China May Be Beating the Coronavirus, at a Painful Cost
BEIJING — As the new coronavirus races around the world, tanking markets, cutting off global travel and suspending school for hundreds of millions of children, governments are desperate for ways to contain it.
China, the place where it first appeared, says it has the answers.
To the surprise of some, the country that concealed and mismanaged the initial outbreak appears to be bringing it under control, at least by its own official figures. The number of new cases reported has fallen dramatically in recent days even as infections are surging in other countries. The World Health Organization has praised Beijing’s response.
Officials reported only 99 new cases on Saturday, down from around 2,000 a day just weeks ago, and for the second day in a row, none were detected in Hubei Province outside of its capital, Wuhan, the center of the outbreak.
China says the trend proves that its containment measures — which include a lockdown on nearly 60 million people in Hubei and strict quarantine and travel restrictions for hundreds of millions of citizens and foreigners — are working. And it has begun trying to promote its efforts as successful in propaganda at home and abroad.
The rest of the world, much of it fearfully confronting its first cases, has taken note. But there is also concern that China’s numbers may be flawed and incomplete. The real test will be whether the virus flares again when children return to classrooms and workers to factories, and commuters start taking buses and subways.
China’s blunt force strategy poses deeper questions for other countries. Its campaign has come at great cost to people’s livelihoods and personal liberties. Even countries that could copy China still have to ask whether the cure is worse than the disease.
“I think they did an amazing job of knocking the virus down,” said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “But I don’t know if it’s sustainable. What have the Chinese really accomplished? Have they really contained the virus? Or have they just suppressed it?”
Elsewhere, Italy, South Korea and Iran are struggling to control the spread of the virus. In the United States, where there are now more than 300 confirmed cases, the government has been criticized for fumbling its rollout of test kits and allowing the virus to spread in vulnerable communities like a nursing home in Seattle. The outbreak now threatens global growth and is intensifying a backlash against immigration and globalization.
Countries studying China’s approach would need to consider how it has upended nearly every corner of Chinese society.
The economy has ground to a near standstill, and many small businesses say they may soon run out of cash. Patients with critical illnesses are struggling to find timely care, and some have died. Hundreds of millions of people have been placed in some form of isolation. As of Friday, about 827,000 people remained under quarantine in Beijing, according to the state-run China Daily newspaper.
“I have been worried about all the focus on just controlling the virus,” said Dr. Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security. She recommended a more measured response, such as that taken by the governments in Hong Kong and Singapore. Officials there enacted targeted quarantines but did not shut down workplaces altogether, allowing their respective economies to continue operating while so far successfully containing the virus.
“We have to take a broad view of the impact on society,” Dr. Nuzzo said, “and do a better accounting for the social tolls of these measures that is not just focused on the numbers.”
For China, the numbers are key.
The number of cases reported on Saturday was a substantial decline from two and a half weeks ago, when China was recording around 2,000 new infections and as many as 100 deaths a day. Twenty-eight new deaths were reported on Saturday, all in Hubei.
By comparison, Italy reported 49 deaths from the virus on Friday.
Outside of Wuhan, the spread has effectively stopped, according to the official figures. All but one of the 99 new cases reported on Saturday were in Wuhan or were people who had traveled to China from abroad.
The World Health Organization says China’s containment measures may have saved hundreds of thousands of people from infection. Its efforts show that uncontrolled spread of the virus “is not a one-way street,” Dr. Tedros Adhanom Ghebreyesus, the group’s director general, said on Thursday.
“This epidemic can be pushed back,” Dr. Tedros said, “but only with a collective, coordinated and comprehensive approach that engages the entire machinery of government.”
W.H.O. experts sent to China have also highlighted clinics that could diagnose hundreds of cases a day with CT scans and laboratory tests, and the mass isolation centers in stadiums in Wuhan that separated people who had mild infections from their families.
“There’s no question that China’s bold approach to the rapid spread of this new respiratory pathogen has changed the course of what was a rapidly escalating and continues to be a deadly epidemic,” Dr. Bruce Aylward, the leader of the W.H.O. team that visited China, told reporters in Beijing late last month.
The numbers suggest that aggressive quarantine measures, when fully enforced, could choke the spread of the virus, said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University.
“This is the largest public health experiment in the history of humankind,” Dr. Schaffner said. “They can’t turn it off, but they did turn it down. And it did provide the rest of the world with some extra time.”
Still, the total number of infections in China, at more than 80,000, is staggering. And there are reasons to doubt the official figures.
In the early days of the outbreak, a shortage of test kits and hospital beds meant that many were not able to get tested. Many mild infections are likely going undetected. The government has changed how it counts cases several times in recent weeks, prompting large fluctuations in the reported figures, though experts say such adjustments are not unusual.
Medical experts say that there have been few signs that the government has aggressively tested for the coronavirus outside of medical facilities in Hubei. Until they broaden the scope of testing, experts say, it will be impossible to determine the true extent of the epidemic because those who have mild infections might not see a doctor.
“At the moment we are focused on the tip of the iceberg,” said David Hui, the director of the Stanley Ho Center for Emerging Infectious Diseases at the Chinese University of Hong Kong.
The ruling Communist Party hails the slowdown of the outbreak as a sign of the superiority of its authoritarian, top-down political system that gives officials nearly unchecked power. But its heavy-handed measures are testing the patience of its citizens, many of whom think such a clampdown could have been avoided if officials had not first hid the scale of the outbreak and silenced whistle-blowers.
The impact of the restrictions has been felt most acutely in Hubei, where 56 million people have been effectively penned in since January. For more than five weeks, the typically bustling hub of universities, commerce and transportation has been transformed into a collection of ghost towns as the virus has ravaged communities, ensnared entire families and infected thousands of medical workers.
China’s experience combating the virus has also highlighted the risk of family transmission if hospitals run out of beds and testing kits, as they did in Wuhan, where for weeks, many who were sick were sent home and infected their relatives.
Roadblocks have sealed off cities, public transportation has been shut down and private cars have been mostly banned from the roads. In Wuhan, restrictions on individual movement have been stepped up in recent weeks, with residents now mostly barred from leaving their homes.
Among residents in Hubei, there are signs that anger and frustration are mounting. Chinese social media sites are flooded with posts from residents saying they have lost their jobs because of the extended lockdown, making it difficult to make payments on mortgages and loans. Others have described food shortages in their communities.
On Thursday, in a rare public rebuke of the government, disgruntled people in a residential community in Wuhan heckled high-level officials as they walked through the neighborhood on an inspection.
“Fake! Everything is fake!” shouted one resident at the delegation, which included Sun Chunlan, a vice premier leading the central government’s response to the outbreak.
The state-run People’s Daily newspaper later said that the accusations were aimed at local neighborhood officials who had “faked” delivery of vegetables and meat to residents. Ms. Sun ordered an immediate investigation into the issue.
Wang Zhonglin, the party secretary of Wuhan, announced plans on Friday to teach the city’s residents to be grateful to the party, a move that was quickly met with derision and anger on Chinese social media.
Relationships are also fraying as families are forced to live for extended periods in confined spaces. Guo Jing, a feminist activist in Wuhan, said she and other volunteers had fielded a number of requests for help from residents reporting physical abuse by their family members at home.
“Under these circumstances, it’s really difficult for them to find help during the epidemic,” said Ms. Guo. “It’s so difficult to leave the house.”
Fang Fang, a writer who has been keeping a widely read — and often-censored — online journal of life in Wuhan, said that the lockdown was exacting a psychological toll on residents.
“Ordinary people have no source of income and lack a sense of certainty even about when they’ll be able to go out,” she wrote in a recent entry. “When you can’t feel the ground or you lose control over a situation, it’s easy to lose the most basic sense of security.”
Outside of Hubei, China wants to fire up its economy, but local officials are also under immense pressure to take no risks in order to reduce the number of infections. Even as provinces have lowered their alert levels for the virus, many companies are choosing to err on the side of caution. Some have even faked electricity consumption rates in order to hit stringent back-to-work targets, according to a recent report by Caixin, an influential Chinese magazine.
Some experts are increasingly wondering if China’s lockdown will become pointless the more widespread the virus becomes. Given the global spread of the virus and the difficulty of spotting mild cases, they say, it is unlikely that it will ever be completely eliminated — even in China.
“I do think the declining case numbers likely mean that all these incredible measures that have been taken are probably having an effect,” said Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health. “But I don’t think zero is zero.”
Donald G. McNeil Jr. contributed reporting from New York. Zoe Mou contributed research from Beijing.