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COVID-19: Comparing jurisdictions - opportunities for policy borrowing?
China, COVID-19 and Public Policy
Greg McCarthy examines what happened in China as the COVID-19 pandemic emerged and was contained – what does the nation’s response tell us about China itself, and what we can learn from it in public-policy terms?
At its simplest, China’s response to the pandemic (or, to be exact, Wuhan’s experience) has shown that if you go in hard, you can contain the virus. That is, the Wuhan experience indicates that by enforcing a comprehensive lockdown it is possible to break the infection cycle and, therefore, the death rate in around 70 days. What China’s delayed response has also shown is that you need to go in hard as early as possible. However, to do this early entails knowing medically what you are dealing with, and to do it speedily requires political will and citizen acceptance.
Medically, despite China’s good pre-existing digital health infrastructure, it took time to identify the new virus. While isolated cases appeared earlier, it was not until late December 2019 that Wuhan doctors and medical laboratories determined the growing number of cases of pneumonia and respiratory incidents were evidence of a pandemic. Likewise, it took time to recognise that there were links between virus patients and Wuhan’s Huanan Seafood Wholesale Market.
By 30 December, laboratories had identified a new virus and began genetic sequencing, which they shared with other countries, including Australia. Also on 30 December, frontline doctors – including the ophthalmologist Dr Li Wenliang – sent a message to fellow doctors that, in their view, there was a potential virus outbreak equivalent to SARS occurring in Wuhan. These medical concerns began to circulate on social media.
In China, however, moving from medical/scientific evidence to government action is contingent on the politics of the day. Politics in China are opaque and complex and, as such, the relationship between central and local authorities is facilitated by secrecy. This created difficulties for Beijing in knowing what was occurring in Wuhan.
In late December, when the medical evidence entered this multifaceted political world, the centre was seeking to develop a party line. In Wuhan, where the epidemic originated, the city administration’s immediate response was a cover-up, because its self-interest was dependent on economic growth. The clearest example of the Wuhan cover-up and denial was the castigation of Dr Li by the District Public Security Bureau for ‘spreading rumors’ about a new deadly virus in Wuhan hospitals.
At the central level, on 31 December, China informed the World Health Organization that there were cases of pneumonia with an unknown etiology detected in Wuhan. However, it was not until 20 January 2020 that President Xi Jinping made a public statement to the country acknowledging the pandemic and calling for ‘resolute efforts’ to combat it. With the party line now enunciated, the Wuhan government moved decisively and severely: on 23 January, with only eight hours’ notice, the city of 11 million people awoke to find it was comprehensively locked down.
By the end of January, China had gone in tough on Wuhan and the Hubei province, and effectively isolated 60 million people by halting all forms of transportation. The city and district population were quarantined to their homes, and simple temperature testing became extensive, with COVID-19 testing at medical centres and hospitals being reserved for patients with serious symptoms. The aim was not simply to hospitalise those infected but to establish case findings, trace contacts and ensure all public gatherings were banned, including the Lunar New Year celebrations. Also, in conjunction with state and corporate enterprises (e.g. Alibaba), a national infection QR-code system was established. Any Chinese who wishes to travel outside their home has to fill in an online health survey. Based on this, they are assigned a coloured health code (red for infected and green for infection-free), which is entered into a national database and directly linked to their smartphone through We Chat or Alipay applications.
Politically, the key to going in hard was the speed with which case findings, contact tracing and quarantining could be achieved at the community level. Here, social control went straight to the grass roots, as Chinese local community organisations readily became the frontline in intelligence gathering, monitoring and policing people. Chinese people live mainly in gated complexes and these compounds immediately came under the guard of residential committees (a revival of the Mao period) and property management committees comprising the police, security guards and retirees. These committees conducted censuses of inhabitants, took temperature tests of residents and visitors, alerted authorities of suspected infected people, made sure people stayed in their homes, and policed the movement of food deliveries coming into and residents going out of the compounds.
At a national political level, having moved to a war footing, the State repurposed its hospitals and prioritised them for patients with the virus. Within hospitals, doctors moved fast to identify infected people, ventilate patients, and oxygenate patients’ red blood cells when ventilation did not work.
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