September 18, 2020

8 Questions From a Disease Detective on the Pandemic’s Origins

For decades, Dr. Daniel R. Lucey, an infectious disease specialist at Georgetown University, has crisscrossed the globe to study epidemics and their origins. His attention now is on the Covid-19 pandemic, which first came to public notice late last year in Wuhan, China. Its exact beginnings are sufficiently clouded that the World Health Organization has begun a wide inquiry into its roots. The advance team is to leave for China this weekend, and Dr. Lucey has publicly encouraged the health agency to address what he considers eight top questions.

“It’s not a legitimate investigation if the team doesn’t ask them,” Dr. Lucey said in a recent interview. He cited public reports and scientific articles as starting points for his queries, adding that Beijing “has never come out and answered these questions.”

Clear answers, Dr. Lucey said, would cast light on how the deadly pathogen spread so rapidly and, perhaps, how exactly the outbreak began. China has not been forthcoming with information, and the Trump administration has inflamed the situation with threats and bullying. It has charged, without presenting evidence, that the microbe jumped to humans from a Wuhan lab. On Tuesday, after long threatening to do so, the administration began formal steps to end its W.H.O. membership.

A student of epidemics, Dr. Lucey has traveled to Asia, Africa, the Americas, Europe and the Middle East, at times as a caregiver. In 2014, working for Doctors Without Borders, he treated Ebola patients in Liberia. He posed his eight questions last month in a post for his blog, which he writes for the Infectious Diseases Society of America. The post came in response to an announcement by Tedros Adhanom Ghebreyesus, director general of the W.H.O., that the agency would be sending a team to China to investigate the pathogen’s source — a move long sought by the Trump administration.

“We can fight the virus better when we know everything about the virus, including how it started,” Mr. Ghebreyesus said on June 29 at a regular briefing in Geneva. In May, the World Health Assembly, the W.H.O.’s top decision-making body, passed a resolution calling on the agency to work with other international groups to identify the “source of the virus and the route of introduction to the human population.”

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Updated 2020-07-10T18:27:27.147Z

Ever since the outbreak erupted late last year in central China, the global rumor mill has buzzed with speculation and conspiracy theories. Experts have ruled out the idea that the pathogen was concocted as a bioweapon. They agree that it began as a bat virus that probably evolved naturally in another mammal to become adept at infecting and killing humans. But so far, after months of concentrated research at sites and laboratories in China and elsewhere around the globe, no clear intermediary has come to light.

The first three of Dr. Lucey’s eight questions center on the Wuhan wet market — a sprawling marketplace that sold fresh fish and meat before being shut down. It was initially viewed as the viral point of origin. That idea was quickly thrown into doubt when a study by Chinese scientists reported that roughly a third of the earliest hospitalized victims — including the first — had never visited the market. In a May blog, Dr. Lucey quoted the head of China’s Center for Disease Control as ruling it out as the pandemic’s place of origin. The market, the Chinese health official said, “is just another victim.”

Hundreds of environmental samples were reportedly collected at the wet market, producing 33 positive results, but few details have been made public. Dr. Lucey asks: Were any of the positive results linked to human infections? And from what kinds of surfaces — doorknobs, cutting boards, sewage, garbage trucks — were the samples collected? So far, none of the reported positive tests have come from animals.

His fourth question widens the scope of investigation to other markets in Wuhan and across China. Were any samples collected from animals “now known to be susceptible to the virus” — including cats, tigers, mink and ferrets? (Ferrets are routinely used to gauge the transmissibility of human flu viruses.) He also asks about pangolins, which were initially considered a possible intermediary in the human outbreak.

Dr. Lucey’s fifth question addresses a detailed report in The South China Morning Post, published in Hong Kong, that identified an early human coronavirus case on Nov. 17 in Hubei province. The province is the size of Washington State, and Wuhan is its capital. In March, Dr. Lucey wrote a blog post about the report, which described the virus’s rapid spread in Hubei, based on information that the report said came from the government. Now, Dr. Lucey is urging the investigators from the World Health Organization to determine where each of these early Hubei cases were reported, if indeed they occurred, and whether any other “documented or suspected” human infections may have occurred even earlier.

The sixth and seventh questions go to whether the deadly pathogen leapt to humans from a laboratory. Although some intelligence analysts and scientists have entertained that scenario, no direct evidence has come to light suggesting that the coronavirus escaped from one of Wuhan’s labs.

Even so, given the wet market’s downgrading in the investigation, “It is important to address questions about any potential laboratory source of the virus, whether in Wuhan or elsewhere,” Dr. Lucey wrote in his blog post.

To that end, he urges the W.H.O. investigators to look for any signs of “gain of function” research — the deliberate enhancement of pathogens to make them more dangerous. The technique is highly contentious. Critics question its merits and warn that it could lead to catastrophic lab leaks. Proponents see it as a legitimate way to learn how viruses and other infectious organisms might evolve to infect and kill people, and thus help in devising new protections and precautions.

Debate over its wisdom erupted in 2011 after researchers announced success in making the highly lethal H5N1 strain of avian flu easily transmissible through the air between ferrets, at least in the laboratory.

In his blog, Dr. Lucey asks “what, if any,” gain-of-function studies were done on coronaviruses in Wuhan, elsewhere in China, or in collaboration with foreign laboratories.

“If done well scientifically, then this investigation should allay persistent concerns about the origin of this virus,” he wrote. “It could also help set an improved standard for investigating and stopping the awful viruses, and other pathogens, in the decades ahead.”

Finally, Dr. Lucey asks the W.H.O. team to learn more about China’s main influenza research lab, a high-security facility in Harbin, the capital of China’s northernmost province. In May, he notes, a Chinese paper in the journal Science reported that two virus samples from Wuhan were studied there in great detail early this year, including in a variety of animals. It reported that cats and ferrets were highly susceptible to the pathogen; dogs were only mildly susceptible; and pigs, chickens and ducks were not susceptible at all.

In his travels, Dr. Lucey went to Brazil to study the Zika virus; to Madagascar to study pneumonic plague; to Jordan to study the Middle East respiratory syndrome, or MERS; and to Guangzhou, China, to study severe acute respiratory syndrome, or SARS. He said his wide travels over the decades had informed his current inquiry.

In an email, he added that the World Health Organization was aware of his eight questions and had given him “good feedback.”

Dr. Lucey likened his queries to the process of unlocking a large building. “The key thing is to open the door,” he said in the interview. “Where you go once you get inside, that’s beyond me.”

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