The novel coronavirus epidemic has reached a critical juncture. Steps taken over the next few days, particularly by Beijing’s leadership, will decide the fate of the virus and whether it spreads internationally to become a genuine pandemic. Time is short for the Chinese government to prevent a catastrophe.
Are China’s official reports, including claims that its control efforts are succeeding and the epidemic will soon peak, credible? Omens look bad. Once praised by the World Health Organization (WHO) and scientists worldwide for its quick, transparent response to the newly named COVID-19, China now faces international vilification and potential domestic unrest as it blunders through continued cover-ups, lies, and repression that have already failed to stop the virus and may well be fanning the flames of its spread.
Since the epidemic came to the world’s attention in early January it has been marked by startling moments when China’s health authorities announced dramatic surges in apparent cases of the disease, none more surprising than the sudden Feb. 12 adjustment that saw case numbers in Hubei province swell by 14,840 in a single day, pushing the national total to 59,804 cases. The adjustment, according to government officials, was due to a widening definition of the disease for just one place, Hubei Province, while authorities continue to limit their COVID-19 case descriptions elsewhere in China by a prior approach, counting smaller numbers.
The pneumonia death last week of China’s real epidemic hero, the ophthalmologist Li Wenliang, has revealed the ugliest side of the Chinese Communist Party (CCP) and its terrible effort to rewrite the history of a seemingly out-of-control epidemic. Li treated patients in December in Wuhan, where the outbreak originated, who looked like SARS cases, he told colleagues on Dec. 30 via a doctors’ social media chatroom. Days later, for the so-called crime of rumormongering, Li and seven other physicians were brought before China’s security police and compelled to sign a document admitting to “spreading lies.” For days, Wuhan authorities sought to stifle Li’s voice, but even after he caught the virus while treating his patients and was confined to an intensive care unit bed, he continued to sound epidemic alarms on the BBC World Service. On Feb. 6, the once-robust 34-year-old physician died. Li’s death opened the gates of political rage across China, sparking an unprecedented outpouring of grief and outrage, denouncing the government cover-up.
Some China watchers have likened the coronavirus crisis for Chinese President Xi Jinping to the threat the Chernobyl nuclear meltdown in 1986 posed to Mikhail Gorbachev’s hold on the Soviet Union. Others have likened the young martyred physician’s brave truth-telling to the legendary “Tank Man,” an anonymous citizen who stood, grocery bags in hand, before a line of Chinese tanks, blocking their entry into Beijing’s Tiananmen Square and their use to quell the 1989 pro-democracy student protests.
As the China expert Bill Bishop wrote last week in his daily Sinocism newsletter, “The Party’s social contract with the people—ensuring the people’s well being and providing ever-increasing economic prosperity—is being stressed on a nationwide level in ways I don’t recall in the past several decades.” He added: “Last Friday I wrote that ‘this is as close to an existential crisis for Xi and the Party that I think we have seen since [the Tiananmen massacre of] 1989’, and I think it is even more so a week later.” Just before I read Bishop’s assessment, I did a CBS News podcast with my former Council on Foreign Relations colleague Elizabeth Economy, one of the world’s top experts on Chinese politics. She, too, labeled Li’s death and apparent splits inside the CCP over how best to handle the epidemic as the most significant threat to his power Xi has faced and a critical test of the viability of the entire current leadership of the CCP. , which leaves China’s leader vulnerable to blame in times of catastrophe.
This is much more than inside-baseball Chinese politics. It matters deeply for businesses wondering how long the pain of China’s shutdown will last and for public health leaders worried about how they might handle the coronavirus should it spread inside their countries, states, or cities. It has spilled over onto WHO Director-General Tedros Adhanom Ghebreyesus, who has faced sharp criticism—even a recall petition—for his meetings with Xi and other Chinese leaders and his apparent reluctance to declare the outbreak a global health emergency.
For his part, Xi disappeared from public view the day after his January 27 meeting the WHO’s Ghebreyesus, not to be seen again for twelve days, when he briefly strolled through the Chaoyang district of Beijing, wearing a medical mask.
The political crisis in China is prompting global concern about the reliability of epidemic data released by the Chinese government, the usefulness of Chinese guidance regarding how the virus is spread and who is at risk for death, and the measures best taken to protect health care workers from falling victim to the disease they are trying to treat. Since the first Dec. 30 announcement of a new disease in Wuhan, the CCP has woven a tapestry of narratives, primarily for domestic political purposes, aligning official case and death numbers with the storylines. Meanwhile, the international health community, from WHO all the way down to academic statisticians and infectious diseases analysts, has tried to infer from the dubious official daily tallies just how dangerous the coronavirus disease may be for the rest of the world.
The bottom line is trust, which appears to be waning inside China and is increasingly unraveling across the public health world. An epidemic cannot be fought and won unless the bonds of trust between governments and people can survive the grief, confusions, emotions, and medical challenges of the battle. The Chinese government, in its negligence, has jeopardized those bonds, perhaps beyond all repair.
A security guard sits outside the closed Huanan Seafood Wholesale Market, which was linked to cases of coronavirus, in Wuhan, China, on Jan. 17. Getty Images
Between early December and Jan. 19, the chief Chinese Communist Party narrative from local officials in Wuhan, the epicenter of the epidemic, was that a very small number of people connected to a local live fish and animal market had become infected with a new virus, causing a few to be hospitalized with pneumonia. Whatever the cause of the sicknesses, it was not SARS or anything like SARS. All released data conveniently suited that narrative. Anybody who, like the physician Li, hinted at facts that countered the narrative was suppressed.
After the official announcement of the new disease on New Year’s Eve, a second narrative took flight, which argued that shutting down the live animal market had effectively eliminated the spread of the disease, as there was no evidence of human-to-human spread of the virus. For two weeks, the official case numbers barely budged and even decreased to 41. The message to the Chinese people was that there was nothing to worry about, local police and health officials had stopped an outbreak, job well done—a scenario accepted by WHO.
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. Throughout December and early January, about half of the coronavirus cases in Wuhan were entirely independent of the animal market, and the epidemic was doubling in size weekly. Researchers at Imperial College London reckoned that 1,723 people in Wuhan were infected by Jan. 12.
As international anxiety, doubting the containment narrative, grew, and evidence of human-to-human transmission of the virus became undeniable, Xi took steps to flush out information. Around the same time, a high-level CCP committee posted a WeChat message (later deleted) that denounced functionaries and bureaucrats who might be suppressing epidemic information, warning, “Whoever deliberately delays or conceals reporting for the sake of their own interests will be forever nailed to history’s pillar of shame.”
Not surprisingly, the official narrative suddenly changed, as did the tally of cases and deaths, quadrupling to 198 cases on Jan. 19. In the new narrative, the animal market was no longer mentioned, and Wuhan’s leaders poked fingers of blame at one another for pushing the prior story and put huge sections of the city of 11 million on lockdown. But with the Lunar New Year holidays approaching, and rampant fears of quarantine, millions of Wuhanese abandoned their city, fanning out to traditional family villages and other cities throughout China—many, unknowingly, taking the virus with them. Drawing from its SARS 2003 playbook, the Chinese government put the entire nation on a range of lockdowns, with Wuhan cut off from the rest of the world physically and, as would increasingly be the case for dissident and critical voices, also from the virtual world. Lunar New Year travel was discouraged; the holiday was lengthened nationwide to minimize the spread of the virus in schools and workplaces; and throughout Hubei province and neighboring regions, some 100 million people were encouraged to self-quarantine, staying inside their apartments and homes.
The virologist Guan Yi of the University of Hong Kong (HKU) warned that the containment strategy might fail and that a bigger outbreak was certain, which he said could conservatively be 10 times bigger than the SARS epidemic, meaning more than 8,000 cases.
Scientifically, the containment strategy rested on a crucial assumption: The virus could spread from one person to another only if the source had a fever. Temperature checkpoints were thus erected across the nation, along highways, at entrances to large buildings, at all points of transit, even in the hands of police patrolling urban streets hundreds of miles away from Wuhan. Trains, airplanes, buses, and highways were shut down entirely. By identifying every single person in China who was running a fever and placing them in quarantine, the virus would no longer spread, and soon the epidemic would be over.
But by Feb. 3, there was evidence that people who had no fevers, only mild forms of coronavirus illness, could pass the virus to others. And one such person might infect two—even four—other people. Not only could the virus spread through cough droplets, saliva, or nasal fluids, but feces also tested positive for contamination, raising the specter of oral/fecal transmission via handled, uncooked food. Worse, the duration of this mildly symptomatic, potentially infectious incubation period might be very long—up to 24 days. Suddenly, the coronavirus didn’t look much like SARS, which had an incubation time of about three days and was only infectious from febrile individuals. No, this new virus looked more like influenza, which can be spread from a person with no symptoms to another via a handshake or shared airspace. But even then, the comparison fails because few people incubate flu for more than 24 hours, much less 24 days.
By late January, Wuhan was a ghost town, with hardly a person or vehicle to be seen, its entire population having either deserted the city or hunkered down in homebound quarantine. Yet the virus continued to claim new victims, and Xi warned the nation of its “accelerating spread.” As the containment narrative proved fallible, and cities beyond Wuhan began to experience the frightening spread of the disease, the CCP turned to another familiar playbook: elevating the police state.
Overnight, gymnasiums, sports arenas, hotels, university dormitories, convention centers, and other large facilities were transformed into holding centers in which thousands of beds were placed in long rows and food, toiletries, and regular fever checks were provided to the thousands of people placed under quarantine inside. There was no question that these weren’t hospitals—many held within these makeshift quarantine facilities complained that they were never tested for infection but were warehoused and compelled to share shower and toilet facilities with hundreds of other, possibly infected, people.
Workers set up beds at an exhibition center that was converted into a hospital in preparation for coronavirus patients in Wuhan on Feb. 4. STR/AFP via Getty Images
As anxiety rose, Xi tried to shift blame, naming to head up the epidemic response and dispatching Premier Li Keqiang to Wuhan. Xi lashed out against “untruthful speech,” focusing on those who were using Weibo and other social media to cast doubts on the containment policy and bemoan their confinements. And he forwarded an added narrative, blaming the U.S. government for China’s plight. On Jan. 30, the same day that WHO declared the epidemic a public health emergency of international concern, Secretary of State Mike Pompeo issued a travel advisory to Americans, warning against visiting China. During the first week of February, the restrictions placed on U.S. airlines, airports, Chinese immigrants, travelers reentering the United States, and trade in key goods between the nations mounted.
By Feb. 3, hospitals all over China were reporting shortages of test kits, forcing a large reduction in diagnosis and the reporting of cases. A medical academic and a member of the high-level expert team put together by the Chinese National Health Commission warned: “Early detection, early diagnosis, early isolation, and early treatment cannot be done in Wuhan at this time. I hope that the country will support Wuhan.”
That same day, the Standing Committee of the Political Bureau of the CCP Central Committee held a meeting, formulating a new narrative: that the epidemic was out of control because of poor management. The CCP would now lead a “people’s war” against the virus, clamping down even harder on quarantines and rumors. The epidemic ought to be easy to control, given 80 percent of its victims were over 60 years of age, 75 percent had bodies weakened by some other health condition, and, curiously, very few were children and 66 percent were men, according to the new official datasets.
In a plea for patriotism, the CCP urged people to identify ailing neighbors and turn them into authorities. Eventually, in at least one town, payments were promised, equivalent to about a third of an average Chinese adult’s monthly income. The identified were removed—sometimes forcibly—from their homes and placed in makeshift field hospitals set up in schools and sports facilities. As international experts questioned whether the virus could be stopped, Beijing threw more resources to the warehousing of suspected cases and hospitalization of those with pneumonia.
But by Feb. 5, the funeral parlors and crematoriums were reported to be having problems keeping up with the disposal of the dead in Wuhan. Though no data was provided to address the matter, Wuhan’s lockdown was endangering not only the lives of coronavirus-infected individuals but also those of thousands of people who required medications and occasional treatment for such things as HIV infection, kidney disease, diabetes, and hypertension. Hospitals no longer welcomed them, medicines were running out, yet there is no count of their numbers or deaths.
Across Hubei, hospitals were by the end of the first week of February running out of beds, respirators, and oxygen and pneumonia support equipment. As more cities saw their case numbers soar, they followed Wuhan’s lockdown and quarantine strategy. On Feb. 14, China’s National Health Commission finally acknowledged the toll COVID-19 was taking on healthcare workers, saying 1,716 of them had been infected on the job, and six had died of the pneumonia disease.
A photo of the late ophthalmologist Li Wenliang rests among bouquets at the Houhu Branch of Wuhan Central Hospital on Feb. 7. STR/AFP via Getty Images
Then, on Feb. 6, Li Wenliang died of the coronavirus disease, sparking an outcry from across the nation, filled with undeniable rage. The government responded to the outpouring of grief and anger by censoring social media posting and blocking accounts. Cecilia Wang—a Shanghai-based reporter for the Economist—tweeted in real time a scrubbing operation unfolding on Chinese social media, as comments about the government’s handling of the epidemic were erased from digital history. On Feb. 8, it was reported that Xi had appointed his protégé Chen Yixin, a man with no medical or scientific background, as second in command of the team in charge of handling the epidemic crisis in Hubei. Chen’s expertise is law enforcement, and he heads China’s most powerful domestic security commission. As Chen swept into Wuhan, heads rolled among the preexisting Hubei and Wuhan epidemic leadership.
On Feb. 9, the official numbers showed a slowing in new case reports—a trend that would persist until the enormous Feb. 12 spike in numbers. During this three-day window, two new narratives emerged. First, that the epidemic had reached its peak. And second, that it was time for the nation to get back to work, restoring the Chinese economy.
But stability was hardly anywhere to be found across the country. In one of the hardest-hit cities in China, Huanggang, the local CCP leader said the municipality could test only 900 people a day. A citywide search identified 13,000 fever patients. Fatality rates, according to the Chinese Center for Disease Control and Prevention (CDC), varied across the nation, with 4 percent of those sick with the coronavirus disease dying in Wuhan and 5 percent of cases proving lethal in Tianmen. But it was difficult to ascribe credibility to those estimates because nobody really knew the baseline—how many people were infected. , meaning some labs were missing half of all infections.
As the makeshift quarantine facilities filled, questions arose about their safety, as people were stacked side by side and shared toilet facilities. There was clear evidence that the coronavirus disease could be spread via feces or the off-gassing from overused toilets and taxed plumbing.
On Feb. 10, Xi sacked two of Hubei’s top health officials, amid claims that the virus could sicken 5 percent of Wuhan’s population, or half a million people. Three days later, Hubei’s party secretary was replaced by a Xi loyalist.
A train attendant gestures support to medical staff as they leave for Wuhan in Nanchang, in China’s Jiangxi province, on Feb. 13. STR/AFP via Getty Images
Wu Zunyou is the chief epidemiologist for China’s CDC, ultimately responsible for estimating and counting the toll of the coronavirus epidemic. On Feb. 13, he spoke with Howard Bauchner, the editor in chief of the Journal of the American Medical Association, defending the accuracy of China’s epidemic numbers. Admitting that diagnostic kits were in short supply and could be difficult to use, he nevertheless insisted that the epidemic was winding down. As more of the infected come to the end of their incubation periods, Wu argued, transmission will slow, and it will be clear that China’s control methods have, indeed, worked.
Robert Redfield, who heads the U.S. Centers for Disease Control and Prevention, told CNN this week that he was far less optimistic. “Right now we’re in an aggressive containment mode,” Redfield said. “We don’t know a lot about this virus. This virus is probably with us beyond this season, beyond this year, and I think eventually the virus will find a foothold and we will get community-based transmission.”
In Geneva this week, some 400 top infectious diseases experts gathered to help WHO solve the many mysteries that still surround the virus. One of them was Hong Kong University’s Gabriel Leung, who does not think China’s strategy will succeed and fears that as schools reopen and millions of people return to Wuhan and other locked-down cities, the virus could, once again, surge. And it could spread far beyond China’s borders, possibly infecting more than 60 percent of the world population.
Even if the coronavirus disease kills only 1 percent of its victims, 1 percent of 60 percent of 7 billion people is a staggering death toll, placing the coronavirus alongside the three biggest pandemics of human history—the 14th-century plague, the 1918 influenza, and the current HIV/AIDS toll.
I prefer to believe that humanity will contain the coronavirus to a far less horrible level for long enough to develop an effective vaccine. But this will require a massive effort over long stretches of time. Novel vaccines require years of research and testing.
Unfortunately, China is showing how all this can go wrong, making a crisis into a catastrophe. Xi’s government has provided the world with reams of data, but their credibility, or lack thereof, is inextricably bound to the CCP’s methods of governance, censorship, intimidation, and toadyism. The rest of the world is left to prognosticate and prepare without really knowing what havoc the coronavirus enemy is capable of wreaking.