In recent weeks there has been a proliferation of reports in both western and Asian media demanding accountability for COVID-19, suggesting that China should be sued through international courts.

· ‘$20 trillion lawsuit against China! US group says coronavirus is bioweapon’

· ‘How China can be held legally accountable for coronavirus pandemic’

· ‘Blaming China for coronavirus is reasonable – not racist’

Some of these articles go so far to suggest economic decoupling and rethinking diplomatic relations. Now, the US has decided to defund the WHO, removing almost 15% of its budget, accusing the organisation of a positive bias towards China amongst other things.





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In the midst of these accusations, China’s predictable response, and the charged undertones that some country leaders are using to frame this disaster, it can be challenging to distinguish truth from political spin. My intention in writing this article is to help readers look beyond the spin to make their own assessment of what has happened. I believe that seeing things clearly is particularly important during this time of crisis so that we can establish the trust to move forward collaboratively.

This article will provide a perspective on China’s response and level of culpability for the current COVID-19 pandemic. Furthermore, this article will explore the contagion of the virus, and conclude with what lessons can be learnt moving forward.

Patient Zero

Current medical journals suggest that COVID-19 originated from Huanan Seafood market in Wuhan, with the earliest [recorded] patient showing symptom onset on the 1st December 2019. The westernmost section of the market contained a wildlife market and the current accepted theory is that the virus crossed from bats to pangolins and then to humans here.

Image source: https://bit.ly/2RL6Qv8

Wildlife markets exist in numerous countries outside of the Western context, and the risk they pose is nothing new. Globally, 30 novel infectious diseases have occurred in the past three decades alone with a majority of these classifying as zoonoses (transmitted from animals to humans). Whilst viruses can occur in any livestock; the more diverse the livestock, the more diverse the type of viruses which stem from them. This is particularly the case when wildlife is present in the same location as food and when hygiene standards are low.





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Transmission probability is determined by several factors including virus dynamics, exposure and human factors that affect susceptibility. This has three functional phases:

Dissemination (Amount, concentration etc) Human and vector behaviour (Likelihood of, route and amount of exposure). Human resistance.

Whilst the first and third phases are related to natural factors and are difficult to control, the second phase presents the greatest opportunity for influence.

A confluence of factors including consumption of a greater variety of animals, demand for agricultural land and generally less stringent food hygiene practices - increase the probability of cross species virus transmission. With these factors commonplace in many countries across the world and exacerbated by economic growth, we are likely to see more and more cross species virus transmission.





How can we reduce the potential of this happening again?

Many are calling for the banning of wet markets - highlighting a huge misunderstanding of Western observers. Wet markets are the equivalent of farmer’s markets in the developing world and are often regarded as providing higher quality produce than [supermarket] alternatives. Only a small subset of these also contain wildlife markets, which engage in the illegal trade of animals.

Banning wildlife markets may sound like an obvious choice but isn’t as simple as it sounds and could have far worse consequences. In China alone, these markets comprise a $70 billion dollar industry employing more than a million people. One of the largest beneficiaries of these markets are local underprivileged farmers who use this as their only source of income.

Driving these markets underground would enable criminal enterprise, remove any aspect of accountability and prevent oversight of quality and standards. These consequences could even include a detrimental effect to wildlife conservation according to Elizabeth Maruma Mrema, the acting executive secretary of the UN Convention on Biological Diversity. Additionally, a ban on wildlife markets by diktat is unlikely to be effective given that many of the animals sold in these markets are considered important both for Chinese cuisine and medicinal elements.

A more nuanced approach is required, steadily increasing hygiene standards, improving education, ensuring effective oversight and providing economic alternatives for farmers.

It is well established the risk of viral contagion can be mitigated through strict measures including limiting the diversity of livestock and ensuring hygiene with the butchering and preparation of meat etc.

There is evidence that the Chinese government is already responding to concerns, with the Standing Committee (中央政治局常务委员会) in February increasing the punishment for those involved in the wildlife trade and promising to review the existing legal framework and public understanding.

Although Western commentators have levelled a lot of criticism at the Chinese government regarding their regulatory approach to managing the wildlife trade, I would argue that the Chinese government is the most qualified and incentivised to respond to this issue.





Birth of a Pandemic

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China’s response to COVID-19 can probably be summarized as an initial cover up coinciding with their own initial investigations, rapid mobilisation in collaboration with the WHO and then mass quarantine.

When early reports came in of a mystery virus spreading in central China, nobody could have predicted the danger this posed to millions around the world.





Timeline

1/12/2019 - First patient symptom onset as reported in the Lancet.

8/12/2019 - First patient sought treatment for symptoms.

21/12/2019 - First cluster of patients with ‘pneumonia of an unknown cause’ according to an article on CCDC Weekly (Chinese Center for Disease Control and Prevention) by Chinese epidemiologists.

29/12/2019 - A group of Hubei hospitals reported a ‘pneumonia of unknown etiology’.

30/12/2019 - Li WenLiang (李文亮) posted in a closed group on wechat warning of a potential novel coronavirus after seeing quarantined patients. He is reprimanded days later by local officials for spreading false statements that disturbed public order.

31/12/2019 - China notifies the WHO of a string of pneumonia like cases.

2/1/2019 - The WHO China Country Office, Regional Office for the Western Pacific and HQ mobilise to combat the virus.

10/1/2019 - An international consortium had sequenced and publicly released partial sequences obtained from a patient in Wuhan demonstrating 70% genetic similarity with SARS. This step is integral to efforts to combat the virus because it is essential for the development of diagnostic tests, therapy and vaccines.

20/1/2019 - China confirms human to human transmission to the WHO.

23/1/2019 - China locks down Wuhan and 2 other cities.

24/1/2019 - China locks down the entirety of Hubei province.





There are two important to consider as we move forwards:

Did China redeem this initial cover up? Did this mistake cause the pandemic to spread to other countries?





Redemption

The appropriate remedy for a situation of this nature requires:

(a) A review of the mistakes made and the systems that allowed these mistakes to go unchecked.

(b) Administrative and potential criminal punishment of those identified by the review as being responsible, and

(c) Rectifying any mistakes which led to the delay in response time in order to prevent recurrence.





Review:

The central government dispatched a top team from the National Supervisory Commission (国家监察委员会) to investigate how whistle-blowers were dealt with.

Redress:

Senior members of the provincial government were replaced by more competent officials from Beijing, including the provincial party secretary (党委书记) of Hubei province.

Remedy:

Once aware of the gravity of the situation the government imposed unprecedented measures to control the situation. They also offered Li WenLiang (李文亮), an early whistle-blower who died of the virus an apology and posthumously labelled him a martyr for his bravery.

Result of Mistake

China took 20 days to progress from identification of the initial cluster to reporting the outbreak to the WHO. A response time which compares favourably with the 2013/ 2014 Ebola outbreak in which 4 months elapsed between from the first case in December 2013 and reporting of the epidemic to the WHO. A complication which was compounded by the WHO’s taking an additional 20 days to recognise the seriousness of the developing situation.

On the 23rd January 2020, the Chinese government locked down Wuhan and two other cities, extending the restrictions the next day to the entirety of Hubei province (an area with a total population of 60 million+ people).

At the time of the lock down, there were a total of 845 cumulative cases making the aggressive move to lock down an entire population, in the words of the WHO, ‘unprecedented in public health history’. This enormous economic and logistical restriction was implemented 3 days after Chinese scientists confirmed human to human transmission and has undoubtedly benefited the global fight against the virus.

A study published in the Journal of Thoracic Disease using AI, projects the differences in viral outbreak had China implemented the heretofore unprecedented quarantine earlier or later than in fact occurred:





In arguments concerning the epidemiology of COVID-19, it is often forgotten that when China started its quarantine, many accused it of implementing draconian measures. No Western government could conceive of quarantining millions of people and it’s from China’s example that Western governments were inspired to take such extraordinary measures.

It is estimated that if China had waited five more days to enforce the provisional lock down, the epidemic would have been triple its current size. Whether or not China could ever have possibly contained this virus is up for debate, however one thing is for certain - it significantly slowed the spread of the virus.

Barely a month after the first case, China had already facilitated the release of partial sequences which allowed other countries to effectively deploy test kits. This move has allowed certain other countries to effectively measure their numbers of infected and will also help speed up the creation of a vaccine.





International Contagion

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China has received a lot of criticism for failing to understand the human to human transmission factor but also for not banning flights to the outside world. However the WHO itself suggested not banning international flights and also failed to recognise human to human transmission. The WHO chief stated that travel restrictions ‘have the effect of increasing fear and stigma, with little public benefit.’ Also warning that interfering with trade and transport would have an effect on combating the virus.

According to the director of the Yale Institute of Global Health, travel restrictions divert public health resources into enforcing a ban when they may not be useful at preventing its spread.

Whether China’s response to flights and the time taken to recognise human to human transmission was a failure or not is up for debate. However, it certainly was not out of sync with international best practice at the time.

Countries such as South Korea have been lauded for their response to the virus. This isn’t because they had information that Western countries didn’t. Their response has been so successful because they planned a response to the virus and meticulously implemented it.

There are those who suggest that post colonial arrogance and orientalism are behind our failure to prepare for the virus. Whatever the reason, we are now paying the price for our inaction.









A Recurring Nightmare

SARS

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SARS infected at least 8000 people between 2002-2003 with a fatality rate of almost 10%. Originating in Southern China the Chinese government’s handling of the virus caused huge international criticism.

Every Asian governments’ response to COVID-19 has been based on their experience with SARS. I am going to quickly cover what went wrong with SARS and then compare this with the Chinese response to COVID-19.





16/11/2002 – Earliest known case.

2/1/2003 – Health experts diagnose disease as infection caused by virus.

20/1/2003 – Ministry of Health sends team of experts

27/1/2003 – Report sent to Provincial Health Bureau in Guangdong and to the Ministry of Health in Beijing. Only top provincial health officials were authorised to open the report marked ‘top secret’. This report doesn’t mention that the virus is considerably contagious or call for preventative measures.

30/1/2003 – An authorised official opens the report followed by the Provincial Bureau distributing a bulletin to hospitals across the province. Most health workers miss the bulletin as they are on vacation for Chinese New Year.

The public aren’t notified of the disease because the Regulations of the State Secrets Law classifies infectious diseases as classified before being announced by the Ministry of Health.

Provincial governments were only obliged to publicise after authorisation from the Ministry of Health (Article 23 Law on Prevention and Treatment of Infectious Diseases 1989) and atypical pneumonia was not an infectious disease under surveillance.

8/2/2003 – Reports of a ‘deadly flu’ begin circulating by mobile phone.

10/2/2003 – Local media acknowledge the presence of the disease and list preventative measures including false information such as using vinegar fumes to disinfect the air.

11/2/2003 – Guangdong health officials hold press conferences reporting a total of 305 cases in the province.

The same day Western media reports on a cover up.

23/2/2003 – After reports questioned government handling of the outbreak the Provincial Propaganda Bureau halted reporting on the disease.

15/3/2003 – WHO issues global warning on the virus.

22/3/2003 – WHO team arrives.

3/4/2003 – The Chinese Center for Disease Control and Prevention issues a nationwide bulletin to hospitals on how to prevent the virus spreading.

17/4/2003 – Urgent Standing Committee meeting. The Chinese government formally lists SARS as a closely monitored disease and to be reported daily under the Law of Prevention and Treatment of Infectious Diseases. Premier Wen admits ‘the overall situation remains grave’.





In under two decades China has made incredible progress in its response to virus outbreaks:





International Failure

Although there has been some international collaboration, for example sequencing the virus, most countries have adopted their own individual strategies and there has been a clear lack of global leadership.

The G20 met to discuss the virus and agreed a joint statement to assess pandemic preparedness and increase funding research to combat the virus.

The UK, France and Germany have all side-stepped American sanctions on Iran to ensure medical aid is delivered to those in need regardless of geo-politics.

The world bank is providing $160 billion over the next 15 months to support the poor, businesses and bolster economic recovery whereas the IMF has made $50 billion available to low income and emerging markets.





But how can we move forwards?

Mudslinging between states and a policy favouring one nation over another has to stop. Collaboration in the face of extinction is not a zero sum game.

Gordon Brown, the UK’s prime minister from 2007-2010 who stepped up and led the global response during the financial crisis has been one of many to advocate a temporary global government to combat the virus.

The WHO and other health organisations require the resources and funding to enact a global response to this virus. If this virus exists anywhere in the world there is the possibility of a resurgence so helping other nations is in everybody’s best interests. Vaccine development is going to take until at least 2021 so we shouldn’t grow complacent after lockdown measures are lifted.

Whatever the response it has to be swift, united and provide immense support to developing markets - millions of people’s lives are at stake.





Conclusion

Simple solutions are lies dreamt up by desperate people looking for an easy answer.

Viruses are going to occur whether we like it or not - we can reduce their frequency and decrease our response time by learning from current mistakes and rectifying them.

China should be encouraged and supported to review its wildlife trade and international bodies should learn from its efforts. In future other developing markets may need to learn from their approach in order to combat the same problem.

Whether or not the virus could ever have been contained is a question up for debate, but the lock down measures in China slowed the virus down and bought the rest of the world time.

China’s response to COVID-19 is incomparable to SARS and is a clear example of China learning from past mistakes and doing its utmost to prevent repeats of those mistakes. With key decision making taking place within days of information coming to light as opposed to months.

Efforts to bring together an international consortium and sequence the virus by China were key in enabling the global community to develop a vaccine at a much faster rate and end this situation.





So, who is to blame then?

We are all to blame - this isn’t the first pandemic and like all global crises this is an international failure.

Ebola, SARS, Avian flu, and Swine flu are perfect examples of international collaboration working to contain viruses. All these episodes involved close collaboration between Western and Chinese scientists and resulted in far fewer deaths than expected.

With the current trend of decoupling, information sharing between China and the West has drastically dropped and significantly impaired our ability to respond to the virus. The US government axed their CDC (Center for Disease Control and Prevention) expert based in China in July last year - a key placement for cross border information sharing.

By scapegoating we are missing the opportunity to learn from our mistakes.

In order to combat this virus the mandate and resources of global institutions must expand, governance has to go digital, private enterprise has to be galvanised and resources need to be managed effectively and responsibly. This will require unprecedented action and resources but the alternative will be far worse.

We face multiple global crises, some threatening our existence as a species.

Instead of decoupling, now is the time more than ever for engagement.

Humanity needs to come first.

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