Had China not been so strict about Wuhan, coronavirus would have stayed in Wuhan

In The Coronavirus, Swapneil Parikh, Maherra Desai and Rajesh Parikh write about the days to disaster in Wuhan and how the virus spread because China wanted to keep mum.

A cyclist wearing a protective mask rides past a banner of Chinese president Xi Jinping in Shanghai | Representational image | Qilai Shen | Bloomberg

If you want to keep a secret, you must also hide it from yourself.
—George Orwell

Located in central China, 650 miles south of Beijing and 430 miles west of Shanghai, Wuhan has a rich cultural history spanning over 3500 years. Strategically positioned at the intersection of the Yangtze river and its most important tributary, the Han, Wuhan has been an important transportation hub over centuries, much like Chicago is to the US. Most of China’s major train routes pass through the city. Wuhan Tianhe International Airport is the only airport in the central mainland to have direct flights to five continents and over 120 destinations. It is also well connected by highways throughout the country’s nine provinces.

Anticipation of the weeklong holiday marking the Chinese Lunar New Year in January makes workers toil harder through the months of November and December. With the festivities scheduled to begin on 17 January 2020, the last quarter of 2019 was no different. Everyone was looking forward to wrapping up work and going back to the family, an indulgence many Chinese citizens enjoy just once a year.

This was the case at Huanan Seafood Market in Jianghan district. With a retail space of over 50,000 square metres, this is the largest wholesale seafood market in all of central China. With over a thousand vendors, stalls are compactly packed together in the market complex. Along with seafood, other animal products were also sold, some of which were illegally traded after being smuggled from overseas. Chinese dietary habits include consuming exotic animal meat purchased from wet markets, where the live animal is inspected before being slaughtered.

Amidst the banter, bargaining and the sale of animal products, sometime in mid-November, a virus made the leap from animals to patient zero, a hitherto unidentified human. Over the next few weeks, it spread to dozens of individuals. There are accounts of patients reporting symptoms as early as 8 December 2019. As multiple reports of unexplained pneumonia cases surfaced, health authorities alerted the Chinese officials, but were silenced. One amongst these was Dr Li Wenliang, a thirty-four-year-old eye specialist who noticed that the hospital he worked at was quarantining several patients with SARS-like symptoms. The Communist Party of China came down heavily on any citizen who deviated from the official narrative. They wanted to control the information available to people.

Finally, with the situation growing out of control, the Chinese authorities announced the illness to the world on 31 December 2019, roughly six weeks after the first animal-to-human transmission. Compared to the SARS outbreak of 2002–03, where China concealed the epidemic for almost three months, this was a relatively prompt response.

On 1 January 2020, the US CDC identified that a wet animal’s market was responsible for the outbreak. Chinese officials reported that over half of these pneumonia cases traced back to the Huanan Seafood Market and immediately downed shutters. By the first week of January, hospitals in Wuhan were already reaching capacity. Meanwhile, Chinese authorities downplayed the situation to their citizens and citizens were comforted that the situation was under control. In the absence of adequate  information  about  the  virus, the WHO, on 5 January, issued a statement encouraging global travel and trade to continue with China. These initial lapses resulted in insufficient precautionary and preventive measures, and jeopardized medical personnel and the public.

On 11 January, China reported fresh numbers that baffled the world. It dropped its infected cases down to forty-one, as opposed to its earlier count of sixty while reporting the first death. Amidst reports of four suspected cases at Thailand’s Chiang Mai International Airport a few days before this announcement, the reduced numbers did not add up. Soon, Thailand and Japan confirmed cases of coronavirus in people who had recently returned from Wuhan, suggesting that the virus had commenced its international journey.

By 20 January, China announced over 200 infected cases and three deaths due to the virus, unleashing fear and panic. For the first time, a Chinese expert revealed that fourteen medical workers had been infected by a single patient, suggesting high rates of human-to-human transmission of the virus. This was confirmed when, over the next ten days, eighteen countries reported confirmed cases, including South Korea, US, Australia, Singapore, Canada, Nepal, Mexico, France, Taiwan, Sri Lanka and India.

A few days short of the country’s grandest festivities, Chinese President Xi Jinping announced a nationwide effort to contain the virus. By 22 January, in just two days, the numbers had more than doubled, with 500 infected cases and seventeen deaths in the country. Immediately, China’s Henan province, neighbouring Hubei province, announced a ban on the sale of live poultry. Next day, Beijing officially cancelled all Chinese New Year celebrations. Travel to and from Wuhan, Huanggang and Ezhou was banned. Wuhan’s three main railway stations, its thirteen bus stations, 251 ferry services, most of the city bus lines and its entire subway network services were suspended indefinitely. Major highways were blocked and the military took over. The transmission rate was estimated at 1.4–2.5 per infected patient. The only way to control the epidemic was to impose quarantine. Travel restrictions were placed on seven more cities.

But it was already too late. In the weeks before the travel ban, many thousands had already travelled overseas, a trend commonly seen that time of the year in China. In the eight-hour window between the announcement and implementation of the ban, millions of Chinese fled the city to be with their families for the Lunar New Year. Wuhan Railways reported that over 300,000 people had travelled out of Wuhan on 22 January itself, many of whom may have been infected and carried the virus with them. The Lancet estimated that over 5 million people left Wuhan before the citywide quarantine.

On 24 January, the eve of the Chinese New Year, 450 military medical staff entered Wuhan. Trained in combating viral respiratory infections like SARS and Ebola, they were sent by the Communist Party of China to contain the situation.

The number of people infected was doubling every 6.4 days. As the number of cases increased, so did the pressure on the hospitals. Even if patients somehow reached hospitals, there were long queues and overcrowded lobbies, with hundreds of sick patients in close proximity. The hospitals themselves were hotspots for the spread of the infection. All beds being taken, thousands were sent back. Those suspected of mild symptoms were asked to quarantine themselves at home, without elaborate details on precautionary measures to be undertaken. Infections between family members became rampant.

Chinese authorities swiftly mobilized national resources. In Wuhan, over 6000 workers constructed a 1000-bed hospital to treat 2019-nCoV-infected patients in ten days. 

Various restrictions were placed on citizens in different regions. These ranged from random temperature screenings on the road,  to regular screenings at the lobby of each building in high-risk areas, to house arrest. In most of Hubei, only one member of each family could go out once in two days to purchase basic necessities.

By February, Vice Premier Sun Chunlan ordered door-to-door checks, rounding up of the sick and warehousing them in massive quarantine centres. Drones and robots disinfected spaces.

The Chinese government was setting restrictions and control that were impossible for most countries to implement. These actions, while containing the spread, had devastating effects on many people. Li Jing, a professor at Zhejiang University, Hangzhou, could not take her husband, who had choked on a fishbone, to a hospital. Her neighbourhood permitted only one family member to leave the house each day. Had she not convinced the officials that night, she might have lost her husband. Yan Cheng, a teenager with severe cerebral palsy, was separated from his father and younger brother who were taken into quarantine. Unable to move, talk or care for himself, he was left under the care of village cadres and doctors. On 28 January, his father took to Weibo, the Chinese version of Twitter, writing that his son was alone and needed care. Censors deleted the message. A day later, Yan Cheng died.

On 3 February, the numbers exceeded 20,000, whereas by 7 February, global infections exceeded 30,000, with over 630 deaths.

The dearth of independent news sources in China, along with the tight control on the media, led to the emergence of citizen journalists like Chen Qiushi and Fang Bin. Their videos display the fear, grief and dissatisfaction with governance of Wuhan residents. [They both disappeared].

Alongside the battle between freedom and censorship, there were other battles raging in China. The biggest of these was the global battle that researchers, physicians and citizens were engaged in against the virus.

Another battle was between resources and the disease. As more patients poured in with symptoms, exhibition halls and sports arenas were converted into temporary medical centres. Another 1600-bed hospital, Leishenshan Hospital, was constructed in just twelve days in Wuhan. Along with the Huoshenshan Hospital, 3400 military medics were serving 2600 beds across both these facilities. Supplies of protective medical clothing and masks were running out. When officials in Xiantao city prohibited factories (which manufacture these medical supplies) from reopening until 14 February, it led to pandemonium. City officials conceded and seventy-three companies reopened on 10 February.

By 10 February, the death toll had surpassed those due to the 2002–03 SARS infection, with over 900 dying in China itself, and over 40,000 infected. Almost 15,000 new cases were reported in a single day, which caused a 33 per cent increase in the total reported cases.

On 14 February, for the first time, Chinese authorities disclosed that 1716 healthcare workers had been infected, of whom six had died. Reports on social media revealed that Wuhan’s healthcare workers were fighting not only the new coronavirus but also dire shortages. Tape was used to patch up battered protective masks and one-time-use goggles were repeatedly reused. Plastic bags served as specialized protection for footwear. Multiple road checks and travel limitations held up fresh supplies. Manufacturing of new supplies was held up amidst staff shortages and inability to procure raw materials. Healthcare workers limited themselves to just one break through the day, meals and toilet combined, for fear of not having a fresh set of protective equipment when they returned. Nurses shaved their heads because they feared long hair might transmit infection. Others, to save protective equipment and maximize time spent caring for their patients, used diapers and took only one toilet break every twelve hours.

Chinese officials came up with innovative strategies to contain the outbreak. In many provinces, citizens were rewarded anywhere between RMB 500 (roughly $72) to RMB 2000 (roughly $290), for reporting individuals who did not comply with the quarantine orders, with a recent travel history to Wuhan or those running fevers. Another technique involved web-based applications that determined an individual’s level of risk and subsequently, the quarantine measures required. Apps like Alibaba assigned colour codes to individuals—red, yellow or green, from high risk to moderate to safe, based on basic information they provided. From some of these apps, information went back to the Chinese officials for monitoring. The message was loud and clear— the quarantine would be in full force under all circumstances.

By 19 February, over 75,000 infections had been confirmed, the death toll had exceeded 2000  and cases were reported in twenty-six countries. Chinese authorities announced that, for the first time, the newly recovered patients exceeded the number of new confirmed cases in the day.

However, thousands of new cases were being reported daily. With the lockdown being implemented rigorously and contact tracing for infected individuals being carried out extensively, Chinese citizens were reaching the limit of their patience. They witnessed those close to them succumb while they were locked up in their houses for almost four weeks.

Yet, hope gleamed. The number of new cases reported daily dropped. As China lifts restrictions, and workers go back to their jobs, will the virus spread again? Is the worst over for China or still to come? Time will tell.

Other researchers fear that cases are going undetected in some countries, especially those with weak healthcare systems. Researching flight data of outward-bound flights from Wuhan for January 2020, many models predict that the virus should have had a wider spread than reported in many countries.

Unfortunately for the world and much to the dismay of the Chinese politburo, both the disease and the information they sought to suppress went viral. Perhaps, like a paradoxical Zen kōan, had the Chinese government not tried so heavy-handedly to contain what happened in Wuhan, it just might have stayed in Wuhan.

This excerpt from The Coronavirus by Dr Swapneil Parikh, Maherra Desai and Dr Rajesh Parikh has been published with permission from Penguin Random House India.