‘Terror and Confusion’: On the Ground in Wuhan, China in the Early Days of Covid-19

With the threat of the Omicron variant bringing coronavirus uncertainty back into our daily lives, freelance journalist Brendan Borrell takes us back to the hazy, early days of the pandemic in this excerpt from his new book, The First Shots: The Epic Rivalries and Heroic Science Behind the Race to the Coronavirus Vaccine. Borrell tells the inside story of how Operation Warp Speed emerged from the Trump administration’s dysfunctional coronavirus response and gave the country vaccines in record time. 

This excerpt describes the harrowing experience of Dr. Michael Callahan, an infectious disease doctor and bioweapons expert who had once been an enthusiastic supporter of the risky virus research taking place at the Wuhan Institute of Virology and other international institutions because of its potential to prepare us for the next pandemic. On the ground in Wuhan in January 2020, Callahan, like many others in the field, believed that the novel coronavirus had spilled over from animals to people, as was shown with the first outbreak of SARS in 2002-2003. Callahan has since advocated for a joint U.S.-Chinese team to investigate the potential that the virus leaked from a laboratory, arguing that maintaining international research ties are the key to getting to the bottom of COVID origins and to preventing future outbreaks.

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Wuhan had not been part of Michael Callahan’s original itinerary. On Jan. 17, 2020, he had stepped off a plane in the Chinese city of Nanjing after some thirty-odd hours in transit.

The American doctor was looking forward to seeing his Chinese pals, a couple of veteran disease fighters he had met in Hong Kong during the 2002–2003 SARS outbreak. He had kept up the friendship by writing letters of recommendation to American universities for their students and children and by visiting China every couple of years for three to six weeks at a time for a collaboration on avian flu. “We’re getting older, we’re getting balder, but we’re still the same people,” he said.

As a wiry young ambulance medic and medical resident, Callahan had rescued people from plane crashes and mountain-climbing accidents. “Onesies,” he called them — the isolated events that were mere stepping-stones to his first passion:disaster medicine. After he tired of tsunamis and earthquakes, he started suiting up for disease outbreaks. The first came in 1993, when he tagged along with the CDC’s Viral Special Pathogens Branch on an investigation into a deadly hantavirus out- break in the southwestern United States. Soon, he was jetting off to Asia and Africa; he always seemed to be the first guy on the ground at the scene of an outbreak. He once had to inject a crazed Ebola patient with a tranquilizer while trying not to poke a hole in his biocontainment suit. “You get infected, you die,” he said.

In the early 2000s, Callahan’s career took the first of many unexpected turns when the government sent him on a remarkable mission. His mandate was to form alliances with scientists at some of the most secretive bioweapons laboratories in Russia and the former Soviet states. “These guys ran the National Institute of Death for Russia, right?” Callahan said. His job was to harness their powers to fight disease rather than weaponize it. He remembered standing around a tundra lake with these killers, fishing for trout, barbecuing, and listeningto Russian folk music as the scientists obsessed about how to get their kids into a good college. They’d hand him avian flu virus samples and give him advice on how to evade Russia’s Federal Security Service, the dreaded FSB. “Don’t leave tonight,” they told him one time. The next time it was “You’ve got to leave Russia now!” When one of their scientists accidentally pricked herself with a syringe containing a deadly pathogen, Callahan flew in to assist in her treatment.

Later, Callahan joined the Defense Department, where he worked to accelerate vaccine and drug development and established an international disease-surveillance effort, enlisting the help of regional hospitals in a dozen countries, including Mexico, Nigeria, and Indonesia. Now 57, Callahan had returned to civilian life. His hair was indeed thinning and his days weren’t as action-packed as they once were, but he hadn’t slowed down.

Nanjing, which is situated on the banks of the Yangtze river, is China’s ancient southern capital and a modern-day center for science. It was a pleasant enough place to go to escape winter weather in Boston, where Callahan held a part-time position at Harvard’s Massachusetts General Hospital. When Callahan set down his bag in the lobby of the Westin Hotel and was handed the key card to his room, he had to smirk. There’s 400 rooms in this hotel, and I get the same room every time? he thought. It was a fine room. Clean bathroom, firm mattress. It was also a tell. Ever since Chinese hackers stole a database containing information about his high-level security clearance, Callahan knew that someone might be watching his every move. “I’m not that good-looking of a guy, but you’d think I was Brad Pitt when I go down and get a beer,” he said. “Honeypots. But, you know, we get training for that.”

first shots

For weeks, Callahan had been following the chatter coming out of Wuhan, some three hundred miles upriver from Nanjing. Shortly after Callahan arrived, his Chinese doctor colleagues heeded a countrywide alert to assist with the outbreak. Callahan could feel his own chest tighten at the thought of another hot zone. There was something about that hypervigilant state that made him feel most alive. If he went to Wuhan, Callahan knew he couldn’t worry his wife by telling her about his plan. He had tobe careful about telling anyone. He didn’t have official permission to travel there, after all. “It was not sanctioned, not authorized,” he said.

He went to Wuhan anyway and hunkered down in a guest house, waiting to get the word from his friends. “They had to check in to make sure things were safe for me.” On Jan. 22, Callahan slipped on medical scrubs and donned an N95 mask and a pair of goggles to pass through the entrance of the Wuhan Central Hospital, a boot-shaped glass building rising up from the city’s empty streets. There, his colleagues registered him as a “guest clinical educator,” a title that would allow him into the wards as an observer. The next day, the city locked down. Callahan had just made it into the white-hot center ofthe outbreak.

He soon saw the familiar look of terror and confusion in the eyes of Wuhan’s infected patients as their shallow breathing quickened and their desperation grew. Perhaps they had inhaled a few hundred virus particles in the air. The phalanx of invaders then touched down on the hairs in their nostrils or deep in the sinuses and upper airways. After a couple of days, the victim felt the itch in the back of the throat, the first sign that something was amiss. A few cells here and there were dying, releasing chemical SOS signals as they perished. In these first stages of a coronavirus infection, the immune system launches a generic defense, ramping up mucus production to flood out the invader and create a physical barrier between the pathogen and the cells. It also amplifies those SOS signals and deploys white blood cells, the foot soldiers of the immune system. This is when the coughing and sneezing begins, and maybe a little fever. Having never been exposed to this virus before, a person’s body had no targeted means to fight it.

Gradually, more specialized white blood cells arrive on the scene, a process that can take longer in older patients and others with weakened immune systems. During this ramp-up, the body is homing in on specific weapons to fight the virus: antibodies. Antibodies are grabby, Y-shaped proteins that cling to other molecules. About one-fifth of the weight of your blood serum is made up of this whitish gunk. Through combinatorial magic, your body makes as many types of antibodies as there are stars in the Andromedagalaxy — one thousand billion. Some of them, by chance, will bind to the coronavirus, but only a vanishingly small number will disable an individual virus before it can infect a new cell. Afterward, these antibody-decorated viruses areswept away, sucked up by the body’s house cleaners.

While the antibody response is still escalating, the coronavirus can largely multiply with abandon. This is its moment of opportunity. It chews through human cells one at a time, turning them into infective slime. That slime oozes down the victim’s throat, lodging itself in the lungs, where infection is harder to clear. The body launches its riskiest line of defense — it sends in its assassins the killer T cells, which seek out infected cells and trigger their self-destruct buttons. As this war zone inside the lungs heats up, collateral damage becomes inevitable. Half of the immune system ends up fighting the other half. Red blood cells burst and disgorge their hemoglobin, an iron-rich molecule that wreaks havoc in the lungs, like a grenade mistakenly dropped in the trenches. As their injured lungs fill with a toxic jelly of dying cells, the patients feel likethey are drowning. This desperation happens long before the patients actually are drowning, and it is the doctors’ job to keep the patients in the game, fighting the disease with their own lung power, aided by supplemental oxygen, steroids, and pain relievers. When they got to a point when the drugs were no longer working, when the oxygen wasn’t helping, when the pulse oximeter readings dropped to 70, 60, 50 . . . there was only one thing Callahan’s colleagues could do to keep them alive: anesthetize them and place them on ventilators.

Those ventilators sat on wheeled pedestals so they could be quickly moved on to the next patient when the current one no longer needed it. Except what Callahan was seeing was that patients were being put on ventilators faster than they were coming off them. Caseloads were rising from the dozens to the hundreds. Every time a new breathing tube was inserted intosomeone’s throat, infectious clouds of virus particles filled the air. Callahan helped his colleagues set up so-called laminar-flow rooms as he had during SARS, positioning fans on the windows to suck contaminated air out. The hospital was running out of rooms, running out of ventilators. Even at this early stage, he could see that this was going to be worse than SARS.

Callahan was witnessing only the most dramatic and immediate impacts of severe infection, the way it stressed the lungs, the heart, and the kidneys. But when you push the immune system so hard, when your body is repeatedly detonating these grenades, not all of that damage can be repaired. Those patients lucky enough to emerge from the intensive care unit alive were not going to pop back into their normal lives the moment they were released. They would continue to have trouble breathing. They would have a persistent cough that might never go away. Joint and chest pain too. Some would suffer from a sort of brain fog that made it difficult to concentrate, leaving them in a permanent funk; depression wouldsettle on them. Others would have their fevers and chills return periodically, along with a racing heartbeat or otherarrhythmias. Even less severe coronavirus infections, Callahan knew, had the potential to scramble the normal functioning of the human body, causing people to develop rashes or lose their hair.

All told, Callahan spent almost a week on the ground helping his colleagues keep the hospital functioning, learning about the virus’s toll on the human body, and taking note of what drugs doctors were throwing at the virus. Chinese officials were planning to tighten Wuhan’s quarantine measures, banning residents even from stepping out to buy food. Callahan slipped across the river by boat — “the black-market way” — and returned to Nanjing, where he and his colleagues had a video link with the ICU units in two hospitals in Wuhan and could provide advice and track patient outcomes. Callahan knew he needed to report what he was seeing to his friends in the U.S. government.

The headquarters of the Department of Health and Human Services are located inside the Hubert H. Humphrey Building, an eight-story brutalist concrete building straddling both a freeway tunnel that burrows underneath the capital and a major sewer line that carries all the crap emerging from it. The department controlled a budget of more than one trillion dollars, an amount larger than the entire military, and its dominion included the Centers for Disease Control and Prevention, the National Institutes of Health, the Center for Medicare and Medicaid, and a number of lesser-known divisions, one of which was the Office of the Assistant Secretary for Preparednessand Response (ASPR). The ASPR was led by a former Air Force doctor and bioweapons expert named Bob Kadlec a.k.a Dr. Bob. Up on the sixth floor, Kadlec’s grim, windowless office was a messy affair. Almost every inch of desk and table spacewas covered with precarious stacks of papers, binders, and manila folders; one small area held a bowl of candy with an American flag planted in it.

scientist michael callahan

Courtesy of Michael Callahan

On Tuesday, Jan. 28, Kadlec received an  e-mail from Callahan. He told him he had seen data showing that the incidence of the disease was four times that being reported to the WHO. The Chinese had 23,000 people under daily observation with confirmed infectious contacts. Of the 277 closely monitored patients he was following, 22 had been released and one had died. The virus stayed active in a person’s body for about nine days, which he believed posed “a  major challenge.” One of the most wily aspects of coronaviruses was that some people were seriously affected and others not so much. Viruses like that were much more difficult to contain because they so easily flew under the radar. Asymptomatic and minimally ill patients, Callahan wrote, “will propagate virus into distant communities.” The new coronavirus was a serious disease, but its fatality rate was anyone’s guess. It wasn’t Ebola, which kills an average of half thepeople it infects, but it was worse than the seasonal flu, which kills 0.1 percent of infected people over the age of 65. He warned Kadlec that the monoclonal-antibody therapies that worked against the first SARS virus were proving uselessagainst the new coronavirus.

Kadlec had known Callahan for 20 years, and the infectious diseases doc had likely now seen more patients infected with the new coronavirus than any other American doctor had. But what he was saying didn’t comport with the early reassurances Kadlec had gotten from the CDC or with the near vacuum of information coming from the intelligence community. “The two most high-confidence sources of information I have can’t tell me shit,” Kadlec said. “No one had a grasp on what was going on.” Over the previous two days, the number of confirmed cases reported by the Chinese in Hubei Province had jumped by 65 percent, from 2,744 to 4,515, confirming that Callahan knew exactly what he was talking about.

Dr. Bob began to envision the pandemonium that could potentially unfurl inside American borders, when the crisis would become his responsibility. After a 9 a.m. meeting with some of the department’s leadership, he pulled Brett Giroir, the assistant secretary of health, aside and asked him what he thought of Callahan’s message. Giroir was an intense man with a buzz cut who dutifully wore the navy uniform of the U.S. Public Health Service Commissioned Corps, of which he was the top doctor. He agreed that it was all very scary and that they needed to convince the rest of the team at HHS, including their boss, Health and Human Services Secretary Alex Azar, to ramp up the nation’s response to the virus.

Within days, Kadlec had signed Callahan up for a six-month stint helping ASPR to provide virus intelligence by way of his Chinese connections and advise on how to respond to virus inside the United States. “His physical location andmeetings will be determined by the ASPR,” read his statement of work. “He will be expected to respond on ICS [Incident Command System] timelines (24/7 mobile access: 2hr to airport; autonomous resources). He will not [be] official U.S. Government, will not represent U.S. Government opinions, will not communicate to media or social media and will presumeall information is [Sensitive but Unclassified / Not Releasable to Foreign Nationals].” Callahan had just accepted his most perilous assignment yet. He was going to work for the Trump administration.

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