Epidemics are a feature of Chinese history. Because of the symbolic threat they posed to an emperor’s ‘heavenly mandate’, they always had a political dimension as well. For instance, in 1910 when the Qing Dynasty was already on the verge of collapse, the royal family’s homeland of Manchuria was devastated by pneumonic plague. Within months tens of thousands of people had been killed. Russia and Japan, eyeing the chaos, contemplated an invasion of Manchuria to ‘restore order’.
At this critical moment, Wu Lien-the, the first Chinese medical graduate from Cambridge University, came to the fore. The Malayan-born physician was appointed by the Qing court to head a medical team to fight the outbreak. One of his first actions was to convince Russia and Japan to call a halt to all rail services (then under their control) in the region. Another directive was even more unpopular: at Wu’s request several thousand corpses were cremated, a move that flew in the face of Chinese traditions that considered cremation inauspicious. Making it worse: the cremations were scheduled for the first day of the Lunar New Year.
For the royal residents of the Forbidden City, the outbreak would turn out to be profoundly inauspicious indeed: the incoming Year of Xinhai would see the end of the Qing, with thousands of years of imperial rule replaced by a new republic (for more on this period, download An A-Z of Chinese History from our website).
In the shorter term some of Wu’s methods enjoyed success. For instance, he asked government officials to light as many fireworks as they could lay their hands on. The firecrackers generated chemicals that helped to sterilise the air and made so much noise they drove away virus-carrying animals. In what was then viewed as a miracle, the deadly disease receded, before finally vanishing.
With another Chinese New Year holiday starting tomorrow, the country is currently in the grip of another public health crisis. This time it’s the worst outbreak of a coronavirus pneumonia since the spread of SARS in late 2002 and early 2003. And it could be set to get worse over the festive season – a period that sees hundreds of millions of people travelling to and from their hometowns, or venture abroad on holiday.
How did the outbreak start?
The previously unknown strain of virus started to spread last month in Wuhan, a transport hub in Hubei province in central China (we first reported on the mystery pneumonia outbreak in WiC478).
In contrast to the attempts to cover up the news of the SARS epidemic – which eventually spread worldwide and killed more than 700 people – Chinese health authorities alerted outside bodies relatively quickly, including the World Health Organisation (WHO) on December 31. On the same date it was made public that 27 Wuhan locals had been treated in hospitals for the illness.
One patient had shown pneumonia-related symptoms as early as December 12. Hong Kong media was unimpressed at the medical response, saying that health agencies were slow to identify the threat. Others have been less critical, like Daniel Lucey, writing in Foreign Policy magazine, who noted it’s difficult to identify new respiratory infections quickly, because influenza and similar illnesses are often rampant in winter.
That said, critics have been asking why so few cases of the virus were reported for nearly three weeks, before a sudden spike in number over the past few days.
What is the new virus and how quickly does it spread?
Over the past week the Chinese authorities have identified a new coronavirus called 2019-nCoV as the most likely cause of infection and shared its genetic sequence with scientists around the world for laboratory testing. It has also been confirmed that the novel virus originated from a wet market in Wuhan (most of the early patients had worked there) where illegal sales of wildlife have taken place. In a similarity to the SARS outbreak, the new coronavirus also resides in animals such as bats. It is able to migrate to our species through close contact between humans and animal hosts.
Early this week, however, there was a new alarm. Zhong Nanshan, a renowned respiratory expert and head of the expert team put together by the National Health Commission (NHC) to tackle the outbreak, told state broadcaster CCTV that two people in Guangdong were confirmed to have been infected through human-to-human transmission.
The two patients had not been to Wuhan themselves but became sick after family members returned from the city.
In another worrying sign, more medical staff were infected. Zhong revealed that 14 medical workers from a hospital in Wuhan had tested positive (after performing a brain operation on a patient who was not identified as a virus carrier).
Even Wang Guangfa, a senior NHC official who earlier assured the public that the outbreak would be contained, was infected. The respiratory expert said a visit to Wuhan last week without adequate eye protection might have been the cause (he inferred he contracted the virus through his eyeball).
The number of cases of infection has also spiked just ahead of the Chinese New Year. As of Thursday, the NHC said there were 830 confirmed cases throughout the country. Up to 177 of the patients are said to be in critical condition. So far the outbreak has claimed 25 lives in China, although the new coronavirus looks less deadly than its SARS counterpart. As of the time of writing, the victims were mostly elderly people in Wuhan, who were often already suffering from other serious health concerns.
In a more welcome note, 25 patients that were confirmed to have contracted the mystery virus have now been discharged, having shown none of the symptoms (like pneumonia) associated with a worsening condition. Two patients in Thailand and one in Japan have also fully recovered.
Respiratory expert Zhong told CCTV earlier this week that China was essentially tackling a “regional outbreak”. Yet the disease has spread nationwide and overseas, with confirmed cases reported – at the time of publication – including the US (1), Japan (1), Thailand (3), Taiwan (1) and Hong Kong (2). Most of these patients had been to Wuhan in the recent past. Thus far, however, the WHO has decided against declaring the Wuhan situation a ‘global health emergency’. Following a couple of special meetings this week, the WHO said it was “too early” to declare such an emergency over the coronavirous outbreak. “Make no mistake, though, this is an emergency in China. But it has not yet become a global health emergency. It may yet become one,” said WHO Director-General Tedros Adhanom Ghebreyesus.
Chinese officials are now seeking to curtail the impact of so-called ‘super-spreaders’, or patients who unwittingly transmit the disease to dozens of others at a time.
Only with the careful quarantining of such individuals can the disease be prevented from spreading more rapidly and of potentially becoming more deadly.
For example, the ‘patient zero’ who triggered Hong Kong’s SARS outbreak in 2003 is believed to have been Liu Jianlun, a 64 year-old from Guangzhou. A respiratory medicine specialist, Liu was in Hong Kong to attend a wedding despite suffering from a high temperature and a cough. Some suggested he was infected while fighting a mysterious pneumonia outbreak in China that had started in late 2002. But having stayed in a hotel for one night (on February 21, 2003), Liu was admitted to a local hospital the next day. By this stage this ‘super-spreader’ had already infected at least 13 other people staying at the same hotel. These victims subsequently passed the deadly SARS around Hong Kong and ultimately to 17 other cities across the globe.
How have the central authorities reacted to the outbreak?
The Chinese government seems to have learned painful lessons from the SARS epidemic, which was made worse because it was initially kept under wraps. The Wuhan Municipal Health Commission has been providing more regular updates on the situation and the central government has been working closely with the WHO. National Health Commission officials have also vowed to hold regular press briefings even during the Spring Festival holidays.
On Tuesday, the NHC listed the new-type pneumonia as a ‘Grade B’ infectious disease, a category that includes the likes of SARS and AIDS. But in a measure of how seriously the situation is being taken, the new virus will be treated as a ‘Grade A’ species, requiring stricter control measures such as mandatory quarantine for anyone who comes into close contact with patients (prior to this only bubonic plague and cholera were classified as ‘Grade A’ threats in China).
The sense of urgency increased after President Xi Jinping weighed in with a directive of his own, demanding “resolute efforts” from government bodies at all levels. The Central Political and Legal Affairs Commission (a senior body in the Party hierarchy) reinforced that message in a social media commentary telling cadres not to forget what happened with SARS. “Anyone who puts the ‘face’ of politicians before the interests of the people will be the sinner of a millennium to the Party and the people,” it warned. “Anyone who deliberately delays and hides the reporting of [virus] cases out of his or her own self-interest will be nailed on the pillar of shame for eternity.”
This sharpening of the political mood may explain the uptick in the number of confirmed case this week, after local authorities were allowed to confirm new carriers as long as they tested positive twice for the virus.
Previously, confirmations of new cases could only be made by bodies connected to the central authorities such as the Chinese Centre for Disease Control and Prevention. Besides, new testing devices have also been developed and distributed to hospitals nationwide. The more decentralised approach to detecting the virus is being supported by these more efficient testing methods at local hospitals, which also helps to explain why more cases are being diagnosed.
Was Wuhan quarantined too late?
Since the beginning of this week, Wuhan’s local government had banned tourist groups from holidaying outside the city. Passengers in vehicles crossing city borders were subjected to spot checks.
However, as the number of confirmed cases continued to spike, the Wuhan government finally announced on Wednesday that it would lock down the city entirely.
This must have been a hard decision to make. Putting aside concerns over the impact on the local economy, the scale and complexity of Wuhan’s quarantine is probably unprecedented.
The city has about 11 million hukou holders [i.e. those with formal residency permits] and it is also home to more than five million migrant workers.
The impact of the closures in Wuhan’s airport and railways will be massive, local media admitted. The city is a critical transport hub – in which major rail links interlock with those in nine other provinces. Almost 25 million passengers were expected to travel through the city during the holiday period.
A number of cities in Hubei province close to Wuhan have also announced the suspension of railways and other public transport.
“No government has ever shut down a city of Wuhan’s size, so there’s no road map for Chinese officials,” Howard Markel, a professor of history and medicine at the University of Michigan, told the Washington Post, adding that the government will also have to arrange for special transits to bring in food, water and medicine.
The day before the quarantine was enforced Wuhan’s mayor Zhou Xianwang had already called on locals not to leave the city and asked outsiders not to visit unless their trip was absolutely necessary. He also cancelled most holiday celebrations planned by his administration for the first 15 days of the Chinese New Year.
The city has already set aside 800 beds in three hospitals for those contracting the virus and will have 1,200 more available soon.
Yet the 57 year-old mayor, has been taking heavy flak, both from locals who were locked down in Wuhan, and onlookers who believe the decision has come too late. Many internet users in the country are now calling for him to resign. “From the perspective of continued understanding of the situation, it is only at this time that everyone realises it is so dangerous,” the mayor explained to CCTV earlier this week. “If we knew at first from the virus spread that it would be so serious, finding effective control and prevention methods of course would be good, but the problem is usually we cannot realise the severity from the outset.”
Could things get worse after Chinese New Year?
The number of confirmed cases is likely to spike further as a result of the annual travel rush for the Chinese New Year – which is often termed as the ‘world’s largest human migration’.
During the same period in 2019, Chinese travellers made around three billion trips over the month-long ‘Spring Movement’. The number of trips on high-speed trains also topped 400 million for the first time.
Such massive volumes of human traffic – often crammed in confined spaces like buses, trains and planes – creates a range of new possibilities for the virus to spread.
But besides government efforts to fight the outbreak, there are signs that public awareness of disease control measures has improved. In busy railway stations the number of passengers wearing masks is much higher than in the past. Indeed, masks have become one of the most sought-after purchases on e-commerce sites across the country this week.
The Spring Festival this year was expected to provide a record-breaking box office haul but the studios behind seven blockbusters announced on Thursday that they’d postponed their release over concerns on the health risks of going to the cinema, another confined space where the danger of virus transmission is high (see this week’s “Entertainment” section).
The city of Beijing has also cancelled large-scale holiday celebrations, including temple fairs in the Chinese capital.
Cautious approaches like these have instilled a measure of optimism among officials fighting the Wuhan virus that its spread can be curtailed. “When comparing with 2003 we have much improved systems on quarantine and disease control,” epidemic expert Zhong Nanshan told CCTV. “I believe the outbreak will not have the impact on society and the economy that SARS did 17 years ago.”
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