Corona in China: Beginning and end of a pandemic

by Markus Pohlmann

It currently has us all firmly in its grip, the „severe acute respiratory syndrome coronavirus 2” (SARS-CoV2). Serious infection control measures are being taken almost everywhere in the world. On 16.4.2020, 2.076.015 cases of infection were confirmed worldwide, 138.008 deaths and 522.881 considered to be recovered. But this is only the beginning. The peak of the pandemic is far from being reached. We are all waiting for the restrictions on physical proximity between people that have been put in place in many countries to take effect, together with other infection control measures, and for a drug and vaccine to be developed as soon as possible.

Quelle: Pixabay

So far, despite the difficulties with the high number of unreported cases, the lethality of this viral disease is estimated to be higher than that of influenza viruses. A recent study estimates a case fatality rate (in relation to confirmed cases) of 5% in Hubei province and 0.8% for China (excluding Hubei). Flu outbreaks, on the other hand, usually have a fatality rate of 0.1% to 0.2%. In Chinese cases [1], the average (median) time from the onset of illness to acute lung failure was eight to nine days. About 80% of the cases were mild to moderate, and in 6% the clinical course was critical to life-threatening (with lung failure, septic shock or multiple organ failure). This is a stress test for healthcare systems worldwide, and only a few are expected to cope well with it.

An initial analysis of 72,314 patient records in China with 44,672 confirmed cases of infection, 16,188 suspected cases, 10,567 clinically diagnosed cases and 889 asymptomatic cases showed that about 87% of the confirmed cases were in the age group of 30-79 years. Younger people and children are clearly underrepresented in relation to their proportion of the population. A mild course of infection was found in 81% of the cases. But there were about 1,023 deaths among the confirmed cases, which corresponds to a case-death rate of 2.3% in relation to confirmed cases. Within six weeks, the virus spread to 1,386 districts and 31 provinces in China [2]. The peak of the epidemic curve in China – measured in terms of confirmed cases – was reached on February 1st, after which the trend flattened out somewhat. By the end of March, 2,971 healthcare workers in China were infected, 21 of whom died. Of course, we do not know how reliable these data are, but they do provide initial indications of the course, incidence and lethality of the viral infections.

In its dynamics of spread, the pandemic shows once again that societies react to exogenous shocks, such as epidemics or natural disasters, in a path-dependent manner, i.e. according to their possibilities, resources and institutional orders. On the other hand, not every society is reinventing the fight against epidemics, but rather they are orienting themselves towards globally spreading „infection protection models“. The Corona crisis shows how different the speed and nature of national, civil society and civic reactions vary worldwide, from ignoring recommendations to abiding by curfews. At the same time, however, a mainstream of global crisis reactions can also be identified. Anyone who thinks that only Germany has developed an „obsession“ for toilet paper will quickly notice that the toilet paper crisis has also reached Australia and the USA and that even in Japan, Hong Kong and Taiwan toilet paper is scarce or sold out. Although China, South Korea and Singapore are exceptions to this, these similarities can be observed in other areas, such as the use of a mouthguard, even if the reference to and protection against the pandemic is scientifically rather questionable. Thus, on the one hand, we find numerous imitation processes in the corona crisis which, regardless of their rationality, generalize a certain „pattern“ in the response to SARS-CoV2. On the other hand, these processes encounter traditions, values and norms in the various countries, which give this global pattern a different color and form.

In all of this, China is an important starting point for this globally widespread „pattern“ in dealing with SARS-CoV2 or COVID.19, being the first country where the new epidemic was identified. At the same time, China, Singapore and South Korea are regarded as successful models in infection control. In China, there are around 1.4 billion people and 81554 people have been infected to date, 67801 of them in Hubei Province alone, and 3311 confirmed deaths. In terms of population, this is much less than in many other countries, including Germany. Nevertheless, the question arises as to what extent is China suitable as a „model“ for fighting the pandemic and how the handling of corona can be characterized there to date.

The first phase or: How it all began …

The COVID 19 pandemic began as a mysterious pneumonia in Wuhan, China, in December 2019, and was reported to the Center for Disease Control and Prevention (CDC) in China on December 27 as a suspected „endemic“ disease. On December 30, Dr. Ai Feng, a physician at Wuhan Central Hospital, received the report on the lung disease. The report already contained a diagnosis: type SARS coronavirus. The doctor photographed the report and sent it to a colleague and former fellow student. That evening already, the report spread like wildfire among Wuhan’s doctors. On New Year’s Eve, the municipal health authority in Wuhan reported for the first time that 27 people had fallen ill with pneumonia, the cause and course of which was unclear. In fact, however, the type and course of the pneumonia appeared to be more familiar than had been predetermined. In the experience of the doctors treating them, it was very reminiscent of SARS.

Quelle: Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020. doi:10.1001/jama.2020.2648

Few in China at the time had any idea what was behind the talk of unclear pneumonia cases, but almost everyone still had a good memory of what SARS meant. At the time, the Wuhan government had done nothing to inform the population fully. It swept the events under the carpet for the time being but continued to work on their clarification in the background. On January 1, 2020, the Huanan seafood market, where most of the infected were working, was closed and thoroughly cleaned. But the reasons for this remained unclear for most of the workers, even though this already aroused suspicion. Those who reported further on the events were forced to remain silent. Therefore, the government, with the involvement of the local police, accused the doctors in this first phase of spreading unfounded rumors and made them – alongside the WeChat group – give up. Until 20 January 2020, the Wuhan government repeatedly reported to the population that there were no significant human-to-human transmissions and no infections among doctors and nurses who had close contact with sick people. The government had already reported the disease to the WHO on 31 December 2019 and on 3 January 2020 announced to the USA a daily status report on the course of the epidemic. On January 9 WHO announced on Twitter that the virus in Wuhan was classified as coronavirus (SARS-COV2). In contrast, most Chinese on the mainland were not informed by the government or the media in a timely or accurate manner.

The second phase: The dictatorship strikes back

For the Chinese Communist Party (CPC), this process of politicization of dissatisfaction already threatened to go awry. To avoid further loss of legitimacy, the Chinese central government introduced many radical measures from 20 January 2020 onward. Unlike in many Western countries, since extensive experience with SARS was already available, the measures followed the already established repertoire of disease control and the established path of crackdown under a socialist dictatorship. This included the immediate construction of an emergency hospital with 1000 beds within 8 days. The top officers who were identified as responsible for the debacle were dismissed. The complete costs of COVID 19 treatment were covered by the state. Under the leadership of the central government, the „First Level Response to Epidemic Situation“ started in 30 provinces in China, from 23 January 2020. This made the fight against COVID 19 the top priority. Curfews and the closure of traffic between provinces, cities and villages were immediately enforced nationwide. All people who came from Wuhan or Hubei Province were located, tested and controlled on site. According to the current state of knowledge, these measures worked very well and were widely supported by the Chinese population.

The reactions of the Chinese population

In contrast to Germany, for example, the Chinese population’s way of thinking followed the firmly established mistrust about the correctness of the statements of the government as well as of top party officials. On the other hand, the rapid state of alarm and the great caution were based on experiences with SARS, which in terms of relevance and extent did not exist in European countries.

Quelle: Statue in Shenzhen Central Park in Memory of the Medical Staff During the SARS Outbreak, Wikimedia Commons

At the same time, due to the previous experience with SARS in 2003, the Chinese population was very much afraid of this new epidemic. Based on their experience with the state media, they knew very well that they always heard more good news than bad news and that their trustworthiness is low. As a result, the assessment of the viral risks was much higher than that conveyed by the state media. When the population was finally fully informed, fears were therefore much greater than in other countries and as much as possible was done to combat the spread of SARS-COV2.

Nevertheless, the misinformation and the attempt to cover up the „endemy“ were not forgotten. The death of Dr. Li Wenliang (a coronavirus whistleblower) on February 7, 2020 brought the disappointment of the Chinese people about this government information policy to a climax. Countless Chinese conducted an online funeral service for him. Against this background, Wuhan’s party leader was severely criticized in social media nationwide when he said he wanted „to train the residents of the whole city in gratitude so that they can thank the General Secretary (of the party, Xi Jinping) and the Chinese Communist Party, march in step with the party and spread positive energy“.

The question of compliance

The question of compliance with the politically prescribed measures arose differently in China than in Germany, for example. The normative pressure that weighed on each individual was already disproportionately higher than in Germany or many European countries when the new virus became known. But also because of the comprehensive controls and the digital dictatorship in China (see our blog from 09.02.2018), it can be assumed so far that risky, non-compliant behavior was less frequent in China than in Germany with its corona parties.

1) Firstly, in order to increase normative pressure, there was a pronounced naming and shaming, something many Western countries are not familiar with. For example, red signs were attached to the front door of infected persons and they were also electronically marked and could be located electronically in the neighborhood.

2) Secondly, severe penalties and coercive measures also came into play. For example, those who moved in public without a mouthguard were sometimes taken into custody, even though the mouthguard was scarce and hardly available. Germany and many Western countries are still far away from this.

3) Thirdly, the electronic possibilities of digital surveillance have been expanded.

For example, an app from Alipay, the „Hangzhou Health Code“, was used to ensure that no infected persons (or people who have had contact with infected persons) move around in public spaces. Anyone who wants to ride a bus, even today, must show the driver his personal code on his mobile phone. If the code is yellow or red, the person is not allowed to ride on the bus.

Hangzhou was one of the first cities to implement the new program called „Health Code“. Users are required to provide not only name, identification number and residential address, but also data on health status. They must report where they have been in the past two weeks. The software itself accesses the users‘ location data. This procedure has now become a de facto obligation for Chinese citizens. Without a green light, they will be denied access to restaurants, supermarkets, the company and public transport. Around 200 cities in China currently use this software [3] .

Nevertheless, even in China there were many deviations from the rules by companies or hospitals, about which little was reported. Many of them proved to be socially and organizationally useful in the fight against the virus. A good example of this is the supply of Chinese hospitals with hygiene and infection control products. Hospitals in China are only allowed to obtain all these protective products through the Health Commission. They are not allowed to contact suppliers outside the hospitals directly to procure equipment for the hospitals. But many top hospitals in Wuhan called for donations of protective equipment (mask, goggles, protective clothing) directly on the online messenger WeChat on 23 January, without the permission of the Health Commission. They were met with great willingness to help from all over the world and have thus received direct donations, especially from Chinese people abroad. The way of distribution through the Chinese Red Cross was also questioned. Many donations did not arrive or did not arrive in time. For this reason, many donors have started to set up direct logistics chains outside the post office and logistics companies in order to avoid the Red Cross or unnecessary administrative measures. As is so often the case, these useful rule deviations ensured that the organization functioned better and thus also made an important contribution to infection control in China’s hospitals.

Quelle: COVID-19 cases in the People’s Republic of China, 10.2.2020, Wikimedia Commons

The third phase or: the quick end of the pandemic?

Since the end of March, the Chinese government has now reported that there are no longer any local new infections, but only “imported” ones. This follows the regulatory requirement to document the socialist victory over the virus and to revive economic growth. Learning from socialism means learning to win, even if it is a dangerous pandemic. The motto issued by Xi Xingping was very clear and unambiguous. Officials who now reported local infections were dismissed. All new infections must be from returnees, who are then immediately quarantined. It is true that China’s Prime Minister Li Keqiang has at the same time called on the party officials not to cover up any cases. But President Xi Jinping’s announcement that he had defeated the corona virus has left the expected traces. The ordered return to economic growth has put the lower levels of administration under massive pressure. Whether the virus is indeed already history in China remains to be doubted. The critical Chinese magazine Caixin, for example, claims that several asymptomatic cases continue to appear daily in Wuhan – people who test positive for Covid-19 but do not show any symptoms.

Many Western experts assume that the virus will unfortunately keep China, and us too, busy for some time to come. Nevertheless, measures to normalize everyday life in China are being initiated. They are met with distrust by population, since the fear of infection among the Chinese is still great. Although there is currently renewed increase in public transportation, visits to snack bars and restaurants are still rather sparse. This is not changed by the fact that many mayors are currently visiting local snack bars and restaurants to demonstrate the harmlessness of such visits. This „parade“ of successful crisis management seems to be reinforcing the mistrust at present. Even if one is used to the idea that what cannot be is not allowed to be, everyone remains very cautious.

In all three phases of China’s handling of the pandemic, it is evident that China – alongside Singapore and South Korea – serves as a global „role model“ for disease control, but that its handling of the corona crisis was highly path dependent. It is possible to discern the particularities of a digital socialist dictatorship as well as a completely different pattern of norms, values and ways of thinking. These particularities very much call into question the easy transferability of this model. They must be considered if we want to learn from China in the fight against the pandemic. Although China is now kind enough to provide the rest of the world – including Germany – with aid, China still seems a long way from returning to normality. Corona is likely to become a historic turning point in China too, and the road to post-corona times will still be very rocky – as it is here.

Sources and references

[3] Associated Press (2020). Inside China’s Smartphone ‚Health Code‘ System Ruling Post-Coronavirus Life. Time.

Edward Gu & Lantian Li (2020) Crippled community governance and suppressed scientific/professional communities: a critical assessment of failed early warning for the COVID-19 outbreak in China, Journal of Chinese Governance.

Campbell, Charlie and Amy Gunia (2020). China says its beating Coronavirus. But can we believe its numbers? Time.

Griffiths, James (2020). China wants to take a victory lap over its handling of the coronavirus outbreak. CNN.

Naughton, John (2020). How a global health crisis turns into a state-run surveillance opportunity. The Guardian.

[1] Robert Koch Institut. COVID-19 (Coronavirus SARS-CoV-2).

Rui, Guo (2020). Coronavirus: Why did China’s multimillion-dollar early warning system fail? South Asia Morning Post.

Wadhams, Nick and Jennifer Jacobs (2020). China concealed Extent of Virus Outbreak, U.S. Intelligence says. Bloomberg.

[2] Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020.

Yuan, Dang (2020). Doubts over China’s claim of beating coronavirus. DW.

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