On the 7th of March China confirmed 44 new cases of COVID-19, down from 99 the day earlier. The lowest figure so far. The specially built hospitals in Wuhan are closing, emergency staff are returning, and businesses are restarting. Life in China is starting to return to normal.

On the 8th of March, Italy declared its first quarantine measures, placing 17 million people under lockdown. It reported its highest death toll yet and confirmed infected people jumped by 25% in a day.

Multiple US states reported their first case and New York declared a state of emergency, one of multiple states to now do so.

With the number of infected people quickly rising across the world we need to ask: How did China beat the virus and can other countries do the same?

Here’s a map I (quickly) made of provinces in China:

Map of the provinces in China.

The outbreak began in Hubei province, the red shape in the centre. There was a secondary cluster in Zheijiang, the purple shape on the east coast below Shanghai.

Timeline

December 2019 — a cluster of people linked to the Seafood market in Wuhan developed pneumonia with no clear cause.

10th of January — first death and 41 clinically confirmed cases of the novel coronavirus.

22nd of January — the novel coronavirus was detected in other major cities in china with 571 total confirmed cases.

23rd of January — all residents of Wuhan were informed that all public transport is suspended. The airport, railway stations and metro was closed. No resident of Wuhan was allowed to leave the city without permission.

14th of January — A total of 14 other cities in Wuhan were placed into lockdown, bringing the total number of quarantined people to 50 million.

2nd of February — Wenzhou, Zheijang implemented a 7-day restriction where each household was only allowed to have one person leave their home for provisions every two days.

68 million people were locked down in Hubei.

30 million across four cities in Zheijing were placed into lockdown.

To demonstrate the scale of the lockdown here is Hubei province laid over a map of the US and Europe:

Hubei Province in the US

Hubei Province in Europe

In total, 780 million people - nearly 10% of the world’s population, were placed into lockdown or under travel restrictions.

The aggressive measures taken by the Chinese government meant that they only had a severe regional cluster in Hubei and a smaller cluster in Zheijiang. The aggressive quarantine measures effectively contained the virus to these two provinces.

Some measures have been taken in the rest of the world right?

Italy announced this morning that it is quarantining the Lombardy region, measures that some are calling extreme. This “lockdown” however, still allows trains to and from the region.

A train from Milan arriving in Zurich.

This is a picture taken by Redditor IAmAnAnonymousCoward showing the 11 am train from Milan arriving at Zurich train station.

This is the strictest lockdown measure undertaken so far by a non-Chinese government and it’s still allowing trains in and out of the largest city in the region.

Experts are clear: the coronavirus is no longer containable.

Ok, so we can’t contain the outbreak.

According to the WHO the next step after containment is control and mitigation. Slow the outbreak down and prepare as best as possible to reduce mortality and economic impacts of the outbreak.

How are other countries doing at that?

Social Distancing

The Chinese government carried out “social distancing” measures across the country.

Extended schools breaks, closing theaters, cancelling sporting events, and canceling the enormous Chinese New Year events taking place all over the country.

How many other countries are willing to do this and how would the population respond?

While many conferences and events have been cancelled many marathons, street festivals and music events are going ahead because local governments either don’t have the power or the will to stop them.

The LA marathon is still going ahead in a few days.

The organiser’s advice is to “stay six feet away from other runners”.

The Japanese government has said that cancelling the Olympics might be impossible.

We know the risks that COVID-19 poses, why are these events still happening?

It’s not the only area other countries are failing.

Testing and Tracing

Tracing and testing is one of the most effective methods of combating an outbreak. People that have been in contact with somebody that has been confirmed to be infected with a laboratory test are tracked and quarantined. It’s very effective in the early stages but becomes less useful as the virus spreads.

Other governments have a threefold problem engaging in tracing and testing as china did:

They don’t have the capacity to produce and widely test their citizens.

They can’t effectively track people that have been in contact with confirmed infected people.

Their citizens are not as compliant and government not willing to make testing mandatory.

Testing

China’s is producing 1.6 million test kits per week.

Vice President Pence said on Wednesday the 4th that the US would be able to produce close to a million testing kits by Friday. On Friday he announced they hadn’t been able to do it but might have 1.2 million tests available by Monday. The Atlantic reported on Friday that less than 2000 have been conducted in the entire country.

Chinese government protocol was that anyone going to the doctor with a fever is tested for the virus. In Guangdong province, 320,000 people were tested at specialised “fever clinics”.

The US CDC has been blocking testing of people in hospital with pneumonia-like symptoms, only relaxing the restrictions last week.

If you phone the non-emergency 111 line in the UK you won’t be tested unless you know somebody that has been infected or I’ve you’ve just returned from China or Iran.

Here are the US screening procedures for passengers:

Another woman on twitter tried to get tested for the virus:

The second person to die of COVID-19 in the UK was taken to a hospital for pneumonia symptoms and placed on a normal ward.

He was coughing excessively and another patient in the ward had complained to a nurse that should be checking him for coronavirus… The nurse told him not to worry about it and that he is being dealt with

As his symptoms worsened, he was tested for COVID-19 and then moved into the ICU where he died a day later. Other patients on the ward he was placed on and staff that came into contact with him now have to be isolated.

How many people now infected with a nearly two week incubation period? The hospital claimed they are following government protocol.

Tracing

The Chinese Government mobilised 1800 teams of epidemiologists, with 5 members per team to track tens of thousands of people that had been in contact with a confirmed case every day.

The social monitoring and surveillance that the Chinese state engages in means they are exceptionally capable of tracing their citizens. For example in Sichuan province 25493 were identified and 25347 (99%) were traced. In Guangdong province, 9939 were identified and 9939 (100%) were traced.

The social measures undertaken by the Chinese government were backed up by technological efforts that other countries can’t replicate.

For years the Chinese government has encouraged the use of Alipay and Wechat apps which have almost completely replaced cash in China.

Use of the apps is so widespread that they allowed perfect tracking of individuals which makes contact tracing and quarantine restrictions much easier.

The apps were used to control and restrict travel. The Chinese government modified the apps on peoples phones to be colour coded with a traffic light system — red, yellow and green to let guards at traffic checkpoints and train stations know if you were allowed to travel.

The tech giants, Google Apple and Amazon no doubt have the same level of data available to them but will they be willing to hand it over to the government?

Probably not, the data is worth billions of dollars, and even if the data is handed over, is the government capable of using it effectively?

President Trump is alternating between downplaying the threat, even going so far as to say it was contained and making completely unrealistic promises about it, such as a vaccine being available in months.

Or blaming the lack of testing kits on Obama.

He seems more concerned with mitigating the effects of COVID-19 on the stock market rather than the US population. He recently admitted that he doesn't want to bring infected people from the grand princess cruise ship back to the US because it would increase the number of patients.

Technology

As you move between EU member states and US states with minimal or no border checks you enter different jurisdictions. Personal data has to be requested by different entities, with databases for shared information ineffective because of lack of oversight and different data standards.

How many infected people have travelled between EU countries and US states since the beginning of the outbreak and been in contact with other people?

How many people have travelled from countries like Italy or the US that have had large undetected outbreaks to other places while countries have only been testing people from China and Iran?

Without the tracking capabilities of China, we have no idea.

The US and the EU also both have millions of unaccounted illegal migrants and homeless populations which are not going to be accounted for in data available to the government.

LA alone, where there has been confirmed community transmission has a homeless population of 60,000 people.

How do you effectively trace people that have been in contact with confirmed infected persons with these restrictions?

You don’t.

This is the difficulty of tracing people in countries technologically capable of doing so.

Countries like Vietnam, The Philippines, Sri Lanka and many countries in Africa have significant economic ties with China without the ability to carry out large scale population tracing and testing.

The world bank announced an emergency $23bn dollar program to help these countries, diverted from other funds. We only hope that this is enough.

The Chinese Mindset

In the early days of the outbreak there were videos of people being seemingly kidnapped from the streets or marched out of apartment buildings and into vans by Chinese government officials.

These were people being taken away for mandatory testing because they had been in contact with somebody that had been confirmed infected.

How many governments have police or military forces capable of collecting hundreds of thousands of people for mandatory testing?

The UK certainly doesn’t. Our current police force is already stretched, taking hours to respond to attempted break-ins and violent crimes in London. It’s even worse in other parts of the country.

The overwhelming majority of Chinese citizens understood the need for testing and complied with both testing and quarantine measures.

The WHO report praises the extraordinary spirit of the Chinese people and the deep commitment that they have to collective action against a common threat.

Bruce Aylward, the leader of the WHO team sent to china commented:

“Everywhere you went, anyone you spoke to, there was a sense of responsibility and collective action, and there’s war footing to get things done.”

No other country has enough social consciousness amongst its population to support or even allow the same kind of measures that China put in place.

Lawrence Gostin, a global health law scholar at Georgetown University commented

“China is pretty unique in that it has a political system that can easily gain compliance with extreme measures.”

Let’s be honest, no other country has the social attitudes of the Chinese people, or the will of the Chinese government to force people to quarantine.

Will people actually quarantine themselves if told to by the government in your country?

In Milan, a Pakistani delivery driver that was identified as having contracted coronavirus went out delivering food.

In Israel, a man went to a restaurant after being told to self-quarantine.

In Japan, an infected man told his family that he was going out to infect people.

Our governments have failed to contain the virus, many are currently failing to trace and test people, what is our next line of defence?

The Healthcare System

I wrote about this in a recent article:

Let’s quickly examine hospital capacity.

16% of people that get infected with COVID-19 need hospitalisation and 6% will require Intensive Care. (It’s much higher in Italy, with 10% of infected people requiring ICU treatment)

To compare only 0.2% of people with influenza need hospitalising.

COVID-19 is much more infectious than the flu, but let’s presume that 8% of the US population gets infected, the same as a severe flu season.

The US population is 327 million people, that’s 26 million infected.

Currents predictions are that 16% of people will require hospitalisation and 6% will require ICU treatment.

If 16% of those people require hospitalization for 3–6 weeks?

That’s 4,160,000 People.

Do you know how many beds US hospitals have?

930,000

90,000 ICU beds

Other countries fare even worse, there are 140,000 beds in the NHS total.

The virus is much more infectious than the flu and many countries were already have a severe flu season before the coronavirus outbreak.

Does your government have enough beds? Almost probably not.

Is your government capable of building two hospitals in a week like china? Almost definitely not.

In a recent article, I posted this picture of a “coronavirus containment facillity” at a hospital in Lincoln, UK.

Coronavirus containment tent

After the government telling local hospitals that they need to increase capacity for the extra burden that COVID-19 patients are going to place on the NHS, they replaced that tent with this:

Coronavirus containment cabins

I feel much better, don’t you?

Despite the outbreak being largely localised, Wuhan quickly reached hospital capacity, 45 hospitals in Wuhan are at full occupancy caring for COVID patients, 6 of those hospitals for patients in critical condition, 39 for seriously ill patients and for infected people over the age of 65.

To increase capacity they built two new hospitals with 2,600 beds were built in a week.

Ten temporary hospitals were set up to in exhibition halls, gyms and public spaces to house people with mild symptoms so that they didn’t take up hospital space.

They mobilised 20,000 doctors and nurses from other provinces into Hubei to contain the outbreak.

Without healthcare, the mortality rate of COVID-19 is much higher than the reported 2%.

Mortality rate in Wuhan was 4.9%

Mortality rate in other provinces was 0.16%.

When asked why Wuhan was so much higher than the national level, the Chinese official replied that it was for lack of resources, citing as an example that there were only 110 critical care beds in the three designated hospitals where most of the cases were sent.

As Healthcare systems become overwhelmed, the mortality rate jumps.

The mortality rate in Italy right now is 4.25%

It’s not only people infected with COVID-19 that are at risk. As hospitals fill up, people that need care for other conditions are going to be unable to access it.

A comment left on my last story by Robert Munroe read:

“I helped respond the West African Ebola outbreak. 10 people died for every 1 Ebola case, due to people with other treatable conditions avoiding healthcare facilities because of the fear they would contract Ebola there.”

The measures taken to strengthen the Chinese healthcare system worked because China managed to contain major outbreaks to just one province — Hubei and a smaller outbreak in Zhenjiang.

Other countries have not contained the outbreak. The US, in particular, has already detected community transfers in multiple states and there are outbreaks in multiple countries in Europe.

The Healthcare system in Italy is already breaking and the mortality rate is about to go even higher as people can’t get access to healthcare.

Unlike China, there are going to be outbreaks in multiple regions at once because of a lack of containment measures.

There’s no backup coming from other regions.

Italy has already started bringing doctors and nurses out of retirement.

The retirement age in Italy is 66 by the way, many of these former professionals heading to the front lines are going to be elderly.

The powerful centralised state in China allowed them to rapidly test people, with no cost to the individual and quarantine them effectively. The government provided food packages.

In the US 27 million people have zero healthcare coverage. One-quarter of workers have no access to paid sick days. Only 29% of Americans can work remotely. If they don’t go to work they can’t pay their bills, they can’t pay their rent. Even if confirmed infected they will have to go to work.

European countries will fare a little bit better, but they face the problem of labour shortages. Delivering food and maintaining millions of people in quarantine requires a tremendous amount of manpower that Europe doesn’t have.

Jeremy Konyndyk, a senior policy fellow at the Center for Global Development said

The country has an extraordinary ability to do labour-intensive, large-scale projects quickly. No one else in the world really can do what China just did.

In the coming weeks and months, it’s pretty much inevitable that countries with large outbreaks are going to have to quarantine to just slow infections in the hope that healthcare systems can withstand the pressure if hospitalisations are spread out over time.

Outside of China cases are doubling roughly every 5 days. There are now 500 confirmed cases in the US. If the doubling rate holds true there will be approximately 1000 confirmed cases by the end of this week. Half a million by the end of April. 16 million by the end of May.

While the rate of doubling will necessarily have to decrease, it’s still illustrative of the need to slow the spread of the virus as we watch the Italian healthcare system crumble under the weight of patients needing ICU treatment.

A UK minister a few days ago admitted that they were moving into the delay phase:

It’s now highly likely that the virus is going to spread in a significant way and officials are ramping up work to prepare for the next delay phase.

The goal is to delay how fast the virus spreads so that too many people don’t get infected at once and regional healthcare systems are not overwhelmed like in Italy.

Prof Whitty, the UK’s Chief Medical Officer said the chances of containment are now. “Very slim. Slim to zero.”

While addressing Parliament he said:

It’s likely but not definite that the spread of the coronavirus would become an epidemic in the UK. […] In the worst case scenario of an epidemic in the UK, critical care beds would be under pressure at quite an early stage.

China has been criticised for it’s draconian, authoritarian response, but China has the outbreak contained and other countries don’t.

I’m not arguing that our countries should turn into authoritarian, single-party dictatorships and I’m not saying there isn’t any room to criticise the actions that China has taken.

However, if our governments had acted sooner and more decisively we might have been able to contain COVID-19 and decidedly avoid a worst-case scenario. Our healthcare systems wouldn't be overwhelmed like that of Italy right now and potentially millions of people wouldn't be at serious risk of dying.

I hope we haven’t sacrificed human lives at the altar of human rights.

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