Context

China’s handling of coronavirus, in contrast to SARS, has been effective, should be a template for others.

Why lockdown of Wuhan is a big deal?

• A move without precedent: China’s lockdown of roughly 60 million people in Wuhan and other cities in Hubei province for more than a month now is without precedent in the history of public health.
• Best way to stop the virus from spreading: The best way to stop a virus from spreading from person to person, is to give it no place to spread to.
  • This is achieved by isolating those who are infected and quarantining those who might be infected.
• Cordon sanitaire: In China, though, the control has moved beyond traditional quarantine to a cordon sanitaire-an exclusion zone people cannot travel into or get out of.
  • In most countries, this simply would not work for a period this long and a population that large.
• Inconceivable move in other places: Wuhan is a city of 11 million people, slightly larger than Chennai or Bengaluru. It would be inconceivable to think of cutting off transportation in and out of these cities or asking people to stay at home for even a day, let alone a month.
  • No political control nor administrative mechanism: Like India, most countries in the world have neither the political control to impose their will on people this way nor the administrative mechanism to enforce this degree of control.

Human cost and ethic of the lockdown

• The human cost: The human cost of such a strategy is immense.
  • Feeling of being unable to escape: The fear induced by being unable to escape from a place where a new virus is circulating is immense.
  • The worries and stresses of everyday life multiply one hundred-fold when everything from shopping for food to occupying children stuck at home becomes a challenge.
  • The slightest cough, cold or fever can trigger panic.
• Ethics involved in the move: The ethics of the cordon sanitaire in Wuhan, as well as the quarantining by Japanese authorities of the cruise ship Diamond Princess, will be debated for years after this particular outbreak is over.
• Slowing the spread: But whatever its human and financial cost, China’s actions in the first month of the outbreak helped to slow the spread of the virus within the country as well as internationally.

How China’s response this time is different from the SARS

• On December 31, the Chinese government informed the WHO, and the world, of the existence of a form of pneumonia of unknown cause
  • It also told the people of Wuhan to wear masks if they had symptoms and seek medical attention.
• Virus identification: For the world, the big breakthrough from China came on January 7, when researchers in Wuhan identified the virus as a new coronavirus.
• Sharing of the genetic sequence of the virus: Two days later, China shared its genetic sequence with the world.
  • How genetic sequence helped? The sharing of the genetic sequence allowed labs all over the world to develop testing kits to detect the disease.
  • It also put countries on the alert for travellers with the disease, without which the new coronavirus would have spread much quicker and farther than it has so far.
• China’s response to SARS: The Chinese response to SARS in 2003, in contrast to this, was a cover-up.
  • The disease circulated for nearly three months, enabled by government secrecy and censorship.
  • Spread of disease without warning: When travellers from China brought the disease first to Hong Kong and from there to other cities across the globe, there was no warning.
  • It was only after the disease spread in Hong Kong, that scientists and public health experts began to decipher this new virus.
  • Lessons learned: China, fortunately, learned the lessons for SARS and put together systems to identify and respond to this new disease quickly.

What India can learn from China

• Infrastructure with speed: Public health officials all over the world, including in India, should study the speed with which China put together an infrastructure to deal with this new disease.
  • Modern, well-equipped hospitals dedicated to coronavirus patients were constructed in weeks.
• Centralised information and logistic system: Centralised information and logistics systems and systems to ensure coordination between multiple levels of government -from the central government to provincial and municipal governments, were put into place.
  • All the systems seem to have worked reasonably smoothly, given the chaotic and complex atmosphere of a disease outbreak.
• Unique approach: The way China has tackled this disease has been an “all of government, all of the society approach”, in the words of Bruce Aylward, the leader of the WHO team that recently spent two weeks in the country.
  • It was, as he described it, “a very old-fashioned approach”, but one that had “prevented at least tens of thousands, but probably hundreds of thousands of cases.”

Conclusion

• In all probability, it is only a matter of time before India sees new cases. The Indian health system, as in China, is multi-layered. Some states like Kerala have strong public health infrastructure and a strong response capability. Many other states like Uttar Pradesh and Bihar do not have strong public health systems. They will find it difficult to respond and will learn that diseases, like the revolution, can be brutal.

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