COVID-19

An Optimist’s Case for COVID-19 Lockdown, Our Safest and Quickest Path Back to Normalcy

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.

 

Jonathan Kay is Canadian Editor of Quillette. He Tweets at @jonkay.

Comments

  1. Social distancing, lockdown, travel restrictions, etc have proven very effective to treating the spread of the coronavirus.

    What i am worried about is pulling the western world out of the economic depression we are about to enter.

    I am a landlord. Two of my renters have told me they have been work furloughed and wont be able to pay rent. How can i make the mortgage payment? Government in Los Angeles has announced renters dont have to pay rent. Woo hoo, left wing populism. Big corporations are getting bail outs. Workers done have to pay rent? Small business owners are in big trouble.

  2. That Asian supremacy, what can you do? Even China can manage to pull itself together after the inevitable bungling you get when you’re dealing with fascist dictatorships.

    Somehow I don’t think Western countries are up to the task. People like Jonathan Kay are more invested in Trump’s failure than anything else, others are principally worried about the economy, others don’t care about the elderly enough to change their habits, others still welcome a kill-off. We’re too fragmented to move decisively in any direction.

  3. I see no scientific evidence that the lock down of Wuhan was the sole driver of a decrease in infections. Until we can fully examine the virus this is just pure conjecture as was the SARS which just…stopped without any medical intervention.

    The wider damage of these lockdowns is quite significant and if the world panics as it has done when the next flu arrives what then ? The infection rate for most of these countries is 0.005% of the population and less in some cases.

    It now appears the biggest threat by far to the world is the social media pandemic. Never fear as history proves over and over again human beings are entirely irrational animals when it comes to self protection.

    A couple of points:

    -Milan Italy has been for many years the hub of the mafia run rag trade from China with murders and violence quite rampant in many of the hidden factories.

    • The SARS virus was isolated to bats in a cave in Yunan.

    • China still remains entirely susceptible to further animal transmission due to their open food markets.However as before I suspect WHO will be too conflicted to press this obvious problem.

  4. A well-written article from an optimistic perspective. Time will tell whether this optimism was justified.

    One remark, though:

    China’s success has been replicated not only in Singapore but also democratic South Korea.

    How is it that Taiwan, which is also democratic and quite successfully overcomes the Corona crisis, is almost always forgotten in the Western media? I don’t think this is done with bad intent, but somehow China’s strategy of making its “breakaway province” invisible seems to be bearing fruit.

    (In defence of the author: Taiwan is mentioned in a list of countries later in the article)

  5. “Western leaders would do well to learn from China’s example“

    Pass. There’s nothing impressive about the suppression of information, silencing of whistleblowers, and violations of basic human rights and freedoms. There is no condition under which these options are to be considered and western leaders should be ashamed for succumbing to the temptation to implement even the most meager efforts in this direction. Reducing the conversation on these issues to a morbid competition over who has the lowest coronavirus death rates ignores the fact that these fundamental rights have had intrinsic value long before coronavirus and will continue to long after coronavirus. Even if one were to concede to the ridiculous notion that China has responded to this crisis well does nothing to delegitimize our fundamental liberties. The same unrestrained power that allows the Chinese government to swiftly enact broad and extreme measures is also what allows the Chinese government to place ethnic minorities in concentration camps and imprison citizens for criticizing the Communist Party.

    Western leaders have little to learn from China, and they should be ashamed for failing to develop effective solutions compatible with western freedoms. Travel bans, lockdowns, restricted movement and forced business closures may be effective at addressing the crisis of today but will cost us our freedoms tomorrow.

    Citing WHOs review of China’s progress on coronavirus is only slightly more legitimate than citing China itself. WHO has demonstrated on multiple occasions a willingness to regurgitate questionable Chinese claims and has demonstrated a remarkable lack of interest in pushing back on the Chinese Government’s behavior. Similarly, this article was curiously eager to present China’s numbers without skepticism.

    To suggest that the response to this crisis in the West is lacking compared to China is baffling. Stupid statements from the president is not morally equivalent to mass censorship and silencing whistleblowers. Curiously, this article goes so far as to condemn the West’s reluctance to impose Draconian measures as if the only problem with revoking our freedoms is that we aren’t doing it fast enough. I can’t even begin to fathom how one arrives at this conclusion. Of all the criticisms one can make about our government’s response to coronavirus, infringing our rights too slowly is not one of them. The CDCs incompetence at ramping up testing is a far more legitimate criticism in my opinion. Furthermore, if our government can’t even be trusted to implement a half decent testing program why should we trust them with our rights?

  6. We are supposed to believe China, uncritically and yet China is expelling the very journalists who can determine the veracity of their claims. Before that, the Chinese doctor who tried to raise the alarm was threatened by Chinese police. Color me a bit skeptical. South Korea is a different story.

    I also find it fascinating, particularly, given the gratuitous anti-Trump comment in the article, that all of the people who have been loudly proclaiming that he is a dictator, are now quite upset that he is not a dictator. Nor is is clear that we are doing a bad job. The death toll in Italy from Covid-19 is 2,503. The death toll in the U.S. is 75, as of March 17. 52 are in one state - Washington. Shutting down travel from China, for which Trump was reviled as racist by the left, now appears to have been a very smart move. There is a assumption that top-down authority is always the best. But we have a large heterogeneous country. Different parts of the country will require different solutions.

    Finally, the economy matters. As was discussed in a previous article, millions of people are going to be put out of work, as the entertainment industry and restaurants shut down. These are in large part, people who live paycheck to paycheck. The economic fate of the the peasants may not matter to Chinese officials but the fate of our citizens matters here. Measures to fight the virus must be balanced against the economic damage they cause. If there was too much concern initially about economic damage I can forgive this as things changed very rapidly. Everyone has 20/20 hindsight and everyone wants to believe in magical easy answers. Sadly, reality is not magical.

    Finally we have the Spanish flu,the West Nile virus, Rocky Mountain Spotted Fever and Lymes disease. We even have Stockholm Syndrome? But we are supposed to be upset because Trump calls Covid-19 the Chinese virus. How come those in Connecticut are not upset about the damage to their image from Lymes disease? Although I actually prefer the Wuhan virus, geographical eponyms have been used for diseases for years.

  7. Yes, because if you don’t have it during war and pest outbreaks then you don’t have it at all. Our liberties don’t exist at the government’s, or anyone else’s discretion. Your question assumes that our liberties exist to achieve a result, such as wealth and prosperity, but this is not true. Liberty is the ends in itself.

    Beyond these ethical issues with limiting liberty there are practical concerns as well. Who gets to decide what conditions warrant the removal of our liberties? How will they measure the value of liberty to make this determination? If liberty must be revoked to save lives or protect property then how many lives and how much property justifies this action? Why? How can this deciding authority be trusted with this power? How will they know when to reinstate our liberties? Is it ethical to revoke person A’s liberty to protect person B’s property? If so, how far can this principle be scaled? Is it ethical to revoke the liberties of all Americans to save the property of some Chinese? How will we measure the effectiveness of these decisions?

  8. The average age of Italian Wuhan virus deaths is, iirc, around 80. That means they were born around 1940.
    Now look what someone that age would have gone through in China as vs. Italy. Both, as babies, would have gone through WW Ii.
    But as the two countries recovered from that, the Chinese inflicted on themselves, among other things:
    The Great Leap Forward — 20-40 million deaths.
    The Cultural Revolution — 1-15 million deaths
    The Laogai System — 15 million deaths

    Of course those numbers are questionable; while the PRC is pretty accomplished at tyrannizing its citizens, it seems rather bad at keeping records of its own madness. The Black Book of Communism puts total victims of the CCP at around 65 million.

    But my basic point is that those who want a PRC style response to the pandemic better carefully consider what they are asking for. It comes at a a very high cost.

  9. Christensen: This is outstanding commentary!!! Although I really HATE parallels between modern political events and Nazi Germany, it is worthwhile to note that Hitler did not seize power. He was democratically elected. At the time Germany was a failed state. The currency was worthless and there was widespread joblessness and hunger. The German people wanted a dictator!! This occurred during the middle of the Great Depression, and many intellectuals, many of whom were Communists, also strongly believed that dictatorships were a superior form of government. They felt democracy was obsolete. We see that the left today wants to suppress free speech and the rule of law.

    For most of the history of humanity, from the time of the earliest tribes, dictatorship has been the predominant form of government. Democracy is a tiny blip upon that history. I suspect that there is something in our genetic nature that makes us want to defer to a strong leader in times of stress.

    And it scares the heck out of me!!

    Fawning articles about China like this one, don’t mention the tens of millions of deaths during the history of the regime, the incarceration of millions of Uighurs and other minorities currently in concentration camps or the continuous Orwellian surveillance and the swift punishment of dissidents. Science Magazine, a more informed source than this article, presented a more realistic appraisal of the pros and cons of China’s approach.

    Democracy is hard. Rights may be given by God but they can be easily taken away by man. It is in times like these that we must strive even harder to preserve our freedoms. You get the bad with the good when you choose dictatorship and the good never outweighs the bad.

    Many forms of Government have been tried, and will be tried in this world of sin and woe. No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of Government except for all those other forms that have been tried from time to time.…’ Winston Churchill

  10. But the gratuitous anti-Trump comment in this article is OK??? It has absolutely nothing to do with the story and this is uncharacteristic of Quillette.

    I agree that both sides need to disarm. I suspect the commentary would have been quite different if this article had been written in a more objective manner. See my reference to Science Magazine in another post as an example.

    China, clearly, after multiple missteps, has made remarkable progress in reducing Covid-19 cases. But so has South Korea. It could be argued that they have done a far better job than China. How the U.S. will do has yet to be determined, but to state that we are failing at this juncture because we have been slow to take draconian measures is clearly premature. What exactly should we be doing that we are not? The article is curiously silent on this. To imply that the the spread of Covid-19 is due to Trump calling it the “Chinese Virus” ludicrous and unworthy of Quillette.

  11. I am not sure I agree with this. A great many essays here on Quillette take the form of “Leftist trying to make the case that the Left has moved so far Left that they have been Left behind”. These authors often feel he need to take at least one swipe at conservatives in general, or President Trump in particular, before they finish. At least that has been my observation.

  12. I’m a retired physician with a crappy immune system due to leukemia and chemotherapy. I’m assuming that if I meet this virus I’m a goner. But more important is how to cope in the longer term. Most people will survive the virus with minor symptoms, and once they have had it are immune and no longer available to take part in chains of transmission. There’s a great deal to be said for the approach advised by British public health officials initially: lock down the vulnerable and let the rest of the population carry on as normal. Their mortality rate will be 0.5 - 1.0%, and once they are immune, we will have sufficient herd immunity to protect those who would have a much higher mortality or no chance of immunity. Maybe I’m selfish, but that appeals to me as I know that even if a vaccine is developed (and is not a live-virus vaccine, which I cannot have as it would overwhelm what’s left of my immune system), I cannot respond to vaccines by making antibodies - I don’t have enough non-malignant lymphocytes that are actually willing to do their job. My only hope is total eradication of the virus (and we know from 1918 that lockdowns delay herd immunity and lead to later spikes in death rates), or adequate herd immunity so that I’m unlikely to meet anyone who will give it to me, or the bone marrow transplant that seems to be on indefinite hold as hospitals are too busy for such frivolities. Not a wildly cheerful prospect, is it?

  13. I have no problem with articles on Quillette that address issues from a left-wing perspective. I have no problem with people who disagree with Trump’s policies. Publish these articles and let’s have a good debate. Free speech does not mean “always agree with Oilman”

    What I dislike are the gratuitous insults and ad hominem attacks on both sides. They add nothing to the discussion and diminish the chances of rational discourse. Quillette usually avoids these in their articles. Jonathon Kay is a good author and should have known better.

  14. I did a back of the envelope calculation. Italy is the epicenter of the virus. It also has a population of about 60 million, skewed toward the older end of the spectrum. Skewed age disregarded, assume the average age at death is 75. That means 800,000 Italians die a year or 2192/day. They had about 350 die of C virus yesterday. Some of them were elderly who would have died anyway but I’m sure there was an increase in expected deaths. The numbers, however, do not indicate the end of the world is coming and I am not sure it is worth the destroying the world’s economy. I am beginning to think that we need to keep a stiff upper lip, try to shelter the oldest and weakest, and try to carry on with life. Work, buy things, make things, and try to live a normal life. Being unemployed, out of money, and being unable to support one’s family is also bad for health. It is like the old and probably apocryphal statement about Vietnam – “We had to destroy a village to save it,” Somehow the calculus doesn’t seem to be working

  15. “Funny how we feel the need to virtue signal that we are not Trumpers before offering an opinion.”

    This is just a trump flavor of the “to be sure, racism and white supremacy everywhere” verbal tick before offering an opinion that perhaps a particular situation is not a result of racism and white supremacy.

    The thing is, a majority of the readers on this site are more annoyed by this OrangeManBad verbal tick than impressed. However, I do appreciate that these authors’ are concerned that their articles might be spotted by some SJW hunting for their daily outrage. The authors probably hope that inserting an anti-Trump virtue signal will save them from the Twitter pummeling (it won’t).

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