The Asian Flu in 1956 killed between one and four million people worldwide. SARS in 2002 infected 8,098 and killed 774 in seventeen counties. H7N9 emerged ten years later to strike at least 1,223 people and kill four out of every ten of them. Now, the milder, yet more infectious COVID-19 has sickened more than 70,000 across the globe, resulting in 1,771 deaths.

All of these outbreaks originated in China, but why? Why is China such a hotspot for novel diseases?

"It’s not a big mystery why this is happening… lots of concentrated population, with intimate contact with lots of species of animals that are potential reservoirs, and they don’t have great hygiene required. It’s a recipe for spitting out these kinds of viruses," Dr. Steven Novella recently opined on an episode of the Skeptics' Guide to the Universe.

South Central China is a noted "mixing vessel" for viruses, Dr. Peter Daszak, President of EcoHealth Alliance, told PBS in 2016. There's lots of livestock farming, particularly poultry and pigs, with limited sanitation and lax oversight. Farmers often bring their livestock to "wet markets" where they can come into contact with all sorts of exotic animals. The various birds, mammals, and reptiles host viruses that can jump species and rapidly mutate, even potentially infecting humans. Experts are pretty sure this is precisely what happened with the current COVID-19 coronavirus, which is why, on January 30th, China issued a temporary ban on the trade of wild animals.

There are also cultural reasons why China plays host to large outbreaks.

"Many Chinese people, even city dwellers, insist that freshly slaughtered poultry is tastier and more healthful than refrigerated or frozen meat," journalist Melinda Liu wrote for Smithsonian in 2017. "The public’s taste for freshly killed meat, and the conditions at live markets, create ample opportunity for humans to come in contact with these new mutations."

Moreover, when stricken with an illness, many Chinese first seek out traditional Chinese medicine (TCM), where practitioners regularly misdiagnose symptoms, then offer acupuncture or ineffective herbal or animal-based remedies as treatments. This drastically increases death rates during outbreaks and allows infected individuals to return to the public where they can infect more people. Widely viewed TCM posts in China have already misleadingly promoted an unproven liquid composed of honeysuckle, Chinese skullcap, and weeping forsythia as a treatment for COVID-19.

China is also notorious for its misinformation, secrecy, and censorship, which raises the chances that new diseases will fester and spread. Back in early January, Chinese government officials told the public that the new infection's spread had been effectively halted. This was not true. At the same time, the authoritarian regime bullied health experts who attempted to sound alarm. The young doctor Li Wenliang attempted to warn others about the new coronavirus. He was 'rewarded' with a threatening reprimand by police. Li subsequently caught COVID-19 and succumbed to the disease the first week of February.

There are some hopeful signs that China is doing away with some of the secrecy that hampered global responses to prior outbreaks. The government is sharing much more data than in past outbreaks, and Chinese scientists are publishing a great many papers accessible to the global community. Still, it remains to be seen how – or if – the country will institute policies meant to prevent future ones. Permanently banning the sale of live animals at public markets, instituting and enforcing food safety regulations, and discouraging the use of traditional Chinese medicine are options that should all be on the table.

Without countrywide action, it's a near certainty that China's 1.4 billion citizens will once again be exposed to novel and dangerous infectious diseases.