How China Controlled the Coronavirus
“The strict Chinese shutdown, in combination with border closings and contact tracing, had eliminated the spread of the virus in most communities. February 20th, the day of my lockdown trip to campus, turned out to be the last day that the Chengdu authorities reported a symptomatic case from community spread. The city has a population of about sixteen million, but since late February there have been only seventy-one symptomatic cases, all of them imported. Virtually every case has involved a Chinese citizen who arrived on an international flight and proceeded directly from the airport to treatment and quarantine. Chengdu’s success was typical in China. In one of my surveys, I asked students if they personally knew anybody who had been infected. None of them did.
While officials seemed to have faith in the economic resourcefulness of citizens, the approach to public health was completely different. Very little was left to individual choice or responsibility. The lockdown had been strictly enforced, and any infected person was immediately removed from his or her household and isolated in a government clinic. By early April, all travellers who entered from abroad, regardless of nationality, had to undergo a strictly monitored two-week quarantine in a state-approved facility.
…I occasionally saw the Chinese term for social distancing—anquan juli—on official notices, but I never heard anybody actually say the phrase. Certainly it wasn’t practiced in public. Once the lockdown ended, subways, buses, and trains quickly became crowded; during my trip to Hangzhou, I flew on an Airbus A321, and all of the hundred and eighty-five seats were occupied. When I interviewed people involved in business or diplomacy, we shook hands like it was 2019. Pedestrians still spat on the street. Mask-wearing remained mandatory indoors and on transport, but otherwise little had changed about human contact.
…Initially, the mask-wearing was enthusiastic. On the first day of music class, my daughters were shown how to play the recorder while masked—they lifted the bottom hem and shoved the instrument inside. During school pickup, I saw teachers who had rigged up masks with external microphones that connected to portable speakers on their hips. But, in the middle of May, the Chinese Ministry of Education declared that students no longer needed to cover their faces if they were in low-risk areas, and our school relaxed the rules. Some teachers stopped wearing masks, although nearly all of the children kept them on.
… Epidemiologists told me that temperature checks, though useful, represent a crude tool, and they generally believe that social distancing is more effective than mask use. One epidemiologist in Shanghai told me that people should wear face coverings, but he noted that there are no data on the level of effectiveness as public policy, because mask use could also affect behavior. And, while Chinese officials required citizens to wear masks from the beginning of the lockdown, they didn’t actually depend much on them. China never allowed residents to move freely in a community with significant viral spread, hoping that masks, social distancing, and good judgment would reduce infections.
Instead, the strategy was to enforce a lockdown until the virus was eliminated. The elementary school never bothered with more effective but disruptive policies—reducing class size, remodelling facilities, instituting outdoor learning—because the virus was not spreading in Chengdu. And, while the government hadn’t trusted people to set the terms of their own behavior during lockdown, it did depend heavily on their willingness to work hard for various organizations that fought the pandemic.
… A number of my students, including Serena, researched neighborhood committees in their home towns. Serena took her usual dogged approach—for much of two months, she spent two or three days a week with a local committee. She told me that, before the pandemic, she hadn’t even been aware that these organizations existed. They were like ancient organisms gone dormant: back in the eighties and nineties, when the Party interfered more in private lives, neighborhood committees had been prominent. But there had been a long period during which they played a diminished role for most residents. After President Xi Jinping came to power, in 2012, he set about strengthening Party structures, including a new emphasis on neighborhood committees. This process was accelerated by the pandemic, and Serena and other students observed how quickly these organizations grew in their communities. With new government funding, committees hired contract workers, some of whom were local shop owners who had been forced to close down. Neighborhood crews went door to door, giving out information, questioning residents to see if they had been to high-risk areas, and helping with contact tracing.”
Contact tracing at scale and detail: “At a party a week earlier, Liu had had a long conversation with a d.j., who, it was later learned, had been infected by someone from Hubei. Liu was thirty-five, single, and highly energetic. The details of his post-contact movements are listed on a public WeChat account maintained by the city government. In China, such case histories are often available, as resources for local residents. Liu’s case history notes that, during the first three days after he is unknowingly infected, he visits a bar, a store, two pharmacies, three gas stations, and six restaurants. Liu’s tastes are eclectic, ranging from a pancake restaurant to a frog-and-fish-head restaurant. He picks up a friend named Huang, and he visits his elderly parents. He goes to work. He gets a fever. Post-fever, Liu hops over to a few more pharmacies, and then he keeps going: he picks up a friend named Li; he visits his parents again; he goes to another party. On the WeChat account, Liu is the Liupold Bloom of northeastern Sichuan, with every step of his urban odyssey recorded in terrifying detail. When is this guy going to stop?
Such meticulous case histories were prepared by contact tracers who worked under the direction of the Chinese Center for Disease Control. There are about three thousand C.D.C. branches in China, each branch containing roughly a hundred to a hundred and fifty staff members. Despite these numbers, the Chinese C.D.C. has traditionally been underfunded, like Chinese public health in general.
Approximately ten thousand contact tracers worked in Wuhan, where more than eighty per cent of China’s deaths occurred. Epidemiologists told me that the tracers were divided into teams of between five and seven, with each group directed by an individual who had formal training in public health. Other team members might have no health background, but they came out of the same detail-oriented national educational system that had produced my students, and they often had local knowledge. Many tracers worked for neighborhood committees or other government organizations, including the police. As the virus spread, tracing teams were established across the country, and the C.D.C. recruited others who had technical expertise.”
Surprising restraint on flouting data privacy: “… By then, many overseas students and others were coming home. It would have been useful to know exactly where they had been, so Jiang wrote a proposal requesting that Tencent, the company that owns WeChat, provide the I.P. log-in information for returnees. “They rejected me because of the data privacy,” he said. He was told that Tencent was adamantly opposed to its data’s being used in this fashion.
…he showed me how our phones automatically sensed each other via Bluetooth. Such data could be used to figure out who had been in close proximity to an infected person. In another C.D.C. work meeting, a colleague of Jiang’s suggested using this tool. But her idea was quickly dismissed. “They said, ‘This is a violation of data protection. We can’t do that,’ ” Jiang explained. “It was surprising to me.”
It surprised me, too—given the heavy-handed tactics of many lockdown policies, I had assumed that the government used any tools available. But there seemed to have been some resistance from prominent tech companies. Tencent and Alibaba helped the government develop “health code” apps that assist in monitoring and controlling the virus’s spread among citizens, but these tools are much less sophisticated than programs used in South Korea and Singapore. In Europe, virus-alert apps based on software developed by Google and Apple have been downloaded by millions of users, and the apps rely on Bluetooth signals to detect close contact with infected individuals.
In some parts of China, the health-code apps register a change in a user’s location largely through a manual data transfer: if the user checks in with his I.D. at an airport, for example, or if his license plate is recorded at a toll booth. An epidemiologist in Shanghai told me that one Chinese city with a flourishing tech industry had commissioned the development of a much better tool that combines G.P.S. data and artificial intelligence to alert anyone who comes into the proximity of an infected person. “But that system was never implemented, even in that city,” the epidemiologist, who asked not to be identified, said. “It could not get approval from somewhere in the government system because of data privacy.”
Jiang Xilin told me that, when the proposals to use automated data collection were rejected, the other C.D.C. researchers grumbled. But then they buckled down and continued to do the hard legwork of phone calls and face-to-face interviews. The C.D.C. policy is that, whenever a new case appears, contact tracers are called immediately, even in the middle of the night. They are given eight hours to complete the tracing.”
Scale of testing: “In June, after Beijing had reported no locally transmitted cases for fifty-six days, there was a sudden outbreak at a wholesale produce market called Xinfadi. The epidemiologist in Shanghai told me that the place was well managed: masks were required, and anybody who entered had to show his health code and have his temperature taken. Even so, more than three hundred people were infected, and all the warning systems had failed to catch it in the early stages. The first alert came when a man in his fifties felt sick and went to a hospital to request a test. It was another example of old science: effective public communication. The man not only recognized his symptoms but travelled to the hospital by bicycle, as officially recommended, in order to avoid infecting others on public transport. Afterward, the government locked down parts of Beijing, and, within a month, nearly twelve million residents were given swab tests. The city had the capacity to test four hundred thousand people per day.”
Comparison with the American approach: “As the spring wore on, conversations often included a standard conclusion: the pandemic showed that Chinese value life over freedom, whereas Americans take the opposite approach. I disliked such simplifications, which failed to consider the initial Chinese coverup of the virus, or the government’s policies in Xinjiang and Hong Kong, or the fact that any number of democracies were handling the crisis much better than the Americans. (Also, the U.S. doesn’t have state-owned tobacco firms that engage in mask ’n’ Marlboro promotions.) I tried to convey the idea that the current American failure doesn’t narrowly reflect national character or values but, rather, a collapse of system: a crisis of leadership and institutional structures.
Despite the political indoctrination involved in Chinese schooling, the system teaches people to respect science. Hard work is another core value, and somehow society has become more prosperous without losing its edge. Nearly a quarter century ago, I taught young people who were driven by the desire to escape poverty; these days, my middle-class students seem to work at least as hard, because of the extreme competitiveness of their environment. Such qualities are perfect for fighting the pandemic, at least when channelled effectively by government structures. In comparison, the American response often appears passive—even enlightened citizens seem to believe that obeying lockdown orders and wearing masks in public is enough. But any attempt to control the virus requires active, organized effort, and there needs to be strong institutional direction.”