From today's NY Times:
Is China Setting Itself Up for Another Epidemic?
The Wuhan outbreak shows that the Chinese government didn’t learn enough from the SARS epidemic.
By Yanzhong Huang
Mr. Huang is a global-health expert specializing in China.
On Sunday, a friend of mine in China wrote an ominous, two-word post on WeChat: “Broke out.” He meant that a mysterious surge in cases of pneumonia in Wuhan, a city in central China, was, in fact, an outbreak of something more serious.
The first case of the Wuhan virus was detected on Dec. 12. Until last Thursday, only 45 cases, with two deaths, all in Wuhan, had been reported, and no health care workers were said to have been infected. The virus was mild, we were told then, with no evidence of human-to-human transmission; all confirmed cases seemed to originate from a food market where live animals are sold. On Jan. 11, local health authorities even suggested that the outbreak was over because they hadn’t registered any new case since Jan. 3.
By Wednesday, though, 17 deaths and more than 470 cases had been confirmed. Cases of ill travelers from Wuhan have been reported in Hong Kong, Taiwan, Thailand, Japan, South Korea and the United States. Disease-modeling experts at Imperial College, in London, have estimated that as many as 4,000 to 9,700 people could be infected just in Wuhan, a city of more than 11 million people.
According to Guan Yi, a virologist based in Hong Kong, the trajectory of the Wuhan virus parallels the early spread of SARS, the virus that spread to 29 countries, sickened thousands and killed 774 people in 2002 and 2003. Perhaps just as worrisome: The government’s response today seems remarkably similar to its response back then.
The Chinese government’s initial response to SARS was, at least at the national level, a combination of inaction, denial and deception. The earliest case of SARS occurred in mid-November 2002; it’s clear that by late January of 2003 the Health Ministry was aware of a dangerous new type of pneumonia in Guangdong Province.
Yet the government did not issue a nationwide bulletin to hospitals with instructions for preventing the spread of the disease until April 3. And it was not until mid-April that it formally listed SARS as a disease to be closely monitored, with daily reports.
In the wake of that debacle, the Chinese government does seem to have become more willing to share disease-related information with both its people and international health organizations. But the government continues its top-down, state-dominated approach in disease surveillance, reporting and response.
Global health experts have pointed out that this time around, the government was tight-lipped for two weeks after the onset of the Wuhan virus. Yes, it shared the virus’s genetic sequence, but only under increasing pressure from the international scientific community. For a time, the government tried to restrict the release of any information related to the disease. Local police departments threatened to punish anyone who spread “false information” about the outbreak.
Only two quasi-independent media outlets in China, Caijing and Caixin, provided extensive coverage on the disease, and there was little discussion of the virus on Chinese social media. According to Caixin, 15 health care workers were infected in Wuhan between Jan. 12 and Jan. 21. Yet the local health authorities — presumably in an attempt to play down the seriousness of the situation — chose not to report that fact until after Monday, after the government warned that any official who tried to cover up information about the virus, or delay reporting, would be “nailed on the pillar of shame for eternity.”
As a result, people in China were poorly informed about the outbreak in its early days, when its spread might have been contained more easily. When I mentioned the Wuhan virus to some of my high school classmates in a WeChat group in last week, one of them, who happens to live in Wuhan, was offended. “Our country’s disease prevention and control system has been very well developed and is transparent,” he responded. “Only overseas people are panicking for us.”
That could be part of the problem: On Monday, 40,000 families in the city held potluck banquets to celebrate the coming Lunar New Year. The next day, municipal authorities were trying to lure more tourists to the city by distributing 200,000 coupons for free events. Needless to say, encouraging large groups of people to come together in the epicenter of a potential outbreak is not an effective health strategy.
Along with its information semi-blackout, the government has failed to respond effectively. Yes, the Chinese Center for Disease Control and Prevention started an investigation immediately after the first cases of the mysterious pneumonia were identified. The Wuhan health authorities also conducted epidemiological investigations. On Jan. 1, they closed down the market where the first cases of infection were traced. And this week it halted travel to or from Wuhan.
Then again, back when SARS broke out, China’s health authorities also responded relatively well at the very beginning. The problems started when the government then failed to undertake effective measures to prevent the disease from spreading further.
Both the Wuhan and the central health authorities could already have done much more to stem the spread of this new virus, including asking people to take precautions like wearing masks. Many suspected cases in Wuhan reportedly were not tested for the disease or quarantined; some people were simply sent home from the hospital without having been screened.
Outside Wuhan, even as the number of patients with pneumonialike symptoms has increased, the authorities may have been reluctant to report cases because the three-step confirmation procedure set out by the central government is so cumbersome. As a result, no new cases were reported in China beyond Wuhan between Dec. 12 and Monday, and yet cases were surfacing overseas. Some Chinese sarcastically took to calling the virus “patriotic” — a disease more interested in infecting people overseas than in China.
But this virus is anything but patriotic. It is exploding in China and spreading to other countries, much as SARS did in 2003. Has the Chinese government fundamentally changed its response to a possible epidemic since then? It appears not, or at least not enough. And to my surprise, people in China, including some in the know, seem to agree. “From 2003 to 2020,” according to one article shared by a government adviser on a WeChat group, Beijing’s “conduct has not changed at all.”