China plans to crush new covid outbreaks with tough measures
They may work, but the cost will be high
CHINA’S MOST frightening outbreak of covid-19 lurks in Harbin, a north-eastern city known for Russian architecture and a winter festival featuring large castles hewn from river ice.
Traced to a Chinese student who flew from America in March, the outbreak has pushed the city of 10m back into semi-lockdown, weeks after a first wave of the virus was defeated in Wuhan, far to the south.
The Chinese authorities are deeply alarmed by imported cases. The country’s borders are closed to almost all foreigners and only about 20 international flights land in all of China each day. Domestically, however, travel bans are being lifted, and businesses and schools urged to resume work. Not in Harbin. Travellers reaching the city from abroad must spend 14 days in government-arranged quarantine, then another 14 in isolation at home.
School reopenings have been postponed. A single case in a housing compound condemns every resident there to a fortnight’s quarantine. When those unfortunate neighbours emerge from isolation they may not leave Harbin. That ban is enforced via smartphone apps that must be shown by all domestic travellers.
The world is familiar by now with China’s approach to virus control, combining brute force (breaking transmission chains by preventing Chinese people from meeting others, if needs be for weeks) with high-tech surveillance and contact tracing.
The Harbin lockdown is revealing because it was triggered by such a small cluster. At the time of writing, the city has just 63 confirmed cases of covid-19, plus another 17 asymptomatic cases.
Compare Harbin with another chilly, northern city with 63 confirmed cases: Fairbanks, Alaska. Though Alaska has a far higher rate of infections per person than China—Fairbanks is home to just 31,500 people—the state began reopening on April 23rd. Alaska’s Republican governor, Mike Dunleavy, told citizens to incorporate the virus into daily life, saying: “There will be deaths, as there have been with car accidents and cancers and strokes.”
In rich countries, politicians and scientists are weighing the economic and social costs of lockdowns. It is increasingly common to hear calls to shelter the old and infirm while letting healthy folk take their chances.
The aim is to restart the economy while keeping the current pace of covid infections—the effective reproduction number, or Rt—below a replacement rate of one-for-one, so that cases decline over time and never overwhelm health systems.
China is taking a different path. Alone among large countries with many land neighbours, it wants an Rt as close to zero as possible, and will endure pain to achieve that. To date, the world shows little interest in debating the wisdom or folly of that strategy. One cause may be suspicion of China’s numbers.
Western politicians call it naive to believe that China has suffered only 84,000 cases to date, and 4,600 deaths. This when Belgium, a country only a bit more populous than Harbin, has reported 7,200 covid deaths.
True, some official claims are risible, such as a boast in March that the 2m-strong People’s Liberation Army had no virus cases. Nor have any senior officials admitted to being infected, which seems odd. Other numbers are surely undercounts.
A new paper in the Journal of Medical Virology, by Yong Feng and others, examines serological tests conducted on 1,402 people at a single hospital in Wuhan in April, after the epidemic’s peak. Most were locals needing test certificates to return to work.
Overall, one-tenth tested positive for covid antibodies. Wuhan’s population is 11m. Even allowing for false positives and a sample skewed by the inclusion of almost 400 hospital patients, very large numbers were clearly infected at some point, many without knowing it. Yet a more basic claim—that China is currently free of large, uncontrolled outbreaks—is credible.
In Wuhan’s worst weeks, smartphone videos of overwhelmed hospitals were seen by millions of social-media users, before censors deleted them. If a city were in such agonies now, it would leak. China has achieved something worth debating.
The Communist Party is a black box. But some incentives that guide its leaders are knowable.
For one thing, maintaining order and keeping people safe is the foundation of the social contract between rulers and the masses. That compact wins public support for a fair amount of sacrifice. Should economic woes endure, the party will stoke nationalism, with even more propaganda reports about incompetence and chaos in the democratic West.
For another thing, covid-19’s first wave almost broke China’s underfunded health system. A paper examining China’s virus response, co-authored by Ruoran Li of Harvard University, finds that any city suffering a Wuhan-like outbreak will need 2.6 intensive-care beds per 10,000 adults. Nationally, China has only about 0.3 such beds per 10,000 people (America has ten times as many).
Forget flattening the curve, China wants no curve
Another sobering conclusion is drawn by Qifang Bi and others from the Johns Hopkins Bloomberg School of Public Health, writing in Lancet Infectious Diseases. They examine how the large, affluent southern city of Shenzhen traced and isolated contacts of early virus cases. The clever sleuthing worked.
But questions about asymptomatic cases missed by surveillance “temper any hopes of stopping the covid-19 pandemic” by tracing and isolation alone, they conclude. Put another way, China may feel obliged to keep imposing lockdowns and border controls for a long time, despite the costs.
Whether Chinese rulers come to regret that trade-off may depend on whether an effective vaccine is found soon, says Benjamin Cowling, head of epidemiology at Hong Kong University.
“If they can protect people’s health and get a vaccine by the end of the year, then China will look extremely smart,” he argues.
Should others open up, China will look more and more unusual: a giant economy repeatedly slamming on the brakes to smother even small clusters. If effective vaccines or treatments fail to emerge, that cannot be sustainable for ever. Born out of caution, China’s virus exceptionalism is a gigantic gamble.
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