Story at a glance
- About 60,000 people in China were undergoing medical observation on Jan. 28.
- There are more than 6,000 confirmed cases globally.
- The numbers only paint part of a picture, but to see the whole situation, social and cultural aspects of the epidemic also need to be considered.
If you are only paying attention to the number of confirmed cases, you aren’t getting the full picture.
According to an update on ProMED mail, 59,990 people were undergoing medical observation for the new Wuhan coronavirus by the end of the day on Jan. 28. At that time there were 5,974 confirmed cases and 9,239 suspected cases. There were also 132 deaths and 103 people who recovered and were discharged.
But China is not a country of numbers. It’s a complex place with a unique history and culture.
Living in high density, highly social spaces
People in China are used to living in close quarters and often enjoy gathering in groups. There’s a compound word in Chinese “热闹,” pronounced re nao, that’s translated as “lively” or “exciting” and which uses the characters meaning “hot” and “noisy,” respectively. There's another term that roughly translates to being around people and a good, buddy-buddy feeling that comes from it. It’s a positive thing that many Chinese people may actively seek out.
Social distancing has been brought up as a way to limit the spread of the disease. It means people choosing on their own to distance themselves from other people to limit their risk of contracting the virus. But even if many Chinese do distance themselves and shutter themselves at home, that still puts them in the vicinity of many other people because they live with their families in high density housing.
One method to try to contain an outbreak is contact tracing. That’s where you ask people who come in sick who they’ve been in contact with and then reach out to those people to see how they are doing and bring them in for treatment if needed. In a rural area in the U.S., that may only be a handful of people. But in China, the people who live on your floor in your building would outmatch that very quickly.
For people who live in cities and even towns in China, it’s difficult to avoid people even if you tried. Privacy is often joked about as a foreign concept that doesn’t exist in China, but there is some truth to that. When you are living with family in a multigenerational household, often with multiple people to a room, in a large building next to other families who are living similarly, there is not a lot of space or wiggle room.
Timing of the outbreak
The timing of this epidemic should also be considered. The Lunar New Year (also known as Chinese New Year) began on Jan. 25, right as the number of cases being reported started ratcheting up into the thousands.
However, the timing of the new year may be good for containing the spread if people do stay indoors more and avoid large gatherings. Businesses and schools already stay closed for up to a full two weeks for the new year, a time during which many Chinese people get their only long chunk of time off for the entire year. We’ll have to see if the number of new cases slows down after the holiday break to know if it may have helped the situation.
The response in China
People remember what SARS was like, and any disease scare will feel urgent and serious, but the response is also measured and practical. Coverage in China seems to be dominated by “fact-based articles with good advice and just the right dose of alarm,” writes Peter Xu for HuffPost Personal, who was recently in China to visit his parents.
In China, people may be quick to comply with recommendations to wear masks because there is a cultural precedent and familiarity with wearing masks. You’ll often see people wearing them even during non-outbreak times because it helps filter out some of the air pollution that hangs over major cities in China. Also, because there is an existing market for face masks, there is an existing supply (even if they sell out quickly).
But China is also known for its all-powerful top-down approach. Last week, Chinese officials clamped down on travel out of Hubei Province, where Wuhan is located. While there is debate about whether quarantines work, there is some evidence that for the swine flu in 2009 reduced large gatherings helped contain spread. A more authoritarian Chinese approach leads to more drastic quarantines including fencing people into villages and guarding the residents. There isn’t any evidence to suggest that these particular tactics work to reduce the spread of disease and experts call for more humane approaches to quarantining people.
How ready is the U.S.?
An interesting question is if the U.S. is ready for the Wuhan coronavirus to come through its borders. While airports are equipped to scan individuals for high temperatures, what about the general public? Are hospitals ready for a potential influx of patients? Emergency departments are normally overwhelmed and overcrowded. Add to that a new disease that many people are afraid of and that puts added pressure on emergency departments and health care workers.
In the U.S., there are some telehealth options for people who are concerned about getting sick that might be able to help alleviate pressure on hospitals. “The role of telehealth is to provide patients quick and timely access to care — without putting healthy individuals at risk,” writes Chief Medical Officer of American Well Peter Antall in an email to Changing America. Doctors can screen patients and let them know what next steps they should take. They can assess risk factors like asthma or recent travel. “But while there is a lot of fear circulating around coronavirus, it’s important to remember that it’s also flu season — and we’re seeing a number of respiratory infections,” writes Antall.
But outside of airports, what’s the availability of infrared thermometers and face masks in the major U.S. cities that are at the frontlines? In the U.S., there has been one case of person-to-person transmission, but it may be premature for the general public to start wearing masks, say doctors, according to CNN. There isn’t evidence yet that 2019-nCov is transmitting through the air, and experts are skeptical that surgical masks help protect against the virus. But masks may provide some amount of protection, if only to block obvious ejections of body fluid through sneezes and coughs.
The current situation
People in the U.S. may not need to worry so much yet about the coronavirus. The likelihood of someone in the U.S. with respiratory symptoms having the new coronavirus is very low unless they’ve traveled to the affected regions, writes Antall. “The best advice for all of us is to be proactive about washing hands, to reconsider any upcoming travel to epidemic regions (East Asia, for now) and use common sense about avoiding close contact with sick people.”
In China, public spaces like shopping malls are eerily empty, according to Xu, a sign that people are staying away from crowds. Everyone is wearing a face mask, and infrared thermometers are abundant. “Everywhere in China other than Wuhan, I feel like you’re safer from not just the new coronavirus, but any infectious disease, than you would be even in the U.S. thanks to the precautions being taken right now,” writes Xu.
Will we be ready in the U.S. if it becomes a larger concern? Culturally, Americans are not known to wear face masks. Plus, people have to be reminded annually during flu season to take part in basic hygiene like covering their mouths, sneezing into their elbows and washing their hands. Let’s hope that we can make those adjustments if it comes down to it.
Chia-Yi Hou was born in New York to Chinese immigrants and has a PhD in infectious disease ecology. Outside of the US, she has lived in China, Singapore and the United Kingdom.
You can follow her on Twitter @chiayi_hou.