The medical virologist Prof Dominic Dwyer has barely been in China for 24 hours, but he has already joined several Zoom calls from his room in hotel quarantine planning the logistics of an ambitious investigation into the origins of the Covid-19 pandemic.
The World Health Organization selected Dwyer, a director at New South Wales Health Pathology in Australia, for the complex and politically fraught task, along with 14 other physicians, scientists and researchers from around the world. Most of the team arrived in China on Thursday after months of intense diplomatic negotiations with Chinese authorities and setbacks to their entry.
As early as April 2020 countries including the US and Australia had called for the independent assessment of what happened before the Wuhan Municipal Health Commission first reported cases of pneumonia in December 2019, later identified as Covid-19. Wuhan, home to more than 11 million people, is the commercial hub and sprawling capital of central China’s Hubei province.
“It’s obviously very complex,” Dwyer tells the Guardian. “There are scientific, medical and political influences on all of this. But I think for this exercise, given that we’re now really just past the first year anniversary of the beginning of all of this … one of the most important tasks is the understanding of what hasn’t been published, what those results are, and what needs to be done to get that information.”
China initially rejected demands for the international investigation, before eventually approving a list of WHO experts to enter the country. In November, a Chinese foreign ministry spokesman said: “Although China was the first to report cases, it doesn’t necessarily mean that the virus originated in China.” In the same month, Beijing amplified its criticisms of Australia, issuing a dossier of 14 key areas of dispute with the Australian government. The call for an independent investigation into the origins of Covid-19 was among the list of grievances.
‘It’s not about where you’re from’
It is in this environment, and amid scepticism about how much access and information China will allow the WHO team, that the investigators’ work in China has begun. But Dwyer says he does not feel uneasy.
“I think one of the features of these WHO missions is the people come in without their national viewpoints, biases or the politics,” he says. “That’s one of the advantages of WHO. As an international organisation it’s not about where you’re from. I think that’s an important way to dampen down political aspects of one country versus another.
“It is very early days, but everyone has been unfailingly polite, welcoming and friendly in obviously constrained circumstances. I’d be surprised if anybody said ‘Oh, you’re Australian, we’re not going to talk to you’. It doesn’t work that way. And that’s why it’s disappointing when leaders in some countries decide they don’t want to fund WHO.
“You need these international organisations precisely to get over the blame game, the politics and the country-versus-country type stuff.”
The WHO team were chosen for expertise in one of three key areas, Dwyer says: animal health and animal viruses; human viral infections and transmission; and epidemiology and public health.
As well as his work in pathology, the 64-year-old is a physician at Westmead hospital in Sydney, where he trained in microbiology, virology and infectious diseases. His specialism is HIV/Aids, and he was involved in the treatment of some of Australia’s first patients with that virus.
Fluent in French, he undertook postgraduate research at the renowned Institute Pasteur in Paris in the laboratory of Luc Montagnier, who in 2008 was awarded the Nobel prize in medicine alongside Françoise Barré-Sinoussi, for their discovery of HIV. Dwyer has worked with the WHO before, spending six months in Beijing in 2003 at the height of the Sars outbreak as China locked down the capital and closed thousands of public places.
“To see a city of that size in complete lockdown, with everything shut, everyone in a panic, was really quite remarkable, and in fact quite a good learning exercise for Sars-CoV-2 [the virus that causes Covid-19].”
He has trained people in laboratories in the Philippines and Singapore, and worked with the Australian government in 2005 to manage the threat of H5N1, more commonly called “bird flu”, in Vietnam. Dwyer says one of the WHO team’s first tasks when their quarantine ends on 25 January will be speaking with laboratory assistants, scientists and physicians in China.
“That face-to-face contact is important,” he says.
“They’re the people actually involved at the coalface, and they may well have a different view, or different findings, to what might be presented at a higher level. My experience with Sars and other things is that when you get to talk to your peer group, they too want to find out what’s going on, they don’t want things to be unknown, hidden or uncertain.”
Visiting the Wuhan wet market
There is evidence that suggests the virus jumped from a natural reservoir, such as bats, to an intermediary animal host, possibly triggering an outbreak among animals in the Wuhan wet market. In humans, the virus was first identified in people who worked at or visited the market. Visiting the wet market will be key, Dwyer says. Access was not granted to a small team of WHO officials when they first went to China to investigate the outbreak in February last year.
“Getting an understanding of the physical layout of that market, even if it’s closed, is important because the very preliminary information to date on the market shows a layout over a very large area, and there were parts of the market that had appeared to have a lot of cases of Covid while other parts didn’t,” Dwyer says.
“Why was that? And how does the market physically interact with other parts of the city? How do people work there? All of those sorts of things you can do on the ground.”
Could it be that despite their efforts, the work of the WHO team over the coming weeks may lead to interesting findings that nonetheless never reveal how and where the virus first infected humans?
“I think that’s true,” Dwyer says. “It may be that we never find virus zero. But I think the important thing then becomes: how did it move from those very few patients in the market and then into the city, then the rest of China and the rest of the world?
“Now of course it doesn’t mean that the outbreak actually started in Wuhan. We know the market was the amplifying event. But there were cases before then. So where were those early cases from? Were they in people travelling to work in Wuhan, or have animals travelled to Wuhan?
“It’s an easy assumption just to say, ‘It’s all in Wuhan’. But I think information from before then, about the early movement of the virus in people before it really got going, is perhaps going to be the most interesting, and indeed difficult, part.”