How the Coronavirus Made Globalization a Deadly Threat
The new coronavirus in China has spread at an alarming rate, unsettling citizens and epidemiologists alike. It poses substantial challenges for our modern way of life – and threatens our globalized world where it is most vulnerable.
By Georg Fahrion, Kristina Gnirke, Veronika Hackenbroch, Martin Hesse, Martin U. Müller, Katharina Graça Peters, Michael Sauga and Bernhard Zand
Kevin Frayer/ Getty Images
On the evening of Dec. 30, a young doctor in the Chinese city of Wuhan sent a short text message to a group of colleagues. "Seven cases of SARS have been confirmed at the seafood market in Huanan," he wrote. SARS, the viral disease that broke out in November 2002, claimed 774 lives.
"It was clear to me that we were dealing with a public health issue," the doctor said.
The name of the doctor and the hospital where he works have not been made public. But the story that he told the Beijing Youth Daily newspaper has been shared tens of thousands of times online in China. At 1:30 a.m. on Dec. 31, the municipal health commission summoned the doctor and questioned him several times throughout the day.
Where did he get his information, officials wanted to know? Did he realize he was breaking the law? Did he understand that spreading that kind of information was a punishable offense?
"Understood," he wrote on a form, signing his statement with his fingerprint.
But the doctor never got punished. Instead, he got sick.
"On Jan. 10, around noon, I began to cough. The next day, my fever rose. That was when I knew I was in trouble," he said. On Jan. 16, he started having trouble breathing. On Jan. 24, he was transferred to the intensive care unit. From there, he typed out his story on his phone on Jan. 27. He couldn't speak and could only breath with the help of a respirator.
Extreme Measures
The coronavirus, the viral disease the doctor had warned about at the end of December and which he ultimately contracted himself, has spread from the Chinese city of Wuhan around the world. As of Tuesday, Feb. 4, there have been more than 20,630 confirmed cases in 24 countries, according to the World Health Organization (WHO). China has reported more than 420 deaths so far. That's more than during the SARS outbreak in 2002 and 2003, which claimed 349 lives in mainland China.
The epidemic is worrying scientists, politicians and entrepreneurs alike. Chinese markets reopened Monday after being closed since Jan. 23 for the Lunar New Year and stocks immediately plunged. The virus has also begun to change people's everyday lives, the way they do business and how they travel. The fear of new infections has made its way around the world. Sports events have been postponed. British Airways and Lufthansa were the first airlines to cancel all flights to China. Cathay Pacific stopped handing out pillows, blankets and magazines in its aircraft to prevent the virus from spreading. What's next?
China, the world's most populous country and its second-largest economy, is facing a "complicated and serious" crisis, according to a group of Chinese officials headed by Prime Minister Li Keqiang. The country exports more than $2.3 trillion worth of goods annually and is responsible for about one-third of global economic growth.
A street in Wuhan: As ground zero of the epidemic, what happens in the Chinese city could determine whether the virus can be contained or not.
GETTY IMAGES
What if, now that the first airports have been closed, China also shutters its ports? This would disrupt countless supply chains around the world, both big and small. And what if, after the initial coverup and subsequent quarantine of cities with populations in the millions, the Chinese lose confidence in their government?
The epidemic has already shown just how vulnerable our interdependent 21st century economy really is. China boasts the world's largest manufacturing industry. Yet many of the assembly lines aren't running. The government extended the Lunar New Year holiday by a few days in an effort to combat the spread of the virus. Meanwhile, preschools, schools and universities remain closed indefinitely. This suggests that factories in China will also remain closed for the time being.
A Globalized Virus
Experts are divided on when the virus will reach its peak. China's best-known epidemiologist, Zhong Nanshan, has said he expects new infections to reach their high point in early February, whereas experts in Hong Kong and London say they think it will be closer to April or May. Manufacturers of everything from electronics to textiles are likely facing shutdowns of several weeks.
Tech giant Apple, which has a production facility in Wuhan, quickly began looking for alternate suppliers "to make up any expected production loss,” CEO Tim Cook said last week. The French carmaker PSA, which has several factories in Wuhan, is facing a similar situation.
China exports more than 80 percent of that which it produces -including industrial and consumer goods, raw materials and food – by sea. If the ports were closed, it would lead to a massive disruption of global trade comparable to a stop in oil deliveries from Saudi Arabia. To a certain extent, China has "swing capacity" in the manufacturing industry. An interruption in production could bring a large part of the global economy to a standstill, although this still seems a long way away.
Globalization has lifted millions of people in countries like China, Indonesia and Vietnam out of poverty. It has provided people in industrialized nations with cheap televisions and laptops not to mention clothing and textiles, yet at the same time, it makes the world more vulnerable to all sorts of disruption, from terrorist attacks to natural disasters – and epidemics.
A panel of experts from the World Bank and the WHO wrote of a "world at risk" when they examined the economic consequences of a serious global health emergency last year. A pandemic like the Spanish flu, which killed as many as 50 million people between 1918 and 1920, would depress global economic output today by around $3 trillion (2.7 trillion euros), the experts calculated.
Even a comparatively mild epidemic could cause damages adding up to more than 2 percent of GDP. "The world is not prepared for a fast-moving, virulent respiratory pathogen pandemic," the report states.
Chinese Prime Minister Li Keqiang during a visit to Wuhan after the outbreak of the novel coronavirus: Fears of the virus are spreading around the world.
STRINGER/ REUTERS
Chinese President Xi Jinping, has compared the virus to a "demon," thus stirring up one emotion that spreads even more quickly than the virus itself: fear. In Malaysia, South Korea and Singapore, hundreds of thousands of people have signed petitions demanding entry bans for Chinese.
In France, people of Asian origin have taken to Twitter to complain about discrimination, using the hashtag #JeNeSuisPasUnVirus ("I am not a virus"). Some people have even refused to be served by Asians in supermarkets. In France, there had been six confirmed cases as of Tuesday, Feb 4. In South Korea, there had been 15; in Malaysia, 10; and in Singapore, 18.
Increasing Interdependence
The story of the coronavirus is about more than just medicine and China. It is a lesson on the increasing interdependence – and the political, economic and social dimensions – of today's world. It is a story about the globalization of danger.
Wuhan, a city of 11 million people in central China, remains at the center of the crisis. For Christian Drosten, the director of the Institute of Virology at Berlin's Charité university hospital who also helped discover the SARS virus, one thing is certain: In Wuhan, the place where it all began and where new infections and deaths have been increasing from one day to the next, the coming weeks will show whether the new virus can be stopped – or whether the world will simply look on helplessly as the virus jumps around from country to country and continent to continent.
Drosten says the decisive factor in the fight against the new coronavirus won't be a few hundred additional doctors or a hospital that was built in just over a week, but residents' everyday behavior. "SARS could only be stopped in Hong Kong in 2003 because people consistently stayed home out of fear," he explains. If people stay away from one another, they can't spread their germs.
What epidemiologists refer to as "social distancing" – i.e. minimizing contact with other people, avoiding unnecessary walks or travel, working from home, etc. – is more effective than anything against dangerous new viruses, Drosten says. If the number of new infections in Wuhan were to decrease in the coming weeks, it would certainly be due to people's behavior there.
Disciplined Residents
Weeks have passed since the outbreak of the virus and it's still not known where exactly it originated in Wuhan. One guess that gained wide traction – that the virus originated at the Huanan seafood market – is now being called into question again. "The virus was immediately and rapidly transmissible from person to person," Drosten says. "That’s why I could imagine it being an infected person rather than an animal that spread the virus at the market." The virus could have even originated at another market altogether and could have spread from there to the Huanan seafood market.
WHO head Adhanom Ghebreyesus and Chinese President Xi during a meeting in Beijing: It may sound counterintuitive, but the crisis actually provides a useful opportunity for the Chinese government. NAOHIKO HATTA / GETTY IMAGES
So far, the city's residents have strictly heeded the call to stay home. "People are only going outside to run errands that are absolutely necessary," says Han Li, 62, a resident of Hamburg who was surprised to learn on Jan. 23 that the city in which he was staying had been quarantined. Until last Saturday, he had been holed up in a hotel in the city center, waiting for the German government to fly him, his wife and around 90 other German citizens out of Wuhan.
In Wuhan, the government's transportation ban and curfew have been highly effective. The streets are all but deserted. On New Year's Eve, many residents could be seen and heard at their windows or on their balconies, singing the national anthem and shouting words of encouragement to one another. "Wuhan!" they yelled. And: "Jia you!" which literally means to "add oil" but is used as an expression of support. It's the same battle cry that protestors in Hong Kong have been using for months.
Last week, WHO Director-General Tedros Adhanom Ghebreyesus praised Chinese leaders for their discipline, though it has really been the medical professionals and residents of Wuhan and the 15 worst-hit cities in Hubei Province who have been the most disciplined.
"We appreciate the seriousness with which China is taking this outbreak, especially the commitment from top leadership," Tedros said during a meeting with Chinese President Xi Jinping. He went on to say that he was "very encouraged and impressed by the president’s knowledge of the outbreak and his personal involvement in the response." And he responded to criticism of his lavish praise for the Chinese leader by insisting that he "would praise China again and again." Beijing's actions had "helped prevent the spread of coronavirus to other countries," Tedros said. He also noted that China had been proactive in alerting the German authorities after a woman infected with the disease had returned to China following a visit to Bavaria.
Welcome Praise
Xi had no trouble accepting the praise. Flanked by a floor-to-ceiling painting of a mountain landscape, Xi nodded approvingly as Tedros commended him for his engagement in fighting the virus. It was welcome reinforcement for Beijing. It may sound counterintuitive, but the crisis actually provides a useful opportunity for the Chinese government to make the case for its system of rule. As if to say, "You in the West may call our measures draconian. We call them efficient.”
In fact, what China is asking of its people would be difficult to imagine in any other country. For Europeans, it may be reminiscent of some blockbuster movie about a natural disaster. More than 50 million people are trapped in Hubei province. That's more than the entire population of Spain. Major cities including Beijing and Tianjin were quick to suspend long-distance bus services.
Travelers who returned from Wuhan were urged to quarantine themselves and report their body temperature to the authorities twice a day. In Beijing's subway stations, security guards in white full-body suits could be seen scanning every passenger with infrared thermometers.
"We will definitely overcome this disease," Xi said during his meeting with Tedros – just as long as his policy was "precisely implemented." His words conveyed confidence, but they were also a warning: If containment wasn't achieved quickly, it would only mean that someone hadn’t sufficiently implemented the directives from Beijing.
There's a Chinese proverb that goes, "Heaven is high and the emperor is far away." Basically, it means that the idea of the central government having absolute power over every last city, town, village and farm simply isn’t true. High-ranking provincial leaders enjoy considerable freedom – say, to ignore processes and rules. Harvard professor Elizabeth J. Perry has called this a "guerilla policy style." Economically, this approach has produced bold experiments that have contributed to China's rise.
The flip side, however, is that the central government often doesn’t have an exact picture of what’s going at the periphery – and that China's regional leaders are often held to account if something goes wrong in their jurisdiction. This could be one reason why the authorities in Wuhan waited so long to sound the alarm. On Jan. 1, the city government closed the Huanan market and the police initiated "legal action" against eight internet users who had "spread rumors" about a new viral disease, including the doctor who had been called in by the health commission the day before.
Almost three weeks later, and only a few days before Wuhan was sealed off, the city administration held a New Year's banquet. Some 40,000 people reportedly helped themselves to bowls of shrimp and hot and spicy duck necks. Later, the mayor of Wuhan said it had been assumed at the time that the virus was not being transmitted from person to person. But he did admit to doing too little for too long. He has since offered to resign.
Administrative failures like this are especially threatening to a regime that does not derive its legitimacy from elections, but instead rules repressively and then points to the achievements of its style of governance. Social media in China have been flooded with expressions of displeasure, testimonies of human suffering and eyewitness accounts – but it's usually the provincial authorities that are held responsible and rarely the central government.
A Sharp Jump
As the crisis first unfolded, the debate over it was extremely open by Chinese standards. Since Xi's public statement about the virus on Jan. 20, he has been trying to present himself as being in charge of containment efforts. Public health took priority, he said, adding that it was "extremely crucial." At the same time, he suggested "strengthening the guidance of public opinion."
So far, the strategy seems to be working. Indeed, the spectrum of what can be said is narrowing again. Particularly drastic reports from Wuhan are being expunged more quickly now than at the beginning of the outbreak. But criticism cannot be completely silenced. This became apparent when a video uploaded by a chief physician went viral last week.
Security personnel guard the Huanan seafood market where the coronavirus was detected in Wuhan on Jan. 24. Hector Retamal/ AFP
The doctor, Zhang Wenhong, said he wanted to give his overworked colleagues in the infectious diseases department at Huashan Hospital in Shanghai a break. Instead, he said he would send Communist Party members like himself into the sick wards. "Didn't the members of the Communist Party take an oath to put the interests of the people above everything and not to let difficulties stop them? So, I say: Now march forward, comrades, and do your best."
China's Foreign Minister Wang Yi surprised doctors last week with his statement that the epidemic was "generally controllable and curable.” Indeed, the virus continues to spread at a high rate. The number of infected jumped sharply over the weekend. As of Tuesday, China alone had recorded more than 17,238 confirmed infections.
A Race Against the Clock
On Thursday of last week, after the virus had spread to a total of 24 countries, WHO declared an international public health emergency. "We must all act together now," Tedros said. WHO's primary concern at the moment is that the virus could spread to countries that don’t have good health systems. The organization did not, however, call for further travel restrictions, with Tedros saying on Monday that there was no need for measures that "unnecessarily interfere with international travel and trade" in trying to get ahead of the virus. Instead, he called for the rapid development of vaccines and medicines. Researchers around the world are racing against the clock to come up with a vaccine. But it will take time – at least three months for human testing of any vaccine to begin.
No drug has yet proven to be effective against the virus, either. There are plans for doctors to start experimenting with different drugs in the hope that something may prove helpful. If the virus were to spread uncontrollably, the world would have few means of protecting itself, and the result would be far more infections and deaths than seen up to this point.
What has been particularly worrying is that it is not yet clear what scientists and doctors are up against. Even though the gene sequence of 2019-nCoV has been decoded and Australian researchers have succeeded in growing the virus in the laboratory, it is not clear how contagious or how deadly the new pathogen really is. "At the moment, we’re dealing with things as they come,” University of Marburg virologist Becker says, summing up the situation.
"It is extremely difficult to make any reliable predictions for a virus that only recently came into the human population," explains David Heymann of the London School of Hygiene and Tropical Medicine, who helped fight the SARS outbreak for WHO back in 2003. Technology, for its part, can only help in determining the characteristics of the virus. So, epidemiologists are now focusing on the careful study of so-called clusters, groups of sick people, and trying to find out how these individual cases correlate with each other.
That’s why experts are attaching great importance to the early cases that have emerged in Germany. In contrast to Wuhan, where it is now often difficult to trace who actually contracted the disease from whom, the chains of infection can still be tracked very closely in this country.
In Bavaria, a 33-year-old employee of Webasto, an automotive supplier, contracted the virus from a Chinese colleague who had traveled to the company’s headquarters in the village of Stockdorf near Munich for a training event.
The initial findings in the German case are both reassuring and disturbing. Contrary to initial reporting on the case, the colleague from China likely did have early symptoms when she infected the first Webasto employee and possibly also a second. The first employee, in turn, infected the third and fourth, before getting diagnosed himself.
Even after he felt completely healthy again, the man still had a large amount of the virus in his saliva, meaning he was possibly still infectious. So, it may be that simple exposure to a person who doesn't appear to be very sick or to a person who appears to be fully recovered is enough to get infected - making it difficult to prevent the global spread of 2019-nCoV.
As of Tuesday, a total of eight Webasto employees had tested positive for the coronavirus, and two children of one employee had also come down with it. Together with two people who had returned to Germany from Wuhan and were infected there, the total number of infections in Germany has risen to 12.
The health of the first four who fell ill in Germany quickly improved after they suffered brief fevers. "The four are in great shape now, with no symptoms, no fever and no cough,” Clemens Wendtner, the senior physician attending to the patients at a hospital in Munich, announced at a press conference on Wednesday.
"More Difficult than We Thought"
Elsewhere, though, the virus struck harder, even among younger people. In Wuhan, a 36-year-old man died after getting infected. And in France, the condition of an infected male around the age of 30 deteriorated.
And yet, it’s not unconceivable that the infections will ultimately be contained. "We will still have to wait a bit to see whether the strict quarantine measures imposed by the Chinese government will work,” says Marion Koopmans, professor at the Erasmus Medical Center in Rotterdam. It would definitely be a good sign if there were only a few more cases in the coming days in the affected countries outside China.
It’s becoming more likely, however, that a pandemic will emerge in which the virus will spread around the world. Stephan Becker, director of the Institute of Virology at the University of Marburg, says, "In any case, containing the virus will be more difficult than we thought." Lee Hyuk Min, a professor at the Yonsei University College of Medicine in South Korea, points to another aspect. "I don't want to provide any estimate on how many people might get infected,” he says, "but this outbreak could last for several months." He fears the virus could spread unnoticed for a long period and cause considerable damage, especially in developing and emerging countries.
But even if a pandemic does ensue, it wouldn’t automatically be catastrophic, because mortality is often overestimated at the beginning of epidemics. Public health authorities are currently estimating a mortality rate of between 2 and 4 percent for the coronavirus, compared to around 10 percent for SARS and 35 percent for MERS (the Middle East Respiratory Syndrome that first emerged in 2012).
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