“One has to wonder how long China would have kept up their false narratives if not for whistle-blowing medical professionals and personal accounts of citizens on the ground in Wuhan.”

Americans are often quick to demand the censoring of what they consider fake news, hoaxes, misinformation or pseudoscience. But censoring information leaves serious questions regarding both the execution and the potentially far-reaching implications of such practices unanswered. To whom would the power and responsibility of thought-policing be bestowed? The government? Media outlets and platforms?

While it may seem an extreme example, the current situation with 2019-nCoV should raise serious concerns regarding censorship and its unintended but likely inevitable impact on free press, free speech, public awareness and public safety.

A bit of background information

Since Wuhan Municipal Health Commission’s first official announcement regarding the novel coronavirus on Dec. 31 — seven weeks ago — the number of reported cases has skyrocketed from 27 to nearly 80,000, with nearly 2,500 known fatalities. At the time of the announcement, local officials noted that they had identified 27 cases — 7 of whom were in critical condition, with the remaining 20 considered “stable and controllable.”

While the primary clinical presentation was fever, some patients also experienced difficulty breathing and presented with bilateral infiltrative pulmonary lesions due to a previously unseen type of pneumonia. The government advised that people could wear masks while out in public to protect themselves from infection.

Censorship, False Narratives and Outright Lies

Highlights: December 31

The Dec. 31 statement released by the local health commission further noted that “The investigation so far has not found any obvious human-to-human transmission and no medical staff infection.” Yet, Dr. Lu Xiaohong — the Director of Gastroenterology at Wuhan 5th Hospital — stated that she first heard of suspected infections in medical staff on Dec. 25. It would take more than three weeks for the government to acknowledge this fact. China Youth Daily subsequently picked up and published Dr. Lu’s account of the circumstances surrounding the outbreak.

As hospital wards filled up — often with multiple members from the same families — it became clear to Dr. Lu that the disease was indeed transmitting from human-to-human. But according to her, it was already too late, “I realized we had underestimated the enemy,” she admitted. Unlike any pneumonia she and her colleagues had seen before, this new and mysterious pneumonia did not respond to traditional treatment regimens.

Medical professionals who attempted to sound the alarm about the virus in those first weeks found themselves silenced. In an effort to warn colleagues, Dr. Li Wenliang posted in an online chat group on Dec. 30 that seven patients who presented with symptoms of a “mysterious illness” had subsequently been quarantined in the emergency department of the hospital.

Rather than acknowledge the situation, the health authority summoned Dr. Li, demanded to know why he had shared such information and ultimately forced him to sign a declaration regarding the illegality of such rumors. Li returned to work where, on Jan. 10, he unwittingly treated a coronavirus-infected patient’s glaucoma. The patient and her daughter later became ill from the virus, as did Li.

Dr. Li would succumb to complications of COVID-19 on Feb. 7. He was just 34 years old.

Also on Dec. 31, police announced further investigations into an additional eight people alleged to have spread rumors about the outbreak. China buckled under the weight of the whistleblowers and finally announced that 27 people had presented with pneumonia of an unknown origin. Chinese authorities notified the World Health Organization of the outbreak that same day. It’s impossible to know how much longer they would have concealed the outbreak from the world if not for the whistleblowers.

The very last sentence of the above-mentioned announcement reads “If you have the above symptoms, especially the persistent fever, you should go to the medical institution in time.” However, due to their lack of a proper primary care system, Chinese citizens often utilize hospitals for routine medical care, which leaves China’s medical system over-taxed even on its best days.

Dr. Lu Xiaohong detailed how she and colleagues struggled to cope with the virus, describing ill prepared and uninformed medical personnel, a lack of appropriate protective gear and swarms of patients who flooded the hospital. This would seem to indicate that, even in the early days, the number of infected was significantly higher than China reported.

A medical system overtaxed on its best days

With the novel coronavirus outbreak, the medical system became so completely overwhelmed that hospitals struggled to meet the needs of the critically ill and turned away symptomatic patients due to a shortage of beds, medical supplies and medications. Chinese companies stated that they were incapable of producing 2019-nCoV test kits in the quantity required — another indicator that the virus was far more widespread than reported.

Lack of proper isolation departments and fever centers throughout the city further compounded the issue. Even today it seems hospitals continue to turn away less critical 2019-nCoV cases. These patients then either trek back home, or on to another medical center — exposing and infecting increasing numbers of people along the way.

Despite mounting evidence to the contrary, the government continued their attempt to control the narrative by insisting they had identified the source of the disease and halted the spread of the virus. They doubled down on prior statements that there was still no evidence the virus could spread between humans.

It is now known that China had identified the first case of the novel coronavirus on Dec. 8. With the rate at which this virus has spread from human-to-human, it is implausible that just 27 cases occurred between Dec. 8 and Dec. 31 — those first few critical weeks before China’s public acknowledgement of the outbreak.

Highlights: January

The government’s announcement regarding the closing of the Huanan Wholesale Seafood Market on Jan. 1 was veiled under a claim that it would undergo renovations. Once closed, the government had the market disinfected by workers in hazmat suits.

January 7

Even as Wuhan’s mayor, Zhou Xianweng addressed his annual report to the city’s People’s Congress on Jan. 7, no mention of the virus was made, while Hubei governor Wang Xiaodong continuously stressed the importance of political issues above all else.

January 9

Yet, on Jan. 9, as the Chinese government confirmed their first 2019-nCoV related fatality — a 61-year-old man who already suffered from chronic liver disease and an abdominal tumor — they failed to acknowledge something far more damning. The man’s wife had begun displaying symptoms of COVID-19 within mere days of her husband’s diagnosis, without ever having visited the seafood market.

January 13

Thailand announced on Jan. 13 that it had identified its first case of 2019-nCoV. Taken together, the first official news of fatalities and the spread of the virus to Thailand marked a shift in China’s public discourse surrounding the virus. They sent top epidemiologist Dr. Zhong Nanshan to Wuhan and called on medical workers to prioritize the treatment of the virus — an ironic twist considering their prior efforts to silence and reprimand whistleblowers within the medical community who had attempted to do just that.

January 18

Supposedly acting under the misguided assumption of limited human-to-human transmission of 2019-nCoV, the local government allowed 40,000 families in Wuhan’s Baibutang Community Square to host their annual Wanjia Banquet on Jan. 18. Commenting on this decision, Mayor Zhou remarked on Jan. 22 that “currently there is no cross-infection, but it does sound alarms for us.”

Weeks had already passed since the identification of the first human-to-human transmissions, both in medical professionals and in members of the public. It should not have come as a surprise that by Feb. 6, many Baibutang Community residents had developed fevers. Local authorities subsequently labeled the residential buildings “fever buildings.” Sadly, this response was already day late and a yuan short.

January 20

Finally, on Jan. 20, Dr. Zhong confirmed what medical professionals in China and people around the world already knew and feared — the novel coronavirus was indeed spreading via human-to-human contact, and at a rapid rate. By Jan. 22, Wuhan City Mayor, Zhou Xianwang had announced that “more than a dozen medical staff were infected” following the completion of a procedure on a neurosurgery patient whose coronavirus infection was ignored during admission.

January 23

On Jan. 23, the central government ordered the lockdown of Wuhan and other cities within Hubei province but, yet again, it was too little, too late. The opportunity to contain the virus at the source was already lost, as it had begun spreading throughout the region. Over the following weeks new cases would pop up around the globe.

Wasted Time

The lag time between the initial cases in early December and the government’s public acknowledgement at the end of the month amounted to a huge lost opportunity to contain the disease and prevent what has the potential to become a worldwide pandemic. Rather than act out of an abundance of caution, government agencies and officials repeatedly assured the public that there was no evidence of human to human transmission.

The prudent response would have been to assume the virus to be highly transmissible until proven otherwise, or better yet – to acknowledge that they were as of yet uncertain about the transmissibility of it. Beyond that, the silencing of whistleblowers within the medical community not only hindered public awareness, but also prevented medical professionals from taking appropriate precautions to thwart the spread of the particularly contagious virus.

Highlights: February

February 2

Feb. 2 brought the first confirmed death outside of China when a 44 year-old man from Wuhan died in the Philippines. He had arrived in the country on Jan. 21. In the days preceding his death, the patient’s health had supposedly shown signs of improvement, but had declined rapidly in the prior 24 hours, ultimately resulting in his death.

February 13

On Feb. 13, China reported a surge in the number of infected as it revised its diagnostic requirements due to their limited lab testing capabilities. The number of infected soared past 60,000 as the new criteria allowed doctors to make the diagnosis based on signs and symptoms. Particular weight was given to CT scans indicative of the presence of infiltrative pulmonary lesions. While this may have sped up attempts at treating the sick, it also made it very difficult for scientists around the world to determine whether the rate of infection was increasing, decreasing or had plateaued.

February 20

Then, just last week, China moved on to its sixth version of its diagnostic plan. Reversing a course set just the week before, in which the government allowed doctors to make a COVID-19 diagnosis on the basis of signs and symptoms alone, officials decided that once again diagnosis confirmation would require genetic testing. To say these repeated changes are confusing and problematic for epidemiologists attempting to study the disease and gain an understanding of how widespread and fatal it is would be an understatement.

What we now know about 2019-nCoV

First and foremost, novel viruses spread rapidly due to the public’s lack of immunity to them.

While the virus did not mutate much during the early stages of the outbreak, the rate of mutation increased as it passed from human-to-human. This poses significant difficulty for scientists studying the virus due to the fact that it may look different each time a scientist looks at a new sample.

Experts believe it is possible that only the most severely ill are receiving treatment and that the number infected could actually be much higher, which would make the fatality rate much lower. Current estimates put the fatality rate at about 2%. So, it may be far less fatal, but also far more widespread, than presently known.

China’s current treatment protocol for the novel coronavirus consists of HIV drugs Lopinavir and Ritonavir administered in combination with traditional Chinese medicines containing ingredients like buffalo horn, jasmine and honeysuckle. While no real evidence supports China’s claims of the efficacy of such natural remedies, journals have previously published studies by Chinese scientists that claimed they relieved pulmonary inflammation during the SARS epidemic.

The Cost of Censorship:

The New York Times discussed how, in the crucial early days and weeks of the outbreak, the Chinese government failed to properly inform both the public and medical professionals about the gravity of the situation surrounding the novel coronavirus, and made repeated declarations that these were likely the only incidences of the disease — even as new cases continued to pile up.

China’s Censorship & Disinformation Campaign

Stories shared on social media starkly contrast with those provided by the government. While China typically keeps a tight lid on criticism on social media platforms, the sheer number of stories shared have made that level of control an impossibility. Even so, the government continues to warn the public against the spreading of rumors as it fights to regain control of the narrative.

China’s misguided face-saving campaign, rife with secrecy and censorship as it attempted to maintain stability, prevent the public from panicking and avoid embarrassment contributed greatly to the spreading of the virus. Not only did they fail to inform the public and medical professionals, they actively silenced whistleblowers and contradicted their statements, while continuing to insist that the virus was both controllable and preventable.

The government’s claims that the virus could not spread between people and had been stopped at the source paired with their failure to accurately report new cases or deaths lulled citizens into a false sense of complacency and security. Their overabundance of optimistic fabrications ultimately resulted in their failure to contain the spread of 2019-nCoV.

Some have decried China’s incompetence in handling the outbreak, but it goes far beyond that. The government made a concerted effort to prevent the truth about 2019-nCoV from getting out. China intentionally misrepresented the virus and the situation surrounding it, and in so doing, it undermined its own legitimacy. That conspiracy theories and public distrust now abound is an undesirable but understandable consequence of their secrecy surrounding the epidemic.

Given their notorious reputation for censorship, secrecy and primarily state-controlled news agencies, legitimate concerns exist regarding the validity of official reports coming from the Chinese government. Rather than mounting an appropriate response to the disease and notifying its citizens and the international community as a whole, China began a face-saving campaign.

Social Media

China’s subsequent work with social media giants to censor and combat what it calls false and misleading information about the novel coronavirus, 2019-nCoV, seems a bit like leaving the fox in charge of the henhouse given the fact that the government’s initial priority with the outbreak leaned more in the direction of an information containment campaign than containment of the virus itself.

On Jan. 30, Facebook announced it would heighten its response to coronavirus-related misinformation by removing content that has been debunked by health authorities. Social media platforms have worked diligently to filter through the massive amounts of content posted to their platforms on a daily basis so they could identify and deprioritize posts that promote misinformation about the virus. At this point in time however, still much is unknown about the novel coronavirus.

With so little understood about the novel coronavirus in January, it is hard to understand how authorities and social media platforms even began debunking and labeling misinformation. To say that there is currently no evidence or indication that something is true is a far cry from being certain or able to prove that it is untrue.

Reconsidering censorship

One has to wonder how long China would have kept up their false narratives if not for whistle-blowing medical professionals and personal accounts of citizens on the ground in Wuhan. Beyond that, it is impossible to know what information they continue to conceal to this day.

While some conspiracy theories and misinformation reach an unbelievable level of outlandishness, the selective silencing of unpopular speech is risky business as it leaves ample room for the suppression of unpopular yet extremely valid opinions and information from the public. Any such censorship should always be regarded with a healthy level of skepticism, and Americans should consider the consequences prior to taking a page from the China’s playbook.