Beating down a highly contagious virus like Covid-19 isn’t easy. Obviously, if everyone in the USA could self-isolate for 14 days, the virus would ‘die’ for want of a host. Short of that, a comprehensive suite of mitigation measures is necessary. Here in the USA we’ve focused on social distancing — where we’ve applied mitigation measures at all — as well as horribly inadequate testing and some contact tracing, hand-washing and some recent lukewarm endorsement of home-made ‘masks’. These efforts have mostly been halfheartedly and haphazardly enforced and observed, and it remains to be seen if we will be successful. We are also losing many lives due to the inadequate preparation for and response to this crisis.
China did it differently.
While there is considerable doubt about the accuracy of the Covid-19 infection data coming out of China, one fact is abundantly clear: China beat down the virus in Wuhan city and Hubei province. No, they haven’t beaten it (nor did they manage to contain it), and it remains to be seen if the ongoing ‘opening up’ of the city and province will result in a second wave, but they beat down the first wave.
Are there lessons to be learned from how they did it? Let’s see…..
The WHO investigated and in late February released a report on China’s actions in dealing with their outbreak of Covid-19. It’s fascinating reading, and here’s the excerpt that is germane to this diary:
In the face of a previously unknown virus, China has rolled out perhaps the most
ambitious, agile and aggressive disease containment effort in history. The strategy
that underpinned this containment effort was initially a national approach that
promoted universal temperature monitoring, masking, and hand washing. However, as the outbreak evolved, and knowledge was gained, a science and risk-based approach was taken to tailor implementation. Specific containment measures were adjusted to the provincial, county and even community context, the capacity of the setting, and the nature of novel coronavirus transmission there.
China has apparently not released any useful data on its Covid-19 testing, but considering the first test was developed in Germany and wasn’t available until January 20 (through the WHO…. the test the USA spurned in favor of our faulty homegrown test), they couldn’t have tested too many people within a month. The only data I found shows that in Guangdong province, 320,000 tests were conducted by February 28. So testing only did for China essentially what it is doing for the USA: separating the already-symptomatic Covid-19 cases from those with other fever-related diseases. That’s worth doing, but by the time you get sick enough to go to the hospital, you’ve been infected and contagious for 5 or more days.
So what did China do that we haven’t?
First: MASKS, MASKS, MASKS. Just about everybody in every picture or video I’ve seen from China since this started has been wearing a mask. Of course, that wasn’t a big deal for most Chinese people, as masks have been commonplace for years because of air pollution.
There’s been a lot of talk lately about whether masks of different types are effective against Covid-19. My take is that the better the mask, the more effective, but as long as you wear it properly, it will decrease your chances of inhaling a bit of the virus if it’s in the air in front of you. More importantly, if you are infected, you will be shedding less virus — again, possibly not zero virus, but less is better, right? Again from the WHO report:
In China, human-to-human transmission of the COVID-19 virus is largely occurring in
families…. Among 344 clusters involving 1308 cases (out of a total 1836 cases reported) in Guangdong
Province and Sichuan Province, most clusters (78%-85%) have occurred in families.
Why is that happening? Because home is where you take your mask off.
Bottom line: masks were a big part of what worked in China.
Second: universal temperature monitoring. Look at the picture at the top — everybody getting on a train is being remotely fever screened. I’ve read a lot of reports and seen a lot of interviews and stories that indicate this happens all over China, all the time.CNN showed video of cops on the street in Wuhan with remote temperature sensors mounted on their helmets, checking the temperatures of people walking down the street.
During the height of the outbreak, there were 12,000 teams of health workers in Hubei province conducting random fever checks. People with a fever were isolated immediately, then tested and quarantined or treated as indicated.
Again, that’s not perfect, but it’s pretty obvious that the sooner in the infection cycle you can isolate the infected person, the fewer people that person will pass the virus to.
Third: Contact tracing on a massive scale:
China has a policy of meticulous case and contact identification for COVID-19. For example, in Wuhan more than 1800 teams of epidemiologists, with a minimum of 5 people/team, are tracing tens of thousands of contacts a day. Contact follow up is painstaking, with a high percentage of identified close contacts completing medical observation.
I have read stories of investigations into some clusters in the USA, but have seen no indication that any significant number of cases are being effectively contact-traced. I suspect that is happening more in the less-affected parts of the country, but certainly nothing on the scale that was employed in China.
In summary, the USA is implementing a far less effective set of mitigations than China did. We obviously haven’t achieved China’s results in beating down the virus, but will our efforts work at all?
NOTE: This diary is NOT an endorsement of China, its government, its society or its actions in this crisis or generally. Those are different debates, for a different time and diary.
Cheers.