The World Health Organization (WHO) has declared COVID-19—the acute respiratory disease caused by the SARS-CoV-2 virus—a pandemic. And almost everywhere you look, the data appear to show a frightening exponential rise in new cases. As I write this, on March 17th, the latest available reports show that confirmed cases have doubled in Italy over the last five days. In Spain, the most recent doubling period has been just three days. In France, Germany, Switzerland, the United States, the UK, and Netherlands, the figures are four, three, three, five, three, and four respectively. When these facts are presented in graph form, the vertiginous lines suggest a world feverishly coughing its way into apocalypse.
But assuming that governments act responsibly, and absent some horrifying SARS-CoV-2 mutation, there will be no apocalypse. Stock markets and economies will suffer greatly. But even this damage can be mitigated through decisive action. The more aggressively that our leaders act to suppress the spread of COVID-19, the more quickly the crisis will pass, and the sooner we will all be able to return to normal daily life. The decisions we make now could mean the difference between a global recession and a historical event on par with The Great Depression.
The good news is that we definitely can suppress COVID-19, even if no cure or effective vaccine emerges. We know this because it already has been done in the most populous country on Earth.
In China, where the pandemic began, the 10,000th confirmed COVID-19 case emerged on February 1st, just 10 days after the country’s 100th confirmed case. This corresponds to a doubling period of less than two days. If this pace had been sustained, more than a million people would have been infected within another two weeks. But of course, that’s not what happened. In late January, China’s government initiated a series of increasingly draconian measures directed at identifying and isolating patients, observing their close contacts, banning mass gatherings, and limiting traffic into and out of Wuhan and other affected areas of Hubei Province.
The effects were stunning. Confirmed new cases in China fell from a high of almost 4,000 per day on February 5th down to about 400 daily cases three weeks later. All of this has been documented in data collected by Chinese officials themselves and reported by the WHO-China Joint Mission on COVID-19.
Skepticism of Chinese data runs high in the West. But WHO officials found these numbers consistent with what they observed. At a major hospital in Wuhan, for instance, the team found that the number of fever-clinic patients fell from a peak of 500 per day in late January to one-tenth that number by mid-February. (Fever is the most reliable symptom of COVID-19, being present in 88 percent of the 55,924 laboratory-conformed cases that were available for analysis at the time the joint mission report was submitted.) All in all, “the Joint Mission estimates that this truly all-of-Government and all-of-society approach that has been taken in China has averted or at least delayed hundreds of thousands of COVID-19 cases in the country.”
Over the last week, the daily tally of new confirmed COVID-19 cases in China has hovered at about 30 (with a low of just 10 on March 13th), suggesting a possible (though unlikely) asymptotic descent toward zero. Given that total confirmed Chinese cases now stand at about 81,000, this corresponds to a doubling period of five years. The rate of new cases may well rise as civil liberties are restored, people mix more freely, and travellers arrive from other countries. But even if the daily tally were to stabilize at triple the current level, this would correspond to just one death per day (assuming China’s observed late-February case fatality rate holds)—this in the nation where the pandemic started, and which accounts for a sixth of the planet’s population.
China’s nationally mobilized response to COVID-19 in late January and the weeks thereafter represents one of the greatest achievements in the history of public health, and shows how much modern technology will help us avoid the uncontrolled contagions of the past. It shows that we can not only drastically suppress the acute spread of COVID-19. We can also do it quickly—on the scale of weeks, not months, seasons, or years.
In some ways, China has advantages over other countries: Its population is so vast that it was able to deploy armies of doctors and nurses to Hubei from (as yet) unaffected areas. This included more than 40,000 health care workers sent into Wuhan alone. An astounding 1,800 teams of epidemiologists operated in the city, with a minimum of five people per team. In Shenzen City, epidemiologists were able to track down and observe every single one of the 2,842 individuals identified as a close contact of an infected patient. (Only 2.8 percent were found to be infected.) Moreover, the effects of Hubei’s economic paralysis could be diluted within a larger national economy. Such an approach is more difficult in the much smaller nations of Europe.
Yet China also faced (and conquered) challenges that Western nations now can avoid, such as the sequencing of SARS-CoV-2, and the initial investigation of COVID-19’s basic properties. All of this information—not to mention detailed epidemiological data from tens of thousands of Chinese patients—has been dropped into the lap of Western policymakers. In December, this virus didn’t even have a name. This week, teams around the world already are engaged in preliminary testing en route to a hoped-for vaccine. China alone now has the capacity to produce and distribute up to 1.65 million testing kits. After some early missteps in December, including apparent dishonesty on the part of officials eager to sweep the disease under the carpet, Beijing is putting the West to shame. If we don’t suppress this pandemic in our own nations, it’s not because we can’t. It’s because we failed.
Nor can any nation resort to the fatalistic excuse that it’s too late for action, or that only an autocracy can enforce the strict measures required to suppress COVID-19. China’s success has been replicated not only in Singapore but also democratic South Korea. As the WHO-China Joint Mission report emphasized, what matters most is that front-line doctors, nurses, and researchers get adequate resources, and that political leaders, local health providers, and ordinary citizens exhibit universal buy-in on the overall policy. This buy-in can be accomplished in a variety of politically and culturally appropriate ways.
Whereas China “placed millions of their citizens on lockdown, South Korea has not restricted people’s movements—not even in Daegu, the southeastern city at the centre of the country’s outbreak,” John Power reports in the South China Morning Post. “Instead, [South Korean] authorities have focused mandatory quarantine on infected patients and those with whom they have come into close contact, while advising the public to stay indoors, avoid public events, wear masks and practise good hygiene.”
The graph below compares the daily rate of new confirmed COVID-19 cases for various countries. South Korea peaked on the last day of February at 813. Two days later, Italy hit a short-term spike of 561 new cases. The curves for the two countries move roughly in sync, time-shifted by just a few days. This is the same disease, infecting people at roughly the same rate, in countries of (roughly) comparable populations—but with radically divergent outcomes.
In January, South Korea began a massive screening program that so far has processed a quarter-million people. On February 26th, the country even adopted an innovative drive-thru approach that allowed drivers to get their noses and mouths swabbed while they remain in their cars. On March 7th, the infection rate began a rapid drop that continues to this day. And the country now has what is believed to be the lowest COVID-19 case fatality rate in the world, at just 0.69 percent.
In Italy, by contrast, the COVID-19-stricken Lombardy region wasn’t locked down until March 8th, by which point there were more than 1,000 new cases daily in Italy. COVID-19 typically has a two-week cycle time from onset till clinical recovery. And if the pattern from other countries manifests in Italy, its rate of new cases should soon plateau and then come down. (According to the latest WHO situation reports, confirmed new cases for March 16th were 3,590, up slightly from 3,497 on March 15th. These numbers remain worryingly high, and account for roughly a quarter of all new global cases.) But even so, the missed opportunity here is tragic. Just a week ago, Italy and South Korea had roughly the same number of total reported cases. But Italy’s total cases are now more than double those of South Korea, with a much higher case fatality rate. As of this writing, more than 1,800 Italians are known to have died due to COVID-19, compared to just 75 in South Korea. As in Iran, Spain, France, the UK, and other countries where governments are belatedly struggling to contain the disease, hundreds, or even thousands of Italians will die unnecessary deaths. For years, residents of those countries will be debating who was responsible and how they should be held accountable.
The good news is that the global COVID-19 numbers do not show an unrelenting exponential march toward some kind of health cataclysm. Even if uncontrolled outbreaks are underway in some countries, it’s important to remember that (1) these global statistics represent the summed total of national statistics; (2) the trend in virtually all affected regions is toward more rigorous policies, and (3) the COVID-19 outbreaks in places where such rigorous policies were implemented earliest, including China, South Korea, Singapore, Japan, and Taiwan, already have either been suppressed or at least plateaued.
New outbreaks are inevitable, including in African, South Asian, and South American countries that have more limited health-care infrastructure. But insofar as the Organisation for Economic Co-operation and Development is concerned, the success of East Asian nations in throttling the pandemic allows us guarded hope that the near-term death toll—which now stands globally at just under 7,000—will be limited to five figures. That counts as a tragedy, but would be a blessing compared to the 200,000 to 1.7 million whom a Centers for Disease Control and Prevention expert predicted might die in the United States alone in the complete absence of government interventions.
The description of COVID-19 itself contained in the WHO-China Joint Mission’s February 29th report also supplies a basis for cautious optimism, not only in the sphere of health outcomes, but also in regard to our disease-devastated economies. Notwithstanding the “high transmissibility” that marks the virus, the Chinese data show that the disease is not quite as easy to transmit as some originally feared. “COVID-19 is transmitted via droplets and fomites [objects likely to carry infection, such as utensils and doorknobs] during close unprotected contact between an infector and infectee,” the authors note. “Airborne spread has not been reported for COVID-19 and it is not believed to be a major driver of transmission based on available evidence.” The report also notes that, as of late February, “most of the recorded cases were imported from or had direct links to Wuhan/Hubei. Community transmission has been very limited. Most locally generated cases have been clustered, the majority of which have occurred in households.” Moreover, “people interviewed by the Joint Mission Team could not recall episodes in which transmission occurred from a child to an adult.” And while some “instances of transmission have occurred within health-care settings, prisons and other closed settings…they do not appear to be major drivers of the overall epidemic dynamics.”
This is important, because it means that once the acute phase of the pandemic is over, governments will have some latitude to moderate blanket restrictions on business operation, transit, travel, and education so long as people avoid the close face-to-face behaviours by which the disease is most easily communicated, and adhere rigorously to common-sense practices such as frequent hand washing, social distancing, and face-covering when sneezing. Even in February, the WHO-China Joint Mission report authors note, China already had begun to embed the expectation of a return to normalcy into its “third stage” protocols, under which policies would “strik[e] a balance between epidemic prevention and control, [and] sustainable economic and social development.” There is no reason why other governments won’t be able to quickly transition their own policies in the same way once COVID-19 has been suppressed. While no one expects COVID-19 cases will be brought down to zero, the prevalence of the virus can be managed in such a way that the health system isn’t so overloaded that doctors must decide who lives and dies, as is the case in some parts of Italy.
In January and February, many in the West imagined that we could muddle through the COVID-19 crisis with a few ad hoc travel restrictions. COVID-19 was described—including by at least one misguided national leader—as being an artifact of a “foreign” virus. And the case for lockdown was rejected on the basis that strict interventions regarding the way people live and work would seriously damage our economies without delivering offsetting medical benefits.
But what’s now clear is that these strict interventions are necessary both for our health and our economy: Without decisive action, the pandemic will linger on, suffocating our economies week by week amid a climate of fear. The decisive measures imposed in Asia, by contrast, are getting the worst of the economic pain over with quickly—with China, in particular, on a seemingly well-planned glide path back to eventual normalcy.
That likely wouldn’t have been possible if the country’s political leadership hadn’t gone all in on shutting down a regional outbreak before it became a nationwide catastrophe that lasted into the summer and fall. It proved to be a far-sighted decision, and one that history will remember well. For the sake of both our physical and economic health, Western leaders would do well to learn from China’s example.
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