On December 30, 2019, Li Wenliang sent a message to a group of fellow doctors warning them about a possible outbreak of an illness that resembled severe acute respiratory syndrome (SARS) in Wuhan, Hubei province, China, where he worked. Meant to be a preemptive confidential message, he encouraged his colleagues to protect themselves against possible infection. When the local authorities became aware of his report, they summoned Dr. Li to a police station, reprimanded him for spreading rumors, threatened him with punishment, and made him sign a form admitting that he was wrong to have sent the message and that he would not repeat the transgression.
Li returned to work after signing the statement and contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), apparently from a patient he was treating for glaucoma. Dr. Li sent reports on social media from his hospital bed until the disease took his life on February 7, 2020. Dr. Li now raises himself as a standard for the profession when faced with the moral obligation of his Hippocratic Oath versus suffering the torment of a repressive regime. His courageous choice can be seen in the known outrage his death brought about in China. Citizens used virtual message boards on social media platforms to voice their gratitude for Li’s dedication to his frontline service. Li’s honesty and moral integrity motivated citizens to criticize Wuhan’s securities’ initial response while inspiring other medical officials to heed his warning.
In the days before his death, Li said, “If the officials had disclosed information about the epidemic earlier, I think it would have been a lot better.” During his interview with The New York Times, Li went on to succinctly explain, “There should be more openness and transparency.”
Li studied clinical medicine at Wuhan University and, after graduating, went to work in Xiamen, a port city in southeast China. He took a position as an ophthalmologist at Wuhan Central Hospital in 2014. That hospital became one of the health facilities at the epicenter of the outbreak of COVID-19. Li raised the alarm after he saw seven patients with SARS-like symptoms. Li reported the suspected outbreak to his colleagues in a closed group on the WeChat social media platform after learning that patients were being quarantined. He told The New York Times that there was already speculation within the group that there could be a new SARS outbreak, and “we needed to be ready for it mentally. Take protective measures.” “One of the world’s most important warning systems for a deadly new outbreak is a doctor’s or a nurse’s recognition that some new disease is emerging and then sounding the alarm,” said Tom Inglesby, the Director of the Center for Health Security at Johns Hopkins Bloomberg School of Public Health in Baltimore, MD. Inglesby would go on to say, “It takes intelligence and courage to step up and say something like that, even in the best of circumstances.” Without question, Dr. Li understood the serious implications of the virus and of his professional opinions.
In the wake of Li’s death, the Wuhan municipal government issued a statement offering condolences to Li’s family, as did the Chinese National Health Commission. Many chapters still must unfold in the story of the COVID-19 pandemic. I am certain that Dr. Li was not motivated by fame or glory. He was a young ophthalmologist who correctly analyzed the situation and tried his professional best to warn everyone. Hindsight will show that heeding a physician’s warning, such as Dr. Li’s, must become a process that medical authorities should act upon if the world is to prevent another disaster.
Lou Rotkowitz is an emergency physician and can be reached at his self-titled site, Louis Philip Rotkowitz, MD, FAAFP.
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