In an interview with a Chinese news outlet obtained by U.S. Right to Know, a frontline doctor in Wuhan reveals in new detail how some of the earliest COVID-19 cases were undercounted — spanning from pressure by authorities to limit positive tests, CT machines overheating from too many lung scans, and pressure to not create a paper trail.
Few were better positioned to observe the stark difference between the growing crisis and authorities’ assurances that the virus was not spreading than a radiologist reviewing CT scans of patients’ lungs at one of the first Wuhan hospitals to detect the new disease.
The radiologist told the Chinese newspaper they saw cases doubling each day in January 2020, even as official reports abruptly halted for two weeks. At the time, Chinese authorities denied the virus was spreading human-to-human, with devastating consequences.
The document may provide a rare and unusually candid firsthand account of a frustratingly opaque chapter of pandemic history — its first chapter. Some scientists believe we have a complete enough picture of the early pandemic to confidently trace it to a Wuhan wet market, but early and ongoing censorship and destruction of crucial evidence challenges that idea.
The radiologist estimated the number of cases in Wuhan to be 10,000 or more by January 21 — many times higher than the official count. The radiologist’s estimate is also thousands greater than the number of confirmed cases identified as having developed symptoms by January 20 in a retrospective search.
“I could see all the CT scan results. I paid attention to the curve of this viral infection,” the radiologist told the news outlet. “Although we had firsthand data, most of us dared not speak out publicly, fearing being summoned by the police.”
The radiologist worked at the hospital that served as the first stop of the World Health Organization during its 2021 origins investigation: Xinhua Hospital, or the Hubei Provincial Hospital of Integrated Chinese and Western Medicine.
The WHO team interviewed the hospital’s radiology department. But the document obtained by U.S. Right to Know may provide a clearer window into the crisis that transpired there than the WHO team’s deeply conflicted and politically compromised final report.
The censorship at Xinhua Hospital had global ramifications.
The intelligence community believed Chinese authorities in 2020 when they said the pandemic was not spreading through Wuhan hospitals, according to a congressional investigation released last year.
Intelligence analysts held off escalating warnings about the novel coronavirus because the Chinese government assured the globe there were no illnesses among health care workers, and thus little sign of human-to-human transmission.
The radiologist’s story shows that was patently, dangerously false.
Health care workers were informed of their diagnoses by phone. The CT scans were handed directly over to the hospital’s infection control managers— a policy adopted by multiple hospitals, according to the news outlet. These cases were not reflected in public statistics.
Doctors were afraid to speak out because of a threat posted by the Wuhan police against “rumor spreaders” on Chinese social media.
The threat of retaliation silenced frontline doctors “like a curse,” the Chinese journalists wrote.
Before the Chinese government admitted the virus was spreading from person-to-person, the radiologist saw ground glass opacities in the lung scan of a colleague in the hospital with no exposure history to the Huanan wet market — strong evidence of human-to-human transmission.
On January 11 — the same day that the National Health Commission once again publicly denied human-to-human transmission — other medical staff in the hospital began arriving in the radiology department for CT scans, worried they too had caught the new virus.
“At that time, the Health Commission said that no human-to-human transmission had been found, but the cases of colleagues around us made us no longer believe it,” the radiologist said.
“Even security guards are infected,” he said.
The denial of human-to-human transmission and crackdown on frontline doctors coincided with the closure of the wet market on January 1, as officials sought to give the impression that the culling of the animals there had stopped the pandemic in its tracks.
Yet investigators with the China Centers for Disease Control (CCDC) would later find that none of the animals tested in and around the market tested positive for SARS-CoV-2.
And the virus was still spreading.
Early and ongoing censorship
More than three years since the pandemic began, the earliest cases remain a mystery. That’s in part because, two years on, the Chinese government has yet to provide the World Health Organization with the raw data underlying its 2021 origins investigation, WHO spokesperson Tarik Jašarević recently confirmed to U.S. Right to Know.
Yet the wet market theory largely hinges on official statistics the Chinese government provided the WHO.
Some Western virologists say the earliest hospitalizations cluster around the wet market like a bull’s eye, proving the pandemic began there beyond a shadow of a doubt.
But Beijing’s years of censoring information from this early period complicates that hypothesis.
The interview with the Wuhan radiologist originally appeared in Caixin. Caixin is the most popular non-English digital outlet in the world. It has a reputation for strong investigative reporting.
The radiologist described the unprecedented nature of the pandemic to a reporter.
“A colleague pronounced a classic sentence, ‘Wuhan will go down in history as a result,’” he said.
U.S. Right to Know uncovered the document through Freedom of Information Act litigation against the U.S. State Department.
Documents obtained by U.S. Right to Know from the State Department also include a screenshot of the Caixin error page.
“Woah, I don’t even have to translate for you to guess what this means … deleted from Caixin,” a State Department official wrote.
But the surrounding pages are heavily redacted, making it difficult to understand the context.
U.S. Right to Know has not independently verified all of the claims in the Caixin document or independently confirmed the radiologist’s identity.
The interview was excerpted in a Caixin article noticed last year by Gilles Demaneuf, a researcher with the independent group DRASTIC, who has been studying the situation in the frontline hospitals and shared the article with U.S. Right to Know. In those excerpts, the radiologist has been given a pseudonym.
For his safety, the radiologist’s name has been redacted by U.S. Right to Know in the State Department document.
How early COVID statistics were censored
The Caixin report lays out in unprecedented detail how COVID cases were censored.
Initially, only six hospitals could report suspected cases, the radiologist claims. He does not specify which hospitals, but it is clear from other sources that early surveillance and retrospective searches focused on neighborhoods around the wet market.
The confirmation of suspected COVID patients had to go through a three-level review process, a claim supported by other reporting.
“The process was complicated and long, and there were very few confirmed cases,” the radiologist said.
The CCDC office for the entire province that encompasses Wuhan, Hubei Province, could only test 200 to 300 virus samples per day. As a result, each hospital could only report a limited number of samples rather than all of the samples they had collected.
Second, the provincial CCDC would pick only a selection of samples from each hospital to test.
“We all knew that each hospital had a corresponding reporting quota,” the radiologist said.
Authorities were “controlling the increase in confirmed cases by controlling the number of virus samples tested.”
Third, hospitals were made aware that not all of their samples should come back positive.
“Though not explicitly stated, the provincial CCDC expected the hospitals to help generate a low seropositivity rate,” the radiologist said.
Officially, there were 59 cases in China on January 5. Reports suddenly stopped without explanation. Six days later, on January 11, the official case count was revised down to 41 after using the very first PCR-test kits.
Yet in his hospital alone, the radiologist observed 2 cases on January 5, 4 cases on January 6, 7 or 8 cases on January 7, and 30 cases by January 10, roughly doubling every three to four days after that.
“The virus is so contagious that many people have already been infected by the time ordinary people become aware,” the radiologist said.
Once word got out that there was a novel SARS-like virus circulating from person-to-person, sick people started showing up in greater numbers at hospitals like the radiologist’s, rather than in cheaper clinics.
“I have never seen a virus spread so quickly,” the radiologist said. “On Jan. 18, I saw 86 cases of ground-glass images, and every day after that, it exceeded 100 cases. On Jan. 21, it was 136 cases, and on Jan. 22, it was 137 cases.”
By Jan. 20, denial of human-to-human transmission became untenable. Officials publicly acknowledged the virus was spreading. Panic set in.
Suspected COVID-19 cases ballooned, overwhelming the CT machines.
“The machines were exhausted, often crashing. We could only capture a limited number of images with a ground-glass appearance,” the radiologist said. “Finally, the numbers stopped increasing because we reached the limit.”
“I privately discussed the situation with other radiologists in different hospitals, and most of them were experiencing the same conditions,” he added.
By observing the CT scans and speaking with radiologists at other hospitals, he generated his own estimates of the pandemic epi curve — one much more grave than the official numbers showed.
Before the CT machines crashed in the fourth week of January, he estimated the number of cases to be more than 10,000.
“After the CT machines in the hospitals reached their limit, I couldn’t observe the actual curve of infection rate changes, making it difficult to estimate the current situation, but things didn’t look optimistic,” he said.
All but the most severe cases were turned away to quarantine at home. Some patients begged on their knees for the hospital to admit them, according to the radiologist. A separate deleted Caixin report corroborates that hospitals were overwhelmed and turned most people away.
“Our hospital’s outpatient department was crowded with a large number of suspected patients who couldn’t be admitted,” he said. “Some begged the doctors to admit them, while some critically ill patients didn’t even have the strength to climb onto the examination table for a chest X-ray. It was heart-wrenching.”
“These people, our parents and grandparents, might have been able to avoid such suffering,” he said.
Epidemiologists say the interview shows in evocative detail how cases were suppressed.
“I found this quite moving,” said Colin Butler, an epidemiologist at Australian National University. “Whoever wrote this was speaking out. I wish they could know that they have sympathisers and allies in far away places who will never know them.”
But the experts also say it’s not surprising that exponential spread was occurring in early January, even as authorities denied a crisis was building.
A 2020 study by Chinese scientists in the New England Journal of Medicine showed that human-to-human transmission was happening by mid-December, Daniel Lucey, a Georgetown University infectious diseases expert, points out.
Lucey said that January cases don’t tell us much about the pandemic’s origin, and that more information is needed about suspected cases in November and December 2019. He said the WHO’s data on the earliest recorded cases are incomplete.
“I am certain not all early cases were reported or shared with the WHO team,” said Lucey.
“Those of us who were watching the news reports from January 1 were curious that case numbers were not changing much in the early days of January,” said Raina MacIntyre, a professor of biosecurity at the University of New South Wales.
“We did a study in early 2020 which estimated vastly higher case numbers in China than were officially reported,” said MacIntyre. “Part of that would be asymptomatic or mild cases, but clearly that only explains a small amount of the discrepancy, as the magnitude of unreported cases in our study shows.”
In order to spread as quickly as the radiologist describes in January, the virus may have needed to begin infecting people before the wet market outbreak.
“I think the most interesting thing this fellow says is that there are clearly tens of thousands of cases,” said David Fisman, a University of Toronto epidemiologist. “That implies a much earlier introduction than would have occurred with a seafood market outbreak due to the time taken for the epidemic to grow.”
“Obfuscation and withholding of key information by Chinese authorities about the epidemiology of influenza-like illness and clinical data pertaining to COVID-like illness has made it extremely difficult to understand when the pandemic began,” said David Relman, a Stanford University microbiologist and biosecurity expert. “Based on all available information, we can reasonably conclude that the pandemic did not start at the Huanan Market in December.”
Pressure on doctors to remain silent
The Caixin interview illustrates how authorities’ pressure on frontline doctors to remain silent and retribution against whistleblowers has made obtaining information about the pandemic’s earliest cases more difficult.
“There has been a deliberate effort to obfuscate useful information about the beginnings of the pandemic,” said Relman. “I’ve even heard Chinese authorities who should have had access to all data say that they were thwarted and have little confidence [in the data] themselves.”
The threat of retaliation loomed, according to the radiologist.
“What really intimidated us was when the Wuhan police announced the lawful handling of eight rumor spreaders. This had a significant impact on silencing the medical community,” the radiologist said.
In several other stories from the frontline flagged by Demaneuf, investigative reporters lay out how the virus’ spread was suppressed at Wuhan Central Hospital and other top hospitals.
The early suppression of information is perhaps best emblematized by Li Wenliang, an ophthalmologist at Wuhan Central Hospital who became a folk hero after he blew the whistle on the SARS-like virus detected at his hospital on Chinese social media. He was formally reprimanded along with seven other “rumor spreaders.” He eventually died of COVID-19.
Other reports indicate that doctors in Wuhan were discouraged from recording new diagnoses, dismissing many with COVID symptoms as having simply a “lung infection.”
That’s also corroborated by a New York Times interview with a Wuhan Central Hospital doctor, who was one of the first doctors to treat a COVID-19 patient.
They said that a patient simply diagnosed in early January with a “lung infection” was transferred to the hospital by people in hazmat suits — “the kind I’ve only seen in movies.”
At that time, most doctors at Wuhan Central Hospital were precluded from wearing masks in order to maintain the ruse that the virus did not transmit person-to-person.
Dozens of workers at Xinhua Hospital had caught the novel coronavirus by the end of January.
“It suggests to me the leaders were either demoralized or callously sacrificing staff or at least knowingly exposing them to high risk, a bit like at Chernobyl,” said Butler.
The documents cited in this report can be viewed here. All of U.S. Right to Know’s FOIA documents about the origins of COVID-19 can be viewed here. Translations were performed with Google Translate, DeepL and ChatGPT 4.