China may be beating the coronavirus at a painful cost
China, the place where it first appeared, says it has the answers.
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To the surprise of some, the country that hid and mishandled the initial outbreak seems to be under control, at least according to its own official figures. The number of new cases reported has declined dramatically in recent days, although infections are increasing in other countries. The World Health Organization has praised Beijing’s response.
Authorities reported only 99 new cases on Saturday, below 2,000 a day just a few weeks ago, and for the second consecutive day, none was detected in Hubei Province, outside its capital, Wuhan, the center of the outbreak.
China says the trend shows that its containment measures, which include a blockade of almost 60 million people in Hubei and strict quarantine and travel restrictions for hundreds of millions of citizens and foreigners, are working. And he has begun trying to promote his efforts as successful propaganda in the country and abroad.
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The rest of the world, much of it facing its first cases with fear, has taken note. But there is also concern that China’s numbers may be defective and incomplete. The real test will be if the virus reappears when children return to classrooms and workers to factories, and travelers start taking buses and underground trains.
China’s blunt force strategy raises deeper questions for other countries. His campaign has had a great cost for people’s livelihoods and personal freedoms. Even countries that could copy to China still have to wonder if the cure is worse than the disease.
“I think they did an amazing job of taking down the virus,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “But I don’t know if it’s sustainable. What have the Chinese really achieved? Have they really contained the virus? Or have they simply suppressed it?
Elsewhere, Italy, South Korea and Iran are fighting to control the spread of the virus. In the United States, where there are now more than 400 confirmed cases, the government has been criticized for manipulating its test kits and allowing the virus to spread in vulnerable communities such as a nursing home in Seattle. The outbreak now threatens global growth and is intensifying a violent reaction against immigration and globalization.
Countries that study China’s approach would need to consider how almost every corner of Chinese society has changed.
The economy has almost stagnated, and many small businesses say they will soon run out of cash. Critically ill patients are struggling to find timely care, and some have died. Hundreds of millions of people have been placed in some form of isolation. As of Friday, about 827,000 people remained in quarantine in Beijing, according to state newspaper China Daily.
“I was concerned about the whole focus on simply controlling the virus,” said Dr. Jennifer Nuzzo, an academic at the Johns Hopkins Center for Health Safety. She recommended a more measured response, such as that taken by the governments of Hong Kong and Singapore. The officials promulgated specific quarantines but did not completely close the workplaces, allowing their respective economies to continue operating while so far they contained the virus successfully.
“We have to have a broad vision of the impact on society,” Nuzzo said, “and make better accounting of the social tolls of these measures that do not focus only on numbers.”
For China, numbers are key.
The number of cases reported on Saturday was a substantial decrease from 2 and a half weeks ago, when China registered about 2,000 new infections and up to 100 deaths per day. On Saturday, 28 new deaths were reported, all in Hubei.
In comparison, Italy reported 49 deaths from the virus on Friday.
Outside of Wuhan, the spread has effectively stopped, according to official figures. All but one of the 99 new cases reported on Saturday were in Wuhan or were people who had traveled to China from abroad.
The World Health Organization says that China’s containment measures may have saved hundreds of thousands of people from infection. Their efforts show that the uncontrolled spread of the virus “is not a one-way street,” Dr. Tedros Adhanom Ghebreyesus, general director of the group, said Thursday.
“This epidemic can be delayed,” Tedros said, “but only with a collective, coordinated and comprehensive approach that involves the entire government machinery.”
WHO experts sent to China have also highlighted clinics that could diagnose hundreds of cases a day with CT scans and laboratory tests, and the massive isolation centers in Wuhan stadiums that separated people who had mild infections from their families .
“There is no doubt that China’s bold approach to the rapid spread of this new respiratory pathogen has changed the course of what was a rapid escalation and remains a deadly epidemic,” Dr. Bruce Aylward, the team leader of the WHO who visited China, told reporters in Beijing late last month.
The numbers suggest that aggressive quarantine measures, when fully implemented, could stifle the spread of the virus, said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University.
“This is the largest public health experiment in the history of mankind,” said Schaffner. “They can’t turn it off, but they rejected it. And it gave the rest of the world some extra time.”
Still, the total number of infections in China, in more than 80,000, is staggering. And there are reasons to doubt the official figures.
In the early days of the outbreak, the shortage of test kits and hospital beds meant that many could not be tested. It is likely that many mild infections are not detected. The government has changed the way it counts cases several times in recent weeks, which caused large fluctuations in reported figures, although experts say such adjustments are not unusual.
Medical experts say there have been few signs that the government has conducted aggressive tests to detect the coronavirus outside the medical facilities in Hubei. According to experts, until they extend the scope of the tests, it will be impossible to determine the true extent of the epidemic because those who have mild infections may not see a doctor.
“Right now we are focused on the tip of the iceberg,” said David Hui, director of the Stanley Ho Center for Emerging Infectious Diseases at the Chinese University of Hong Kong.
The ruling Communist Party praises the slowdown of the outbreak as a sign of the superiority of its authoritarian political system, from top to bottom, which gives officials an almost uncontrolled power. But its harsh measures test the patience of its citizens, many of whom think that such repression could have been avoided if the officials had not first hidden the magnitude of the outbreak and silenced the complainants.
The impact of the restrictions has been felt most sharply in Hubei, where 56 million people have been scrutinized effectively since January. For more than five weeks, the bustling center of universities, commerce and transportation has been transformed into a collection of ghost towns as the virus has devastated communities, trapped entire families and infected thousands of medical workers.
China’s experience in fighting the virus has also highlighted the risk of family transmission if hospitals run out of beds and test kits, as they did in Wuhan, where for weeks, many of the patients were sent to their homes and infected.
Road blockades have closed cities, public transport has closed and private cars have mostly been banned from roads. In Wuhan, restrictions on individual movement have intensified in recent weeks, and residents are now largely prohibited from leaving their homes.
Among Hubei residents, there are indications that anger and frustration are increasing. Chinese social networks are flooded with publications from residents who say they have lost their jobs due to the prolonged blockade, making it difficult to pay mortgages and loans. Others have described food shortages in their communities.
On Thursday, in a rare public reprimand from the government, discontented people in a residential community in Wuhan interrupted high-level officials as they walked around the neighborhood on an inspection.
“False! Everything is false!” shouted a resident of the delegation, which included Sun Chunlan, deputy prime minister who led the central government’s response to the outbreak.
The state’s People’s Daily newspaper later said the allegations were directed at local neighborhood officials who had “falsified” the delivery of vegetables and meat to residents. Sun ordered an immediate investigation on the subject.
Wang Zhonglin, secretary of the Wuhan party, announced on Friday plans to teach city residents to be grateful for the party, a move that was quickly seen with mockery and anger on Chinese social networks.
Relationships also wear out, as families are forced to live for prolonged periods in confined spaces. Guo Jing, a feminist activist in Wuhan, said she and other volunteers had sent a series of requests for help from residents who reported physical abuse by their family members at home.
“In these circumstances, it is really difficult for them to find help during the epidemic,” Guo said. “It is very difficult to leave home.”
Fang Fang, a writer who has kept a widely read, and often censored online life journal in Wuhan, said the closure was charging a psychological price on residents.
“Ordinary people don’t have a source of income and lack a sense of certainty, even when they can leave,” he wrote in a recent post. “When you can’t feel the ground or lose control over a situation, it’s easy to lose the most basic sense of security.”
Outside Hubei, China wants to boost its economy, but local officials are also under great pressure not to take risks to reduce the number of infections. Although the provinces have reduced their alert levels for the virus, many companies are choosing to err as a precaution. Some have even falsified electricity consumption rates to achieve strict return to work goals, according to a recent report by Caixin, an influential Chinese magazine.
Some experts are increasingly wondering if China’s blockade will be useless as the virus becomes widespread. They say that, given the global spread of the virus and the difficulty of detecting mild cases, it is unlikely to be completely eliminated, even in China.
“I think that the decrease in case numbers probably means that all these incredible measures that have been taken probably have an effect,” said Marc Lipsitch, an epidemiologist at Harvard T.H. Chan School of Public Health. “But I don’t think zero is zero.”