Timeline of COVID-19: Science, Decisions and Outcomes
Mona S. Ottum, MS, RDN, IFMCP, CLT, CD
I’m a scientist, chemical engineer, registered dietitian and thinker, with arguably a little too much time on my hands. I have been curious about the idea that the Chinese government or some “mad scientist” created COVID-19 and/or lied about its origin, extent or seriousness (pathogenicity). So I did what I always do, I went to published journal articles and reputable science reporting to put together scientific facts and a timeline of the course of the COVID-19 pandemic. See a summary of my discoveries in the diagram. I identified week 0 as the week of the onset of illness of the first case identified in Wuhan. I then asked and answered a series of questions that have presented themselves recently.
When was the first case of COVID-19 in Wuhan identified?
A New England Journal of Medicine article published on January 29, 2020 reviews studies of the first 425 confirmed COVID-19 patients.1 They state that the first 4 cases of a “viral pneumonia of unknown cause” were reported by hospitals in Wuhan on December 29, 2019. All 4 were linked by a seafood market. The local authorities had the seafood market closed and decontaminated January 1, 2020. However, an article published in The Lancet on February 15, 2020 reported that, although scientists earlier thought the virus originated from seafood market in Wuhan, careful investigation showed that 1/3 of the first cohort had no exposure to the market.2 Among the group with no connection to the seafood market was the first person to present with symptoms, a gentleman with a symptom onset date of December 1, 2019. 1,2,3
When were world experts notified of the virus by Chinese medical experts?
The Chinese CDC announced the novel virus and 15+ cases, January 8, 2020. An article published in Viruses January 24, 2020 describes the dissemination of the complete genome map and description of the virus to scientists worldwide on January 11, 2019. Their intent was not only to notify outside entities of the new novel virus and the serious public health threat but to engage the global research community in analyzing the data. Within two weeks of the appearance of the cluster of patients in the hospitals, the world scientific and medical community was notified and engaged.3,4
When did China isolate and quarantine its affected populations?
The first fatality due to COVID-19 was reported 1/10/2020 and the second on 1/15/2020. Four weeks after the first cases appeared in hospitals and two weeks after the first fatalities, Chinese officials instituted a quarantine on Wuhan and other affected cities on January 23, 2020. A detailed timeline by Gralinski and Menachery in previously mentioned article in Viruses, January 24 reported that at the time there were 655 confirmed cases and 18 deaths in 9 countries.4
What is the origin of COVID-19?
The complete genomic sequencing of the novel coronavirus was repeated, shared and analyzed by a variety of scientific entities throughout the world. “…Andersen and collaborators at several other research institutions used this sequencing data to explore the origins and evolution of SARS-CoV-2 by focusing in on several tell-tale features of the virus.” All medical and scientific experts, including those in the U.S., now agree that COVID-19 was without doubt of zoonotic origin, a naturally occurring mutation from an animal virus, as has been the case on a variety of previous similar outbreaks. It is clear that the version of coronavirus that COVID-19 is closest to and must have mutated from was previously non-pathogenic and importantly, non-human infecting. They go on to explain that if there was any salacious intent, this particular virus would have been a ridiculous choice, from any scientist’s perspective.5,6
How long after the first case in China did the U.S. have its first confirmed case and death?
According to a New England Journal of Medicine article epublished January 31, 2020, the first US confirmed case was reported on January 20, 2020, seven weeks after China’s first illness onset (traced backward) and four weeks after first known illness presentations. The first reported U.S. death was the week of January 29, 2020, three weeks after China’s first reported death. It is certainly likely that there were earlier deaths but the virus was new and uncharacterized making linking of death to the infection impossible in early stages of the outbreak.7
What did the US know at the time of the first U.S. case about the severity and extent of COVID-19 in/from China?
Immediately following the first U.S. case, earliest publications characterizing the nature of COVID-19 in the scientific community appeared in PubMed January 22 and 24, 2020. These studies suggest a highly contagious virus with a reproduction number (R0) of 2.0 to 3.0. Coinciding with the U.S. first case, an outbreak of COVID-19 occurred on a cruise ship that initiated a quarantine on February 3, 2020 that lasted 4 weeks. Patient 0 developed symptoms on January 22 and disembarked. At the time of the first US death, 3 weeks into this quarantine, a great deal of information regarding how contagious and lethal the infection is was gleaned and shared. The on-board transmission was initiated by food service workers and went unrestricted for 1 ½ weeks prior to quarantine, likely exposing close to 100% on board. Of the 3,700 passengers and crew, 17% eventually tested positive, 1.3% of those who tested positive died (IFR) and 2.6% of those with illness and symptoms died. It was here that we learned that even in a generally disproportionately older population, about 50% are infected but remain asymptomatic (but yes, still contagious). Infection rate was about 17% of this vulnerable older population, case fatality rate was about 2.6% in this population though a more representative population is about 1.4% and infection fatality rate would be about 0.7% in a typical community. This is conditional on isolation 1 ½ weeks into first illness but relatively high exposure.8,9,10
How long after the first illness and death in the US did the US states isolate and quarantine and how does this compare to China?
Nine weeks after the first confirmed U.S. case and four weeks after the first U.S. death, California, Washington, Oregon, New York, Ohio, Louisiana and Illinois were the first states to issue shelter in place quarantine orders, on March 23, 2020. At the time, the US had 33,404 confirmed cases and 454 COVID-19 deaths. The following week, 21 more states issued stay at home orders. At that point the U.S. had 54,453 confirmed cases and 2,339 COVID-19 positive deaths. In spite of China being completely naïve to the new viral pneumonia outbreak, it took quarantine actions over two weeks sooner than the U.S.11,12
Now that we have substantially more data, is the severity of the disease worse or milder or the same as China originally characterized?
After the first month of COVID-19, Chinese scientists estimated that the novel COVID-19 virus had a Case Fatality Rate (CFR) of 1.41% in Hubei and 5.25% in the epicenter Wuhan. 13 As previously mentioned, early estimates of R0 was 2.0 to 3.0, indicating a remarkably infectious agent. With two additional months of experience globally, the CFR worldwide is estimated at 3.6%. In the U.S. the flu causes about 30,000,000 illnesses and 40,000 deaths every recent season and COVID-19 has caused 746,625 cases so far (4/20/2020) and 41,758 deaths. This is about a CFR (case fatality rate) of 0.14% for the flu. Said another way, 25 times more people die of COVID-19 when becoming ill than people with the flu. While penetrance of the flu is enormous (lots of people get it), few people die of it. Still, the flu has taken approximately equal numbers of lives to COVID-19 this season. Importantly, the Chinese scientists and officials early estimates were absolutely in line with the infectious capacity and lethality of COVID-19.
What is the risk with uncontrolled penetrance, meaning what if the U.S. didn’t quarantine at all, or what benefit if we had quarantined earlier?
If we did not quarantine at all, current estimates suggest 8% of the US population actually becomes infected, 4% become ill and of that 4%, 1.4% die, that would be 13,000,000 illnesses and 183,000 deaths. That is about 5 times the number that have died thus far and three times the current total projected deaths. It is currently projected that there will end up being about 60,000 deaths in the U.S., which suggests about ¼ to 1/3 of the U.S. population will have been exposed before the disease is controlled. Furthermore, if we had quarantined 2 weeks earlier, comparable to China’s aggressive regional restrictions, it is estimated that the peak would have happened 2 weeks earlier and total deaths would have been about 20,000, or 1/3 of the expected total.
- Qun Li, M.Med., Xuhua Guan, Ph.D., Peng Wu, Ph.D., Xiaoye Wang, M.P.H., Lei Zhou, M.Med., et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. March 26, 2020. N Engl J Med 2020; 382:1199-1207 epublished 1/29/2020
- 1st known case of coronavirus traced back to November in China. Jeanna Bryner – Live Science Editor-in-Chief March 14,2020 Found: https://www.livescience.com/first-case-coronavirus-found.html
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506.
- Gralinski LE, Menachery VD. Return of the Coronavirus: 2019-nCoV. Viruses. 2020 Jan 24;12(2). pii: E135. doi: 10.3390/v12020135.
- Science News COVID-19 coronavirus epidemic has natural origins. https://www.sciencedaily.com/releases/2020/03/200317175442.htm?fbclid=IwAR0MTtvAjpDzf7fBsjyIe_a1dR8_E35HMHoAsoB8XHaQa8gM20y_RMO-Z5c
- Ranjit Sah, Alfonso J. Rodriguez-Morales, Runa Jha, Daniel K. W. Chu, et al. Complete Genome Sequence of a 2019 Novel Coronavirus (SARS-CoV-2) Strain Isolated in Nepal Microbiol Resour Announc. 2020 Mar 12;9(11). pii: e00169-20. doi: 10.1128/MRA.00169-20.
- Holshue ML1, DeBolt C1, Lindquist S1, Lofy KH1, Wiesman J1, et al; Washington State 2019-nCoV Case Investigation Team. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020 Mar 5;382(10):929-936. doi: 10.1056/NEJMoa2001191. Epub 2020 Jan 31.
- Ying Liu, Albert A Gayle, Annelies Wilder-Smith, Joacim Rocklöv. The reproductive number of COVID-19 is higher compared to SARS coronavirus. Journal of Travel Medicine, Volume 27, Issue 2, March 2020 epublished 2/13/2020
- Kensaku Kakimoto1; Hajime Kamiya2; Takuya Yamagishi2; Tamano Matsui2; Motoi Suzuki2; Takaji Wakita3 Initial Investigation of Transmission of COVID-19 Among Crew Members During Quarantine of a Cruise Ship — Yokohama, Japan, February 2020 Weekly / March 20, 2020 / 69(11);312-313 On March 17, 2020, this report was posted online as an MMWR Early Release.
- Russell TW1, Hellewell J2,1, Jarvis CI2,1, van Zandvoort K2,1, Abbott S1, Ratnayake R3,1, Cmmid Covid-Working Group4, Flasche S1, Eggo RM1, Edmunds WJ1, Kucharski AJ Estimating the infection and case fatality ratio for coronavirus disease (COVID-19) using age-adjusted data from the outbreak on the Diamond Princess cruise ship, February 2020. Euro Surveill. 2020 Mar;25(12).
- The New York Times: See Which States and Cities Have Told Residents to Stay at Home found at: https://www.nytimes.com/interactive/2020/us/coronavirus-stay-at-home-order.html
- CDC National Center for Health Statistics. National Vital Statistics System: Provisional Death Counts for Coronavirus Disease (COVID-19) Available at: https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm
- Yang S1,2, Cao P3, Du P4, Wu Z5,6, Zhuang Z7. Early estimation of the case fatality rate of COVID-19 in mainland China: a data-driven analysis. Ann Transl Med. 2020 Feb;8(4):128.
- Morteza Abdullatif Khafaiea and Fakher Rahimb, Cross-Country Comparison of Case Fatality Rates of COVID-19/SARS-COV-2. Osong Public Health Res Perspect. 2020 Apr; 11(2): 74–80
- CDC. Disease Burden of Influenza. Available at: https://www.cdc.gov/flu/about/burden/index.html