How Did China Do It?

By the time a lockdown was imposed on January 23, 2020 in the central Chinese city of Wuhan, ground zero of Covid-19 pandemic, five million people had traveled out of the city in the previous few weeks, according to the city’s mayor.  It was the peak of the pre-holiday traveling season, and Wuhan is a major transportation center in China. Some of those five million people took foreign-bound flights to other countries.  The majority of them, however, traveled to other parts of China by airplanes, trains, buses and cars, eventually causing tens of thousands infected cases outside Hubei province, of which Wuhan is the capital and the most populous city.  

Then, as early as March 7, Mainland China outside Hubei province reported no new domestically transmitted cases.  How did China contain the spread of Covid-19 outside Hubei province? As situations in some Covid-19 hotspots such as New York seem to be out of control, the answer to the above question may provide some useful reference for what can be done here in the U.S.

It goes without saying that what has been done in China may not be even feasible, not to mention desirable, for the U.S. First, the lockdown ordered for Wuhan and other cities in Hubei province was, and is, much stricter than that imposed on New York.  Indeed, the initial motivation behind the January 23 lockdown of Wuhan was to cut the city off from the rest of the country, and the first set of regulations was all about stopping flights, trains, buses and cars LEAVING the city. Other, more typical measures of lockdown – including closing down of nonessential businesses, banning social gatherings and confining people to their homes except for grocery and medicine shopping – were only introduced later. 

As a compensation for Wuhan’s sacrifice, medical resources poured into the city.  Directed by the Central Military Commission, two very large military-style field hospitals were built in a couple of weeks, which then were operated by medical personnel from the military. Encouraged, if not ordered, by the central government, many provinces sent “Rescue Hubei” medical teams to work and live in Wuhan or other Hubei cities for weeks in a row.  Members of these teams either worked at local hospitals as reinforcement or at newly set up make-shift hospitals transformed from stadiums, schools or exhibition centers.  This type of across-province mobilization of resources is more feasible in China, perhaps because the top officials in a province are essentially appointed by the central government, rather than being elected locally. 

Second, law enforcement and businesses in other provinces adopted very strict measures to restrict the movements of people who recently came back from Hubei to celebrate the Chinese New Year in their hometown or who were passing by with an ID card issued in Hubei.  In the first two weeks after Hubei became famous with the January 23 lockdown, many hotels turned back travelers from Hubei and some evicted current lodgers from Hubei. Law enforcement in many localities set up checkpoints on highways to deny entry of cars with Hubei license plates.  Stories abounded on WeChat (China’s counterpart of Facebook) about being stuck on the road with nowhere to go.  In these Catch-22 circumstances, many out-of-town people from Hubei were even forced into temporary homelessness.       

Later on, a uniform policy came from the top. Local governments were responsible for accommodating the travelers from Hubei in their area. Local governments all over the country set aside designated hotels to quarantine these travelers, and their temperatures were monitored daily. The travelers did not regain their freedom even after a fourteen-day streak of no symptoms.  Only recently have these stranded travelers been allowed to return their homes in Hubei.    

Third, many cities outside Hubei, especially large cities such as Beijing and Shanghai, adopted strict preventive measures, which included postponing the return of migrant workers, quarantining migrant workers for fourteen days before they could settle down and start to work, enforcing mandatory social distancing practices (wearing a face mask, for example), establishing regulations/guidelines to encourage working from home, and operating with a skeleton schedule.   

Finally, an additional consideration is that people in China are accustomed to wearing face masks, often due to air quality concerns. During the Covid-19 outbreak people in China were required to wear a facemask outside their homes, and that requirement remains in force in Wuhan.  While the efficacy of a surgical facemask at protecting the wearer of the facemask is a subject of debate – and the U.S. CDC claims it is not effective at protecting the wearer from contracting Covid-19 – it does appear that wearing a facemask protects others from contracting the disease.  Individuals can be infected and asymptomatic.  Even those who eventually develop symptoms can be unaware that they are infected, and contagious to others, for several days before symptoms appear.  Wearing a facemask protects others from getting the disease from someone who is currently unaware that they are infected and contagious.  This phenomenon would be present in China, and in several other nations where facemasks are often worn (such as South Korea, Singapore, and Japan), and in all of these nations the rate of growth of infections is slower than that in many western nations where facemasks are much less frequently worn.

Compared to the strategies of most other countries, China’s primary strategy was to eradicate the virus quickly so that life could get back to normal and the economy could get back on track. Under this strategy, the aforementioned extreme measures aimed at cutting off Wuhan and other cities in Hubei province, as well as quarantining travelers and returning locals from Hubei, though costly, were deemed to be justified by the goal of reducing current and especially future damage to the economy.  Indeed, since the beginning of the nationwide lockdown introduced across the country in late January and early February, the Chinese leadership has been emphasizing the importance of having “zero new confirmed cases” and quickly putting the economy back on track as soon as possible.  Of course, this goal had to be later adjusted to allow “imported cases,” given the outbreaks elsewhere in the world.     
 
Has China succeeded in eradicating the virus originally in China?  The answer is “yes” if one accepts the official data. However, the official data have to be taken with a grain of salt.  One main caveat is that China has redefined what constitutes a “confirmed case” twice so far, seemingly according to its priority at the time.  After the two military field hospitals were completed and many make-shift hospitals were made available, China redefined the “confirmed case” to include not only those who tested positive but also those who tested negative but had clinical symptoms (pneumonia in particular) of Covid-19.  More recently, China redefined the term again, this time to exclude those who tested positive as long as they did not have any symptoms.  As of March 23, Wuhan had six straight days of “no new confirmed cases,” and the city is set to end its lockdown on April 8.  Time will tell if China has, indeed, stopped the virus in its tracks.

Even if China succeeds in containing Covid-19, its approach was very costly. According to China’s National Bureau of Statistics, the total value of industrial production dropped 13.5% in January and February from a year earlier, the index of services production declined by 13.0%, the total of retail sales of consumer goods declined by 20.5%, and fixed-asset investment decreased by 24.5%.[1] These are huge declines, and need to be read in the context of an economy that was considered to already be having slow growth when the growth rate was a positive 6%.

Can China’s economy quickly rebound if the outbreak is indeed under control? The initial assumption behind China’s strategy, that the economy could get back on track as soon as the battle against Covid-19 ended, has already turned out to be false.  The virus may have started as a Chinese problem, a Chinese virus, but it has since spread throughout the world, further hurting the Chinese economy due to reduced global demand for its products.  It seems China’s battle against Covid-19 will not truly be over until the global war on the virus is over. 
 

[1] http://www.stats.gov.cn/enGliSH/PressRelease/202003/t20200316_1732244.html

Posted: March 25, 2020 by Dennis W. Jansen, Liqun Liu, Andrew J. Rettenmaier