The "Fog of War" concerning the origins of SARS-CoV-2

 

The following essay is converted from an 18 part twitter thread I posted on December 30, 2021. I have converted this semi-telegraphic thread to more familiar prose, but I'm not at this stage, anyway, proposing to write it up more formally. I might add more links, in future. The original thread can be found here.

 

This morning (December 30, 2021) I listened to two consecutive radio programmes on Australian Radio National. The first was a convincing story about the deliberate release of smallpox in the colony of NSW, 1789, in order to assist with British colonisation and Indigenous depopulation. The second was the "Health Report", a conversation between Dr Norman Swan and Prof Peter Doherty, an immunologist awarded the Nobel Prize. It concerned the origins of SARS-CoV-2. A transcript of this conversation is available at the ABC website, where you can also hear the broadcast. (Not sure if this is available outside Australia.) I remember hearing this episode when it was first broadcast [July 12, 2021] and I probably tweeted about it then.

 

However, even if I did tweet about this interview in July, I have more knowledge and new ideas today. 

 

First, I have enormous respect for Prof Doherty. He and I are each scientific advisors for Doctors for the Environment Australia. That is one of my most prestigious honours, but probably one of Prof Doherty's top hundred. In comparison (to Prof Doherty) my last grant, an Australian Research Council "Future Fellowship" was awarded in 2011. Since 2016 I've only held honorary (unpaid) academic positions. 

 

To add to my obscurity, I've never been interviewed by Dr Swan, who (as it happens) is also a scientific advisor for Doctors for the Environment Australia. However, I have spoken with Prof Peter Doherty, for over an hour, in 2019 (pre-pandemic). Our conversation was mostly about climate change, but we also discussed infectious diseases, especially my paper from 2012 called "Infectious disease emergence and global change: thinking systemically in a shrinking world".

 

In this ABC interview, Norman Swan raised the issue of "gain of function". Norman seemed a bit more sceptical, on rehearing today, than I had appreciated in July. Peter, on other hand, seemed a little more agitated than I recall, almost shrill at times.

 

My second main point, therefore, is that Norman Swan should have interviewed someone for balance - not me; perhaps Prof Richard Ebright (@R_H_Ebright), or Prof Simon Wain-Hobson, (Pasteur Institute, Paris) whose essay "Britain MUST lead the way in banning disturbing lab research that could have created Covid-19, says virologist who discovered the genetic blueprint for AIDS" was published in October 2021.

 

At the time of the original broadcast Prof Doherty had just co-authored a review of the origins of SARS-2 in Cell, a high ranking journal. More recently, a letter to Cell (in response) by a group of authors including Prof Jacques van Helden, Richard Ebright, myself and many others was rejected. It is available here, but as a non-indexed comment.

At the time of the interview (July 2021) a long (over 1000 word) letter to the Lancet by van Helden et al and 13 co- authors (including myself as second author) was in limbo. It had been submitted in January 2021, but rejected alsmost immediately; for no good reason. You can read it here. It is called "An appeal for an open scientific debate about the proximal origin of SARS-CoV-2". But we resubmitted a version (this time with 16 co-authors) in July (or perhaps early August) 2021, and it was finally published in Lancet in September, 2021. You can read it here.  This letter was in response to the now rather infamous Lancet letter (Calisher et al) [February, 2020] co-ordinated by Dr Peter Daszak of the EcoHealth Alliance (EHA). This letter wseemed to characterise anyone suggesting SARS-2 could be lab leak as supporting "conspiracy" thinking.

We now know (as of a few days ago, via this broadcast by a committee of the British parliament, that Dr Richard Horton (@richardhorton1) - the Lancet editor - had to "extract" a conflict of interest concession from Dr Daszak, regarding his role in Calisher et al. This took 16 months.  Several other co-authors (of 27) also had links with the EcoHealth Alliance; yet they also failed to declare any conflict of interest. (Perhaps a topic for a future twitter thread?)

We also now know, as of October 2021, that Prof Jeffrey Sachs (@JeffDSachs) queried Dr Daszak's transparency, as discussed in an article in Science.

 

Summing Up

 

In short, this story is a mess, involving conflicts of interest, overly trusting editors (but in asymmetric direction - away from a lab leak as a viable hypothesis) and sleepy science journalists, with a few exceptions eg Paul Thacker @thackerpd and Ian Birrell @Ianbirrell.

 

In his public interview by the British parliamentarians, Richard Horton implied that publication of our response to Calisher et al was made possible because Dr Tedros Ghebreyesus (WHO Director) gave some credibility to the lab leak possibility (eg here). If so, Tedros does, in part, because of three open letters written by the "Paris group" (of which I am a member, along with many of my Lancet and Cell co-authors.) You can read the first open letter, published in the Wall St Journal, here. The first two of our three open letters (and perhaps the third, which was to the WHO) preceded a letter in Science by Bloom et al.  This letter made very similar arguments to our open letters, and also to our then unpublished letter to Lancet.

 

Some of the authors involved with this letter in Science mentioned (though not in their letter) their preference for publication in a journal rather than open letters. I agree, but as mentioned, we chose to self-publish primarily as our letter to Lancet (January 2021) was at that stage rejected, just as our more recent letter to Cell was.

8 points concerning the conversation between Peter Doherty and Norman Swan (i.e. The Health Report)

 

1. Norman needs to interview an expert (eg Prof Richard Ebright or Prof Simon Wain-Hobson) to balance Peter Doherty's view (as mentioned above). 

 

2. Publication in high impact journals (eg Cell, Lancet) does not necessarily mean the full story, nor absence of bias. 

 

3. The possibility of a lab leak need not be "evil"; it could be human error.

 

4. Peter uses the term "crazy" to describe the events in 1977 that led to the H1N1 pandemic. He also says is was a "million years ago". However, I am not so sanguine as to to think human error has since been eradicated. For example, in December 2021 a lab leak of SARS-2 occurred in Taiwan.  

5. Peter mentions the 1977 event may have been deliberate, from "old USSR". Maybe that's right (I don't think it's proven) but we now know a part of the US military, called DARPA, rejected  a proposal involving Gain of Function and the Wuhan Institute of Virology on ethical grounds. For example, Emily Craig reported (based on whistle-blown material) that "experts wanted to genetically enhance coronaviruses" for release among Yunnan bats to "stop new viruses jumping from bats to humans"; rejected over concerns it could put 'local communities at risk'. That is, in this case, DARPA had more concern for ethics than the grant proposer, which included the EcoHealth Alliance.

 

6. Peter defends Gain of Function work to Norman Swan, using beneficial examples such as the vacines for measles, mumps and rubella and also yellow fever. However, not all Gain of Function work is benign or safe; as DARPA understands.

 

7. Peter stated "people like Eddie Holmes .. looked very hard at sequences .. they couldn't see anything that suggested that it was "an engineered strain in any sense whatsoever". 

However, many others have pointed out that engineered viruses can now be extremely hard to detect. 

When Ian Birrell (@Ianbirrell) reviewed Dr Jeremy Farrar's book on the pandemic he stated that it said "Holmes was, at first, 80% sure this thing had come out of a lab". Dr Farrar is the head of the Wellcome Trust, and a co-signatory of Calisher et al; he certainly warrants an interview by the UK parliament, as Richard Horton was.

 

Conclusion 

 

Mistakes can occur, even in 2021. There is a "fog of war" about the origin of SARS-2. Its cause matters because SARS-3 could be from a lab leak.

 

We need more respectful listening, debate & rigour.

 

Finally, I would like to acknowledge citizen scientists, such as the many involved in DRASTIC, including Billy Bostickson. Their work did a great deal to convince me that a lab leak was plausible, something I mentioned in an editorial I published in the Journal of Human Security in December 2020, before I was aware of the Paris group.

PS. The issue of gain of function and lab leaks is also relevant to "novel entities" and to "planetary health". The journal Lancet Planetary Health has (also this month) rejected a co-authored letter ("Laboratory-constructed pathogens: a new risk to planetary health?") making that point.  Its editor (Dr. Alastair Brown) stated, in the rejection letter, in part: 

"While we certainly appreciate the importance of the points raised, in the present case, we do not feel that your comment would be likely to pique the immediate interest of the broader planetary health and sustainable development communities such that we can find space for it in our comment section."

We are now trying for another journal .. it's a sadly repetitive story.

Science, also recently, rejected a letter I wrote in response to their editorial by their new (and youngish) editor - H. Holden Thorp. I hope you can soon read about it here - Science even rejected my e-letter, publishing a single one, in support.

Eco-anxiety, Krystallnacht and the pathologizing of existential risk

Writing in the New England Journal of Medicine, Dr Nitin Ahuja states "By pathologizing the existential questions raised by global warming rather than the warming itself, health care authorities position themselves as responsive rather than vulnerable to the coming upheaval." The American Psychological Association (APA) formalized “ecoanxiety” as a mental health diagnosis. Ahuja notes that although a report on the subject, by the APA, includes recommendations to “foster optimism” and “support national and international climate–mental health solutions,” it does not mention any specific carbon-reduction efforts, individual or collective, that might forestall climate change in the first place“support national and international climate–mental health solutions.

 

However, to be fair, the APA report (published 2017) has a large section on the health effects of climate change. It is not, in any sense, dismissive of the topic - though the word "activism" is not mentioned.

 

It's perhaps not fair to contemporary psychologists, but reading the opening sentence (above) by Ahuja reminded me of a conversation at a reception for new staff with a recently arrived academic psychologist at the Australian National University in about 2011. I was just starting to supervise a PhD student whose topic was climate change, conflict and public health (my student had trained in psychology among other things). I tried to explain the topic to a potential ally. But she responded not with a diagnosis of "eco-anxiety" but "existential angst". To which I said "if you were Jewish during Krystallnacht and you felt anxious, would you dismiss that as unjustified anxiety?" That must have been too confronting; she immediately moved away. 

 

Donald Trump repeatedly dismissed Greta Thunberg's eco-anxiety. In so doing, he must have felt he had the support of millions of people of his generation - men and women who have benefitted from fossil fuels, but whose future is increasingly precarious. The current rise in the price of food and many other goods in the US and elsewhere is not only to do with the economic recovery from the pandemic, but also climate change (affecting crops) and the rising price of oil. Many of Trump's most loyal supporters are especially vulnerable.

 

Before WWI, Carl Jung had a prophetic vision which is easily interpretable as a premonition of the war - though he dismissed it at the time (described in his autobiography Memories, Dreams, Reflections). Sometimes, people do sense what is coming. Ignoring such warnings risks chaos.

 

President de Klerk made, as one of his final statements, a deep apology to the non-Caucasian people of South Africa. Will coal-loving Australian prime minister Scott Morrison and his fellow travellers one day come to rue their stubborn and unscientific views about climate change and other aspects of limits to growth? It does not seem very likely, but de Klerk's views changed.

Health journals are awakening to the existential risk to well-being, and even to human survival, that untrammelled climate change represents. So must the general population. Eco-anxiety is painful, but justifiable. Its only remedy is emergency action to cool the planet. The first step for that is to move rapidly away from all forms of fossil fuel, and switch to electricity powered by the sun, wind and falling water. We must also reduce animal farming.

Coal Harms Health: Climate Change and Health, Past, Present and Future

Hello everyone. It’s a great pleasure to be speaking (October 16, 2021) at the 20^th anniversary conference of Doctors for the Environment Australia (DEA); I’d like to thank the organisers and to acknowledge the traditional owners, the Kuarna people. I’d also like to congratulate DEA for no longer being a teenager and for having over 2,500 members. I can recall when there were fewer than ten.

The organisers asked me to prepare no slides but with one exception – I am thus calling my talk “Coal harms health”. This photo was taken near Maules Creek coal mine, in 2014. It’s an export mine; from there coal is taken by train, through the air-polluted Hunter Valley, to the coal dust contaminated city of Newcastle, where I studied medicine. This protest was organised by the Australian Religious Response to Climate Change; my support team were devout – even if they look scruffy.

While waiting to be arrested I was holding this book – the first edition of “Climate Change and Global Health”, which had just been published, and which I edited. 

 

At that time I had also just contributed to the health chapter of the 2014 IPCC report, thus I was the first IPCC health contributor to be arrested for what could be called “climate disobedience”.  I take the issue of climate and health seriously, and I also take seriously the issue of climate justice – the main reason I chose arrest was to protest at the immorality of rich Australia profiting from the export of a substance clearly harmful to health, especially future health. I also lament the decline of ethics in science.

If this was not virtual I would ask for a show of hands: who attended the first iDEA conference, in Melbourne in 2009? I did – in person of course. My talk there focussed on the “tertiary” – or catastrophic - health consequences of climate change, including conflict, war and famine. The first editorial on climate change and health – in The Lancet in 1989 – hinted at these issues. However the topic is still vastly under-recognised, despite the implications of Will (and other’s) work. For me, the risk of runaway climate change (or Hothouse Earth) is terrifying, and trying to prevent that has now motivated me for 3 decades. We are making progress but there is enormous work ahead.

Since the early 90s I have used a three-way categorisation of how climate change will impact human health and well-being. In addition to tertiary effects are what is generally called direct and indirect, or “primary” and “secondary”. I based the first and forthcoming editions of my edited book on these categories.

By “primary” health effects Andy Haines and co-authors meant comparatively obvious things, such as heat stroke. Of course, nothing is simple, but I ask you to consider the field at a time when the existence of anthropogenic climate change was challenged by most, and when, for conservative doctors, links between it (as opposed to climate) and health were considered speculative. Thus tertiary health effects were a largely no go area at that time.

Temperatures in the high 40s in Australian cities were unimagineable when I was at medical school, they now seem almost unremarkable. Extreme heat has adverse effects that are pretty well-known; such as heat strain and heat stroke. Their risk is worsened by high humidity; indeed in some parts of the world, in the near future (without emergency climate action), the combination of heat and humidity will be fatal, even without exercise. Thus some areas of the planet will literally be uninhabitable, at least for some times of the year. Heat strain is an incredibly important issue for occupational health, especially for outdoor workers in already hot places and for emergency workers wearing protective clothing in hot conditions. Heat strain may also have a “long tail” of adverse effects, including on some chronic diseases – especially people with pre-existing cardiovascular disease. What happens to people who are vulnerable but who recover? It seem unlikely that they all return to their previous level of function. I believe this question remains under-explored.

An important co-author of that early work on primary, secondary and tertiary effects was the late Tony McMichael. Tony, with David Shearman, were the true founders of DEA. Both were far ahead of their time; with viewpoints best called “ecological.” Tony’s most influential book, published in 1993, was called “Planetary Overload”. Four years later, David’s book “Green or Gone” was published.

Four years after, DEA was born, and now it is 2021.

Some of you will have heard of the UN Conference on the Human Environment, in Stockholm: 1972. More will have heard of the Rio Earth Summit, 20 years later. The main organiser for these meetings was Maurice Strong; he was also founding director of the UN Environment Programme.

His autobiography, “Where on Earth are We Going?” was published in 2001. It starts with a report to the shareholders, from 2031; a world of profound disorder, massive forest fires, including Siberian, and famines, droughts, floods, conflict, refugees, plague and “Virus X”. Global population is below five billion; it is, today, about eight. These risks arise not only from climate change, but as Kerryn Higgs, a co-editor for the 2^nd edition of Climate Change and Global Health, says, endless growth on a finite planet is a collision course.

 

 

Hopefully Strong’s forecast is too pessimistic. However, global life expectancy has fallen due to the pandemic; hunger has risen, and foodprices are at a 10 year high.

There is risk from exaggeration, but also from under-statement. Pessimism paralyses; understatement generates complacency. I believe it is our duty to sound a warning. Prevention is better than cure. Past civilisations have collapsed; ours could too.

But I will end with hope. Activism lifted Greta Thunberg from depression, and is an important antidote to despair; as is fellowship. Getting arrested – even here – is serious; consequences can be unforeseen. I was unable to attend the inaugural planetary health conference in New York because a timely visa was denied.

Protest is necessary, but not sufficient.

Last month, over 230 medical journals jointly published an editorial (includiung in the Medical Journal of Australia) calling for “emergency action to limit global temperature increase, restore biodiversity, and protect health.”

That is progress. So is the growth of DEA and the involvement of so many medical colleagues and colleges in this struggle, globally. The link between the health of our planet and the health of people is now widely accepted. Tough times are ahead, but together we can make a great difference.

Thank you.  

Is the Pandemic a Warning we are Pushing Nature too Hard?

This is the text of my prepared talk given at the Inaugural Regional Session of UNEP Science Policy Business Forum held in Korea and virtually on October  5, 2021. 

Our session starts at 7 hours 2 minutes (I am responding to the first question); I answer the second question (The Ambitious Actions that Pave the Way) at 8 hours 6 minutes.

I will add some other links later

Thank you for that question and my thanks also to the organisers of this session and to the government of the Republic of South Korea. Good morning and good afternoon to my online colleagues.

You have asked me to comment on whether we are pushing nature too hard and is the pandemic a warning. 

My first comment is that nature is not vindictive, and has no mind of its own. So the question should not be taken literally. However, from our human perspective I think we should definitely treat this pandemic as a profound warning. 

 

I’m not sure how many in the audience are familiar with the United Nations Conference on the Human Environment, held in Stockholm, Sweden in 1972. Probably more of you will have heard of the conference in Rio de Janeiro, Brazil, two decades later, often called the Earth Summit. The first meeting, in 1972, was very important in the foundation of the United Nations Environment Programme, the UNEP, which was founded in the same year.

 

The main organiser for both of these meetings was a Canadian businessman and diplomat called Maurice Strong; he also became the founding director of the UNEP. 

 

Strong’s autobiography “Where on Earth Are We Going?”, published in 2001, starts with a “report to the shareholders”, from 2031. It describes a world of profound disorder, of massive forest fires, including in Siberia, and of famine, drought, floods, refugees and plague. Global population has fallen to fewer than five billion; it is, today, about 8 billion. 

 

2031 is now only nine years away, and it looks as though Strong’s forecast is too pessimistic – but perhaps he would justify that by saying that he was trying to motivate his readers. 

 

There is, however, a risk from exaggeration. I have been unable to discover if Confucianism or other Asian philosophies discuss “crying wolf”, in other words, of warning of something so often, and so prematurely, that the listener becomes jaded, and ignores it – even though the warning is valid and the wolf appears. The story of crying wolf is credited to a Greek slave who lived about 2,500 years ago, but it is likely that Aesop, the slave, collected these fables, rather than wrote them. I think it is ancient story, and I hope its message may be universally understood. 

 

Clearly, human civilisations could not have evolved and flourished without their leaders collectively preparing for risk, whether from winter, food shortage or invasion. The Great Wall of China shows an understanding of risk by many successive Chinese governments. 

 

The manifesto by Bertrand Russell and Albert Einstein, signed in 1955 at the height of the Cold War, also warned that the continued existence of our species is in doubt, due to the threat of nuclear weapons. That risk has not gone away, but it has abated, although it took 30 more years, and a great deal of effort, before that happened. But, just as the risk of nuclear war seemed to be lessening, a book was published called “New World New Mind”. Its authors argued that although humans have evolved to understand some risks, such as from a predatory animal, or winter, our species has not evolved to easily understand the risks that arise from excessive global climate change or from global biodiversity loss.

I think Maurice Strong understood those risks. 

 

Bad as it is, the direct deathtoll from COVID-19 is small compared to annual human population increase. However, the pandemic has had many indirect effects, including a significant increase in global hunger. 

 

Strong, and others of his generation had personally experienced great hardship, wrought by the Great Depression and World War II. I think, for people of that time, the risk of another catastrophe seemed more plausible than to many people now alive, in which many experience abundance and affluence on an once unimaginary scale. That is great progress, but it creates a risk of complacency.

 

When the ocean suddenly retreated around the Andaman Islands in 2004 its Indigenous people did not go out to explore the seabed, as some did elsewhere, but instead they interpreted this sign, as an urgent warning: in that case of the tsunami. As far as is known, they all survived, because they immediately fled to higher ground. 

 

In the Indian city of Surat, in 1994, the rumour of plague caused a great panic, with as many as 100,000 people immediately fleeing. We may be better, collectively, at responding to earthquakes and plague than to climate change and biodiversity loss, the challenge is to see that these issues are connected.

We are pushing nature too hard, we are creating unprecedented risk, and if, as now seems plausible, vaccines and new drugs make COVID-19 manageable, then we should use that breathing space to re-invigorate the global community to prepare and to prevent the many risks from adverse environmental change which too many complacent populations are currently creating. 

 

VII. The Ambitious Actions that Pave the Way (see 8 hours 6 minutes at this link)

 

Maurice Strong, who I mentioned earlier, was also influenced by the book The Limits to Growth also published in 1972. He argued that the task for humanity was “rational global management of the finite resources of the Earth” on behalf of all people.

 

We need to establish international co-operation, different from the slogan of globalization, which relies too much on market forces. The UN system needs to more clearly acknowledge that resources are limited; instead of thinking that economic growth is endless. The UN should champion redistribution, especially of hope and opportunity, as I believe Dag Hammarskjöld, the UN secretary general whose plane mysteriously crashed in 1961 did. We need to recognise and respond to climate change as a genuine emergency. We need more integration of the understandings of the Population Division of UN with its other parts, including to respond to and prevent refugees, and hunger. We also need, collectively, to develop a less exploitative attitude to nature, greater emotional attachment to nature, greater respect for animals (which have consciousness and emotion), more appreciation of the health risks of diets high in meat and better treatment and prevention of parasitic diseases.

 

The generation who were children in 1945 are old today, and even their children are retiring. I think that the inevitable loss of people whose lives were personally transformed by the experience of those crises has created vulnerability, where the idealism, determination, and hope that gave birth to the UN risks being replaced with dogma. I think one example of dogma is excessive belief, even faith, that market forces alone will solve our problems. Another is too much faith in technology, technology is necessary but not sufficient. We have lost idealism; “Health for All by the Year 2000” now seems naïve, but it did not when it was promoted, in the 1970s, a time which Halfdan Mahler then WHO Director General called the “warm decade for social justice”. Although we have the SDGs, they are, in my view, a poor substitute; they are too obviously out of reach and rely too much on market forces. We need idealism, but we need to recognise the reality of limits and to build social mechanisms to attain our targets.

 

**

 

key points

 

Is the Pandemic a Warning we are Pushing Nature too Hard?

 

1.              Nature is not vindictive – however, we should treat the pandemic as a profound warning.

2.              The main individual driving the formation of UNEP and its founding director (Maurice Strong) was, by 2001, deeply concerned that civilisation would collapse, perhaps as soon as 2031.

3.              There is a risk of “crying wolf” – but remember, the wolf did appear.

4.              The UN system was founded and inspired by visionaries who had personally experienced and witnessed great hardship. Their direct influence has passed. “Abundance for many” – since – may inadvertently have created vulnerability.

 

The Ambitious Actions that Pave the Way

 

1.              There are limits to Earth’s abundance; we should not fool ourselves otherwise.

2.              We need genuine co-operation, not slogans of globalisation; market forces are not enough to save civilisation.

3.              We need to develop and practice greater respect for nature; make nature more of a partner than a resource.

 

Rejected by The Conversation (again)

In recent years (about 7) The Conversation has rejected every single "pitch" I have made. This is typical:

"Thanks for the pitch. It’s an interesting idea but unfortunately I have to decline. With current resources we’re only able to publish  a small minority of the pitches we receive and while this idea has merit I’ve reluctantly decided there are others with stronger content."

Here are some of the topics they have not thought of sufficient interest. They have a common theme; limits to growth, existential risk to civilization, regional overload, the "fortress world" and philanthrocapitalism and planetary health. 

The most recent rejection concerned existential risk. My paper (Climate change, health and existential risks to civilization: A comprehensive review (1989–2013)) showed that while the risk to civilization, and thus to global public health, from climate change has grown, the willingness to discuss this in the health literature has fallen considerably.

I know that the budget for the Conversation has fallen a lot in recent years.

 

But I also think that their gatekeepers are very conservative.  

PS They didn't just reject my approach suggesting that the origins of COVID-19 could be from a lab even though, again, I had a published paper (the 4th such paper in the world, that I know of, published in 2020); instead they ignored my pitch.

On the other hand, TC has solicited one paper from me (since 2012); the experience (for me) was unsatisfactory; I felt rushed and pressured.

A discrepancy between the WHO-convened report into the origins of SARS-CoV-2 and the Addendum to Nature

On March 30, 2021, the WHO-convened study into the origins of SARS-CoV-2 was released. Annex D3 states that “with regard to the matter of morbidity and mortality in miners in a mine in Mojiang, Yunnan Province, where bats were present, Professor Shi said that the events had been clarified in an addendum to her Nature article.” 

 

These illnesses had occurred in miners exposed to bat guano in 2012. 

 

The Annex states “the reported illnesses associated with the miners, according to the WIV experts, were more likely explained by fungal infections”. However, the Nature Addendum referred to (Addendum: A pneumonia outbreak associated with a new coronavirus of probable bat origin) states that “we suspected that the patients had been infected by an unknown virus”. In addition, the Master’s thesis by Li Xu, which meticulously documents the clinical course of the six miners, hypothesised a viral illness, stressing this in its title (Analysis of Six Patients With Unknown Viruses). This thesis records that Dr. Nanshan Zhong (consulted remotely) reached a similar diagnosis, even noting that he stated there is a “great possibility for virus (sic) infection”. The Master’s thesis makes it clear that the Kunming-based clinical team (and Dr Nanshan Zhong) considered that a secondary (co-existing) fungal infection (secondary aspergillosis) was considered plausible. For this reason the patients were treated with anti-fungal medication, including Caspofungin. However, three of the six patients still died and it is clear that the primary scientific interest in the cases was the possibility of a novel virus. It is inferable that the possibility of novel viruses being found in the Mojiang cave was rapidly communicated to Professor Shi’s team, most probably by Dr Nanshan Zhong or the Kunming medical team (or both), leading to the first of about seven visits made to the Mojiang cave between 2012-2015, by Professor Shi’s team, as described in Annex D7.   However, Annex D7 does not explain why the theory of a bat (or bat-guano) associated virus infecting the miners, originally considered such a strong possibility as to provoke about seven visits to this remote cave, was discarded, apparently between November 2020 (when the Nature Addendum was published) and February 2021 (when Professor Shi and her colleagues provided this different opinion included in Annex D7). 

 

Annex D7 also provides a rudimentary occupational history of the miners’ exposure, stating that the “miners had been to the cave 2-3 times”. This contradicts the details provided by Li Xu (published in 2013, apparently based on clinical records made at the time of the miners’ illnesses, three of which were fatal) which states, for example, that one patient (aged 63) “had been working in the mining well for half of a month. He worked 7 hours a day”. The occupational history for case three (aged 45) is described as: “The patient went into a 150 meter deep cave 24 days ago. He continuously inhaled some unknown gas for 10 days”. The relevant occupational history of case five (age 30) is translated as “he has been to a big cave (about 150 meters deep) to work and was exposed to feces of bat for 4 days.”

Annex D7 does not give any detail of the source or “provenance” of information about the miners’ illnesses, other than it was provided by Professor Shi between January 14 and February 10, 2021. Unless one or more of Professor Shi’s team was working in the Kunming hospital in 2012 and was caring for one or more of the Mojiang-exposed miners the Wuhan team’s information about the miners must be secondary. Was it from Dr Nanshan Zhong? Was it obtained directly from one or more doctors at the Kunming hospital? Was additional information obtained from the Master’s thesis, written by Li Xu? In any case, claiming (as Annex D7 does) that “the illnesses of the miners exposed to bat guano in 2012 in Mojiang” were  “clarified” in the Nature addendum is a gross exaggeration.

There is a long history of obfuscation about the exposure and illnesses of these miners (three of whom died), as documented, for example by Rahalkar and Rahalkar (2020) "Lethal pneumonia cases in Mojiang miners (2012) and the mineshaft could provide important clues to the origin of SARS-CoV-2" and Butler (2020) "Plagues, pandemics, health security, and the war on nature". Neither of these studies is cited in the WHO-convened Global Study of Origins of SARS-CoV-2 (including the Annexes), further demonstrating the biased and incomplete knowledge and selection of the literature used by the report’s authors.