How China crushed coronavirus

Getty Images / WIRED

Hong Wei* returned to his hometown of Luoyang in Henan province for the Spring Festival in early February. It took a few days for the gateway of his residential compound to be cordoned off, signalling that only residents should enter. For Hong, this was just the first sign of the mass mobilisation of people that has characterised China’s remarkably successful response to the coronavirus pandemic. Hong’s uncle had already stocked up on all the ingredients to serve roast meat, braised fish and soup at his restaurant ready for what is usually his most lucrative period, but once state media began telling people to stay at home, he voluntarily closed his restaurant. He was far from alone in taking a financial hit – over 85 per cent of small businesses in China reported that they could only last three months without regular income. They turned to family and friends for loans.
China lost the first round against Covid-19 as officials dithered, allowing the virus to escape Wuhan and seed a global pandemic. But once it was clear that the country was facing a serious crisis, China’s vast bureaucracy pulled itself together and mobilised. The face of epidemic control for most people was not president Xi Jinping in Beijing. It was the lowest rung of the bureaucracy – the neighbourhood committee. They ensured public compliance in a national pandemic control effort that went right to the doorstep.

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Committee members live within the residential compounds they manage. They kept track of those entering and exiting, enforced lockdown orders, recorded temperatures. If a case occurred, they locked the apartment block’s main door. They tracked down those who didn’t want to quarantine – in those situations a nosy neighbour was often more effective than any technological notification. They organised grocery deliveries so that people could stay at home. Some were better than others at this – when a senior Politburo member walked through a residential compound in Wuhan, she was heckled by people from their windows shouting, “fake, fake,” as the residential committee had organised grocery deliveries of vegetables and meat just in time for the official inspection.
An employee at China’s Centre for Disease Control and Prevention who requested anonymity – as any interviews should be approved by their superior – explains having people isolate until symptoms are obvious filters out those who are infected. Wuhan underwent mass testing to make sure that the whole country was clear. Local transmission of Covid-19 was eliminated. China reported zero new cases on May 29 – not a single case of local transmission or imported cases. Since then, there have been local clusters in Beijing, the port city of Qingdao, and the western city of Kashgar, but official numbers show that the number of new cases never exceeded the low hundreds.
This employee says that outsiders coming in must isolate to “become a normal person.” Only then can they rejoin society. The heart of China’s coronavirus response is, in short, infected until proven healthy.
Chinese nationals and foreign workers fly in from other countries everyday, some of them carrying Covid-19. These “imported cases” can number in the double digits. The aviation authority throttles flights to control the number of people coming in. People returning from high-risk countries such as the UK need to present a negative on both a nucleic acid and antibody test before boarding the plane, and they are tested again upon arrival.

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Each person flying into Shanghai has a group of three people assigned to them: a doctor, a policeman, and a neighbourhood committee member. Quarantine is mandatory – at home or in a hotel – and the quarantined are not allowed to venture outside. Those who choose home will find a device mounted on their front door. Whenever they open it, the doctor and the Party committee member’s phones receive an alert, and a call will come in to ask why they have opened the door. “We can’t stand outside their door the whole time,” said Wu Yongxu, one of the doctors assigned to patrol the residential communities. “One time, someone left the compound to walk around outside. After that, we started using these devices.”
Wu visits each person every day to take their temperature and ask about their health, climbing in and out of a hazmat and disinfecting it before she visits the next flat. In all, each visit takes about half an hour. Most people comply with the measures, she says, though some didn’t, at first. “Perhaps they thought it was annoying, or they thought they were healthy.” In those cases, their assigned policeman goes to their door and lectures them on their legal responsibilities. There is no reason for the quarantined to leave their apartment, she says, as their Party committee member is responsible for all their daily needs, including collecting their rubbish and bringing them food deliveries, if they order them. On the 12th day of their quarantine, Wu administers a nucleic acid test. If they test positive, she notifies the Health Commission and they are sent to hospital for supervision. If negative, they “become normal”.

Social distancing in cinemas with seatings set by viewers from same household to prevent the spread of Covid-19 in Shanghai in August
Getty Images / Barcroft Media / Contributor

The flipside of treating outsiders as abnormal was a rise in discrimination. Holders of Hubei ID cards were the first to bear the brunt of this. Personal information of university students in Wuhan including their ID numbers, phone numbers and home addresses were leaked and they were harassed or intimidated on the social network WeChat. In February, China’s highest body released a regulation saying that personal information gathered in the public health effort should only be used to fight the pandemic. Later it was Africans who were forced to sleep on the streets in Guangzhou as they were refused accommodation and also access to local restaurants.

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Shanghai’s Motel 168, which became Qiao Ziying’s workplace in late January, was not a pretty sight. Once she stood in the doorway of one of its rooms for half an hour, trying to convince a student, who had just returned from overseas, to go in, but to no avail. The student said that she had bipolar disorder and that she had walked out in front of cars before. In the end, they found her a fancier quarantine hotel, and she sent them a thank you message on WeChat. Qiao admits Motel 168’s state escaped her attention. “It was shabby, but I was busy filling in forms so I didn’t notice,” she says. Since many doctors had been sent to Wuhan or had not returned to Shanghai from their hometowns, she and another doctor were looking after anything from 20 to 70 people, administering tests, recording their temperatures, and sorting through their mail. In other cities, she’s heard doctors have become the maintenance and the hotel staff too.
At the beginning of the epidemic, Qiao was on call 24 hours a day and slept in the hotel for two-week stints. On her toughest day, when supplies were low nationwide, she kept her hazmat suit on for six hours straight as they only had two suits left. Now they have rotas, and she alternates between hospital and quarantine hotel. The hotel has a psychiatrist on call. Since many of those flying into China come from countries where the virus is not yet under control, they have been isolating for long periods. An on-call psychiatrist does video calls with people who suffer from sleep issues or anxiety, and dons a hazmat to speak to them in person if they’re suffering from a more serious issue, such as self-harm.
As small businesses closed, and people stayed inside, the government ramped up other fronts of pandemic control. It increased testing capacity – now officials claim that they can test 3.8 million samples per day. “The economic cost of mass testing is high,” says Shengjie Lai, senior research fellow at WorldPop, at the University of Southampton. But then, he says, there are the “enormous cost of lockdowns and social distancing, and the indirect benefits” to consider. In communities with high transmission risk, mass testing can help control the outbreak, allowing people to get back to normal life, preventing excess deaths, and increasing public confidence.
Supply shortages were dealt with by leveraging China’s supply chain advantages – within two weeks, electric vehicle manufacturer BYD had started producing millions of masks, which it is now shipping overseas to California too. After patients with mild symptoms were discovered to have infected their family members, the government changed its policy. Instead of allowing people to stay at home, medical authorities took them to shelter hospitals called fangcang, separating them from their families. Fangcang are, in essence, large convention centres with rows of beds. Those staying there describe 600-people-strong dorm rooms where the lights are always on. Later, asymptomatic cases had the same treatment. Patients could only leave these hospitals after they tested negative twice, and then stayed in quarantine wards for another two weeks.
Avoiding quarantine, hiding symptoms or concealing that you had been to a virus hotspot were designated crimes. Even without that, people did largely comply with strict lockdowns. Part of that may be because in the outbreak’s early days, they didn’t know what we know now, that it could manifest with only mild symptoms or no symptoms at all – the focus of the news was the rising death and case count. People like Hong’s uncle were scared.

In May, medical workers tested all of Wuhan’s 11 million residents over ten days
Getty Images / Barcroft Media / Contributor

While many in the rest of the world believe that China’s fight against the virus has been dominated by high-tech surveillance, those within the country do not think so. In a videoed speech picked up by several news outlets, Chinese Academy of Medical Sciences president Wang Chen said: “China’s epidemic prevention is about social organisation not technology,” and pointed to the efforts of other countries who had developed rapid testing. While health codes that generate traffic light colours for users have gotten a lot of press, they rely on self-reporting health status and travel history, not any Bluetooth or GPS-based proximity data. They were designed to allow cities to reopen and people to move, while maintaining control.
It’s true that big data has been used to aid contact tracing – in February, people received a text message reminding them that they can authorise telecommunications operators to access provinces and cities they had been to within the past 15 or 30 days. And for the Xinfadi market outbreak, the authorities used signals registered at local base stations run by mobile phone carriers to send text messages to people who had passed within a few kilometres of the market, including those who had been sitting on the metro or driven by. It was characteristic of China’s approach – spread the net wide, then filter – quite unlike the UK’s Bluetooth contact tracing app which identifies person-to-person contact. When a case was discovered, a human-intensive effort would begin. Local disease control units interviewed the patient to track down close contacts and close contacts of those contacts, testing them, and requiring them to isolate. They watched footage from local surveillance cameras around places a patient had visited to see who they had been in close contact with.
China’s virus control effort was single-minded – the goal was always total elimination. Officials were fired for perceived dereliction of duty, or promoted for successfully controlling the virus. There was never large-scale debate on the efficacy of masks, or whether only vulnerable people should shelter, or whether there was a trade off between saving the economy and saving lives, or whether the cost was greater than the cure. And it was costly: 25 million migrant workers may be out of a job. There is no furlough scheme for them. As in other countries, Covid-19 revealed social inequities – it is no coincidence that those detected in clusters since have been workers at markets in Beijing, docks in Qingdao, and a factory in Kashgar. And the narrative of success is such that those who might feel otherwise, who lost relatives in Wuhan, have faced interrogations and suspicion from local authorities.
Hong returned to Beijing five days after he left – he was worried that restrictions would tighten to the point that he wouldn’t be able to return. He registered with his Party neighbourhood committee for a permit to enter his compound. He filled out a form with details on where he had been to enter his office. People on different floors were assigned specific lifts to use, the company distributed masks, security guards constantly checked they were worn inside. His manager would say repeatedly to them: “Get nervous. We’re not that safe.” Hong admits some of it seemed like pandemic theatre. But he thinks it kept people alert. There was no single magic bullet in how China wrangled the virus under control. Through residential communities, offices, and public spaces, there was a pervasive sense that pandemic control relied on doing many things at once. Later, with much of the world paralysed by second or third waves of the virus, China’s labour-intensive approach is still proving devastatingly effective.
*name has been changed
Updated 19.11.20, 09:05 GMT: The article has been updated to clarify the number of daily cases in China since May 29.
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