An interesting report published in The Lancet 6 February 2020 by John Zarocostas reports on the investigation.  

With new infections of COVID-19 still spreading rapidly, and health systems stretched to their limits, public Interest is now focused on the WHO led international mission in China which is investigating the origin of the virus that initiated the pandemic. 

“No one should be in doubt that this is a scientific exercise”, said Tedros Adhanom Ghebreyesus, WHO Director-General to health ministers on January 18, 2021.  This was a few days after the mission had arrived in China and was a move to shield the WHO’s work from the political tensions that have marred the pandemic response over Beijing’s initial lack of transparency in the early days of the outbreak centred in the Wuhan.  

Ministers passed a resolution requesting the WHO to work with partners and countries in order to identify the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts.

As Peter Embarek, the WHO scientist for food safety and zoonosis and team leader of the mission noted in mid-January “It is important to understand the origin of the virus for three reasons, one is if we find the source and it is still out there, we can prevent future reintroduction of the same virus into the human population.  Second, if we understand how this one jumped from bats origin into humans, we can prevent perhaps similar events in the future.  Third, if we can find the virus, what it looked like before it jumped to the human population, we could potentially be in a better position to develop more efficient treatments and vaccines for this disease”.  

The investigatory team consists of 10 international experts and includes epidemiologists, animal and human disease experts, veterinarians, medical doctors and virologists from 10 countries and also includes five WHO experts from the food and agricultural organisation and two representatives from the World Organisation for Animal Health. 

In the first two weeks, the deployed team worked online with their Chinese counterparts from China’s Centre for Disease Control and Prevention and different ministries and research centres, and in the remaining two weeks will be able to move freely and visit sites that are important for their research.

This research will include investigating the Huanan market in Wuhan and trying to identify everything that went in and out of the market in late November and December 2019, conducting interviews with some of the first identified COVID-19 patients, and visiting hospitals and laboratories, including the Wuhan Institute of virology and the Wuhan CDC laboratory, and other research facilities to review epidemiological, virological, and serological studies, and also look at bio safety, in order to prepare their report. 

The team will also map supply chains at Huanan and other markets, test frozen sewage samples, and do other studies as appropriate. 

The team is also expected to review hospital records for cases compatible with COVID-19 before December 2019 and review disease trends for the months preceding the outbreak for any unusual pattern of illness. 

Embarek, the team leader of the mission, feels that there will not be clear answers after the initial mission but hopes that additional missions will provide these. 

David Heymann, Professor of Infectious Disease Epidemiology at The London School of Hygiene and Tropical Medicine, however, told the Lancet that he felt it was unlikely that the WHO team working with the Chinese investigators would be able to determine the origin of the pandemic.  He felt that it was very difficult to do this retrospectively by identifying early cases and then proceeding with case control studies to identify risk factors for infections.  He felt that what is more important is controlling the current outbreak and understanding how to better prevent such pandemics in the future.  The WHO themselves admitted that it can take years to find the origin of viruses that have made the zoonotic jump from animals to humans.

The London General Practice hopes that the officials from the WHO will have access to all necessary evidence and areas in order to hopefully at some stage provide an answer to this dreadful pandemic.

Dr Paul Ettlinger
BM, DRCOG, FRCGP, FRIPH, DOccMed

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