China’s no longer the problem

12 March 2020 08:52 am - 0     - {{hitsCtrl.values.hits}}



The COVID-19 crisis has changed for the worse. In February, China was the problem – the rest of the world feared Chinese travelers and hoped to ride out disruptions to China’s economy. Today, the problem is outside China, and the fear in China is of foreigners carrying disease. 

Countries around the world are repeating China’s mistakes. If this continues, the epidemic might infect most people in the world, leave potentially millions dead, and cause a severe global recession. We are running out of time. I explain what has happened.


What is COVD-19?
COVID-19 is a corona virus that came from bats, just like SARS in 2002. Bats tolerate high infestations by viruses, which leads them to harbor and breed stronger viruses. Although causing bats no harm, these viruses can be much more deadly if they infect other animals. COVID-19 probably jumped from bats to another animal and then to humans in November 2019 in Wuhan in the Hubei province of China. The first COVID-19 patient was discovered on 1 December 2019.


Why did the epidemic start?
China’s response to COVID-19 contains failures and achievements. We should learn from both. 

SARS was the last deadly virus to jump from animals to humans in China, also in a wet market. The world heavily criticized China at the time. It took too long to respond and it hid the problem, which made the epidemic much worse. China learnt from this. It put in place systems to watch for any new viruses, and it regulated wet markets and trade of wild animals.
This did work in part. China detected an unknown virus, isolated it, sequenced its genetic code and warned WHO within six weeks of the first case. It then shared the genetic code with other countries on 12 January. This is an impressive scientific achievement. The openness in sharing data meant that tests for COVID-19 were soon available around the world, including in Sri Lanka.


However, there were two serious failures.
First, China tasked the national forestry agency with regulating wildlife markets. But this agency had conflicting goals: (i) to regulate wildlife trade and (ii) to boost business by promoting sale of wild animals. This conflict and the pressure by businesses on government officials to turn a blind eye to illegal activities meant that the sale of wild animals and unregulated wet markets continued after SARS. This includes Wuhan’s illegal wet market, where the epidemic started. Such things should not surprise us in Sri Lanka.

Second, officials delayed for weeks to act on warnings of a new, fatal virus spreading in Wuhan. It seems that government leaders did nothing partly for short term benefit and partly because they didn’t take the experts seriously enough. News censorship - ever present in China – contributed. However, it’s wrong to think that this could only happen in China. We have suffered many calamities because our elected leaders ignore experts. And many advanced democracies, like the USA, Japan and Italy, have since made similar mistakes with COVID-19. 


China’s response
Between 23 January and 3 February, the Chinese government quarantined Hubei with its 60 million people, stopping all travel in and out. It confined cases across China to home or hospitals and traced their contacts. China also made huge efforts to stop infection by reducing contact between people, what experts call “social distancing”. This included extending holidays, shutting schools and factories, preventing crowds and meetings, reducing travel, and changing people’s behaviors. Disease quarantine and isolation dates back thousands of years, but nobody has attempted social distancing on this scale before. What China did was a very big experiment, with huge costs – effectively crippling its economy.


Did China’s experiment work?
One way of thinking about the spread of COVID-19 is to treat Hubei province as ground zero – where the virus started and took root and think of the rest of China as the great wall protecting the rest of the world.

Hubei’s quarantine largely left the province to manage on its own. It shows what happens if the virus spreads unchecked. There were almost 70,000 cases and people have been shut at home for weeks. The large numbers overwhelmed Hubei’s hospitals. They could not provide enough intensive care beds and ventilation, and one in 20 patients died. Fortunately, the lock-down worked: new cases have declined since mid-February. 

The great wall around Hubei – the other provinces - largely held. One week after ground zero was cut-off, new infections fell rapidly. With fewer patients than Hubei, hospitals coped better and only one in 100 patients died. There are now less than 600 patients with COVID-19 in these provinces from a peak of 9,000 in mid-February. Even more importantly, many provinces have reported zero cases in the past few days, and these cases increasingly appear to originate from foreign countries. 

China’s experiment tells us that draconian controls and social distancing work. They can beat COVID-19 within three months. China is on track to be largely free of the virus by May, and it is no longer the source of new cases in other countries.


What’s happened outside China?
Unfortunately, other countries are repeating China’s mistakes. Many have ignored expert advice, bungled their responses and taken too long to act. Government officials in Japan ignored experts and mismanaged their handling of a cruise ship with originally one case, infecting almost a thousand people from many countries. In Iran, the government did not take the virus seriously, allowing it to spread it to all parts of the country and to other countries. And the USA botched the production of test kits, resulting in thousands of potential cases not being tested and the virus spreading undetected in many parts of the country. 

There are some bright spots. In particular, Singapore and Hong Kong have been able to control COVID-19, and Sri Lanka seems to have done well so far. 


What are the prospects?
China is no longer the front-line in the battle against a global epidemic. After serious mistakes, China did what it had to do. It contained the virus in Hubei, and then cleaned it up. Our problem today is that the virus is racing out of control outside China. Of particular concern are Europe, Korea, Japan, Iran and USA. Most COVID-19 patients, new infections and deaths are now outside China, and most countries have yet to recognize this.

If other countries fail to replicate China’s success, we will lose our chance to stop the virus, and our only option will be to slow its spread. Once that happens, quarantine, isolation and tracing contacts of infected cases will no longer work. A vaccine is at least a year away. We will face millions of cases and large-scale disruption to normal life everywhere. 

Some people argue that COVID-19 is no different to a bad flu. They are wrong. Many COVID-19 patients need intensive care. No health system in the world can cope with the numbers that would need such care, and many will die as in Hubei… and is now happening in Italy. We must avoid this. This means replicating the measures that China got right, and without hesitation when they become necessary, and adjusting our risk assessments to take a more global perspective. 

Dr Ravi P. Rannan-Eliya is Executive Director of the Institute for Health Policy. He trained as a physician at Cambridge, and in public health and economics at Harvard. The views and opinions expressed in this article are his alone and do not necessarily reflect the opinions of the Institute for Health Policy.


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