China struggles with a fast-moving outbreak, as the authorities move to cut off unauthorized information
It's Lunar New Year, usually a time of celebration in China, but instead of heading into the streets to let off fireworks, people are staying at home out of fear of contracting a fast-spreading coronavirus. The quarantine in China has now extended to nearly 50 million people, as sweeping restrictions on travel are expanding daily out from the epicenter of the outbreak in the city of Wuhan. These include bans on tour groups across the country, on long-distance travel in some cities, and on private transport in the center of Wuhan itself. The number of officially confirmed cases has reached 2,018, and continues to rise fast, with at least 56 dead, mostly elderly. China is struggling to cope with its worst health crisis since SARS in 2003, amid fears that Lunar New Year travel has already spread the infection far and wide. Every province and region in China, barring Tibet which is geographically and politically isolated, has had cases of the virus. The United States has sent charter planes to evacuate its approximately 1,000 citizens and consular staff from the quarantine zone.
Is the quarantine working?
It's too soon to tell, but quite probably not. The confirmed numbers may be just a fraction of the real total of infected victims, with many not yet diagnosed or even showing symptoms. But the biggest problem is that the long incubation period means hundreds of thousands of people left Wuhan long before the virus was seen as a major problem—especially as the Lunar New Year, when hundreds of millions of people return to their families across China, was coming up. A lot now depends on where they ended up. The constant expansion of the quarantine zone, which now covers a huge chunk of the central Chinese province of Hubei, suggests that local transmission may have been fierce and fast, outrunning the authorities. Modeling by foreign scientists is producing disturbing results—250,000 or more infected inside Wuhan and large outbreaks elsewhere, with 60 percent or more of possible transmissions needing to be blocked to contain the outbreak. [The authors of the original paper have since revised their estimations of the transmission rate down, though have not yet produced new figures for likely infections.]
The quarantine creates its own problems. Feeding and supplying the population inside, with regular logistical links severed, is a huge, though not impossible, task. China has exceptional logistics companies such as Alibaba, and they may be brought in, along with the military, to make sure shops stay supplied and people fed; long lines of trucks are heading into Wuhan to supply the population. That's good, since price gouging and shortages have already started.
So are we all going to die?
Probably not. The coronavirus is highly worrying, but so far it lacks the pandemic properties of influenza and has a relatively low—experts believe—mortality rate.The coronavirus is highly worrying, but so far it lacks the pandemic properties of influenza and has a relatively low—experts believe—mortality rate. The deaths so far have been mostly, but not exclusively, confined to older people, most of whom had preexisting conditions. The World Health Organization has declined to declare a global emergency, pointing to the relatively small number of cases outside China, although that could well change.
That said, many people remain in serious condition, and the virus has already mutated to pass from human to human—and could evolve further. At least one super-spreader—someone who passes the virus to an unusually high number of other victims—has already emerged in a Wuhan hospital.
And while cases of infection appear to have been largely caught in foreign countries, thanks mostly to the victims being relatively well-off people who had access to health care resources, they've been popping up all over the place from Washington state to Malaysia. Given what seems to be a relatively long incubation period of seven to 12 days, during which victims can spread the virus without showing symptoms, it's hard to tell just how far the virus has already reached.
On top of that, the range of symptoms is long, and some victims haven't shown the most characteristic signs—and the ones being tested for—such as fever. The world could well see multiple outbreaks, especially if it reaches poorer and more vulnerable countries, as Laurie Garrett has highlighted. Reports so far have been confined to developed nations like South Korea, France, and the United States, but it's entirely possible that cases elsewhere have simply gone undetected.
Can we trust the government figures right now?
No, for a variety of reasons. The first is that China has a record of concealing the numbers around disaster events for political reasons, from the initial cover-up around SARS to the regular underreporting of the number of dead from floods, landslides, industrial explosions, and other relatively routine disasters. In Wuhan's case, it seems very likely that the leap to human-to-human transmission, and the sudden explosion in numbers, was concealed by local authorities keen not to risk the local economy or to disturb the smooth progress of the "two sessions," important mid-January political meetings. The number of cases stayed at 41 for weeks and then suddenly jumped to more than 200 after the virus reached other countries a week ago. Meanwhile, Wuhan officials were scheduling large-scale public events right up until the quarantine was imposed.
There's less reason for the central government to squash the numbers, and the enormous leap from 41 to nearly 2,000 cases this week may be the result of the sudden interest by Beijing in the epidemic.There's less reason for the central government to squash the numbers, and the enormous leap from 41 to nearly 2,000 cases this week may be the result of the sudden interest by Beijing in the epidemic. But government officials are also in the routine—and hard-to-break—habit of concealing information from the public, especially negative information. Huge amounts of resources are put into controlling and suppressing information in China, and doctors, reporters, and ordinary people have already been threatened or arrested for posting independently about the outbreak. A sudden flood of online posts today praised the government and criticized people for posting unauthorized information.
Chinese media is enjoying a short burst of relative freedom, with Caixin and other outlets producing some excellent and critical reporting. But that's common in the aftermath of disaster in China; the sudden impetus of the news creates several days of comparative openness before the propaganda authorities decide and enforce new lines. (I saw it happen after the Sichuan earthquake and again after the Tianjin explosions when I worked in Chinese newsrooms.). Papers are already being forced to issue apologies if their reporters speak out of line. The internet might well be cut at some point, as happened in Xinjiang in 2009 after the riots there.
Even if the government doesn't want to distort data, its ability to gather information is also limited. Diagnostic test kits are in short supply, the population potentially affected is huge, and many poorer Chinese—those most affected—are out of reach for the state.
The scientific community in China is genuinely extremely concerned and attempting to share information as rapidly and transparently as it can with foreign counterparts. But it is also working within an environment where everything, even scientific research, is politicized. Since the ascent of Chinese President Xi Jinping to dictatorial status, many scientific papers begin with routine encomiums to Xi Jinping Thought, for instance.
I keep seeing all these videos of dead bodies and people flooding Wuhan hospitals. What's up with that?
Several videos have emerged from Wuhan showing disturbing scenes at hospitals, such as bodies abandoned in corridors. But this doesn't mean they're victims of the virus—except indirectly. Wuhan has 11 million people: Using the average mortality rate for China, that means approximately 213 people die there daily, as in any large city. Add in that it's winter, and it's flu season, and the conventional rate of death is even higher. Some of the videos are also mislabeled, or fakes; there's a useful list being maintained here.
Now remember that Wuhan's health care system is completely flooded right now. Everyone with a cold is heading to the hospital to get checked, and medical staff are exhausted and overwhelmed. 450 army medical staff have been sent to help, and two emergency field hospital using prefabricated materials are being erected, but that's unlikely to be enough. Those corpses are very likely people who died of regular causes but who simply haven't been processed as they would in calmer times. As anyone who has been through Chinese health care knows, hospitals there are often chaotic places where patients regularly find themselves sitting with IVs in corridors, on the floor, or even in the parking lot; add in epidemic and quarantine, and everything falls apart. The regular medical number—120—is producing no response most of the time.
There's one scary possibility here, though. Hospitals themselves could be becoming vectors for the virus. They're already known to have infected at least 14 health care workers, and there are reports of widespread infection among medical staff who are running out of masks and gloves. Add to that patients crowding to get help, and even those whose symptoms are the result of ordinary colds rather than the virus might end up walking away infected.
Are people panicking?
Inside the quarantine zone, perhaps. A tremendous amount of fear is emerging in the patchy picture we get through social media. But there are no accounts of riots or disturbances or of clashes with police or attempts to escape the quarantine zone. That's hopefully a good sign.
Outside of Wuhan, people seem worried but calm. This is where some of China's advantages, such as extensive networks of block workers and community centers, can come into play in keeping people informed without panic. There are runs on masks and hand sanitizer, which you'd expect. The most disturbing aspect may be the measures taken by some villages and townships, which are posting their own blockades to keep travelers out. That could get quite nasty, as anyone who has passed through a village gate late at night—where locals sometimes set up informal tollbooths, enforced by thugs—knows.
The control on information is probably helping to reduce potential panic and unjustified rumor, even as it may also be concealing vital facts.The control on information is probably helping to reduce potential panic and unjustified rumor, even as it may also be concealing vital facts. Chinese-language chat groups and forums in the United States, which lack those controls, seem far more panicked than those inside China itself, with extreme concern being shown over, for instance, visiting school groups from Wuhan and people warning others to stockpile medical supplies from CVS.
There are also widespread rumors among the Uighur diaspora—the Turkic minority persecuted by China in the Western region of Xinjiang; they're expressing both fears that the original virus might have been a byproduct of Chinese bio-experimentation on Uighurs and more grounded worries that if the virus reaches the detention camps in which over a million Uighurs are held, the results could be a devastating infection.
What about the political fallout?
It's still very early days, but heads will almost certainly roll over the initial delay or cover-up. The central government has already made ominous noises. Given the usual pattern, this may well involve suddenly discovering that the Wuhan mayor, or local party leaders, was corrupt all along.
If the outbreak can be controlled, then this may be spun as a success for the system and a justification of authoritarian powers. If it isn't, it's a genuinely serious threat—not to Communist Party rule itself but to Xi. He's already facing private dissent from members of the political-economic elite who believe he has mishandled national affairs. The disruption of a full-scale epidemic would be a perfect opportunity for his opponents to reveal themselves and move against him.
The top levels of the propaganda media—People's Daily and the Xinwen Lianbo news broadcast—were still heavily downplaying the story until late in the week. People's Daily hasn't yet mentioned it on the front pages, which have been devoted entirely to praise of Xi and national prosperity; the story was buried on Page 4 on Wednesday, while it took the nightly news 22 minutes to reach the story. On Saturday, however, the broadcast led with a seven-minute meeting of the Central Committee, showing Xi in a leadership role.
That's a contrast with previous disasters under Hu Jintao and Wen Jiabao, where the media led with images of national leadership and personal appearances. Wen, in particular, became sardonically nicknamed "the best actor" for his kind but stern appearances in disaster zones, ordering local officials around and representing the paternal control of the party. Neither Xi nor premier Li Keqiang has visited Wuhan or announced plans to do so.
That might be simply because it's far more difficult to protect a leader from a virus than from fire or flood. But it might also be a real fear that the epidemic will run out of control—and thus a desire to disassociate themselves from it as much as possible.