In any infectious outbreak, one of the first steps in the epidemiological response is to locate case one—the first infected patient, also known as the index case or patient zero. This is not a mere clinical curiosity: it is the foundation for reconstructing the chain of transmission.

Modern epidemiology treats this process as a technical priority. As stated in the Dictionary of Epidemiology by the International Epidemiological Association, identifying patient zero is essential to understanding patterns of dissemination and establishing effective control strategies.

Yet in the case of SARS-CoV-2—the virus that unleashed a global pandemic between late 2019 and early 2020—no independent or transparent international investigation was ever conducted to clearly identify where, how, and with whom it all began. The city of Wuhan, China, is widely acknowledged as the epicenter of the earliest cases, but no international health authority was granted free access to clinical records, sample banks, or laboratory data.

This refusal to apply the basic principles of epidemiological inquiry raises a question that is as much technical as it is political: why was the origin of the virus not investigated with the same rigor applied to other pandemics?

Wuhan, the Lab, and What Remains Unknown

Wuhan—the capital of China’s Hubei province—is home to the Wuhan Institute of Virology (WIV), one of the world’s leading centers for research on animal-origin coronaviruses. Even before the pandemic, the WIV had been conducting experiments with bat viruses, including gain-of-function techniques—genetic manipulations designed to increase viral infectivity in model organisms, such as humanized mice or cell cultures.

In 2015, an international study involving the WIV and American researchers, published in Nature Medicine, drew attention for creating a chimeric bat virus capable of infecting human cells, sparking debates about scientific risks and bioethics.

When the outbreak emerged in December 2019, several anomalies immediately stood out:

  • The virus’s initial strain already had high affinity for the human ACE2 receptor;
  • No intermediate animal host was identified;
  • Biological samples and patient data disappeared or became inaccessible

Still, the World Health Organization (WHO) only organized a supervised visit to the WIV in January 2021. The final report—drafted in cooperation with Chinese authorities—dismissed the lab-leak hypothesis as “extremely unlikely,” although WHO Director-General Tedros Adhanom Ghebreyesus later acknowledged that “all hypotheses remain on the table.”

It’s worth noting that Tedros is not a physician, but a biologist. He served as Ethiopia’s Minister of Health and Foreign Affairs during the rule of the Ethiopian People’s Revolutionary Democratic Front (EPRDF), an authoritarian regime. According to reports by the New York Times and The Telegraph, Tedros was accused of covering up cholera outbreaks by labeling them as “acute watery diarrhea”—hiding them from the international community.

During his tenure, he was accused by NGOs and global news outlets of officially reclassifying cholera outbreaks to avoid tarnishing the regime’s international image—allegations supported by regional health workers and UN specialists. The Telegraph also reported that the outbreaks were deliberately underreported and renamed under his watch.

Furthermore, the EPRDF has been widely criticized for suppressing dissent, curtailing civil liberties, and systematically censoring political opposition and the independent press.

Although these issues do not technically invalidate Tedros’s current role, they raise legitimate concerns about the institutional trustworthiness of international authorities emerging from opaque regimes. When a WHO director with such a background becomes the leading global voice during a pandemic, it becomes all the more urgent to demand open, verifiable investigations conducted by truly independent teams—something that, in the case of SARS-CoV-2, has never effectively occurred.

Medicine without Etiology: The Clinical Paradox

Modern medicine is, above all, a science of causes. Since Hippocrates, it has been understood that treating a disease requires understanding its origin—biological, environmental, or epidemiological. Clinical practice, microbiology, infectious diseases, and public health share this principle: without etiology, there is no complete diagnosis; without diagnosis, there is no prevention or lasting cure.

In epidemiology, identifying case one—the first infected patient, also called the index case—is essential for containing outbreaks and tracing transmission routes. Cases like Ebola in West Africa in 2014 or SARS-CoV-1 in 2002 demonstrated how tracing the origin enabled effective, evidence-based health responses.

However, with SARS-CoV-2, this logic was reversed. Instead of rigorously investigating the outbreak’s origin in Wuhan, international institutions chose to manage the pandemic as if the origin were irrelevant. There was no access to raw data, initial clinical samples, or the genetic database of the Wuhan Institute of Virology. Medicine began treating the global symptom while ignoring the local lesion.

This break in clinical logic created a troubling paradox:

  • Physicians and scientists were called upon to prescribe mass solutions without knowing the etiological agent in its initial form;
  • Global protocols were implemented without understanding the primary cycle of infection;
  • Public policies were based on statistical models disconnected from the real origin of the phenomenon.