The COVID pandemic: 4 years on

It has been four years since the World Health Organization first declared COVID-19 a pandemic. The ensuing outbreak, which left millions dead, was the worst in more than a century. It also severely hampered the education of children and students worldwide, and strict lockdowns battered the global economy. I asked one of the key players at the World Health Organisation for her recollections of the situation 4 years ago, and the questions we still need answers to today about where the virus came from…

Maria - My name is Maria Van Kerkhove, I work for the World Health Organization. I'm the interim director of the Department of Epidemic and Pandemic Preparedness and Prevention and, during the COVID-19 pandemic, I am also our health operations and technical lead. This week, four years ago, we reached the point where WHO characterised the global situation as being in a pandemic. It's significant in many ways because it's where the world woke up to the threat of Covid. The anniversary actually should have been the 30th of January, 2020 when we declared Covid - it wasn't even called Covid at the time - a public health emergency of international concern. And that date in 2020 should have been the time where the entire world and governments activated their systems to tackle this unknown threat so that we could have potentially prevented a pandemic.

Chris - Was the threat recognised and realised by people at that point? Did they know and were just hoping it would stay a Chinese problem? Or was there an element of, well, no one's done anything yet, so we'll just go business as usual until they do?

Maria - I think that's a good question. I think the perception of what the threat was varied around the world. There were certain governments that knew the threat immediately, and that was because of the muscle memory they had because of other pathogens like SARS, like MERS, like avian influenza. They knew that they needed to activate systems to mitigate that potential introduction of the virus and, if it did get into their country, what they could do to buy themselves some time so that their health systems didn't get overwhelmed. I do think that much of the world did not take this seriously despite warnings because they thought this is a problem somewhere else in the world, you know? Whereas six weeks prior where we were saying; it could become a pandemic, this could be something really bad, it is an emergency at a global level, activate your systems, prepare, prepare, I don't think many governments around the world really understood that threat

Chris - Because initially the World Health Organization reassured us that there didn't seem to be any evidence this was spreading among people. Now, is that just because you were going on what you were told by China at the time? Or were there questions: we don't know that this is actually spreading?

Maria - There were so many questions that we didn't know. Of course early on, what was reported from China, certainly they were adamant that there wasn't any human to human transmission. But even before that, the first press conference that I ever did was January 14th, 2020, where I was talking about - I think there were 41 confirmed cases at the time - that there was likely some human to human transmission among families. But for us, we had already issued guidance about preventing human to human spread. I had articulated the hallmarks of what Coronaviruses were because we have experience with SARS coronavirus, with MERS Coronavirus, and the hallmarks of these types of pathogens. This viral family are super spreading events. We did have some warnings out there, certainly there were mixed messages from China. We were very frustrated with this. We've been extremely vocal about this over time. Nothing I'm saying right now is new. Regardless of what was being released from China, there were a lot of questions about transmission: how was it transmitted? Who is most affected? How do we stop it? One of the biggest, biggest, biggest questions we had in the beginning was around household attack rates. What was happening within the families themselves? That was important to understand how transmissible this was. But there was so much uncertainty in the beginning.

Chris - You actually went to China, didn't you, in February, 2020. Were they cooperative and supportive of your endeavours, Maria, because you were one of, and have been one of the few people who have stood up and vocally not let them off the hook when you think that they have not done the right thing. So back then, even in February 2020, were they supportive or were they trying to obfuscate

Maria - When we were there in February 2020, I'm not talking about the first few weeks of the pandemic - and yes I have been very vocal about calling out China and other countries for that matter when they don't release the information - a lot of that relates to the origins of COVID 19. You and I have spoken about that before. But when we were there on mission, I remember sitting with colleagues and being very impressed at the level of data that was available at subnational level. I remember speaking to our counterparts at China CDC and saying, why aren't you releasing this information? Why aren't you making these sitreps available? In my experience with everywhere we went, and of course we didn't go everywhere, and I'm sure that the places that we went were selected on purpose, but we got answers and we pushed for those answers. Our focus was not on origins on that particular mission, though we did discuss it a little bit. Our focus was really on understanding what was happening, what this virus was doing, the disease it was causing, and what could be done and how do we inform the rest of the world. At that time, the most heavily affected country was China.

Chris - On that latter point, you mentioned origins, and it's not a question that's gone away: we still don't have satisfactory answers. The WHO has asked questions of China about this, and they haven't been very forthcoming, have they? How are you working towards trying to get us closer towards understanding why this happened, without finger pointing, but why this happened and therefore how we can prevent it again.

Maria - I think that's the point. It's not about finger pointing. It's really trying to understand. The origin of COVID-19 is still open. The only ability we have is to assess available information, and the key here is available information. We've asked multiple questions. Not just questions, there are recommendations of studies that need to be done, there are assessments that we want to have happen, in interviews to happen with labs that were in the areas in Wuhan where the first cases were identified. We don't have the answers to this. Despite repeated requests on this, we don't have the results of studies that follow or that trace those animals that were sold at the Huanan seafood market back to their source farms. We don't have that information. Most of the available information does suggest that we do have a zoonotic origin, that the market played a very important amplification role, but the market is not the origin of Covid.

Maria - The market is potentially where susceptible animals were sold, where people were infected. But the question for us is, where do those animals come from? And then, of course, we have to look at the whole spectrum of the potential hypotheses of what might have happened. One of those is looking at a breach in biosafety, biosecurity. We still can't answer that question because we still have not had the audits and the interviews with the labs despite repeated requests. So we're working with SAGO, our advisory group, to try to advance this. But the only thing that they're able to do is evaluate and provide an independent evaluation away from politics, away from any of these conspiracy type discussions, but really rooted in science. But you can only evaluate data, and I think the last time we spoke there was the release of information and data from 2020 from the market which infuriated me. There's even been a recent study that has just come out that has looked at a number of sequences from human patients, I think from January through September 2020. There's more data that exists that has not been released, and that's the frustration that I have, that the global community has, because we can't put this to rest. It's not just a scientific question, it's a moral question. It's about preparedness for the future. We need to know specifically what happened so that our interventions, our prevention methods could be much more precise.