by Vijay Prashad, Weiyan Zhu, Du Xaiojun, published by the Independent Media Institute, April 7, 2020
Part 1: Growing Xenophobia Against China in the Midst of CoronaShock
Violent attacks against Asians in the United States has spiked as a consequence of the stigma driven by the Trump administration.
March 31, 2020
On March 25, the foreign ministers of the G7 states failed to release a statement. The United States—the president of the G7 at this time—had the responsibility for drafting the statement, which was seen to be unacceptable by several other members. In the draft, the United States used the phrase “Wuhan Virus” and asserted that the global pandemic was the responsibility of the Chinese government. Earlier, U.S. President Donald Trump had used the phrase “Chinese Virus” (which he said he would stop using) and a member of his staff was reportedly heard using the slur “Kung Flu.” On Fox News, anchor Jesse Watters explained in his unfiltered racist way “why [the virus] started in China. Because they have these markets where they eat raw bats and snakes.” Violent attacks against Asians in the United States have spiked as a consequence of the stigma driven by the Trump administration.
Quite correctly, the World Health Organization’s Director-General Tedros Adhanom Ghebreyesus called for “solidarity, not stigma” in a speech given on February 14, long before the virus had hit Europe or North America. Ghebreyesus knew that there would be a temptation to blame China for the virus, in fact, to use the virus as a weapon to attack China in the most repulsive way. His slogan—solidarity, not stigma—was intended to sharply demarcate an internationalist and humanist response to the global pandemic from a narrow bigoted and unscientific response to the virus.
Origins
SARS-CoV-2, which is the official name for the virus, developed in the way many viruses develop: through the transmission between animals and humans. There is as yet no firm consensus about where this virus developed; one suggestion is that it developed in the west end of the Huanan Seafood Wholesale Market in Wuhan, in China’s Hubei province, where wild animals are sold. A central issue is the expansion of agriculture into forests and hinterlands, where humans have a greater chance to interact with new pathogens, such as SARS-CoV-2. But this is not the only such virus, even though it is undoubtedly the most dangerous to humans. In the recent period, we have seen a range of panzootic avian flu such as H1N1, H5Nx, H5N2 and H5N6. Even though H5N2 was known to have originated in the United States, it was not known as the “American virus” and no one sought to stigmatize the United States for it. The scientific name was used to describe these viruses, which are not the responsibility of this or that nation; the arrival of these viruses raises the more fundamental question of human encroachment into forests and the balance between human civilization (agriculture and cities) and the wilds.
The naming of a virus is a controversial matter. In 1832, cholera advanced from British India toward Europe. It was called “Asiatic Cholera.” The French felt that since they were democratic, they would not succumb to a disease of authoritarianism; France was ravaged by cholera, which was as much about the bacteria as it is about the state of hygiene inside Europe and North America. (When cholera struck the United States in 1848, the Public Bathing Movement was born.)
The “Spanish Flu” was only named after Spain because it came during World War I when journalism in most belligerent countries was censored. The media in Spain, not being in the war, widely reported the flu, and so that pandemic took the name of the country. In fact, evidence showed that the Spanish Flu began in the United States, in a military base in Kansas where the chickens transmitted the virus to soldiers. It would then travel to British India, where 60 percent of the casualties of that pandemic took place. It was never named the “American Flu” and no Indian government has ever sought to recover costs from the United States because of the animal-to-human transmission that happened there.
China and the Coronavirus
In an important article published in the medical journal The Lancet, Professor Chaolin Huang wrote, “The symptom onset date of the first patient [of SARS-CoV-2] identified was December 1, 2019.” Initially, there was widespread confusion about the nature of the virus, and whether it could be transmitted from human to human. It was assumed that the virus was one of the known viruses and that it was mainly transmitted from animals to humans.
Dr. Zhang Jixian, director of the Department of Respiratory and Critical Care Medicine of Hubei Province Hospital of Integrated Chinese and Western Medicine, was one of the first doctors to sound the alarm about the novel coronavirus pneumonia outbreak. On December 26, Dr. Zhang saw an elderly couple who had high fever and a cough—symptoms that characterize the flu. Further examination ruled out influenza A and B, mycoplasma, chlamydia, adenovirus and SARS. A CT scan of their son showed that something had partially filled the interior of his lungs. That same day, another patient—a seller from the seafood market—presented the same symptoms. Dr. Zhang reported the four patients to China’s Center for Disease Control and Prevention of the Jianghan District of Wuhan. Over the next two days, Dr. Zhang and her colleagues saw three more patients with the same symptoms who had visited the seafood market. On December 29, the Hubei Provincial Center for Disease Control and Prevention sent experts to investigate the seven patients at the hospital. On February 6, Hubei Province recognized the valuable work done by Dr. Zhang and her team in the fight to identify and reveal the virus. There was no attempt to suppress her work.
Two other doctors—Dr. Li Wenliang (an ophthalmologist from Wuhan Central Hospital) and Ai Fen (chief of the department of emergency treatment at Wuhan Central Hospital)—played a significant role in trying to break through the confusion to bring clarity toward the new virus. In the first days, when everything seemed fuzzy, they were reprimanded by the authorities for spreading fake news. Dr. Li died of the coronavirus on February 7. Major medical and government institutions—the National Health Commission, the Health Commission of Hubei Province, the Chinese Medical Doctor Association and the Wuhan government—expressed their public condolences to his family. On March 19, the Wuhan Public Security Bureau admitted that it inappropriately reprimanded Dr. Li, and it chastised its officers. Dr. Ai Fen was also told to stop spreading fake news, but in February she received an apology and was later felicitated by Wuhan Broadcasting and Television Station.
The provincial authorities knew about the new virus by December 29. The next day, they informed China’s Center for Disease Control, and the following day, on December 31, China informed the World Health Organization (WHO), a month after the first mysterious infection was reported in Wuhan. The virus was identified by January 3; a week later, China shared the genetic sequence of the new coronavirus with WHO. It is because China released the DNA that immediate scientific work took place across the planet to find a vaccine; there are now 43 vaccine candidates, four in very early testing.
China’s National Health Commission assembled a team of experts from the Chinese Center for Disease Control and Prevention, the Chinese Academy of Medical Sciences, and the Chinese Academy of Sciences; they conducted a series of experiments on the virus samples. On January 8, they confirmed that the novel coronavirus was indeed the source of the outbreak. The first death from the virus was reported on January 11. On January 14, the Wuhan Municipal Health Commission said that there was still no evidence of human-to-human transmission, but they could not say with certainty that limited human-to-human transmission was impossible.
A week later, on January 20, Dr. Zhong Nanshan said that the novel coronavirus could be spread from human to human (Dr. Zhong, a member of the Communist Party of China, is a famous respiratory expert and a leading person in the fight against SARS in China). Some medical workers were infected by the virus. That day Chinese President Xi Jinping and Premier Li Keqiang instructed all levels of government to pay attention to the spread of the virus; the National Health Commission and other official bodies were told to begin emergency response measures. Wuhan went into full lockdown on January 23, three days after human-to-human transmission of this virus was established. The next day, Hubei province activated its Level-1 alert. On January 25, Premier Li assembled a coordinating group. He visited Wuhan two days later.
It is unclear if China could have done anything different as it faced an unknown virus. A WHO team that visited China from February 16 to 24 praised the government and the Chinese people in its report for doing their utmost to stem the spread of the virus; thousands of doctors and medical personnel arrived in Wuhan, two new hospitals were built for those infected by the virus, and various civic bodies went into action to assist families under lockdown. What the Chinese authorities did to stem the rise of the infections—as a major new study shows—was to put those infected in hospitals and those who had been in touch with them into quarantine. This targeted policy was able to identify those who had been in the chain of infection and thereby break the chain.
The World and China
The Indian state of Kerala’s Health Minister K. K. Shailaja followed the rise of the cases in Wuhan and began emergency measures in this state of 35 million people in India. She did not wait. What China was doing taught Shailaja and her team how to respond. They were able to contain the virus in this part of India.
The United States was informed about the severity of the problem early. On New Year’s Day, Chinese Center for Disease Control officials called Dr. Robert Redfield, head of the U.S. Centers for Disease Control and Prevention, while he was on vacation. “What he heard rattled him,” wrote the New York Times. Dr. George F. Gao, the head of the Chinese CDC, spoke to Redfield days later, and Dr. Gao “burst into tears” during the conversation. This warning was not taken seriously. A month later, on January 30, U.S. President Donald Trump took a very cavalier position. “We think it’s going to have a good ending for us,” he said of the coronavirus. “That I can assure you.” He did not declare a national emergency till March 13, by which time the virus had begun to spread in the United States.
Others around the world were as cavalier. They were like the French politicians of 1832 who felt that France would not be affected by “Asiatic cholera.” There was no such thing as Asiatic cholera in 1832, but only cholera that would harm people with poor hygienic systems. In the same way, there is no such thing as a Chinese virus; there is only the SARS-CoV-2. The Chinese people showed us the way to confront this virus, but only after some trial and error on their part. It is time to learn that lesson now. As the WHO says, “test, test, test,” and then carefully calibrate lockdowns, isolations, and quarantine. Chinese doctors who developed expertise in fighting the virus are now in Iran, Italy, and elsewhere, bringing the spirit of internationalism and collaboration with them.
On March 4, Dr. Bruce Aylward, who led the WHO team to China, was interviewed by the New York Times. When asked about the Chinese response to the virus, he said, “They’re mobilized, like in a war, and it’s fear of the virus that was driving them. They really saw themselves on the frontlines of protecting the rest of China. And of the world.”
Part 2: How China Learned About SARS-CoV-2 in the Weeks Before the Global Pandemic
In the early weeks when the virus emerged in Wuhan, the Chinese government neither suppressed evidence nor did their warning systems fail.
April 6, 2020
The World Health Organization (WHO) declared a global pandemic on March 11, 2020. Dr. Tedros Adhanom Ghebreyesus, the director-general of the WHO, said at the press conference on that day that this was “the first pandemic caused by a coronavirus.” He said, “In the past two weeks, the number of cases of COVID-19 outside China has increased 13-fold, and the number of affected countries has tripled.” From March 11 onward, it became clear that this virus was deadly and that it had the capacity to tear through human society with ease. But this was not always so clear.
On March 17, Kristian Andersen of the Scripps Research Institute in California and his team showed that the new coronavirus strain, SARS-CoV-2, had a mutation in its genes known as a polybasic cleavage site that was unseen in any coronaviruses found in bats or pangolins and that there is a likelihood that the virus came to humans many years ago, and indeed not necessarily in Wuhan. Dr. Chen Jinping of the Guangdong Institute of Applied Biological Resources, along with colleagues, had earlier published a paper on February 20 noting that their data did not support the claim that the new coronavirus in humans evolved directly from a pangolin coronavirus strain. Zhong Nanshan, a noted epidemiologist, said that “although the COVID-19 first appeared in China, that does not necessarily mean it originated here.”
Scientific studies will continue and will eventually give us a conclusive understanding of this virus. For now, there is no clarity that it emerged directly from the Wuhan market.
The Western media have consistently made scientifically unfounded claims about the source of the virus, even when Western scientists were urging caution. They were certainly not listening to the doctors in Wuhan or to public health experts in China.
When doctors in Wuhan first saw patients in their hospitals in December, they believed that the patients had pneumonia, although CT scans showed severe lung damage; the patients were not responding to the typical medical treatment. Doctors were alarmed by the situation, but there was no cause to imagine that this was going to escalate into a regional epidemic and then a global pandemic.
The doctors and hospitals in Wuhan eventually came to grips with the evidence before them, and as soon as it became clear that this was an unfamiliar virus and that it spread rapidly, they contacted China’s national Center for Disease Control (CDC) and then the WHO.
You would not know this if you only read Western newspapers, notably the New York Times, which suggested in a widely circulated report that the Chinese government had suppressed information about the epidemic and that the Chinese warning system did not work.
Our investigation finds neither of these arguments to be true. There is no evidence that the Chinese government systematically suppressed information; there is only evidence that a few doctors were reprimanded by their hospitals or the local police station for divulging information to the public and not using the established protocols. There is also no evidence that the Chinese direct reporting system was faulty; instead, there is only evidence that the system, like any system, could not easily adjust to unknown or unclassified outbreaks.
The Chinese medical system, like other systems, has a rigorous procedure to report such things as health care emergencies. Medical personnel report to their hospital administration, which then reports to the various levels of CDC and the Health Commissions; they can also use the internet-based direct reporting system. It did not take long for the medical personnel to report the problem, and even less time for a high-level investigation team to arrive in Wuhan. This is what our investigation found.
Did the Chinese Government Suppress Information?
Dr. Zhang Jixian, director of Respiratory and Critical Medicine at the Hubei Provincial Hospital of Integrated Traditional Chinese & Western Medicine, saw an elderly couple on December 26. Their ailment bothered her. She arranged CT scans of the lung of the couple’s son who otherwise appeared healthy; the result, however, “showed ground glass opacity.” Uncertain about the causes, Dr. Zhang reported the situation to Xia Wenguang, the vice president of the hospital, as well as other departments of the hospital; the hospital promptly told Jianghan District Center for Disease Control and Prevention. This took place within 24 hours.
More patients arrived at the Hubei Provincial Hospital on December 28 and 29. The doctors still did not know more than that these patients presented symptoms of pneumonia, and that they had significant lung damage. It became clear to them that the immediate location for the spread of the virus was the Huanan Seafood Wholesale Market. On December 29, as the cases increased, the hospital’s vice president Xia Wenguang reported directly to the disease control department of the provincial and municipal Health Commissions. That day, the disease control department of the municipal and provincial Health Commissions instructed Wuhan CDC, Jinyintan Hospital and Jianghan District CDC to visit the Hubei Provincial Hospital for an epidemiological investigation. On December 31, an expert group of the National Health Commission arrived in Wuhan from Beijing. In other words, officials from Beijing arrived in Wuhan within five days of the first sign of a problem.
The day before the expert group arrived from Beijing, one doctor—Dr. Ai Fen—expressed her frustration at the mysterious virus with some medical school classmates. Dr. Ai Fen saw a test report of unidentified pneumonia. She circled the words “SARS coronavirus” in red, photographed it, and passed it on to a medical school classmate. The report spread among doctors in Wuhan, including Dr. Li Wenliang (a Communist Party member) and seven other doctors who were later reprimanded by the police. On January 2, the head of Wuhan Central Hospital Supervision Department warned Dr. Ai Fen not to release information outside the channels of the hospital.
The reprimands received by these doctors are offered as evidence of suppression of information about the virus. This is not logical. The reprimands took place in early January. By December 31, a high-level team arrived from Beijing, and on that day, the WHO had been informed; China’s CDC and the WHO had been informed before these two doctors were reprimanded.
On February 7, 2020, the National Supervision Commission decided to send an investigation team to Wuhan to investigate the situation. On March 19, 2020, the team published the results of their investigation and held a press conference to share their findings. As a result of the investigation, the Wuhan Public Security Bureau issued a circular to revoke the letter of reprimand issued to Dr. Li Wenliang. On April 2, Dr. Li Wenliang and 13 others who died in the fight against the virus were honored by the government as martyrs (this is the highest honor given by the Communist Party and the People’s Republic of China to its citizens).
There is no evidence that local officials were afraid to report the epidemic to Beijing. There is no evidence that it took “whistleblowers,” as the New York Times put it, to shine a light on the issue. Dr. Zhang was not a whistleblower; she followed the established protocol, which led to information being passed on to the WHO within days.
China’s Early Warning System
In mid-November 2002, a SARS outbreak broke out in Foshan, Guangdong Province, China. Doctors could not easily understand what was going on. Eventually, in mid-February China’s Ministry of Health wrote an email to the WHO Beijing office “describing ‘a strange contagious disease’ that has ‘already left more than 100 people dead’” in one week. Also mentioned in the message was “a ‘panic’ attitude, currently, where people are emptying pharmaceutical stocks of any medicine they think may protect them.” It took eight months to contain this SARS outbreak.
In its aftermath, the Chinese government set up a direct reporting system to catch any health emergencies before they go out of control. The system works very well for clearly defined infectious diseases. Dr. Hu Shanlian, a professor of health economics at Fudan University, describes two such incidents. As part of the polio eradication expert group, his team found two cases of polio in Qinghai. The local government reported the cases to the central government, and it began emergency immunization as well as gave children a sugar cube vaccine to effectively control the imported poliomyelitis. As well, he reports about the two cases of plague in Beijing that came from the Inner Mongolia Autonomous Region. “Diseases like these,” he wrote, “can be quickly absorbed from the direct reporting system.”
Well-known ailments such as polio and plague can easily be entered into an early warning system. But if the doctors are confounded by the virus, the system cannot easily work. Dr. Ai Fen, who forwarded some clinical records to her colleagues, said that the direct reporting system is very effective if the ailment is commonplace, such as hepatitis and tuberculosis. “But this time it was unknown,” she said. Dr. Zhang Wenhong of Shanghai said that the direct reporting system “is more powerful than those in most countries in the world for known pathogens [such as MERS, H1N1] or pathogens that do not spread quickly and have limited human transmission [such as H7N9].” If confronted with a new virus, the medical personnel and the direct reporting system are bewildered.
The most effective way to proceed when there is no clarity about the infection is to inform the disease control department in the hospital. This is exactly what Dr. Zhang Jixian did, and her superior, the head of the hospital, contacted the local CDC, who contacted China’s national CDC and the National Health Commission of China. Within five days of Dr. Zhang’s alarm, the WHO was informed about a mysterious virus in Wuhan.
Since January 21, the WHO has released a daily situation report. The first report highlights the events from December 31 to January 20. The first bullet point of that report says that on December 31, the WHO China Country Office was informed that there were “cases of pneumonia unknown etiology (unknown cause) detected in Wuhan City, Hubei Province of China.” The Chinese authorities isolated a new type of coronavirus on January 7, and then on January 12 they shared the genetic sequence of the novel coronavirus for use in developing diagnostic kits. Precise information about the virus’s form of transmission would not come until later.
The direct reporting system was updated on January 24, 2020, with the information about the novel coronavirus. It has now learned from experience.
Facts and Ideology
Florida Senator Marco Rubio accused the WHO of “servility to the Chinese Communist Party.” He wrote that the United States will open “investigations into the WHO’s unacceptably slow decision-making on whether to declare a global pandemic and into how China has compromised the integrity of the WHO.” U.S. funds for the WHO are in the balance. Characteristically, Rubio offered no facts.
Was the WHO slow in declaring a global pandemic? In 2009, the first known case of H1N1 was detected in California on April 15; the WHO declared a global pandemic on June 11, two months later. In the case of SARS-CoV-2, the first known cases were detected in January 2020; the WHO declared a global pandemic on March 11—one and a half months later. In the interim, the WHO sent in investigation teams to Wuhan (January 20-21) and to Beijing, Guangdong, Sichuan, and Wuhan (February 16-24); their investigation, before the declaration, was thorough. The timeframe for the WHO declaration is similar, even faster in 2020 than it was in 2009.
Whether it is the New York Times or Marco Rubio, there is an urgency to conclude that China’s government and Chinese society are to blame for the global pandemic, and that their failures not only compromised the WHO but caused the pandemic. Facts become irrelevant. What we have shown in this report is that there was neither willful suppression of the facts nor was there a fear from local officials to report to Beijing; nor indeed was the system broken. The coronavirus epidemic was mysterious and complex, and the Chinese doctors and authorities hastily learned what was going on and then made—based on the facts available—rational decisions.
Part 3: How China Broke the Chain of Infection
As information about coronavirus emerged, the Chinese government and Chinese society began to organize an immense campaign against its spread.
April 13, 2020
On March 31, 2020, a group of scientists from around the world—from Oxford University to Beijing Normal University—published an important paper in Science. This paper—“An Investigation of Transmission Control Measures During the First 50 Days of the COVID-19 Epidemic in China”—proposes that if the Chinese government had not initiated the lockdown of Wuhan and the national emergency response, then there would have been 744,000 additional confirmed COVID-19 cases outside Wuhan. “Control measures taken in China,” the authors argue, “potentially hold lesso[n]s for other countries around the world.”
In the World Health Organization’s February report after a visit to China, the team members wrote, “In the face of a previously unknown virus, China has rolled out perhaps the most ambitious, agile and aggressive disease containment effort in history.”
In this report, we detail the measures taken by the different levels of the Chinese government and by social organizations to stem the spread of the virus and the disease at a time when scientists had just begun to accumulate knowledge about them and when they worked in the absence of a vaccine and a specific drug treatment for COVID-19.
The Emergence of a Plan
In the early days of January 2020, the National Health Commission (NHC) and the Chinese Center for Disease Control and Prevention (CDC) began to establish protocols to deal with the diagnosis, treatment, and laboratory testing of what was then considered a “viral pneumonia of unknown cause.” A treatment manual was produced by the NHC and health departments in Hubei Province and sent to all medical institutions in Wuhan City on January 4; city-wide training was conducted that same day. By January 7, China CDC isolated the first novel coronavirus strain, and three days later, the Wuhan Institute of Virology (Chinese Academy of Sciences) and others developed testing kits.
By the second week of January, more was known about the nature of the virus, and so a plan began to take shape to contain it. On January 13, the NHC instructed Wuhan City authorities to begin temperature checks at ports and stations and to reduce public gathering. The next day, the NHC held a national teleconference that alerted all of China to the virulent novel coronavirus strain and to prepare for a public health emergency. On January 17, the NHC sent seven inspection teams to China’s provinces to train public health officials about the virus, and on January 19 the NHC distributed nucleic acid reagents for test kits to China’s many health departments. Zhong Nanshan—former president of the Chinese Medical Association—led a high-level team to Wuhan City to carry out inspections on January 18 and 19.
Over the next few days, the NHC began to understand how the virus was transmitted and how this transmission could be halted. Between January 15 and March 3, the NHC published seven editions of its guidelines. A look at them shows a precise development of its knowledge about the virus and its plans for mitigation; these included new methods for treatment, including the use of ribavirin and a combination of Chinese and allopathic medicine. The National Administration of Traditional Chinese Medicine would eventually report that 90 percent of patients received a traditional medicine, which was found to be effective in 90 percent of them.
By January 22, it had become clear that transport in and out of Wuhan had to be restricted. That day, the State Council Information Office urged people not to go to Wuhan, and the next day the city was essentially shut down. The grim reality of the virus had by now become clear to everyone.
The Government Acts
On January 25, the Communist Party of China (CPC) formed a Central Committee Leading Group for COVID-19 Prevention and Control with two leaders—Li Keqiang and Wang Huning—in charge. China’s President Xi Jinping tasked the group to use the best scientific thinking as they formulated their policies to contain the virus, and to use every resource to put people’s health before economic considerations. By January 27, Vice Premier of the State Council Sun Chunlan led a Central Guiding Team to Wuhan City to shape the new aggressive response to virus control. Over time, the government and the Communist Party developed an agenda to tackle the virus, which can be summarized in four points:
1. To prevent the diffusion of the virus by maintaining not only a lockdown on the province, but by minimizing traffic within the province. This was complicated by the Chinese New Year break, which had already begun; families would visit one another and visit markets (this is the largest short-term human migration, when almost all of China’s 1.4 billion people gather in each other’s homes). All this had to be prevented. Local authorities had already begun to use the most advanced epidemiological thinking to track and study the source of the infections and trace the route of transmission. This was essential to shut down the spread of the virus.
2. To deploy resources for medical workers, including protective equipment for the workers, hospital beds for patients, and equipment as well as medicines to treat the patients. This included the building of temporary treatment centers—including later two full hospitals (Huoshenshan Hospital and Leishenshan Hospital). Increased screening required more test kits, which had to be developed and manufactured.
3. To ensure that during the lockdown of the province, food and fuel were made available to the residents.
4. To ensure the release of information to the public that is based on scientific fact and not rumor. To this end, the team investigated any and all irresponsible actions taken by the local authorities from the reports of the first cases to the end of January.
These four points defined the approach taken by the Chinese government and the local authorities through February and March. A joint prevention and control mechanism was established under the leadership of the NHC, with wide-ranging authority to coordinate the fight to break the chain of infection. Wuhan City and Hubei Province remained under virtual lockdown for 76 days until early April.
On February 23, President Xi Jinping spoke to 170,000 county and Communist Party cadres and military officials from every part of China; “this is a crisis and also a major test,” said Xi. All of China’s emphasis would be on fighting the epidemic and putting people first, and at the same time China would ensure that its long-term economic agenda would not be damaged.
Neighborhood Committees
A key—and underreported—part of the response to the virus was in the public action that defines Chinese society. In the 1950s, urban civil organizations—or juweihui—developed as way for residents in neighborhoods to organize their mutual safety and mutual aid. In Wuhan, as the lockdown developed, it was members of the neighborhood committees who went door-to-door to check temperatures, to deliver food (particularly to the elderly) and to deliver medical supplies. In other parts of China, the neighborhood committees set up temperature checkpoints at the entrance of the neighborhoods to monitor people who went in and out; this was basic public health in a decentralized fashion. As of March 9, 53 people working in these committees lost their lives, 49 of them were members of the Communist Party.
The Communist Party’s 90 million members and the 4.6 million grass-roots party organizations helped shape the public action across the country at the frontlines of China’s 650,000 urban and rural communities. Medical workers who were party members traveled to Wuhan to be part of the frontline medical response. Other party members worked in their neighborhood committees or developed new platforms to respond to the virus.
Decentralization defined the creative responses. In Tianxinqiao Village, Tiaoma Town, Yuhua District, Changsha, Hunan Province, Yang Zhiqiang—a village announcer—used the “loud voice” of 26 loudspeakers to urge villagers not to pay New Year visits to each other and not to eat dinner together. In Nanning, Guangxi Zhuang Autonomous Region, the police used drones to play the sound of trumpets as a reminder not to violate the lockdown order.
In Chengdu, Sichuan Province, 440,000 citizens formed teams to do a range of public actions to stem the transmission of the virus: they publicized the health regulations, they checked temperatures, they delivered food and medicines, and they found ways to entertain the otherwise traumatized public. The Communist Party cadre led the way here, drawing together businesses, social groups, and volunteers into a local self-management structure. In Beijing, residents developed an app that sends registered users warnings about the virus and creates a database that can be used to help track the movement of the virus in the city.
Medical Intervention
Li Lanjuan was one of the early medical doctors to enter Wuhan; she recalled that when she got there, medical tests “were difficult to get” and the situation with supplies was “pretty bad.” Within a few days, she said, more than 40,000 medical workers arrived in the city, and patients with mild symptoms were treated in temporary treatment centers, while those who had been seriously impacted were taken to the hospitals. Protective equipment, tests, ventilators, and other supplies rushed in. “The mortality rate was greatly reduced,” said Dr. Li Lanjuan. “In just two months, the epidemic situation in Wuhan was basically under control.”
From across China came 1,800 epidemiological teams—with five people in each team—to do surveys of the population. Wang Bo, a leader of one of the teams from Jilin Province, said that his team conducted “demanding and dangerous” door-to-door epidemiological surveys. Yao Laishun, a member of one of the Jilin teams, said that within weeks their team had carried out epidemiological surveys of 374 people and traced and monitored 1,383 close contacts; this was essential work in locating who was infected and treated as well as who needed to be isolated if they had not yet presented symptoms or if they tested negative. Up to February 9, the health authorities inspected 4.2 million households (10.59 million people) in Wuhan; that means that they inspected 99 percent of the population, a gargantuan exercise.
The speed of the production of medical equipment, particularly protective equipment for the medical workers, was breathtaking. On January 28, China made fewer than 10,000 sets of personal protective equipment (PPE) a day, and by February 24, its production capacity exceeded 200,000 per day. On February 1, the government produced 773,000 test kits a day; by February 25, it was producing 1.7 million kits per day; by March 31, 4.26 million test kits were produced per day. Direction from the authorities moved industrial plants to churn out protective gear, ambulances, ventilators, electrocardiograph monitors, respiratory humidification therapy machines, blood gas analyzers, air disinfectant machines, and hemodialysis machines. The government focused attention on making sure that there was no shortage of any medical equipment.
Chen Wei, one of China’s leading virologists who had worked on the 2003 SARS epidemic and had gone to Sierra Leone in 2015 to develop the world’s first Ebola vaccine, rushed to Wuhan with her team. They set up a portable testing laboratory by January 30; by March 16, her team produced the first novel coronavirus vaccine that went into clinical trials, with Chen being one of the first to be vaccinated as part of the trial.
Relief
To shut down a province with 60 million inhabitants for more than two months and to substantially shut down a country of 1.4 billion inhabitants is not easy. The social and economic impact was always going to be very great. But, the Chinese government—in its early directives—said that the economic hit to the country was not going to define the response; the well-being of the people had to be dominant in the formulation of any policy.
On January 22, before the Leading Group was formed, the government issued a circular that said medical treatment for COVID-19 patients was guaranteed and it would be free of cost. A medical insurance reimbursement policy was then formulated, which said that expenses from medicines and medical services needed for treating the COVID-19 would be completely covered by the insurance fund; no patient would have to pay any money.
During the lockdown, the government created a mechanism to ensure the steady supply of food and fuel at normal prices. State-owned enterprises such as China Oil and Foodstuffs Corporation, China Grain Reserves Group, and China National Salt Industry Group increased their supply of rice, flour, oil, meat and salt. All-China Federation of Supply and Marketing Cooperatives helped enterprises to get direct connection with farmers’ cooperatives; other organizations like China Agriculture Industry Chamber of Commerce pledged to maintain supply and price stability. The Ministry of Public Security met on February 3 to crack down on price gouging and hoarding; up to April 8, the prosecutorial organizations in China investigated 3,158 cases of epidemic-related criminal offenses. The state offered financial support for small and medium-sized enterprises; in return, businesses revamped their practices to ensure a safe working environment (Guangzhou Lingnan Cable Company, for instance, staggered lunch breaks, tested the temperature of workers, disinfected the working area periodically, ensured that ventilators worked, and provided staff with protective equipment such as masks, goggles, hand lotion, and alcohol-based sanitizers).
Lockdown
A study in The Lancet by four epidemiologists from Hong Kong show that the lockdown of Wuhan in late January prevented the spread of infection outside Hubei Province; the major cities of Beijing, Shanghai, Shenzhen, and Wenzhou, they write, saw a collapse in numbers of infections within two weeks of the partial lockdown. However, the scholars write, as a consequence of the virulence of COVID-19 and the absence of herd immunity, the virus might have a second wave. This is something that worries the Chinese government, which continues to be vigilant about this novel coronavirus.
Nonetheless, the lights of celebration flashed across Wuhan as the lockdown was lifted. Medical personnel and volunteers breathed a sigh of relief. China had been able to use its considerable resources—its socialist culture and institutions—to swiftly break the chain.