                                                                                                                                                                                                 Xinhuanet
                                                                                                                                                                                                 Cases per million
                                   NEWS REPORT                                                                                                                                                   China: 1.44
                         Trump: The US appreciates                             CASES                                      CASES                                      CASES                                     CASES
                         China’s efforts and transparency
                                                                  France and Viet Nam: First                Australia: First reported cases            Index case disembarks Diamond             China nears 2,000 cases, spread
                         “China has been working very             reported cases                                                                       Princess in Hong Kong                     to 10 countries
REAL-TIME EVIDENCE

                         hard to contain the Coronavirus.                                                   First cases reported in Australia.
                         The United States greatly                France and Viet Nam
                                                                                                            WHO Dashboard and Situation Reports,
                                                                                                                                                       Government of Hong Kong                   2,014 cases globally, of which
                                                                                                                                                       Published: 01 Feb 2020                    1,985 are from China. There are 29
                         appreciates their efforts and            First reported cases in Viet Nam          Australian Department of Health
                         transparency. It will all work out       and France. The two Vietnamese                                                       An 80 year old man disembarks             cases in 10 other countries.
                         well. In particular, on behalf of the    cases involve a father who                                                           the Diamond Princess in Hong              WHO Situation Report
                         American People, I want to thank         travelled to China, who met his son                                                  Kong with a cough. On 1 Feb. he
                         President Xi!” Trump writes in a         in Viet Nam.                                                                         tests positive for COVID-19.
                         tweet.                                   WHO Dashboard and Situation Reports,                                                 Government of Hong Kong, Journal of
                         Reuters                                  NEJM, franceinfo                                                                     Travel Medicine

                          24 Jan, cont.                                                                       25 Jan                                                                                26 Jan
RETROSPECTIVE EVIDENCE
COVID-19: The Authoritative Chronology, December 2019–March 2020, Background paper 2a, The Independent Panel for Pandemic Preparedness and Response, May 2021 — Page 23 of 48

                                                                                    ACTION                                PUBLICATION                                  27 Jan–28 Jan 2020
                                                                                                                                                                           MEETING
                                                                      R&D Blueprint: Open call to               Publication of trial designs for
                                                                      researchers                               experimental therapeutics                  WHO DG meets President Xi
INTERNATIONAL

                                                                      WHO HQ                                    WHO                                        WHO DG
                                                                      Evaluating cross-reactivity               WHO publishes outline of                   WHO Director-General (DG):
                                                                      of nCoV with SARS to identify             trial designs for experimental             “We appreciate the seriousness
                                                                      possible designs for experimental         therapeutics.                              with which China is taking
                                                                      vaccines and therapeutics.                WHO                                        this outbreak, especially the
                                                                      WHO STAG-IH                                                                          commitment from top leadership,
                                                                                                                                                           and the transparency they have
                                                                                                                                                           demonstrated, including sharing
                                                                                                                                                           data and genetic sequence of the
                                                                                                                                                           virus.”
                                                                                                                                                           WHO News Release                            BORDER CONTROL MEASURES
                                                                                                                                                                                                     Viet Nam implements border
                                                                                                                                                            BORDER CONTROL MEASURES                  controls
                                                                                                                                                           Singapore expands border                  Prime Minister
                                                                                                                                                           controls
COUNTRY

                                                                                                                                                                                                     Government announces plans to
                                                                                                                                                           Health Ministry                           ban travel from China.
                                                                                                                                                           Travel ban from Hubei                     Government News Report, Think Global
                                                                                                                                                           implemented, later expanded to            Health
                                                                                                                                                           include China.                            Cases per million
                                                                                                                                                                                                     Viet Nam: 0.02
                                                                                                                                                           Straits Times
                                                                                                                                                           Cases per million
                                                                                                                                                           Singapore: 1.20
REAL-TIME EVIDENCE

                           late Jan                                     27 Jan                                                                               28 Jan
RETROSPECTIVE EVIDENCE

                                        CASES
                         Possible community circulation of                                                                                                             23 Jan-01 Feb 2020
                         SARS-CoV-2 in Washington state
                                                                                                                                                                           SCIENCE
                         Bedford T, Greninger A, et al.
                         Published: 10 Sep 2020                                                                                                            Dramatic Re reduction to 1.18 in
                         Phylogenetic analysis suggests                                                                                                    China
                         SARS-CoV-2 were circulating in                                                                                                    Hao X, Chen S, et al.
                         community in Washington state as                                                                                                  Published: 16 Jul 2020
                         early as late Jan., prior to active                                                                                               Re estimated at 1.18 (1.11-1.25) in
                         community surveillance.                                                                                                           China for the period 23 Jan.-1 Feb.
                         Science                                                                                                                           Nature
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