China has almost eliminated Covid-19. What can the world learn?

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In January 2020, as the epicentre of the Covid-19 pandemic, China was grappling with cases in all 29 of its regions, daily increases in the triple digits, and an impending shortage of medical supplies. To tackle that, China went quick and hard – implementing lockdowns of various degrees of rigour in cities and regions across the country, resulting in about 760 million people being subject to restrictions. Every time an area showed a spike in cases, a lockdown followed.
Fast forward to today and China is on the other side of the pandemic: after weathering 85,307 coronavirus cases, and 4,634 deaths, the country is reporting just a handful of daily cases. On September 23, China’s overall number of active coronavirus cases was 402. The UK, which is hurtling towards a potentially devastating second wave, reported 6,178 new cases.

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In May 2020, Xi Chen, an associate professor of public health at the University of Yale, published a study explaining how China’s prompt and decisive reaction – including “quarantines, city lockdowns, and local public health measures” – in the face of the first outbreak of Covid-19 resulted in the avoidance of what he and his coauthors estimated to be 1.4 million infections and 56,000 deaths.
But Chen does not think that all countries should go down that path. “Every country will adopt very different measures based on several things: there are more ways to control [the virus],” he says. “Decisions should take into account elements such as the country’s culture, its social norms, whether people will accept it, and also – very importantly – whether the health infrastructure is good enough to allow more spreading.” He points out that China’s ICU beds for 100,000 people are only half the UK’s, which made more stringent lockdowns inevitable.
Cultural differences matter, too. Regardless of the fact that China is an authoritarian state able to impose restrictions at the drop of a hat, it is an inescapable truth that some cultures are more resistant to limitations than others. Chen cites a recent study explaining how people living in the US’s westernmost states tend to be more individualistic and therefore less prone to observing restrictions than their east coast counterparts. Prime minister Boris Johnson’s remark about British people’s “freedom-loving” nature was crude, but gestured at something that does have an impact.
Johnson’s remarks – an attempt to explain the UK’s less successful handling of Covid-19’s second wave compared to countries like Germany or Italy – were made as he unveiled a new series of measures to stem the virus’s spread. Among the new measures is the requirement that pubs and restaurants close by 10pm; mandatory face mask-wearing for retail workers; hiked fines for Covid-security violations; and the recommendation that workers work from home if they can.

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Some rules were met with bafflement: why, for instance would pubs have to close at 10pm rather than shut their doors altogether? And why did the “rule of six” – which allows six people from different households to meet up indoors and out – remain, despite the fact that inter-household spread seems to be one of the reasons cases are climbing up?
The answer is that at this stage every decision is a compromise between what is necessary and what can be done without further pummelling a prostrate economy and fatigued population.
“We know that total lockdowns work – the question is how much restriction do we need?,” says Keith Neal, an emeritus professor in epidemiology at the University of Nottingham. He says that falling back into a full-on lockdown every time cases start growing would exact a different cost: people’s health faltering because of missed tests and operations, and a more widespread deterioration in mental health. Compliance would also likely suffer.
Which is why you don’t want to overdo it. Shutting down pubs and bars might result in people meeting in their homes – which is harder to control. The emphasis, Neal thinks, should be on pubs following the guidelines to the letter. “If pubs follow the rules: service only if you are seated, social distancing – that is all right,” he says. “And pubs that break the rules should get closed first for one day, then for a week, then for a month and so on up to a year.”

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According to David Wrigley, deputy chair of the British Medical Association Council, while the 10pm threshold seems “plucked out of thin air” and the rule of six for household mixing “should be reconsidered”, the latest guidelines are at least clear on issues such as face coverings. “Adherence to the rules is the most important thing, but the rules needed to be clearer,” Wrigley says. The government’s repeated changes of tack have been often criticised for being confusing, with the “Stay Alert” slogan singled out as a pinnacle of muddiness.
Will clarity – and minor tweaks to the rules – be enough to bring case numbers back under control? Many experts argue that the government is once again doing too little, too late. But Chen does not believe that repeated China-style lockdowns are going to be the future: they are way too onerous to be triggered as a routine countermeasure. In his latest study, he puts forward a new way of nipping the contagion in the bud, by enforcing different degrees of restrictions in different parts of the country – regions, cities, towns, down to the individual neighbourhood – depending on how bad the outbreak is, and how central to the country’s general movement of people that specific location is. “I don’t think a complete lockdown is the optimal choice,” he says.
Gian Volpicelli is WIRED’s politics editor. He tweets from @Gmvolpi
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