Saturday, 8 February 2020

C.D.C. and W.H.O. Offers to Help China Have Been Ignored for Weeks

Privately, Chinese doctors say they need outside expertise. But Beijing, without saying why, has shown no interest so far.
Credit...Naohiko Hatta/Pool photo, via Associated Press
For more than a month, the Centers for Disease Control and Prevention has been offering to send a team of experts to China to observe its coronavirus outbreak and help if it can.
Normally, teams from the agency’s Epidemic Intelligence Service can be in the air within 24 hours.
But no invitation has come — and no one can publicly explain why.
The World Health Organization, which made a similar offer about two weeks ago, appears to be facing the same cold shoulder, though a spokeswoman said it is just “sorting out arrangements.”
Current and former public health officials and diplomats, speaking anonymously for fear of upsetting diplomatic relations, said they believe the reluctance comes from China’s top leaders, who do not want the world to think they need outside help.
In 2003, China was badly stung by criticism of its response to SARS, another coronavirus epidemic; it has also been embroiled in a trade war with the United States for more than a year.
Some experts also say that outsiders could discover aspects of the outbreak that are embarrassing to China: for example, the country has not revealed how many of its doctors and nurses have died fighting the disease.
But China does need help, experts argue.
In private phone calls and texts, some Chinese colleagues have indicated that they are overwhelmed and would welcome not just extra hands, but specialized expertise in a couple of fields.

The Coronavirus Outbreak

  • What do you need to know? Start here.

    Updated Feb. 5, 2020
    • How is the United States being affected?
      There have been at least a dozen cases. American citizens and permanent residents who fly to the United States from China are now subject to a two-week quarantine.
    • What if I’m traveling?
      Several countries, including the United States, have discouraged travel to China, and several airlines have canceled flights. Many travelers have been left in limbo while looking to change or cancel bookings.
    • How do I keep myself and others safe?
      Washing your hands is the most important thing you can do.

Also, C.D.C. officials have said that they hope to learn more about the new coronavirus from their Chinese counterparts to improve the American response if the virus starts to spread widely here.
On Friday, Alex M. Azar II, secretary of health and human services, said at a news briefing that he had recently reiterated the offer of a team to his Chinese counterpart, Dr. Ma Xiaowei.
Asked what the holdup was, he answered: “It’s up to the Chinese. We continue to expect fully that President Xi will accept our offer. We're ready and willing and able to go.”
On Jan. 29, Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, returned from a brief trip to China full of praise for President Xi Jinping and the country’s extraordinarily aggressive response, which has nearly walled off Hubei Province from the rest of the country and the world.
China had “agreed to a mission of international experts” to better understand disease transmission and clinical severity, Dr. Michael Ryan, the W.H.O’s emergency response chief, said at the time.
Asked if that team would include American experts, Dr. Tedros replied that “best would be a bilateral arrangement.”
On Thursday, a W.H.O. spokeswoman said that there was no delay in the organization’s own mission to China.
“Our understanding is that the mission is on,” Marcia Poole, the spokeswoman, said. But she could not say when the team would leave or who would be on it.
“It’s a matter of sorting out the arrangements,” she added, noting that Dr. Ryan had said a team would “need representation from North and South, East and West, with relevant areas of expertise.”
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Credit...Olivier Douliery/Agence France-Presse — Getty Images
The United States has offered Dr. Tedros 13 specialists who are ready to go, Mr. Azar said.
The two fields in which China appears to need outside help, experts said, are molecular virology and epidemiology.
The first involves sequencing the virus’s genome and manipulating it to refine diagnostic tests, treatments and vaccine candidates.
The second involves figuring out basic questions like who gets infected and who does not, how long the incubation period is, why some victims die, how many other people each victim infects and how commonly hospital outbreaks are occurring.
“This isn’t rocket science, it’s basic stuff — but it’s been five weeks and we still don’t know the answers,” one expert said.
It would be very useful, for example, to have a blood test for antibodies. That would make it possible to see how many infected people had recovered, which would make it clearer as to how lethal the virus is — and how widespread.
A major epidemiological failure by China is that the Wuhan authorities appear to have closed and disinfected the seafood market that was the outbreak’s early focus without swabbing individual animals and their cages and without drawing blood from everyone working there. That would have provided a wealth of information about which animal might have been the source of the coronavirus and which people had become infected but survived.
Asked what had happened to the animals — whether they had been burned or buried, for instance, one expert said: “No one can tell me that. I don’t think they know.”
China has greatly improved its ability to fight disease since it was embarrassed by SARS, and its scientists now frequently publish in major medical journals.
Many of them trained at the American C.D.C. and have friends there.
“We have a decade-long relationship,” Mr. Azar said Friday. “It’s not an accident that it’s called the Chinese C.D.C.”
Experts raised a related concern: China’s scientists are given large rewards for publishing in prestigious journals. That creates an incentive to hold back samples and data until publication. Although the American C.D.C. has in the past sometimes had fraught relations with other countries because it used their samples and published analyses of them without giving credit they felt was due, its first priority was still to issue epidemic warnings if they were needed and then to publish later.
“In an epidemic, you don’t want information held back,” one expert said. “You want transparency.”
Donald G. McNeil Jr. is a science reporter covering epidemics and diseases of the world’s poor. He joined The Times in 1976, and has reported from 60 countries.  
Zolan Kanno-Youngs is the homeland security correspondent, based in Washington. He covers immigration, border issues, cyber security, transnational crime and other national security threats. 

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