Blog Global Health Center COVID-19 Infectious Disease

COVID-19 lost in translation

Written by Lingzi Luo, MSW/MPH, Clinical Research Coordinator at WashU School of Medicine; Institute for Public Health Summer Research Program – Public and Global Health Track alumnus

Wuhan (China) is my hometown. To me, the COVID-19 outbreak has already lasted more than two months. I did not just go through one outbreak. I went through outbreaks in Wuhan, in Korea, in Italy, and now in the United States.

January 26, I sent an email to Habif Health Center at WashU warning that COVID-19 is transmissible during incubation period, which means increased threat of community spread in the U.S. At that time, although the Chinese government announced it, U.S. CDC experts doubted it and asked for more evidence – the evidence was reported, but it was in Chinese.

A lot of information was lost in translation, the translation of other languages to English, and the translation of research evidence or knowledge to policy implementation, practice, and public awareness.

Dr. Wenliang Li, ophthalmologist at Wuhan Central Hospital, sent a private group message to warn about confirmed SARS cases on Dec 30, 2019. The message was leaked. He was admonished by the police for spreading ‘rumor’ on Jan 3. He continued working as an eye doctor. It’s such a tragedy that he passed away because of COVID-19. We will remember him forever. If you Google search, “Wenliang Li Coronavirus”, there are 2,230,000 results.

Blog author, Lingzi Luo
Dr. Jixian putting on an isolation gown (Photo by Ke Hao for
putting on an isolation gown (Photo by Ke Hao for

If you Google search, “Dr. Zhang Jixian Coronavirus”, there are only 35,400 results. She is the first doctor who noticed the few cases with pneumonia as being unusual, reported to the hospital on Dec 27, 2019. The hospital reported to Wuhan CDC on Dec 29. Wuhan government announced it to the public on Dec 31. According to the New England Journal of Medicine, the World Health Organization and countries, including the U.S., were notified on Jan 3, 2020. This part of the story was rarely in the news. To me, Dr. Zhang is the hero.

In Wuhan, the initial testing criteria was narrow, giving priority to those linked to a “Wet Market” or with severe symptoms. Later, it turned out that market may not be the source of the virus. The lack of reporting was partially due to local government’s hesitancy (the local leadership’s emergency response was not comparable to cities like Shanghai or Beijing), but also because it was a novel virus and the testing kit was neither widely available nor reliable (30%-50% accuracy rate, need two positive tests to confirm a case). Wuhan was on lock-down on Jan 23, a week after test kits were distributed to Wuhan on Jan 16 and testing criteria was then expanded.

Does this story sound familiar? In early February this year, the U.S. CDC realized test kits were not as reliable as desired so did not distribute them widely. The testing criteria was set to be travel related, and community spread went undetected for weeks until late February. Then, BANG. The WHO and the U.S. CDC had no discussions about providing test kits to the U.S., because probably no one, including the WHO, had foreseen that the U.S. had such a big issue with testing.

We are proud of our high standard in the U.S., but will these high standards drag us down in future emergencies? Besides initial issues with testing, when there is not adequate supply of N95 respirators, the FDA did not approve Chinese KN95 respirators from its initial list as alternatives until a week later. A week of golden time when countries in Europe were also competing. Hopefully now it is not too late.

I do have great confidence in the U.S. winning this war. But overconfidence, the lesson we learned from the initial Wuhan government response, and the lessons we learned from outbreaks outside of China, and the stereotypes and propaganda from some public and media certainly did not help. I pay so much respect to nature, and to everyone who is in this fight together, one way or another.