There are chances that there were 104 patients with COVID-19 in the city of Wuhan in the Hubei Province of China—the epicenter of the outbreak—before 31 December 2019 when the government officially communicated it to the World Health Organization, says a new research paper prepared by the Chinese CDC.

According to the Global Times, the research paper found that it was likely that 104 cases of COVID-19 existed before 31 December 2019, the day the WHO was notified by China, and that the rapid surge in the number of infections was during mid-January of 2020, towards the last ten days when 26,468 new infections were reported.

Five phases of the outbreak

After conducting a retrospective investigation of 44,672 patients who were confirmed to have the condition, the researchers divided the outbreak into five phases. They were: Before 31 December 2019, 1 January to 10 January, 11 January to 20 January, 21 January to 31 January and 1 February and 11 February.

Wuhan Coronavirus
Twitter / Coronavirus Breaking News

Between 11 and 20 January, a total of 5,417 infections were reported, matching the information provided to the Global Times by regional hospitals in Wuhan. This suggests that prior to the warning on 20 January by a senior medical adviser, Zhong Nanshan, about human to human transmission, a large number of hospitals in Wuhan had begun receiving many patients complaining of fever arising due to an unknown cause.

No prevention and control measures were not enforced by local authorities and the concerns regarding the increasing number of sick were addressed only at the hospital level.

Local authorities remained mum

It is important to note that between 31 December to 17 January, the local health authorities not only refrained from reporting the capacity of the disease for human-to-human transmission but also remained tight-lipped about the number of new cases. Open records substantiate this occurrence.

Also, it was during this phase that Li Wenliang, the doctor who was the first to report that a SARS-like infection was spreading in the city, attempted to inform people about the gravity of the situation. Following his message on the messaging platform We Chat, he faced a police crackdown. Wenliang finally succumbed himself to the infection on 7 February.

Emergency responses were launched by the authorities in Hubei two days after Zhong's announcement about the virus's human-to-human transmission. Widespread criticism was directed towards local authorities for the undue delay in addressing it.

A crucial learning from the paper is the examination of 1,688 medical personnel who were infected. The infection among medical workers began spreading at the beginning of January. Initially, the spread was not deemed critical. But soon the infection began to rise from mid-January and peaked during the month's last ten days. The so-called 'super-spreader' incident was not backed by evidence for its occurrence, the study found.

The mortality rate in Hubei

Being the epicentre of the outbreak, the mortality rate in Hubei is 7.3 times higher than the rate of infection elsewhere. This was attributed to slow response time in some cases, while largely due to inefficient execution of prevention and control measures. The paper also said that the mortality rate outside Hubei is 0.4 percent while the region stands at 2.9 percent.

Of the 2,006 reported deaths so far, 1,921 are in the Hubei Province alone. Among the 14,617 who have recovered, 9,201 are from the region. The latest tally for the number of confirmed cases across the world is 75,200.