A rigorous testing and reporting system that China established following the Sars outbreak more than a decade ago is the most probable explanation for the long delays in confirming new cases of the virus that originated in Wuhan, according to medical specialists.
The sudden surge in confirmed cases over the past few days - including more than 130 in Wuhan along with the first instances in Beijing and Guangdong province - have raised questions about the robustness of China's reporting system for communicable diseases and whether mainland officials are willing to share information about the strain of pneumonia.
Professor David Hui Shu-cheong, an infectious diseases specialist at the Chinese University of Hong Kong, said confirmation for suspected cases of the novel coronavirus was often delayed because it required tests in a separate laboratory to avoid errors.
"I am not familiar with mainland's reporting mechanism. But I understand that the genomics sequence was not submitted to the World Health Organisation until the 12th [of January] and it takes two days for reagents to be generated for the diagnostic test kits before they can be distributed to local public health institutions," Hui said.
"That's why we saw a sudden surge of diagnosed cases over the weekend as local health institutions also received the diagnostic kits in batches.
"At least in Hong Kong, a delayed confirmation is most certainly expected as it takes two positive results done in two laboratories before it can be publicly declared. But it might even be more complicated for cases in China as it involves multiple levels of administration," he added.
One of the Guangdong cases involved a 66-year-old man who started showing symptoms of fever in Shenzhen on January 3 after a visit to Wuhan.
He sought medical consultation in the border city the following day and was quarantined a week later.
But it was not until Sunday that the authorities could confirm that the patient had contracted the virus.
A Guangdong health official who requested anonymity as he was not authorised to speak publicly confirmed that all health workers are required to follow a time-consuming three-step confirmation protocol.
"Actually it only takes a short while to get virus results in local hospitals with the test kits. What is time-consuming is that suspected cases are required to wait for a second positive result from the Chinese Centre for Disease Control and Prevention [in Beijing] before a panel of experts can go ahead with clinical diagnosis.
Only after these three steps are completed can we publicly declare any confirmed case," the official said.Professor David Hui Shu-cheong said suspected cases needed a second lab test to avoid errors. PHOTO: South China Morning Post
China has learned a painful lesson about the lack of transparency and emergency planning during the severe acute respiratory syndrome crisis, which exposed its lack of an effective central command system to coordinate and control the reporting of diseases and the sharing of information.
Since then, China has spent billions of yuan on training and rebuilding its infectious disease control system and on strengthening the information-sharing networks both domestically and with international bodies such as the World Health Organisation.
By 2006, it had established a national, real-time and internet-based reporting system for communicable diseases and public health emergencies.
On Monday, mainland Chinese internet users started to express increasing concern about the spread of the disease, which has so far killed three people.
"How can we avoid a large-scale outbreak? It is too difficult as the Spring Festival travel peak season is under way," one wrote on the social media network Weibo.
"The health authorities issued statements many times [about the epidemic] these days, and this shows that the situation is becoming more serious. I am really scared," another person wrote.
A financial worker in Guangzhou surnamed Yuan said he was worried about the arrival of a relative of his wife from Wuhan to celebrate Lunar New Year.
"We will pick him up at the railway station and have dinner on New Year's Eve," he said. "It's a dedicate matter: the relative insists on visiting us and it would not be polite for us to say no."The new cases coincide with the peak travel season for Lunar New Year. PHOTO: AFP
Zhou Hongming, a university teacher in Wuhan, said she did not feel there is a panic in the city, although the local health authorities have stepped up a campaign to remind people of the importance of hygiene.
"I think that after Sars, people are less alarmed [about infectious diseases] than before," she said.
She said local people only started paying more attention to the epidemic on Sunday after the authorities reported a significant increase of confirmed cases.
"I heard that face masks are beginning to run out of stock," said Zhou.But a Beijing-based media worker who is a Wuhan native said that when he returned to his hometown on Saturday, he was the only one wearing a mask at the railway station.
"Wuhan's epidemic prevention and control measures do not seem to have been well implemented. The public generally has relatively low awareness of the danger of the infection," said the man who did not want to be named.
"A local friend said he saw many people living in other cities sharing information about new confirmed cases in Beijing and Guangdong on social media. My friend jokingly said that people from outside Wuhan are more frightened than Wuhan residents."
This article was first published in the South China Morning Post.