Rushed data collection of suspected early Covid-19 cases in Wuhan

1. The Request for Data Collection

Regarding the request to Wuhan city to assist with the novel coronavirus pneumonia

Written instructions for search of early cases

Wuhan city novel coronavirus pneumonia epidemic prevention and control Headquarters:

Pursuant to:

(1) Search for fever cases in key areas
Jianghan District is requested to search for fever cases in (a) level 2 and above medical institutions having fever clinics within its jurisdictions and (b) all clinics that are within its jurisdiction and within three kilometers of the South China Seafood Market. [note: not 100% clear, but by far the most logical interpretation]
It should collect all fever cases from October 1st to December 10th, 2019, with Case name, ID number, time of consultation and contact information (see attached Form 1 for details).
At the same time, the above-mentioned medical institutions are requested to screen the chest imaging data of all fever cases within the same period of time and to provide the medical records of the the cases with the imaging characteristics of the novel coronavirus pneumonia (see Form 2 for details).

(2) City-wide search for novel coronavirus pneumonia-like imaging characteristics
All level 2 and above medical institutions in Wuhan City district are invited to conduct a retrospective review of the chest imaging data of all patients who visited between October 1 and December 10 , 2019 to identify the top 10 cases with imaging characteristics of the novel coronavirus pneumonia at the time of the disease (consultation) in each medical institution and provide information on each person’s case (for specific information see Form 2).

(3) City — wide check of pneumonia death cases
All medical institutions in Wuhan city jurisdiction are requested to screen all pneumonia death cases (with emphasis on pneumonia cases of unknown causes) from 1 October to 10 December 2019, find out cases with clinical features of the novel coronavirus pneumonia, and to provide information on each person’s disease case (see Form 3 for details).

(4) Case screening in key medical institutions
The following key medical institutions are requested to carry out the above
screening requests: Union Cancer Hospital of Huazhong University of Science and Technology, Wuhan Central Hospital Houhu District, Hubei Integrated Traditional Chinese and Western Medicine Hospital, Wuhan Red Cross Hospital, Wuhan Sixth Hospital, Tongji Hospital of Huazhong university of science and technology, Union Hospital Affiliated to Huazhong University of Science and Technology, Wuhan Jinyintan Hospital, Jianghan Xinxin Clinic.
[note: Confusing. Why such an explicit list when actually (1) (2) and (3) apply to different lists of medical institutions?]

The screening results of the above medical institutions should be submitted in one go.
[note: Possibly meaning each institution to send all its data (3 forms) in one submission. Alternative: Wuhan City to send back all data across all institutions in one go.]

Based on the screening results, the National Investigation Team will go to some organisations to carry out on-site investigation work. Please assist in arranging the work. Specific requirements will be notified separately.
[note: Confusing. May apply to medical institutions listed in (4), or may apply to all medical institutions (so really part of (5) below).]

(5) Other matters
Please collect the relevant reports from the general medical institutions and return the paper and electronic versions (Excel) to the National Investigation Team by 21 February 2020 at 17:00.

Contact person
Contact phone :

Forms:
1. Registration form for fever cases of medical institutions in Jianghan district, Wuhan city
2. Registration form for Wuhan City pneumonia cases with novel coronavirus pneumonia-like imaging features
3. Registration form for deaths from pneumonia in Wuhan city

February 19, 2020

Jianghan District and 3km perimeter from Wuhan Seafood Market
Extent of early confirmed cases disclosed in Lancet — 24th Jan.
104 confirmed cases + suspected & diagnosed — Dec 19

“They would get stuck on a word,” Dr. Fisher said about his Chinese colleagues

Hospital classification system of China [4]

2. Results: Early Medical Cases

Form 3 for Wuhan Sixth Hospital
Form 2 for Wuhan Puren Riverside Hospital
Form 2 for Wuhan Yaxin General Hospital

3. Limitations

4. Discussion

“We are looking forward to seeing a tremendous partnership in strengthening our understanding of the Covid-19 epidemic” (Dr Tedros Adhanom Ghebreyesus)

Wuhan Confirmed/Diagnosed/Suspected/Asymptomatic by date of onset (test for asymptomatic)

The Joint Mission systematically enquired about testing for COVID-19 from routine respiratory disease surveillance systems to explore if COVID-19 is circulating more broadly and undetected in the community in China. These systems could include RT-PCR testing of COVID-19 virus in influenza-like-illness (ILI) and severe acute respiratory infection (SARI) surveillance systems, as well as testing of results among all visitors to fever clinics. In Wuhan, COVID-19 testing of ILI samples (20 per week) in November and December 2019 and in the first two weeks of January 2020 found no positive results in the 2019 samples, 1 adult positive in the first week of January, and 3 adults positive in the second week of January;

Zoonotic origins
COVID-19 is a zoonotic virus. From phylogenetics analyses undertaken with available full genome sequences, bats appear to be the reservoir of COVID-19 virus, but the intermediate host(s) has not yet been identified. However, three important areas of work are already underway in China to inform our understanding of the zoonotic origin of this outbreak. These include early investigations of cases with symptom onset in Wuhan throughout December 2019, environmental sampling from the Huanan Wholesale Seafood Market and other area markets, and the collection of detailed records on the source and type of wildlife species sold at the Huanan market and the destination of those animals after the market was closed.

Source
National confirmed cases (onset and reporting dates) at the bottom — as of 11 Feb 20

‘As of February 25, our entire database has about 47,000 confirmed cases. There are some data on patients with onsets before December 8 last year, but we cannot be sure of the authenticity of these data. Verify further.’ [..]

Professor Yu Chuanhua said, ‘For example, there is data on a patient who became ill on September 29. The data shows that the patient has not undergone nucleic acid testing. The clinical diagnosis (CT diagnosis) is a suspected case. The patient has died. This data has not been confirmed and there is no time to death. It may also be wrong data.’

Through the research of the database, Professor Yu Chuanhua found more and more case data before December 8. There were two cases in November, and the onset time was November 14 and November 21, 2019. Before December 8, there were five or six cases. Among them, one patient who became ill at the end of November was hospitalized on December 2 and was clinically diagnosed with pneumonia.’

The amount of data is too large. It is difficult to verify the data, distinguish between true and false, and sort and analyze, and the team is working hard.” Yu Chuanhua told reporters that many of these data are incomplete or incorrect, and some have no contact history. Need to further contact the patient or family member to verify.

Before the deadline for publication, Professor Yu Chuanhua said that the data of two patients with new coronary pneumonia in November were entered incorrectly, and other data have yet to be verified one by one. When is the earliest time of onset? Yu Chuanhua said ‘We need to verify one by one and investigate the relevant contact history before we can analyze it.’

Health Times article on the Analysis of the Wuhan novel coronavirus pneumonia patients database
Nov 14 and Nov 21 cases in actual spreadsheet

5. Questions

6. Post Scriptum:

‘Retrospective review of cases identified a total of 124 confirmed cases with onset date in December 2019, 119 of whom were from Wuhan and 5 others from Hubei or other provinces, but all with travel links to Wuhan during the period of exposure.’

A study of 41 initially identified confirmed cases showed that 70% of the cases had a link to the Huanan market (Huang et al, 2020), but detailed
exposure factors within the market and elsewhere remain unclear.

Phase 1: Short term studies
a) Descriptive Epidemiological Study
1. In-depth reviews of hospital records for cases compatible with COVID-19 before December.

104 confirmed cases for Dec 19

The first case of someone in China suffering from COVID-19 can be traced back to November 17, the report said quoting government data.[…]

By December 31, the number of confirmed cases rose to 266. On January 1, the numbers jumped to 381.

In the bottom left hand column of the graph marked 2019 the number of “confirmed cases” and “clinically diagnosed” cases appears to reach around 200 altogether. The documents do not elaborate further. To date, the clearest indication of how many cases were detected in 2019 is the 44 “cases of pneumonia of unknown etiology (unknown cause)” that Chinese authorities reported to the WHO for the period of the pandemic up to January 3, 2020

Data Collection — Sources:

References & Notes:

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