Story at a glance
- China locked down Hubei Province, where Wuhan is located, before a crucial migratory holiday period.
- Testing and contact tracing were crucial in China, as well as other countries like South Korea.
- Institutional and social memory of SARS may have affected how several countries in Asia responded to the coronavirus outbreak.
We are in the middle of a nationwide outbreak of COVID-19 caused by the coronavirus now named SARS-CoV-2. China, however, is towards the end of their epidemic with businesses and factories starting to open back up again.
What can we learn from the response to the coronavirus in China?
Lockdown of Hubei Province
The most drastic and obvious measure that Chinese officials took was to lockdown Wuhan and Hubei Province on Jan. 23. At the time, it seemed like a serious move because there were only about 800 confirmed cases. However, considering that the Lunar New Year celebration began the next day on Jan. 24, the lockdown came at a time just before a period of massive annual migration, which may have been crucial to limiting spread of the coronavirus.
Chinese officials were first notified about the cluster of cases in Wuhan in mid-December 2019. The first report to the World Health Organization (WHO) was submitted on Dec. 31. This means about five weeks went by from the first notices to the lockdown.
In the U.S., the situation is more complex because we are not dealing with one geographical source of the outbreak; we are dealing with an unknown number of outbreaks all across the country because the coronavirus has likely been spreading and traveling into the country for an unknown period of time.
Another important factor to note is that government officials were sharing data, says CEO of the South China Morning Post Gary Liu to TED Connects. Mainland China shared data with Hong Kong, which helped with their quick and active response to the outbreak.
But there is also a lack of thoroughness in data sharing. According to reporting by South China Morning Post, the first cases of COVID-19 may date back to Nov. 17, although the government has not published this data. There is new information every day and week that passes, says Liu, that will change how we understand the way things happened in China.
Testing and contact tracing
Themes that have come about multiple times in reference to the response in the U.S., South Korea and other countries are testing and contact tracing. These two public health measures are basic to disease control and epidemiology. Notably, South Korea is considered to have done both well, whereas in the U.S., we have unfortunately fallen behind.
Testing capacity was immediately ramped up in China in response to the climbing number of confirmed cases. In addition having access to tests, there were technology and personnel available to conduct the tests in labs and carry out follow ups on contacts. Although China changed the definition of a case to not include asymptomatic cases, it doesn’t mean that those individuals were lost or left to their own devices. Their contacts were still traced and tested for SARS-CoV-2 and told to stay in quarantine, according to Liu.
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Openness of information (or lack of)
In some ways, there has been more openness of information in China’s response to COVID-19. For example, compared to when SARS happened in 2002 and 2003 and it was kept quiet for months, government officials seem to have acted much sooner to inform their citizens and WHO, although there is reason to think they were not completely open about the seriousness. The government also made an app that allowed people to find out if they were near infected people using big data and artificial intelligence.
But it is difficult to know what we don’t know. “We can only judge the information we are being provided and have no way to determine if any information is not being disclosed,” says Raina MacIntyre, who is head of the biosecurity research programme at the Kirby Institute in Sydney, to Reuters.
There has also been a lack of openness and continued censorship. The whistleblower doctor, Li Wenliang — who died in early February —was first punished and silenced. His news about the mysterious pneumonia spread by word of mouth in China, especially on the chat app WeChat. Although there was censorship of messages about coronavirus on WeChat, people found creative ways to spread the message using emoji, ancient Chinese text or formatting text like Star Wars intros, according to Liu. People in China have started demanding freedom of speech. Recently, the Chinese government has taken back the penalty on Li and apologized to his family. They’ve also released new data about asymptomatic cases, although there may still be some doubts about the reliability of the numbers.
Institutional and social memory
A major difference in how COVID-19 is perceived in the U.S. versus China has to do with how recent was the last major outbreak scare. In 2009, there was an H1N1, or swine flu, outbreak that affected more than 60 million people and resulted in 12,469 deaths in the U.S. But that outbreak was largely geographically limited to California and states in the Southern U.S. The last time there was a major nationwide outbreak was the 1918 influenza outbreak that killed about 675,000 people in the U.S.
Having past experience with a serious outbreak matters in both how you perceive the threat of a new outbreak and how you respond. “The institutional and social memory of SARS matters a heck of a lot,” says Liu. “When you look at how China, Hong Kong, South Korea, Singapore and a lot of these countries in Asia have dealt with COVID-19.” There is political and social will in those countries to act seriously and quickly because they have an understanding of what it means to not do so. Lives are lost. Reputations and images are damaged, and the economic, physical and emotional recovery is long.
This is partially cultural in terms of acceptance of orders and expectations to comply with lockdowns and orders to practice hygiene and social distancing, but it’s also about learning from past experience. People in China and other Asian countries have experience dealing with large outbreaks. After SARS, people in Hong Kong will wear masks when they are sick, says Liu. “People understand social distancing is important.” If you had lived through the traumatic experience of SARS, then you will probably also be more likely to take COVID-19 seriously.
Short or long term memories?
Liu says that the health care system in Hong Kong changed after SARS. It was a major turning point, after which it became normal practice for people to wear masks out in public when they were sick. Officials put into protocols ways to ramp up capacity in hospitals and new health alert systems to inform citizens. In the current outbreak, there were two new triage hospitals built for patients in Wuhan in less than two weeks so that people who had milder cases of COVID-19 could be treated off-site while the main hospitals handled the more severe cases.
Not only has our memory potentially shaped how we respond to COVID-19, it may affect how we change things after the pandemic has ended and how long we keep those changes in effect. Do we treat SARS-CoV-2 like a one and done, it’ll never happen again? Or do we learn to expect that there might be a SARS-CoV-3 that emerges in the next decade or two? Do we stockpile more masks and ventilators or bring production back to the U.S.? Do we change the hospital system so that it doesn’t continuously run at near full capacity? We don’t know the answers to these questions.
For up-to-date information about COVID-19, check the websites of the Centers for Disease Control and Prevention and the World Health Organization. For updated global case counts, check this page maintained by Johns Hopkins University.
You can follow Chia-Yi Hou on Twitter.
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