Lockdown in China

Emphasis on widespread testing and contact tracing.

The role of asymptomatic carriers in spreading COVID-19 is being increasingly understood with estimates up to 50% of cases. To identify this group and prevent further spread, widespread screening, early testing and contact tracing is the only possible strategy. In China, your temperature was measured multiple times of day — at your office, at the grocery store, even when returning to your apartment building. If you are found to be febrile, you are immediately directed to a “fever clinic” for further evaluation and possible testing for COVID-19. Such aggressive screening strategies in China, South Korea, Taiwan, Hong Kong and Singapore have been the hallmark of their containment strategy developed in the aftermath of SARS.

Routine temperature checks in Wuhan. Getty Images.

Quarantine of positive and suspected cases away from their family.

You may have seen photos of gymnasiums in China filled with rows upon rows of beds. These were quarantine centers for patients with mild cases of COVID-19 as well as suspected patients awaiting test results — and it wasn’t voluntary. While inconceivable in the United States, China mandated quarantine of positive patients away from their families until their symptoms resolved. Even patients discharged from the hospital after recovering from the virus were subject to a quarantine away from their families. The WHO report on the outbreak in China identified this step as critically important to stopping transmission among family clusters which fueled the early phases of the outbreak.

Beds in an exhibition center in Wuhan used as a hospital for patients with mild COVID-19 symptoms. Getty Images.

Local enforcement of strict quarantine orders.

Across China, cities and villages alike were divided into a grid-like network of neighborhoods, each charged with containing COVID-19 within their confines through surveillance of travelers and enforcement of quarantine orders. One by one, each neighborhood would be systematically cleared of the virus. In Wuhan city and Hubei province, the strictest measures were enacted. Entry in and out of apartment complexes were recorded and social visits were prohibited. A temperature was measured with every entry. Families initially could send one person out every 3 days for groceries. In time, even this was restricted and many communities organized teams to deliver groceries and medications to residents. Community officials were empowered to enforce quarantine orders and called in the police if anyone refused to cooperate. Rewards were established for reporting violators.

In truth, some of these measures were taken too far. Stories circulated and relayed to me through my relatives told of the ways travelers from Hubei province were obstracized over the Chinese New Year holiday: many were refused entry into their villages and even refused service at gas stations, restaurants, and hotels.

Strict nationwide travel restrictions.

All travel in and out of Hubei province was suspended: flights and trains were canceled and highways were barricaded by checkpoints. In Shanghai and Beijing, traffic cameras showed eerie footage of deserted highways. Even in my grandparent’s parochial village in Fujian province — thousands of miles from Wuhan city — two checkpoints were established between the village and the nearest town. To cross the checkpoint and leave the village meant that you would have to self-quarantine at home for 14 days upon your return in addition to a 14-day quarantine at your destination. Travel within China came to a complete stop.

Aerial view of roads in Wuhan. Getty Images.

Police checkpoint at the Jiujiang Yangtze River Bridge, which connects to Hubei province. Thomas Peter / Reuters.

Use of smartphone GPS technology to track potential cases.

China, as did many other Asian countries, turned to smartphones and apps to track travelers and monitor suspected cases. For example, inbound travelers arriving in Shanghai were required to download and register on an app before leaving the train station or airport. The app served as a reminder to quarantine at home for 14 days as well as a tracking tool in case someone later became infected. Singapore developed an app for its citizens that tracks your location and records any sustained close contact with other people. If a person becomes infected, their app data is accessed to identify close contacts who may requires testing and quarantine. Despite assurances that the data would be destroyed when the pandemic is over and accessed only for positive cases, privacy issues abound and would be a non-starter in the United States.