Coronavirus is slowing down across China, just as the pandemic accelerates rapidly elsewhere around the world.
A recent multilateral mission to China by health authorities from around the globe has revealed the rest of the world “is simply not ready” to tackle the coronavirus with the speed and seriousness that China has, as the World Health Organization’s Dr. Bruce Aylward, who led the international team of 25 health experts, told reporters upon his return.
“Hundreds of thousands of people in China did not get COVID-19 because of this aggressive response,” Aylward said, adding that the techniques were old-fashioned public-health tools but applied “with a rigor and innovation of approach on a scale that we’ve never seen in history.”
But this rigor comes at a cost, as professors, journalists and doctors in China have reported being silenced after sharing vital information about the coronavirus outbreak without the consent of the Chinese government.
“These draconian measures seem to have worked to bring down the cases in a very short period of time in China,” Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations, told Business Insider. “Although there is a cost to the economy, to society, not to mention also the second-order problems, like access to health care for people without the coronavirus. The question is whether the United States is willing to pay such a high price.”
Here are 12 of the dramatic disease-fighting tools that China has used to end the spread of the new coronavirus.
Huang says he cannot imagine an America where many of these measures are implemented.
Coronavirus testing was easily accessible and free.
In China, patients who were confirmed to have the coronavirus were either sent to an isolation center or hospital, Aylward told the Times. “In Wuhan, in the beginning, it was 15 days from getting sick to hospitalization,” he said. “They got it down to two days from symptoms to isolation.”
The government also made clear that testing for the new virus was free, and COVID-19-related charges that weren’t covered by a person’s insurance would be paid for by the government.
In the US, there has been a push to make COVID-19 testing free. Tests given by the CDC or a state laboratory are free for patients, but private labs aren’t, and given that state-owned laboratories are overwhelmed, many people are turning to private labs for tests. While Medicaid, Medicare and private insurance will cover the cost of tests, many people who are underinsured or lacking insurance will likely hesitate before heading to the doctor.
But Americans may still be on the hook for coronavirus treatment. One woman was charged over $34,000 for coronavirus testing and treatment.
And while the test is in some cases free, it is still far from available. COVID-19 testing capacity still lags far behind many other countries. Though drive-through testing sites are opening up in certain spots, public health laboratories are still far behind other countries. In South Korea, a country with a population that is one-sixth the size of the US’s, more than 300,000 people have been tested for the novel coronavirus so far, according to the Korea Centers for Disease Control and Prevention.
“South Korea and China got through this in two to four weeks,” Dr. Rishi Desai, a former epidemic intelligence service officer in the CDC Division of Viral Diseases told Business Insider. “The dangerous thing is that our healthcare system stands to get overrun.”
China built new hospitals in a rush, with workers toiling night and day to get them done.
China built two new 1,000-1,300-bed hospitals to fight the coronavirus, one created in six days, and the second in 15 days, using prefabricated modules.
This isn’t the first time China has quickly manufactured hospitals dedicated to handling outbreaks. During the 2002-2003 SARS outbreak, Beijing built a hospital in seven days with 7,000 people working day and night.
Other buildings got repurposed to support more coronavirus patients, too. “They would convert a training center or a stadium in between 24 and 72 hours,” Aylward said. “That was the time frame they took in Wuhan to increase by a thousand their capacity.”
The ramp-up of bed space has not been perfect, though. At least one makeshift quarantine spot set up in a hotel in Quanzhou collapsed, killing 10 people.
In America, makeshift arrangements are also being put together to help American’s overwhelmed healthcare system handle the expected surge in cases. Four sites in New York will now function as temporary hospitals; the Jacob K. Javits Convention Center, and locations at SUNY Stony Brook, SUNY Old Westbury and the Westchester Convention Center.
The US Navy is planning to deploy two of its hospital ships into action, to be used for COVID-19 patients, and triage tents are being put up outside existing hospitals.
The Army Corps has also begun the process of converting empty hotels and college dormitories into makeshift hospitals, first in New York, but experts say the process is likely to extend to California and other states.
The country postponed non-urgent medical care, and moved many doctor’s visits online. Not all patients were given the critical care they needed during the outbreak, though.
In China, elective surgeries and other non-critical doctors visits were delayed, and many medical services were moved online. “Someone in one place said 50% of their consultations are now done online; they just moved a whole bunch of what was normally done physically online to be able to keep the regular health services going,” Aylward said.
But the move hasn’t been without negative consequences. One man with kidney disease in China jumped to his death, Human Rights Watch reported. He couldn’t get dialysis during the outbreak. Another boy with cerebral palsy died after being left alone for six days while his father was quarantined in China. One patient died by suicide in China, and people living with HIV in China struggled to obtain their medicine.
In America, many hospitals cancelled elective surgeries like breast augmentations and hernia repairs, although some hospitals continued their work. “I’ll be clear: There is no reason to cancel elective procedures at this time,” UC Davis Chief Medical Officer Dr. J. Douglas Kirk wrote in an email to employees.
Telemedicine experienced a boom in America, as many doctor’s appointments went digital. Telemedicine company Teladoc Health told the Wall Street Journal it had provided about 100,000 virtual medical visits to patients in one week.
The US’s roughly 95,000 intensive care unit beds could get filled as the coronavirus outbreak worsens, and equipment like ventilators, space to treat patients, and staff to care for them may all face shortages, Business Insider previously reported.
In Italy, those fears are already a reality, with medical supplies and hospital bed shortages reportedly forcing doctors to choose which coronavirus patients to save first.
During the height of the outbreak, trains didn’t stop at the disease’s epicenter, Wuhan.
When Aylward’s team disembarked their train in Wuhan, most of the other trains kept moving. “Trains whirr right through the station. I mean continually now for a month,” Aylward told reporters after his trip. “The big inner city trains, they roll right through, with the blinds down.”
Trains, as well as other tightly-packed forms of transportation, can serve as vectors of illness, Dr. Darria Long Gillespie, clinical assistant professor at University of Tennessee Erlanger and national spokesperson for the American College of Emergency Physicians, previously told Insider.
“The more people, the more closely packed, and the more poorly ventilated the space, you can imagine that’s a bad situation — it’s why the CDC is now discouraging people from going on cruise ships — because there are a ton of people, they’re in very close quarters, and they’re a totally captive audience,” she said, adding that a packed concert or a conference would also fall into those avoid-at-all-costs categories.
“Cutting off transportation was considered on the top three measures to contain the spread of the virus,” Huang told Business Insider. “But it would hard to imagine the complete shutdown of an American city due to government order.”
People who thought they might have the coronavirus could go to one of the nation’s many fever clinics.
People who thought they had the novel coronavirus in China would often be sent to a special fever clinic, which have been widespread since the country dealt with an aggressive SARS outbreak in 2002. Their temperature would be taken, and they’d discuss their symptoms, medical history, travel history, and any prior contact with anyone infected with a doctor.
If necessary, patients might receive a CT scan, which is one way to do an initial screening for COVID-19.
“Each machine did maybe 200 a day. Five, 10 minutes a scan,” Aylward told the New York Times. “A typical hospital in the West does one or two an hour.”
After all that, if you were still a suspect case, you’d get swabbed and a coronavirus PCR test would be run through a machine. Even during the peak of the outbreak, a lot of people came in to the fever clinics with colds, flus, and runny noses, looking for reassurance they didn’t have the novel coronavirus.
In the Chinese province of Guangdong, for example, which is a more than 10-hour drive away from Wuhan, there were 320,000 COVID-19 tests done in the clinics. At the peak of the outbreak, only 0.47% of those tests were positive for the coronavirus.
China walled off entire hospital wards to contain the virus.
In addition to China’s quickly-created hospitals, China also took pre-existing hospitals and repurposed them to solely handle patients with the novel coronavirus, sealing them off from others.
“You had to take whole hospitals and take them out of general service and make them basically response hospitals for COVID 19 cases,” Aylward said. “What China’s done, rather than have some beds that are isolation beds, is at the start of that ward, they built a wall with a window on it. They seal the whole thing and said a full ward, that whole 40 beds to 100 beds, is now an isolation unit.”
Speed was also key to containing the crisis, he said.
“I think the key learning from China is speed — it’s all about the speed,” Aylward told Vox in a later interview. “The faster you can find the cases, isolate the cases, and track their close contacts, the more successful you’re going to be.”
China used technology that aims to trace every single COVID-19 case.
Chinese public health officials have attempted to trace near every single one of the 80,000-plus cases in that country.
Emergency centers tracking the virus across the country use huge screens that show every disease cluster. Officials militantly track where cases are spreading, with governors not hesitating to call local field teams when they have questions, as Aylward witnessed on his trip.
“They pulled up another screen, and there was the team that was out in the field actually trying to do this,” he said. “The whole thing is linked up, and they’re in constant contact trying to make sure that together they solve the problems of trying to sort out the transmission … they have changed the course of this outbreak.”
Chinese social media including Weibo, Tencent, and WeChat also shared out accurate, up to date information on the virus, providing a counter to fake coronavirus garlic cures and other disease misinformation on the internet.
“You could have Facebook and Twitter and Instagram do that,” Aylward said.
But communicating the urgency of the virus, and pushing citizens to follow stringent health restrictions, isn’t as simple as it is in China. “It is not easy in a liberal democracy,” Walter Ricciardi, a World Health Organization board member and a top adviser to the health ministry, told the New York Times.
“It would be a big change right for the US people to get accustomed to,” said Huang, “if the government wants to use this high tech means, like using the cell phones to monitor the movement of the people.”
Huang added that even though there is little technological barrier to doing this, this kind of behavior is considered a form of digital authoritarianism, that involves uses privacy issues. Huang would be hard-pressed to imagine the US government using this approach to containing the spread of the coronavirus.
The country implemented large-scale contact tracing in the early 2000s.
During the SARS outbreak in 2002-2003, China set up large-scale surveillance systems that included contact tracing, a front-line public-health strategy that involves identifying and following up with people who may have come into contact with an infected person.
The contact tracing technology Chinese public health officials used was “idiot-proof,” according to Aylward. If a tracer made a mistake on their forms, their screen flashed a yellow alert.
During a World Health Organization press conference last Wednesday categorizing the novel coronavirus as a pandemic, WHO’s executive director, Dr. Michael Ryan, said some countries “have been too willing to give up on contact tracing at a very early stage of the fight against the epidemic.”
He emphasized that the strategy is an effective, inexpensive, and “very basic public health intervention” compared to broad measures like social distancing, which is more burdensome and doesn’t work if there’s no cultural buy-in.
“When people move towards broader-based social distancing measures,” he said, “it effectively accepts that the chains of transmission are no longer visible.”
While staying home, it’s been relatively easy for Chinese people to get extra food and supplies.
China essentially mandated a country-wide shutdown, demanding that every Chinese resident stay home until the curve was flattened. But in America, unlike China, a country-wide shutdown would be difficult to enforce.
“In America, you have to stay at home, but there’s no police,” said Huang. “There’s no one actively enforcing that rule, but in China, you have what are basically security guards on patrol of every residence to make sure they don’t violate the government containment measures. That’s a kind of approach I think can’t be copied here in the United States.”
“Fifteen million people had to order food online. It was delivered,” Aylward said. “Yes, there were some screw-ups. But one woman said to me ‘every now and again there’s something missing from a package, but I haven’t lost any weight.'”
In America, in contrast, fears about quarantining have led to panic-buying supplies, and shortages of toilet paper. Huang says this wouldn’t be possible in China, since people wouldn’t be able to leave their homes to purchase supplies.
People quickly shifted jobs in order to assist during the outbreak.
When it came to the non-medical response, Aylward said there was a nationwide sense of solidarity with Hubei. Other provinces sent 40,000 medical workers to the center of the outbreak, many of whom were volunteers.
Workers in transportation, agriculture, and clerical positions were reassigned to new positions, too.
“A highway worker might take temperatures, deliver food, or become a contact tracer,” Aylward told the New York Times. “In one hospital, I met the woman teaching people how to gown up. I asked, ‘You’re the infection control expert?’ No, she was a receptionist. She’d learned.”
Chinese citizens did their part to curb the disease’s trajectory on an individual level, too, though we may never know the true scale of their complaints or sacrifices in this outbreak.
In contrast to reports in the US of people clamoring over the last hand-sanitizer, Aylward said he was struck by the attitude of people in China that they were all in this together.
“This is not a village,” he said of Wuhan, which is bigger than New York City. “As you drive into this city, in the dead of night, the lights on, it’s a ghost town. But behind every window and every skyscraper there are people cooperating with this response.”
Still, the human cost of this widespread compliance with China’s strict disease-fighting measures may never truly be known.
“Most Chinese people can’t get on Twitter or Facebook to tell their COVID-19 stories, as these and many other global platforms are blocked in China, and government censors speedily scrub away posts describing virus-related events on Chinese social media platforms,” Human Rights Watch China Researcher Yaqiu Wang wrote recently online. “Because it’s well-known in China that expressing criticism toward the government can bring you trouble, even long prison time.”
The country may punish people who don’t disclose that they’ve been to coronavirus hotspots around the world, with a social credit score downgrade.
One woman flew to Beijing recently from the US, and might’ve hidden some of her symptoms from authorities before she tested positive for the coronavirus, according to Chinese tech news site Abacus.
“Beijing police said Monday that the woman is under investigation and could be charged for impairing the prevention and control of infectious diseases,” Business Insider’s Isobel Asher Hamilton reported.
“I feel believe it’s important that we find the right balance between the maximum protection and minimum disruption to life,” said Huang, who studied China’s response to the 2003 SARS outbreak, which is widely critiqued. “It’s good to do the aggressive testing and let people know you know how dangerous this virus is, but you don’t want to create panic among the population and exert pressure to the existing system.”
China’s been lambasted in the past for its refusal to share information with its residents, and reports are emerging about the ways the Chinese government appeared to try and smother early talk about the new coronaviurs. “Effective communication and information sharing with the public is also crucial,” said Huang.