As the Coronavirus spreads, countries must learn from each other and adapt successful practices locally. As a US citizen floating around the cities where cases are now appearing, I'm especially worried about the US system and culture that is not effectively tackling this situation in a coordinated mass response. Here's my realistic assessment of the differences between the US and China in their abilities to cope with the Coronavirus (COVID-19).

Warning: this is going to trigger people who want to blame China for the outbreak. I view the virus as a mirror for all of us to see and work out our own triggers. If something makes you feel uncomfortable in this article, take a moment to think about why it gets you upset. What can you learn from that?

Note that I'm not a China apologist. I'm a bicultural, dual resident, US-born citizen who has family living in both the US and China. I'm an engaged, compassionate, neutral observer who spends a lot of time explaining how China works to the West. I urge both countries to just accept each other's differences, be compassionate about each other's imperfections, stop wasting energy posting indignations and conspiracy theories, and focus on figuring out what makes sense to learn from each other and adapt at home.

I've been a virus refugee since I left China in December for the holidays. I've been floating around from friend's house to friend's house in the US while my parents and colleagues have self-imprisoned themselves in small apartments in Shanghai. My mother and brother's many restaurants have been flattened. My father's company has a branch in Wuhan and everyone is now working remotely. Life has been turned upside down and transferred online in China.

Now it's starting all over again in the US. My other brother is now pulling his two kids out of U of Washington which just shut down today, affecting 50,000 students. Stanford and other schools are following. I can't find masks at Walgreens. CVS has a run on Purell. Grocery stores are seeing inventory depleted. Events are being canceled, not just in the US but globally. As a public speaker, this hurts my income.

In three months, the Coronavirus has spread from a heavily populated city in China to countries on every urban continent. Most people who don't have underlying symptoms ("co-morbidities") and weak immune systems will recover from mild symptoms. As of March 12, over 129,000 people have contracted the virus and 4,750 have died globally. That's a pretty low infection number compared to the regular seasonal flu. As a point of comparison, H1N1 “swine flu” in 2009 started in the US, then infected 100 million Americans and killed up to 575,400 people globally in the first year alone.

So why are people freaking out? Because the incubation period is so long and people don't necessarily show fever as a first symptom. It's hard to detect who has it until they have transmitted the disease to their family and friends. Also, if people aren't tested thoroughly, cases will slip through the cracks and contact trails can branch out like tree roots. This is how epidemics grow exponentially.

Marc Lipsich, a Harvard epidemiologist professor, says that most countries’ screening procedures miss two-thirds of travelers exhibiting the virus's symptoms. Lipsich estimates that, if not curbed, 20-60% of the world will be infected with the virus this year.

Countries must come together and stop this from becoming a seasonal pandemic globally. What the World Health Organization and the Chinese government have both said is that the only way to curb the epidemic is to identify infected people, get a full list of who they have been in contact with ("contact trail") and quarantine all of them for 14 days, ideally at home instead of taking up a valuable hospital bed.

LACK OF COMMUNICATION AND BIG DATA SYSTEM

There is no single centralized source of real-time information in the US. There are only some partial lists floating around. This makes it hard to get the word out about school/office/church closures and reopenings, canceled flights and commuter trains, canceled events. This makes it difficult to inform an entire city about the latest medical services.

In China, the availability of good real-time information on cases and prevention tactics has provided citizens with peace of mind among the chaos. China's ubiquitous WeChat application is a single ecosystem that makes it easy for anyone to see a dashboard of real-time cases by neighborhood throughout the country, connect to government and medical services, learn more through official and social group chats, donate, and make mobile payments within one mobile ecosystem.

A Silicon Valley-based engineer originally from Wuhan created this GitHub open-source platform to gather information of hospitals, hotels, factories, logistics, donations, contributions, prevention, and treatment to help people more efficiently coordinate the fight against Coronavirus in China. This type of effort could be adapted for other regions as well.

Even if there was a centralized source of info, it won't be available in all the different languages needed to reach the immigrant communities thoroughly soon enough.

China has one colloquial language, even though every province has its own dialect.

No real ID on social media means it's much harder to collect data on everyone's whereabouts and trace contact trails of existing cases. If you asked the American populace if they would be willing to give the federal government all of their contact and location information so that they could mobilize huge amounts of resources to eradicate the virus immediately, or if they preferred not to be tracked knowing that this would cause them to be infected sometime soon due to a less robust response, Americans would overwhelmingly choose the latter.

AsiaTimes says "China used sophisticated computational methods on a scale never attempted in the West." China has Real ID for social media and police registration for all residents.

WeChat and Alipay - China's two mobile payment megaplatforms - normally do not keep location data. Telecom operators do. The State Council issued emergency guidelines allowing WeChat and Alipay to access telecom location logs to create apps for citizens and medical staff to check if people may have crossed paths with infected patients. The guideline is a onetime provision for the sole purpose of this epidemic. Wechat and Alipay can't keep the data or use it for other purposes.

In the US, location data is available commercially. Facebook and Google could be called upon to quickly create such an app.

Undocumented immigrants will not want to get checked, or come in for medical treatment, even if it's free.

Undocumented immigrants are not a significant issue in China because everything in daily life requires strict real registration. Although there are an unknown number of women who are not registered in the system because they were born outside the one-child policy during that specific policy window.

Hard to communicate with hundreds of thousands of homeless who might not have phones and IDs. In Seattle, the hardest-hit city in the US so far, there is a huge homelessness issue. If they get sick, they will have no resources to get tested or self-quarantine in homes they don't have.

I haven't seen a single homeless person in Shanghai or Beijing since 2004 when I moved to China.

"Cults" and churches that have members who don't like their member lists posted will not voluntarily report their contact trail. (And I imagine sex clubs and nefarious groups.)

China has medical teams that interview each patient for all the people they have come in contact with. Each person is tested. There are 1,800 teams of at least 5 people each in Wuhan city alone. Shenzhen city tracked down and tested 2,842 contact persons named by infected patients, with a 2.8% positive test rate. In Sichuan province, 25,493 contact persons were named, 99% were found, and 0.9% of them were infected. In Guangdong province, 9,939 contacts were named, all found, and 4.8% of them were infected. That means: If you have direct personal contact with an infected person, the probability of infection is between 1% and 5%.

American evangelical preachers will claim en masse that their members will be safe from the virus and discourage them to get treated or tracked.

China fines people who start rumors or puts up fake news. This sometimes works in their favor, sometimes not, as it depends on the quality of the censoring individual. After the controversy over the censorship of Dr. Li Wenliang's initial posting to warn about his fears that this virus was serious, I suspect China will shortly announce refined policies that fine the people who spread rumors but also improves the whistleblower protection law and epidemic reporting procedures.

It's hard to track down new cases in the US without people self-identifying.

People in China get daily text messages from Municipal governments saying to wear masks and not hide symptoms. The government knows if you try to hide symptoms because they track down everyone that purchases fever-related medical supplies and tests them for Coronavirus. Digital payments tied to ecommerce systems make it even easier to track this information down.

Without extensive testing, Americans will not be able to tell if they are infected quickly and it will be hard for people to diagnose themselves over the long incubation period of 14 days.

China has been combining their AI capabilities with medtech, two of the country's priority industries, to scale testing capabilities. Alibaba and Ping An have now tested at scale AI to diagnose accurately patient's chest Xrays to identify new patients. China mandates people under medical quarantine to use a new online temperature checking app, which allows people to report their temperature from home each day for 14 days.





LACK OF EQUIPMENT

Testing kits are not widely available in US yet even in single digit thousands for hospitals. Each person needs several tests to confirm. Clinicians, hospitals, academic labs, local governments across the US are all calling for more availability of test kits.

Instead of waiting for the CDC, Stanford Clinical Virology Laboratory has launched it's in-house developed test kit and is using it on patients at Stanford health care centers. U of Washington Medicine has also launched their own homegrown kits in response to the shortage.

The Bill and Melinda Gates Foundation hopes to soon offer home-testing kits to get results in a couple days. This service will be available in limited quantities (400 tests per day to start).

China now has 1.9M test kits per week, results available that same day, for free.

There is a massive gap between what CDC or Mike Pence say on number of tests available and what is actually being produced and distributed. Gap in state and federal communication means nurses who have gotten sick and not able to get tested are pissed.

In China, medical staff can easily be tested. But on the other hand, they are voluntarily working themselves to death and harming their immune system. 49,000 medical workers have volunteered to come into Wuhan from all parts of China to help combat the virus.

The US has no ability to manufacture masks and hazmat suits and such on a massive scale. Can you imagine 320 million masks for the US population, multiplied by ten masks per person? The shortage of protective gear for medical staff in Wuhan led to infections in hospitals. All the medical equipment needed seems to be made mostly in China. 50% of all masks in the world are produced in China. US supply has dwindled quickly. US hospitals had already been stocking up for a while to prepare, making it harder to get at retail. In California, much of the N95 mask stock was already reserved for fire fighting.

Currently, China is producing over 110 million masks. Private companies whose businesses are not focused on mask production have started to produce them at scale. Foxconn, battery company BYD, car company SAIC have all jumped in to set up mask production lines. My compound just gave each resident 5 masks for $0.30, vending machines are now selling masks.

The US Trade Representative's office wisely eliminated tariffs on masks, hand sanitizing wipes, exam gloves and other medical equipment being imported from China to relieve the supply constraint.

US doesn't have the capability of quickly building isolation centers. Dr. David Agus emphasizes on CBS that the best thing people can do to not overextend hospitals and unnecessarily risk medical staff's health is know when it is appropriate to go to the hospital. If you have mild symptoms, stay at home for 14 days and treat as you would a normal fever or cold. Only if you are finding it seriously hard to breathe, go to the ER and call from outside to have them come get you. Do not go inside and infect people. In Korea, they now have drive-thru screening for the virus that is located separately from hospitals. I've just started to see these popping up on March 12 in Denver and Marin County.

China built one in 2 days out of an empty building. Wuhan City transformed stadiums and convention centers into temporary hospitals that have treated 12,000 patients with mild symptoms since February 5. They saw zero deaths thanks to the ability to isolate them and treat them with 15 teams of medical staff. Now the number of new cases is on the decline, 11 of those 14 temporary hospitals were closed.

I don't hear any US government officials or practitioners talking about the potential lack of external-use forehead thermometers. I tried to source 5000 units for Beijing at the beginning of the epidemic and couldn't find any across my contacts in three countries.

China now requires each shopping center and residential block to test your temperature for you to get in, along with requiring ID and entry documents. Innovative companies have launched self-driving robots that can measure people's temperatures up to 4 feet away.





COSTS

The cost of American health care is wack. I can't believe how much it costs in the US! The US also has a very unequal healthcare system. There are many facilities in poorer communities that lack proper funding and the capability to withstand an outbreak. Forty percent of Americans cannot afford a $400 emergency medical bill.

Healthcare generally has continued to improve in China year after year. Every Chinese citizen has social benefits that provide free basic healthcare in their registered province and virus care is covered. China's closest comparable to the US homeless are the 300 million migrant workers. These are workers that have a Hukou (a type of provincial passport) in one province, but they move for better job opportunities to a different region where they are not registered. These migrant families cannot receive medical care in that new region. Yet these families can still get tested and treated for the Coronavirus.

American nursing homes aren't prepared to handle epidemics. Senior citizens are most at risk of dying from the Coronavirus due to existing conditions and weaker immune systems.

In Chinese families, the culture is for the elderly parents to stay with their eldest son's family. There is less reliance on nursing homes. Family members can help take care of the sick at home.

Lack of a low-cost delivery system for basic meals, groceries and goods will make having enough stock at home difficult during a quarantine. In US, people are already panic buying, possibly unnecessarily, like survivalists in the wilderness. This will cause massive runs on everything.

In China, same-day delivery is widespread, sophisticated and cheap. Meals and groceries are delivered within the hour. Even throughout the quarantine, China's delivery service is $1 and still ubiquitously available. There has been a massive change in delivery behavior though. People are generally not allowed to come visit you if they aren't residents of the development. Instead of to your doorstep, deliveries are dropped off at the border of residential compounds. Restaurants will handwrite the temperature of the three people who touched your food on the bag when they deliver it to you.

Supply and demand market pricing will jack up the cost for everything.

The Chinese government has ordered retailers not to increase prices on virus-related medical equipment and groceries at the risk of strict fines.

New York has set up a hotline at 1-800-697-1220 to report illegal price gouging on products like cleaning supplies & hand sanitizer.

US stock markets are in for a wild ride. I'll be shocked if there is transparency or a plan for where to spend any emergency monies coming from the federal government.

China's recovery will be more predictable. Its central government has already announced many "V-shaped" recovery financial instruments. And more are expected. But beyond that, many private companies are chipping in to help. Chinese generally are used to sacrificing in times of crisis for the collective e.g. Earthquake donations.

COMPLIANCE ON QUARANTINE AND TREATMENT

Strict quarantine will require whole regions to shut down at the same time. In the US, decisions to shut down will be made company to company, school district to school district. As long as there is a single infected person actively moving about an area, the entire area is at risk for more infections.

Schools that double as social service centers for hundreds of thousands of poor students in cities like New York will be reluctant to shut down. People who only make money hour-to-hour if they show up to work will also be reluctant to self-quarantine unless they are severely sick.

China just issues one directive and boom everything is shut down, including roads and metros. It's now mandatory in China to register your location if you are asked to quarantine yourself for 14 days - whether from being infected, being part of an infected person's contact trail, or traveling in from a suspect region. You will be called at home randomly several times to make sure you are actually there.

The one scenario in the US that is equivalent to this is martial law, where a region or the entire country is placed under the control of a military body. In the past, martial law has been declared after the Japanese attack on Pearl Harbor, after the Great Chicago Fire of 1871 and the San Francisco earthquake of 1906. More recently, after the Cambridge riot in 1963 during the Civil Rights Movement.

Citizens will not readily volunteer as entire developments and communities and neighborhoods to self-quarantine (really self-imprisonment).

Chinese are used to working together as communities, and self-monitoring collectively. From the start of the epidemic, my roommates, parents, friends volunteered to stay indoors almost 99% of the time (grocery shopping was the only exception).

When people do visit the few places that are open for food or shopping, they are going to great lengths to avoid human contact. Book stores are sliding books under the door to customers who preorder and pickup. Steamed bun street vendors use a long wooden plank to slide the bag of buns down to the customer. Starbucks now doesn't allow me to fill my thermos with coffee — I have to take their paper cup.

I can only imagine how dysfunctional families are getting along in cramped quarters and nowhere to go.

Individual freedom is more important than safety in the US. Americans perceive all surveillance as evil waiting to happen, tragically killing our rights to privacy.

In China, the safety of citizens is more important than individual freedoms. This value difference is rooted in recent history.

Conspiracy theorists will claim that this is a government conspiracy to track them and refuse to help prevent spread. “I don’t believe anything the CDC says about this virus. It’s full of deep staters who want to use this to create a recession to bring down the President.”

Chinese generally believe in their National government when it comes to science and technology. For example, the existence and importance of climate change has not been denied since the first national policy paper in 2007. If the central government says this is an epidemic, they are not exaggerating.

Americans will use this as an opportunity to complain about leadership failures instead of spending that valuable energy acting against the virus. POTUS will use this as an opportunity to say how well the WH is responding in the most amazing way ever.

Chinese are coming together in solidarity and generally very proud of their government. They also know that the government alone cannot conquer the virus. A communal sense of solidarity has blanketed the nation, watching out for everyone's good, cheering citizens/doctors/researchers/workers/etc on to combat the virus together. This has really been great for China's sense of community and citizenry. China is not only doing its best, but they've stretched 150% every day beyond their capacity to get the virus under control, together.

American leadership will be quick to blame China for acting slowly and infecting the world, rather than learn from its experience with compassion.

How slowly did China really act? Let's compare.

For context, the first 41 confirmed cases admitted to Wuhan were between December 16, 2019 and January 2, 2020. None of the doctors could figure out what they are dying from as most showed underlying diabetes, hypertension, and cardiovascular diseases. The first epidemiological alert was released by the local health authority on Dec 31, 2019. The Huanan seafood market which was suspected to be the original location of infections was shut down on Jan 1, 2020. China shut down Wuhan City (60 million population) on Jan 23 - Just 23 days after the first alert.

The first confirmed case in the United States was Jan. 21, 2020. That means the US had at least as many weeks to prepare plans as China had to discover the virus from having no prior knowledge. The White House formed a new task force headed by Vice President Pence on January 29, 2020 to ensure Americans have accurate and up-to-date health and travel information, it said. WHO declares global health emergency on Jan. 30, 2020. The inevitable first case of local transmission happened on Feb 26, 2020.

Finally on March 3, 2020, CDC lifts restrictions for virus testing, although almost no kits are available at a practical level to patients who are worried they have the virus.

Anti-vaxxers will not take the vaccine in two years when it is available.

Chinese students MUST take shots on schedule. Each year they get a medical test from a designated medical facility. The benefit of this is the world's largest medical data bank.





CULTURE

Looting may ensue, as they do in riots. I was living in Los Angeles during the Rodney King riots and had to be evacuated out of Venice Beach. I can only imagine what it's going to be like when Costco and Sam's Club shelves are empty.

No way Jose that this will happen now in China. Your neighbors will hunt you down for endangering them. The government works hard to ensure that grocery supplies are in order, even during quarantine. Mask sales are limited per person.

For many Americans, the change in their behavior that will be necessary to avoid getting sick is going to be like an ice-cold swim in the North Pole.

Every aspect of life has changed in China. China is using this crisis as an opportunity to adapt, learn how to be resilient, create enormous innovations in all sectors of life and business and government.

Logistical and technical innovations have accelerated in crazy positive ways. The future of work, education, and delivery has been forced upon us even more quickly than it was already happening.

This will spur much economic progress in the medium term with advances such as: online education, AI mixed with medtech, faster gene sequencing, vaccine development, remote med diagnostics, delivery by self-driving car or drone, drones that fly around lecturing people wandering outside and without masks to go home, manufacturing and availability of priority equipment such as masks and Tyvek outfits, big data management of contact tracing of patients, management of information flow to and from citizens during disasters, online government meetings, cloud-based parties/events/exercise classes/TV shows, live-stream commerce, food reserves, demand for healthier foods for immune systems, contingency plans for work, faster construction capability, remote work as standard, vending machines in front of compounds for grocery delivery, batter rapid response preparedness working across ministries, and so much more.

It's really exciting to see this technological innovation happening so fast.

Much of these changes are also great for the environment. Less car traffic, less smog, less oil and gas use, fewer factories using coal-fired energy, less food packaging, less food waste, etc.

Americans are not used to wearing masks.

Asians are very used to wearing pollution masks. Japanese are used to wearing masks for hygiene already. China has now added to video AI surveillance technology the ability to tell if you are wearing a mask or not and scold you if not.

Anyone coughing, sneezing for any reason at all, even allergies, should be wearing a mask for the sake of the people around you. Prevent your droplets from spreading on surfaces and onto people's faces.

If you are treating someone at home who is ill, wear a mask when you go into their room.

Hugging is going to be a hard habit for Americans to stop.

Chinese behavior is very rapidly adaptable to new situations. Hugging is foreign anyway.

Hubris and political maneuvering are preventing an effective response. Trump brags about his "perfectly coordinated and fine-tuned plan" that is HUGELY better than China. Top deputies downplay the risk from the virus. These mixed messages are not helping local authorities such as New York Governor Andrew Cuomo as he declares a state of emergency.

WHO has called China a model for response. Here's the report and press conference. But the West only wants to criticize China, making it hard to learn from it.

In my work on clean energy policies in China, I have found it very good at quickly establishing policies in response to these issues that arise. China's government acts from the assumption that nothing is ever perfect. Much of the government is made up of engineers with masters degrees. They are constantly looking at the system, learning from setbacks, and rapidly pushing through new policies.

For example, there were guesses that the source of the Coronavirus was a wet market teeming in wildlife like bats. Rather than wait to confirm this, wildlife trade has been formally banned across China. "The hunting, trading, and transportation for the purpose of consumption of terrestrial wild animals that naturally grow and breed in the wild is completely prohibited" as of Monday. Consumption will be punished. Having said that, now researchers are saying the wet market was not actually the source of the virus.

The Key Question

In times where we need to adapt to great change quickly, centralized/business-like governance is most effective. I've made the point before that China's governance style is more like a multinational corporation than the "dictatorship" that the West fears.

The West's fear that China's rise will force a change in values is preventing the West from learning from China. In 30 years, China has gone through change at an unprecedented scale and pace in a relatively smooth fashion. There is a lot to learn from China's struggle with the Coronavirus. China is now sending its medical teams abroad to share knowledge. Importantly, other societies can learn from China's experience without having to adopt the China way.

Is it possible to have a democracy where temporary processes are put in place that allow for more centralized coordination to manage crises? If China's crisis managers and US peers were to sit down and really think through this, I bet some transformational ideas would come out that can both help the US be more resilient and allow for the people's voice to be heard.

I believe in my heart that both the US and China want the best for their people. The systems can be different. The goal can be the same. People first.





This article was collaboratively written with help from Latoya Abulu, Meredith Bosco, David Li, PT Black, Cory McCormack, Mason McCormack, Ari Steenhoven, Richard Brubaker, Ruoxi Liu, Vincent Chung, Jerry JP Lin, Carolina Acosta-Sheinfeld, Neil Cohn, Momo Estrella.