Introduction
The epidemic of COVID-19 is caused by a novel virus first detected in Wuhan, China. This virus was previously named as 2019-nCoV and it is a positive, enveloped, single-strand RNA virus. It also shares a lot of similarities with two other coronaviruses, the MERS-CoV (Middle East Respiratory Syndrome) and SARS-CoV (Severe Acute Respiratory Syndrome). Outbreak of the COVID-19 started with the report of a first suspected case on December 8, 2019 in Wuhan. The first two months of the epidemic covered three significant holidays, including the New Year of 2020, the Chinese New Year’s Day with vacations from January 24 to February 2, 2020, and the Lantern Festival on February 8, 2020. During this period, one study by the Chinese Center for Disease Prevention and Control (CDC) and Hubei Provincial CDC with data collected by Wuhan CDC documented the details of the epidemic day by day from December 8, 2019 to January 21, 2020 [1]. Data in this study showed that detected and confirmed cases with COVID-19 infection declined from the peak of 44 on January 8 to only 2 on January 19, 2020, suggesting that the epidemic was likely under control.
China officially declared the epidemic as an outbreak on January 20 when obvious human-to-human transmissions were ascertained with reagent probes and primers distributed to local agencies on that day. Immediately following the declaration, massive actions were taken the next day to curb the epidemic at Wuhan, and soon spread to the whole country from central to local government, including all sectors from business to factories and to schools. On February 23, 2020, Wuhan City and other cities along with the main traffic lines around Wuhan were locked down. Rigorous efforts were devoted to 1) identify the infected and bring them to treatment in hospitals for infectious diseases, 2) locate and quarantine all those who had contact with the infected, 3) sterilize environmental pathogens, 4) promote mask use, and 5) release to the public of number of infected, suspected, under treatment and deaths on a daily basis.
On January 24, 2020, the New Year’s Eve and 25, the Chinese New Year’s Day, President Xi Jinping held a special meeting at the Central Chinese Government and decided to implement massive national efforts to curb the epidemic. An Anti- COVID-19 Group headed by Premier Li Keqiang was established to lead the massive national efforts. Vice Premier Sun Chunlan was sent to Hubei and Wuhan to directly lead the local efforts. A massive number of detection kits were made available to all locations to test all susceptible patients for final diagnosis. People in other cities and provinces who either traveled to or out of Wuhan were quarantined, with suspected patients being diagnosed and treated.
The sudden escalation of the control and the spread of the number of infected and deaths, however, ignited strong emotional responses of fear and panic among people in Wuhan. The negative emotional responses soon spread from Wuhan to other parts of China, and further to the world via almost all communication channels, particularly social media. The highly emotional responses of the public were fueled by (1) sudden increases in the number of detected new cases after the massive intervention measures to identify the infected; (2) massive growing needs for masks; (3) a large number of suspected patients waiting to confirm their diagnose; (4) a large number of diagnosed COVID-19 patients for treatment; and (5) a growing number of deaths, despite national efforts to improve therapy, including the decision to build two large hospitals within a period of days. The emotional responses, mostly stimulated by the daily release of data have created a big barrier for effective control of the epidemic as has been observed in other epidemics of similar nature [2, 3].
It is a paradox that during the early period of an epidemic, little is known or available about the new infections; while the need for such information is at the highest level. This is particularly true for the COVID-19. The occurrence of this epidemic may follow a nonlinear, chaotic and catastrophic process, rather similar to the epidemic of SARS that occurred in Hong Kong in 2003 [2], the Ebola epidemic in West Africa during 2013–16 [4, 5], the pandemic of 2009 H1N1 epidemic started [6–8] and the recent measles outbreaks in the United States (US) [9]. Similar to an eruption of a volcano or occurrence of an earthquake, no matter how closely it is monitored, how much research we have done, how much we know about it, no one knows for sure if and when the virus infection will become an outbreak. Therefore, there is no so-called rational responses, no standard-operating-procedure (SOP) to follow, no measures to take without negative consequences [2].
However, defining the COVID-19 as nonlinear and chaotic does not mean that we cannot do anything after we knew it was an outbreak, but simply waiting. On the contrary, defining it as nonlinear and chaotic will better inform us to make right decisions and to take appropriate actions. (1) During the early stage of an infection, which we cannot tell whether it will be growing into an outbreak, we must closely monitor it using limited data and to find the early signs of change and to predict if and when it will become an outbreak; (2) After it is declared as an outbreak, it is better to take actions as soon as possible since infectious diseases can be controlled even without knowledge of the biology [10]; and evaluate if the control measures work.
The ultimate goal of this study is to attempt to provide some solutions to this paradox by providing early messages to inform control measures, to be optimistic and not panic, to ask right questions, and to take right actions.