The first case of the novel coronavirus, COVID-19, is believed to have occurred in Wuhan, China in December of 2019, with the first four cases being reported on December 29.[1] Chinese authorities, in response to the outbreak, reported these cases to the World Health Organization (WHO) on December 31st. By mid-January, they locked down Wuhan along with 15 other cities in Hubei province, restricting all travel.[2] Along with subsequent shelter-in-place orders, nearly 760 million citizens were confined to their homes save for food or medical emergencies.
Today, the international response to the virus has been varied, leading to a range of results. Where states such as New Zealand have been able to largely manage viral spread, India and the United States have failed to respond effectively. The global caseload approaches a cumulative 29 million.[3] While multiple vaccine efforts are underway, it is important to understand how early actions taken by governments affected the spread of the virus. Looking at the United States and China, we can extrapolate policy responses that exacerbated the outbreak or contained it--creating lessons for the next virus.
The Chinese Response to COVID-19
Fundamentally, the People’s Republic of China followed three key policies as part of their pandemic response: travel bans, enforced shelter-in-place orders, and data surveillance.
Chinese travel bans were locally enforced and total in scope. Research suggests that travel bans in pandemic situations are only effective given at least a 95% restriction.[4] Their efficacy is impacted by the season and country of origin and has an ambiguous effect on total infectivity (may cause an increase or decrease) due to seasonal travel differences.[5] WHO research concludes that overall travel restrictions have limited effectiveness in the prevention of influenza spread.[6]
Monitored shelter-in-place orders across some region of China completely stopped all human movement, with varying degrees of strictness, covering up to 760 million people.[7] The tactics ranged from guarded checkpoints at building entrances enforcing specific occupancy limits to groups of “enforcers” that walked the streets and checked citizens’ temperatures for early detection.[8] This policy focuses on limiting interpersonal infection by limiting travel, but also allows for early detection and testing which is the crux of its success. By bringing the testing to the citizens, it limits the upfront costs of testing infrastructure and relies on the labor of volunteers and professionals to ensure a sufficiently large scope.
In-person monitoring was supplemented by large-scale data surveillance and hoovering. Digital apps track user travel, names, phone numbers, and more, disclosing data to authorities for monitoring.[9] Such apps allow users to further be notified if anybody they might have come in contact with has contracted the virus, allowing for authority monitoring as well as self-quarantining. Similar methods of monitoring have spread to other apps like Alipay or even incorporated cell phone location data or facial recognition technology.
There are some broad concerns about the use of such invasive methods, where personal information is so freely given to the central government. It infringes on individual liberties and reveals the level of control that the People’s Republic of China has over its populace.
It is not clear to what extent these specific measures have been successful, as compared to more lenient and less intrusive options. A lack of broad public sector cooperation and private reluctance to hand over private data render it difficult for comprehensive data on viral spread.[10] It seems that a large portion of the tracking has been done through voluntary action, where citizens can relay virus information to authorities through an online questionnaire.
Examining the American Case
The American response to the COVID-19 pandemic has been ineffective. The response itself was delayed by debate over the seriousness of the virus while the eventual policy steps and their societal adoption were limited in their success at reducing spread. Fundamentally, the United States’ response to the outbreak has been largely decentralized with very lenient guidelines from the federal government.
The core strategies were rooted in travel bans/limitations and limited testing measures. As mentioned in the earlier section, the efficacy of travel bans is contingent on their totality and their precision. Starting with Proclamation 9984 of January 31st, the travel bans instituted by the federal government were meant to limit international transmission of the virus.[11] While this measure may have been marginally successful in limiting spread, it was more likely successful in only slowing spread, as was the case with the Chinese travel bans.
The differentiating factor here is that local/regional travel bans were never implemented within the United States. While many states and cities enacted shelter-in-place orders, these regulations were not levied until late March, two months after the first domestic case. Furthermore, these regulations were loosely enforced, serving as more of a signal than an actual limitation on individual travel.
The testing measures meant to support these travel bans were similarly limited in their success. Till March 4th, testing criteria was focused on international travelers and symptomatic patients.[12] This tactic ignores asymptomatic carriers, a significant vector of viral spread, and failed to be enacted early enough. Early tests developed by the CDC were proven to be inaccurate to add to the fire.[13] The United States simply did not have the infrastructure for mass testing, despite early knowledge of the viral threat and even after developing a successful test, national distribution was poorly executed. Currently, testing capacity is extremely limited with many testing centers overwhelmed.
From a public health perspective, the actions to prevent spread were slow to begin and insufficient in scope. With Chinese lockdowns beginning in mid-January and a high-risk assessment to the global community from World Health Organization authorities emerging in late January, pushes for social distancing and relevant policies should have been in development by February and March.[14]
While federal guidelines continue to recommend social distancing measures, President Trump has absolved responsibility to state governors. This diffusion of responsibility may allow for a more precise response to the virus inspired economic turmoil, but it has resulted in a short-run rush to reduce many shelter-in-place orders and reopen state economies. Georgia represents a case in which federal understatement of the effects of the virus along with an emphasis on economic performance has yielded policy that is less focused on reducing viral spread and more focused on economic stability, managed to achieve neither. Since Governor Brian Kemp announced reopening on April 24th, Georgia case numbers have risen from around 700 cases daily, peaking at 4200 in late July and falling to 1800.[15]
The state of Michigan represents the civilian side of this discourse, as many are protesting shelter-in-place orders in support of local businesses. It is unclear the extent to which these protests are exclusively focused on the health of local businesses, as many protesters have deeper qualms regarding the overreach of government power, but it is clear that an element of quarantine fatigue plays its part in these protests.
Comparing the Responses
The World Health Organization features an effective response checklist for influenza pandemics. While COVID-19 is an inherently different beast, many of the precautions built into this pandemic response transfer well into the steps necessary to combat the virus. The steps are as follows: preparation, surveillance, case investigation and treatment, spread prevention, essential service maintenance, research and evaluation, and implementation.[16]
The Chinese policy response featured much stronger efforts across most categories. Greater surveillance efforts have been made through the data hoovering featured in the first section. Some efforts have been made to analyze cell phone data to track movement in the United States, but few efforts have been individualized to allow for infection tracking, with a strong focus on the potential loss of civil liberties and the invasion of privacy.
Case investigation and treatment, dependent on testing capacity, is an unclear diagnostic tool. The United States, by virtue of a late rollout and insufficient infrastructure, has a severely stunted testing regime. China, by contrast, should have a larger testing capacity based on the many patients released from hospitals, the mobile testing strategies described in their policies, and the strong quarantining measures they had in place. China may be insufficiently testing or leading a false narrative regarding their success in tackling the outbreak. This outcome, however, is unlikely given the number of patients released in Wuhan alone –the public health threat of a second wave far outweighs the potential benefit to international reputation gained by misrepresenting the data.
Preventing the spread of disease will be determined by public health measures, vaccination programs, and antiviral research. While both states are engaging in research to combat the spread of the virus, there is a stark disparity in the public health measures taken to combat spread. The Chinese government has been far more successful at enforcing social distancing and quarantine guidelines. Community infection-control measures such as restricting access to public places with a high risk of spread are enforced by volunteer and official monitoring in China, while most public places never reached any level of restriction across the United States. Both countries, presumably, were successful in strengthening community knowledge on personal hygiene measures, but limited access to face masks, unclear evaluations of their efficacy, and a general lack of leadership rendered the United States’ societal response lacking.
Maintaining essential services are divided into health services and “other” essential services. Both states were effective in repurposing or building new infrastructure to target the treatment of viral patients and reprioritizing anti-viral efforts among private and public labs. The other essential services were similarly available for most citizens, but the method of transmission was largely different. Chinese local governments were ordered to ensure the provision of medical products and necessities. Several new projects in energy, transportation, and IT (5G) were launched during the outbreak to ensure the public provision of goods, but to also jump start the economy.[17] The United States has similarly been able to maintain most essential services, but this is by a very limited social distancing procedure. Most restaurants have maintained pick up/drive-through options, many businesses have transferred into the food delivery market, and grocery stores have remained open with very little change to normal proceedings.
It is unclear how to effectively evaluate the success of research in both states, as no clear progress has been made toward the vaccination of COVID-19. In terms of plan implementation, the PRC has made much stronger efforts in fighting the pandemic and remaining flexible in their response. This is likely a greater part of their public health response than it is the execution of a national plan. The revision of a national pandemic response plan was lacking in both states, owing to insufficient infrastructure to address the issue.
Conclusion
In the early days of the pandemic, China was able to leverage the agility of its centralized authority toward effectively combating the virus. The United States did not even approximate the extent of these efforts demonstrating inconsistent leadership and political struggle, rendering a poor response.
With no clear end in sight to the COVID-19 pandemic, the American policy response must be measured and sustainable. Whole-of-economy shutdowns will not render the same responses realized in the Chinese market, and authoritarian measures will not be replicable. These policy options must focus on incentivizing responsible action, demonstrating strong leadership from the federal government, supporting the health of businesses, ensuring the function of the healthcare system, and meeting the basic needs of citizens. Simultaneously, these policy options must respect the fundamental differences in market structure, regime type, societal norms, and more.
[1] Li, Qun, and et al. “Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia: NEJM.” The New England Journal of Medicine, March 26, 2020. https://www.nejm.org/doi/full/10.1056/NEJMoa2001316. [2] Cyranoski, David. “What China's Coronavirus Response Can Teach the Rest of the World.” Nature News. Nature Publishing Group, March 17, 2020. https://www.nature.com/articles/d41586-020-00741-x. [3] “COVID-19 Map.” Johns Hopkins Coronavirus Resource Center. Accessed September 12, 2020. https://coronavirus.jhu.edu/map.html. [4] “Are Travel Restrictions Useful in Controlling Pandemic Flu?1.” Center on Social and Economic Dynamics. Brookings Institute. Accessed September 12, 2020. https://www.brookings.edu/wp-content/uploads/2016/07/05flu_epstein_factsheet.pdf. [5] Ibid. [6] “Effectiveness of Travel Restrictions in the Rapid Containment of Human Influenza: a Systematic Review.” World Health Organization. World Health Organization, November 28, 2014. https://www.who.int/bulletin/volumes/92/12/14-135590/en/. [7] Gunia, Amy. “Would China's Draconian Coronavirus Lockdown Work Anywhere Else?” Time. Time, March 13, 2020. https://time.com/5796425/china-coronavirus-lockdown/. [8] Ibid. [9] Ibid. [10] Liu, Qianer. “China, Coronavirus and Surveillance: the Messy Reality of Personal Data.” Subscribe to read | Financial Times. Financial Times, April 2, 2020. https://www.ft.com/content/760142e6-740e-11ea-95fe-fcd274e920ca. [11] “Suspension of Entry as Immigrants and Nonimmigrants of Persons Who Pose a Risk of Transmitting 2019 Novel Coronavirus and Other Appropriate Measures To Address This Risk.” Federal Register. Executive Office of the President, February 5, 2020. https://www.federalregister.gov/documents/2020/02/05/2020-02424/suspension-of-entry-as-immigrants-and-nonimmigrants-of-persons-who-pose-a-risk-of-transmitting-2019. [12] Wallach, Philip A., and Justus Myers. “The Federal Government's Coronavirus Actions and Failures.” Brookings. Brookings, April 1, 2020. https://www.brookings.edu/research/the-federal-governments-coronavirus-actions-and-failures-timeline-and-themes/. [13] Ibid. [14] “Archived: WHO Timeline - COVID-19.” World Health Organization. World Health Organization. Accessed September 12, 2020. https://www.who.int/news-room/detail/27-04-2020-who-timeline---covid-19. [15] “COVID-19 Status Report.” Georgia Department of Public Health. Accessed September 12, 2020. https://dph.georgia.gov/covid-19-daily-status-report. [16] “WHO Checklist for Influenza Pandemic Preparedness Planning.” World Health Organization. World Health Organization, July 24, 2015. https://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_4/en/. [17] “Saving China from the Coronavirus and Economic Meltdown: Experiences.” VOX, CEPR Policy Portal. Accessed September 12, 2020. https://voxeu.org/article/saving-china-coronavirus-and-economic-meltdown-experiences-and-lessons.