The 2019–2020 COVID-19 outbreak in mainland China was the first COVID-19 outbreak in that country, and the beginning of the COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). China was the first country to experience an outbreak of the disease, the first to impose drastic measures in response (including lockdowns and face mask mandates), and one of the first countries to bring the outbreak under control.

The outbreak was first manifested as a cluster of mysterious pneumonia cases, mostly related to the Huanan Seafood Market, in Wuhan, the capital of Hubei province. On 8 January 2020, a new coronavirus (SARS-CoV-2) was identified as the cause of the pneumonia by Chinese scientists.[3] During the beginning of the pandemic, the Chinese government showed a pattern of secrecy and top-down control.[4] It censored discussions about the outbreak since the beginning of its spread, from as early as 1 January,[5][6] worked to censor and counter reporting and criticism about the crisis – which included the detention of several citizen journalists[7] – and portray the official response to the outbreak in a positive light,[8][9][10] and restricted and facilitated investigations probing the origins of COVID-19.[4][11] Several commentators suspected the Chinese government had deliberately under-reported the extent of infections and deaths.[12][13][14] However, some academic studies have found no evidence that China manipulates COVID-19 data.[15][16][17]

The local governments of Wuhan and Hubei were widely criticized for their delayed responses to the virus and their censorship of the related information during the initial outbreak, especially during the local parliamentary sessions. This allowed early spread of the virus,[18] as a large number of Chinese people returned home for the Chinese New Year vacation from and through Wuhan, a major transportation hub.[19][20] However, stringent measures such as lockdown of Wuhan and the wider Hubei province and face mask mandates were introduced around 23 January,[21] which significantly lowered and delayed the epidemic peak according to epidemiology modelling.[22] Yet, by 29 January, the virus was found to have spread to all provinces of mainland China.[23][24][25] By the same date, all provinces had launched high-level public health emergency responses.[26] Many inter-province bus services[27] and railway services were suspended.[28] On 31 January, the World Health Organization declared the outbreak a Public Health Emergency of International Concern.[25] A severe shortage of face masks and other protective gear[29] led several countries to send international aid, including medical supplies, to China.[30][31][32]

By late February, the pandemic had been brought under control in most Chinese provinces. On 25 February, the reported number of newly confirmed cases outside mainland China exceeded those reported from within for the first time; the WHO estimated that the measures taken in the country averted a significant number of cases.[33] By 6 March the reported number of new cases had dropped to fewer than 100 nationally per day, down from thousands per day at the height of the crisis. On 13 March, the reported number of newly imported cases passed that of domestically transmitted new cases for the first time.[34]

By the Summer of 2020, widespread community transmission in China had been ended, and restrictions were significantly eased.[35] Sporadic local outbreaks caused by imported cases have happened since then, which authorities responded to with testing and restrictions.[36] Different neighbourhoods or townships were classified into high-, medium- or low-risk based on the number of confirmed cases and whether there were cluster cases,[37] which formed the basis for the gradual easing of lockdown measures since March.[38] Lockdown in hard-hit Wuhan was officially lifted on 8 April.[39]

China is one of just a few of countries that have pursued a zero-COVID strategy, which aims to eliminate transmission of the virus within the country and allow resumption of normal economic and social activity.[40]

Despite concerns about automated social control, health codes generated by software have been used for contact tracing: only people with green code can move freely, while those with red or yellow code need to be reported to the government.[39][41] With domestic tourism first reopened among the pandemic-hit industries,[42][43] China's economy continued to broaden recovery from the recession during the pandemic, with stable job creation and record international trade growth, although retail consumption was still slower than predicted.[44][45] China was the only major economy to report economic growth in 2020.[46]

In July 2020, the government granted an emergency use authorization for two COVID-19 vaccines.[47][48] It has also pledged or provided humanitarian assistance to other countries dealing with the virus.[8][9]

Graphics

Initial outbreak

Discovery

One of the earliest Wuhan MHC notices about the pneumonia epidemic. It was first posted on Weibo on 30 December 2019 and was confirmed by Wuhan CDC the next day (31 December).

Based on retrospective analysis published in The Lancet in late January, the first confirmed patient started experiencing symptoms on 1 December 2019,[49] though the South China Morning Post later reported that a retrospective analysis showed the first case may have been a 55-year-old patient from Hubei province as early as 17 November.[50][51] On 27 March 2020, news outlets citing a government document reported a 57-year-old woman, who started having symptoms on 10 December 2019 and subsequently tested positive for COVID-19 may have been the index case in the COVID-19 pandemic.[52][53] Although the first confirmed patient did not have any exposure to Huanan Seafood Market, an outbreak of the virus began among the people who had been exposed to the market nine days later.[19][54]

The outbreak went unnoticed until 26 December 2019, when Zhang Jixian, director of the Department of Respiratory Medicine at Hubei Xinhua Hospital, noticed a cluster of patients with pneumonia of unknown origin, several of whom had connections to the Huanan Seafood Market.[55] She subsequently alerted the hospital, as well as municipal and provincial health authorities, which issued an alert on 30 December.[55][56] Results from patient samples obtained on 29–30 December indicated the presence of a novel coronavirus, related to SARS.[55] On 1 January 2020, Jianghan District's Health Agency and Administration for Market Regulation closed down the seafood market and collected samples for testing.[57]

On 28 December 2019, Lili Ren, a virologist at the Chinese Academy of Medical Sciences & Peking Union Medical College in Beijing uploaded a partial sequence of the COVID-19 virus's structure to the United States National Institutes of Health's GenBank. The NIH did not publish the submission, as it did not include technical information required by the institute's rules, and attempts by the NIH to contact Ren went unanswered. On 17 January 2024, The Wall Street Journal released a report about the 28 December upload.[58]

The World Health Organization (WHO) issued its first report on the outbreak on 5 January 2020.[59] Professor Zhang Yongzhen of Fudan University completed sequencing of the novel virus almost identical to the previous 28 December upload on 5 January.[58] On 8 January 2020, a new coronavirus, SARS-CoV-2, was announced by Chinese scientists as the cause of the new disease.[60] Professor Yongzhen published the results to the online database GenBank on 11 January.[55]

On 14 January, the WHO tweeted:

On 15 February 2021, WHO investigators in China said they had found evidence that the initial outbreak in Wuhan was more widespread than originally thought. They asked the Chinese government for permission to study hundreds of thousands of blood samples from Wuhan; as of 15 February, this permission had not been granted.[62]