Monday this week was the 2nd anniversary of the Death of Dr Li Wenliang
On October 18th, 2019 in New York the Johns Hopkins Center for Health Security, in partnership with the World Economic Forum and the Bill and Melinda Gates Foundation, hosted Event 201, a high-level pandemic exercise. Event 201 was a 3.5-hour pandemic tabletop exercise that simulated a series of dramatic, scenario-based facilitated discussions, confronting difficult, true-to-life dilemmas associated with response to a hypothetical, but scientifically plausible, pandemic.
Fifteen global business, government, and public health leaders were “players” in the simulation exercise. It highlighted unresolved real-world policy and economic issues that could be solved with sufficient political will, financial investment and attention now and in the future. The scene was set by Dr Mike Ryan, Executive Director of the WHO.
Some participants were from relatively close to ‘home’, e.g. Jane Halton, AO, PSM, FAICD, FIPPA, a member of the board of the ANZ Bank; Clayton Utz, the Australian Strategic Policy Institute; and the US Institute of Health Metrics and Evaluation. Ms Halton is chair of the Coalition for Epidemic Preparedness Innovations, COTA, and Vault Systems. It would have been a worthwhile exercise to have a closer look at Ms Halton’s advice and activities before and after Covid-19 became known.
More aptly, present were George Fu Gao and Martin Knutchel.
Martin Knuchel is Senior Director and Head of Crisis, Emergency & Business Continuity Management, for Lufthansa Group Airlines. He is responsible for strategic development of crisis and emergency procedures, emergency field organisation and care organisation procedures for the Lufthansa Group. His responsibilities entail planning and coordinating the interface work with communication, ground operations, security, safety and training, as well as planning and executing emergency exercises for the group’s crisis teams.
He also serves as the pandemic coordinator for the airline. He has been with Swiss International Air Lines since 2002 and is responsible for emergency operations with partner airlines as the leader of the Swiss International Air Lines crisis team. He directs emergency training for staff worldwide, and he is responsible for interfacing with national and international organisations, including the Swiss foreign ministry, the Swiss health ministry, and embassies and authorities in various countries.
We look at Martin for three reasons. Firstly because of his expertise in the role of international travel and the potential spread of a pandemic. Secondly, because he was working with the group. Thirdly, and particularly, his rapport with George Fu Gao.
The first point is obvious and his contribution to the pandemic simulations seems entirely appropriate. Secondly, his input was considered by the group. Evidence for this recognition is embedded in the recommendations of the group following the closure of Event 201 (recommendations that Mr Gao took part in constructing). These recommendations can be found here.
The third point leads us to consider the following timeline. On December 31st, 2019, only 2 months after the Event 201 meeting, reports began to emerge from China of a potential pandemic. Some recent investigations have pushed the date of suspicion back before Event 201.
Between January 6-8 of 2020, reports and travel warnings began to be issued from the US CDC about an influenza-like outbreak in China. On Jan 16th the US announced that passengers from Wuhan would be screened for symptoms of a ‘flu-like’ disease. January 21st, the first US case was identified. On January 29, the US set up a coronavirus taskforce. Jan 31st, Trump blocked travel from China… meanwhile, back in China, Wuhan was “locked down” from the rest of China on January 23rd, 8 days before the US announced a lockdown.
For 8 days there were unrestricted international flights out of Wuhan to the US and the rest of the world.
China is the second-largest international flight centre in the world, after the US.
However, and still, on February 4, the Civil Aviation Administration of China requested that local airlines keep operating international flights to countries that hadn’t imposed restrictions on inbound travel.
It is beyond comprehension that, at this point, Mr Knuchel could not have understood the implications of what was going on as only 12 weeks beforehand he had participated in scenarios of a pandemic.
His responsibility should have been to play his role – and also to warn every other airline of what was potentially going on. Possibly he did.
And now we come to his colleague at the pandemic simulation exercises. Mr Gao.
Professor George F. Gao is the Director-General, Chinese Center for Disease Control (what we call CDC) and Prevention; a Professor in the Institute of Microbiology, Chinese Academy of Sciences; President of the Chinese Society of Biotechnology; and President of the Asian Federation of Biotechnology (AFOB). Dr. Gao obtained his DPhil degree from Oxford University, UK, and did his postdoctoral work at both Oxford University and Harvard University, with a brief stay at Calgary University.
His research interests include enveloped viruses and molecular immunology. His group research is mainly focused on the enveloped virus entry and release, especially influenza virus interspecies transmission (host jump), structure-based drug-design, and structural immunology. He is also interested in virus ecology, especially the relationship between influenza virus and migratory birds or live poultry markets and the bat-derived virus ecology and molecular biology.
Dr. Gao has published more than 450 refereed papers and ten books or book chapters, and he has applied for and obtained more than 25 UK, US, and Chinese patents. His research has recently expanded to public health policy and global health strategy.
He led the China CDC team from September to November 2014 to work in Sierra Leone in the fight against Ebola. Dr. Gao is a member (academician) of the Chinese Academy of Sciences, a fellow of the Third World Academy of Sciences (also known as the World Academy of Sciences), a fellow of the American Academy of Microbiology, and an associate member of EMBO. He is a recipient of several national and international awards, including the TWAS Medical Prize (2012), the Nikkei Asian Prize (2014), and the HLHL S&T Advancement Award (2015).
As Director General of the Chinese CDC, having led a fight against Ebola, and having partaken in the simulations, it is incomprehensible that Mr Gao did not, at a very early stage, understand what was going on and the implications.
Mr Gao is a specialist in “interspecies transmission” and “Covid-like viruses”, bat viruses and pandemic spread. On January 22nd it had already been indicated that human to human transmission was now a probability. Yet we have an eight-day lapse between the closure of Wuhan and the restriction of international flights
With a simple phone call, he could have contacted any other member of the Event 201 group and exchanged information and advice. If he had spoken to Martin, the airlines could have taken precautions as well as limited the spread of the virus. But he did not.
Even a cryptic hint could have alerted the rest of the world or any of his colleagues from Event 201. He could have let the sponsors of the event know what was going on. Instead, everyone had to rely on the plaintive shout-out of a dying doctor Dr Li Wenliang from the front lines. Professor Gao could have been more open with the WHO.
Those 8 wasted days have so far cost the additional lives of a million plus people and will cost more. Professor Gao could have and should have acted. Why didn’t he?