In the midst of the COVID-19 outbreak, the stories on China’s quarantine and population control measures seem downright crazy, with people needing hall passes to go out of their apartments, buildings turning away residents who had been out of town, periodic temperature checks on residents, drones being deployed to disinfect villages or to shame people to go indoors or put on a mask, and health workers deployed in train stations checking phone records of visitors to see where they have been.

Over the weekend, the New York Times reported the extent of the measures China has imposed on its citizens to control the coronavirus outbreak, which encompass about half of China’s entire population, some 760 million people.

Are these draconian measures working? News out of China is confusing. The last few days have seen a decline in the number of new cases which raises hopes that the herculean efforts imposed by the Chinese government (implemented with zeal by local actors) are succeeding.

However, international observers, like Dr. Tony Fauci of the National Institutes of Health, warn that that it too early to conclude the worst is over: “I think we need a few more days to determine if that’s real or variability.” Others like mathematician John Allen Poulos have made similar points.

It is not clear when China’s workforce of some 700 million will get back to work after a three week hiatus and what that will do to infection numbers.

In my previous posts in this series, I laid out basic attributes of the virus, the declaration by the WHO of an international health emergency, and the role played by international travel restrictions. In this post, I want to review whether or not China’s efforts have made the situation better or worse.

My basic takeaway is that the same authoritarianism that gave China the ability to respond to the virus is the same one that allowed the outbreak to get as bad as it did in the first place.

Has China’s response been adequate?
As I mentioned in my second post, Dr. Tedros of the World Health Organization praised the response of the Chinese government. Indeed, we have seem some heroic efforts on the part of the Chinese government — notably the construction of a 1600 bed hospital in twelve days — that are hard to imagine in democracies.

However, as Matt Kavanagh writes, authoritarian governments have their own deficiencies both in the lead up to an epidemic and in their response.

Information politics in China undermined a rapid response to the 2019-nCoV outbreak. Health-care workers suspected an outbreak in early December, 2019,7 but information with which the public might have taken preventive measures was suppressed, and communication channels that might have alerted senior officials to the growing threat were shut down.8 Police detained a clinician and seven other people posting reports on 2019-nCoV, threatening punishment for spreading so-called rumors. Social media was censored; a preliminary analysis of Weibo and WeChat published on China’s biggest online platform9 showed outbreak discussions were nearly non-existent through much of January, 2020, until the Chinese Government changed its official stance on Jan 20, 2020.

Matt KavANAGH, the LANCET Public Health

I’ve seen some discussion on Twitter about the government knowing several weeks before travel restrictions were imposed in Wuhan about the virus, which suggests a more serious failure of the government in the lead up to the outbreak.

On February 10th, China’s president Xi Jinping, who had been largely invisible to the public throughout much of the crisis, finally appeared wearing a mask walking around a Beijing hospital and getting his temperature checked.

He released a timeline of his actions to contain the virus which suggests he issued orders to the Politburo Standing Committee on January 7th, which was two weeks before the government’s public pronouncements of the seriousness of the problem on January 20th.

Several articles note that a banquet in Wuhan for 40,000 went ahead on January 18th, with government approval, which suggests a serious lapse in judgment given the government’s awareness of the virus.

Laurie Garrett faults the Chinese government for downplaying the risks of virus after the government became aware in December of an outbreak at a live animal market in Wuhan. The government’s official announcement on New Year’s eve 2019 gave the impression that everything was under control. Meanwhile, Garrett writes:

Throughout those two vital weeks—time when aggressive control efforts might have stopped the outbreak—the virus was spreading completely independently from the animal market, as it had been since at least mid-December. 

Laurie Garrett, foreign policy

Nick Kristof writes that the government’s response to doctors ringing the alarm in early December was to discipline and silence them. We know of the whistleblower Li Wenliang whose death from the virus sparked tremendous outrage and grief in change.

And act decisively they did — not against the virus, but against whistle-blowers who were trying to call attention to the public health threat. A doctor who told a WeChat group about the virus was disciplined by the Communist Party and forced to admit wrongdoing. The police reported giving “education” and “criticism” to eight front-line doctors for “rumormongering” about the epidemic; instead of punishing these doctors, Xi should have listened to them.

Nick Kristof, New York tIMES

Harkening back to the classic discussion from Amartya Sen, Kavanagh notes that authoritarian governments struggle precisely when there is bad news. In nondemocracies, nobody wants to report information to the highest levels or, when they do, there is a tendency by autocrats to kill or suppress the messenger. That clearly seems to have happened here, which undermined the seriousness and speed of the initial response.

This is precisely the argument made by Tsinghua University professor Xu Zhangrun in his essay, “Viral Alarm: When Fury Overcomes Fear,” that was published on February 10th on ChinaFile. The professor has been under house arrest and had his internet access blocked in the wake of publication.

The cause of all of this lies with The Axlerod [that is, Xi Jinping] and the cabal that surrounds him. It began with the imposition of stern bans on the reporting of factual information that served to embolden deception at every level of government, although it only struck its true stride when bureaucrats throughout the system shrugged off responsibility for the unfolding situation while continuing to seek the approbation of their superiors. They all blithely stood by as the crucial window of opportunity to deal with the outbreak of the infection snapped shut in their faces.

Xu Zhangrun, ChinaFILE

As Pin Ho and George Win write in the National Interest, the perceived deficiencies in the Chinese government’s response to the crisis may pose the most significant challenge to Xi Jinping to date:

Indeed, the Chinese state’s inability to contain and manage the crisis has exposed the extent to which Xi’s concentration of power has engendered a risk-averse and incompetent Chinese bureaucracy that lacks the capacity for action (buzuowei).

Pin Ho and george Win, national interest

Are China’s quarantine measures warranted?

Despite these failures in the early response to the outbreak, China’s coercive policies to stem the virus may have been necessary on some level, even if local actors implemented them overzealously.

One study reported on by Tom Inglesby from Johns Hopkins found that the virus spread from one city to the entire country in a month despite all of the restrictive measures. Had China not implemented these control policies in the midst of the lunar year vacation, what would have happened?

Howard Markel argued that these measures are typically counterproductive because they trigger counter-measures by people who try to evade the controls. It is not clear that is really possible in the Chinese setting, though he is right to note that the announcement of the measures triggered a flood of five million people out of the city of Wuhan before the controls could be imposed.

Given the relatively high infectiousness of this new virus and the limited diagnostic tools we have had to know if people have it, the population control measures seem to have been an emergency measure that China resorted to, given previous failures. Would something else have worked better, given the early delays and suppression of evidence from Li Wenliang and others? I don’t know or if anyone knows.

With any luck, we have seen the worst, but more needs to be done both to ensure that the danger subsides and how to prevent the next outbreak. I’ll discuss what to do next in my fifth and final post.

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