The origins of Covid-19: from Wuhan to Paris, in search of “patient zero”

On this December 8, 2019, the world is continuing its mad race, as usual. In France, the pension reform is in the news against a backdrop of social discontent. On the other side of the globe, protests are taking place in Hong Kong. Not far away, in China, in the then little-known megalopolis of Wuhan, a man named Chen is not feeling well. Perhaps he contracted the flu as the country faced its worst episode in a decade. In fact, the 40-year-old is the first documented case positive for Sars-CoV-2, a virus that has since killed more than 4 million people around the world. A year and a half later, the trail that leads to the origins of the pathogen stops with this man.

How and where did he get infected? Nobody knows. In its report on the genesis of the pandemic published in March, the World Health Organization (WHO) gives some details on this patient, called “S01”: he is an accountant, originally from Wuhan, in his forties. years and has not traveled before his infection. Moreover, he did not frequent the Huanan Market – once considered the epicenter of the epidemic – but a modern supermarket called RT-Mart, located on the other side of the Yangzi River, which cuts the city in two. The only certainty: it is the first officially recognized case, but certainly not the first contaminated. “We can’t say for sure who patient zero is,” said Lawrence Gostin, professor of global health law at Georgetown University in Washington. He’s most likely from China, but it’s not proven. ”

This quest for origins is made all the more delicate as Beijing is blurring the lines. In its report, the WHO provides the genetic identifier of S01: EPI_ISL_403928. A kind of bar code specific to each blood sample analyzed. However, this series of figures corresponds in Chinese databases to a 61-year-old Huanan market employee who fell ill on December 20, 2019. In reality, S01’s profile corresponds more to a younger person. But again, there is a catch: to believe the data shared by Beijing, this suspect No. 1 would have officially fallen ill on December 16, and not on the 8th. Faced with these inaccuracies, the WHO acknowledged Friday, July 16 “editing errors” in the joint report with China from last March, and changed the code for patient S01, which is now called EPI_ISL_403930. A slight correction which is not likely to speed up the search for the famous patient zero, but which says a lot about the effectiveness of the investigation into the origin of the pandemic and the incessant obstacles raised by Beijing. WHO chief Tedros Adhanom Ghebreyesus himself recently spoke of a lack of Chinese sharing of raw data on the virus.

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Circulation in Europe from November 2019

Despite an intense desire to understand the origins of this virus, it is not surprising that gray areas remain. “It is quite common not to quickly find out who patient zero is, because the task is difficult. But here the problem also seems to come from the lack of transparency and cooperation from China,” notes Lawrence Gostin.

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Infographics

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If Beijing revealed on December 31, 2019 the existence of an outbreak of unknown viral pneumonia on its soil, the country does not admit that the Covid-19 is of Chinese origin, and even hinted that it could have been imported. A theory that has found little support within the scientific community due to the genetic similarity between SARS-CoV-2 and the bat coronaviruses collected in the south of the country. To complete his speech, Chinese propaganda widely relayed several studies showing that the virus was already circulating in Europe well before December. Italian researchers documented in a study published in December 2020 in the journal Emerging Infectious Diseases, the case of a child positive for SARS-CoV-2 on December 5, 2019, i.e. three days before patient S01. In France, an Inserm team thus discovered a posteriori antibodies to Covid-19 in 13 blood samples taken from November 2019 to January 2020. For Marie Zins, scientific director of the project, this study “shows that the virus was circulating in Europe at that time “, perhaps in a less aggressive form, but” that does not mean that he was originally from Europe “. “What we know,” she continues, “is that whenever we have had access to viral samples from patients with the disease as we know it, it was the virus of Wuhan. ”

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According to experts in phylogenetics, a discipline studying virus strains to reconstruct their origin, the global SARS-CoV-2 epidemic appeared in humans between the end of August and the beginning of December. Problem: While in June, Gao Fu, director of the Chinese Center for Disease Control and Prevention, said the centralized medical monitoring system allows Beijing to be aware of a new disease in just six hours, that -this then goes completely unnoticed. The oldest known cases, discovered retrospectively by analyzing chest X-ray archives, were hospitalized on November 16 in Colmar in France and on November 17 in the Hubei region in China, even if these a posteriori analyzes, without serological analysis, were not do not allow to certify 100% that they are patients of Covid-19. Contacted by L’Express, Santé Publique France assures us that the search for patient zero in the country “is no longer relevant”, “on the one hand because the epidemic context makes this research not very relevant with regard to the follow-up work of the epidemic (…). On the other hand, it is now very clear that there is not a zero patient, the only one responsible for all the cases of the first wave “. “Multiple viral introductions giving rise to distinct chains of transmission have occurred, and their detection has been delayed by the existence of numerous asymptomatic cases, the excretion existing before symptoms for the other cases, and the concomitant circulation. influenza, “continues the health agency.

Originally was Wuhan

In this game of (false) leads, the hunt for the first infected patients is complex. Marie Zins assures us: the vast majority of people with antibodies in France as of November 2019 had no connection with China. Only one of them had spent two months traveling the country, but he had not been to Wuhan. Still, the investigation continues, at least in the United States, where President Joe Biden is awaiting a report from his intelligence services on the origins of the pandemic – and in particular as regards a potential accidental leak from the Institute of Wuhan Virology (WIV). According to information published in the American press, three researchers from this laboratory where bat coronaviruses were studied had been hospitalized in November 2019, presenting symptoms compatible with Covid-19, but also with those of a “seasonal infection “. That is to say a month before the first cases officially identified by Beijing. The latter had previously visited a cave housing “horseshoe” bats in Yunnan province, 1,500 km south of Wuhan. At the White House, immunologist Anthony Fauci even went so far as to say that it is “entirely conceivable that the origin of Covid-19 was found in this cave, and that it began to spread naturally or passed through the lab. ”

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One thing is certain: the city of Wuhan was teeming with activity between October and December 2019. The megalopolis of 11 million people hosted the Military World Games, with athletes from all over the world, and then the world’s largest motor show. ‘Asia, then a world forum for the construction of bridges or a meeting of former students of Peking University. So many events that could have led to the massive and silent propagation of an unknown virus. Especially since at that time, China was facing a very strong influenza epidemic. According to official Chinese statistics, there were five times more influenza cases in the country than a year earlier in October 2019. In December, there were nine times more. In other words, it would have been easy to miss the first contaminations with a virus hitherto unknown and which causes, among other things, fever and coughing fits.

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Today, there is no “rigorous” and “well coordinated” international hunt to track down patient zero, regrets Lawrence Gostin. Will we one day know the end of the story? “It will be difficult, because this pathology includes many asymptomatic patients”, explains Marie Zins. The American researcher agrees, but considers this research “important” because it “would help to understand how the new coronaviruses act and evolve” with a view to preventing … a future pandemic.


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