COVID-19 Coronavirus

On the plus side, I think these measure will actually prove effective in containing the spread of the virus. On the down side, all the road blockages is wreaking havoc on regional logistics. I just read a story today that said 600 million chickens in Hubei are at risk of starving to death, since the chicken farm operations are having difficulty getting the feed to their chickens.

How about the rest of China?

Even without official lock downs, people across China are strongly encouraged to stay at home, and most people seem to be obeying most of the time (further encouraged by inability to purchase masks). Public places are much more sparse. From the WeChat messages of my friends and colleague across the country, people are bore out of their minds and are counting down the days to when they can return to work. Chinese government has delayed the end of Chinese New Year break to 2/2, and a number of provinces and municipalities have further delayed it to 2/9. Most people I am in contact with (they invariably live in large cities) are dealing with the situation with humor, if sometimes black humor.

The hospitals outside of Hubei are not over-stressed. If you develop light to moderate symptoms, there is a good chance you will be relatively quickly diagnosed and treated. People from Wuhan and Hubei are required to stay home and self-quarantine.

Can we trust the numbers from China?

The numbers from Hubei and especially Wuhan are not accurate, useful for only looking at the trend, at best. Not necessarily because the government is trying to suppress the numbers (although there could be pressure for that). In Wuhan, at least, people with light to moderate symptoms are staying home to self-quarantine. They are not captured in any statistic. Even the severe cases or deaths, if they have not been confirmed by test kit, are not counted as confirmed cases (some may not be even counted as suspect cases). They will likely end up in the flu or other pneumonia column as causes of death.

My WAG (and that’s all it is) is that the number of infected in Wuhan could easily be north of 10K, with tens of thousands not out of the realm of possibility. However, I suspect that the vast majority of the uncounted are likely to be the younger and healthier people with light to moderate symptoms before they fight the virus off, despite the horror stories we have heard or read. At least in Wuhan and possibly Hubei province, most of the reported suspect cases are likely to be 2019-nCoV cases (essentially just waiting for confirmation via test kit), but Chinese data does not break down suspect cases by location, only confirmed cases, deaths and cured cases. The number deaths reported due to 2019-nCoV in Wuhan is certainly too low, due to the factors I stated before. (2 – 3X higher is my WAG). On the other hand, accurate data could actually show that the severe case and death rates are lower than currently reported (~ 20% and ~ 2%, respectively).

I think data from provinces other than Hubei are probably more reliable, since the government and medical institutions are not nearly so over-stressed. The data overseas should be reliable.

The next few days will be critical. If the confirmed + suspected cases in other provinces in China reaches inflection points, then we know the lock downs and public awareness campaigns are effective. It will take longer to reach inflection in Wuhan and Hubei. The rapid increases we saw in the past few days has already been baked in, will likely continue for at least a few more days.

How do I see Chinese government’s (at various levels) response?

Well Wuhan municipal and Hubei provincial have certainly come off as incompetent and paralyzed, even other provinces put them to shame. I get that quarantining 50 million is unprecedented in human history, and a great deal of chaos and ad hoc is to be expected. However, a disturbingly large number of measures appear to be right in the broad directly but not at all thought through in detailed execution.

Why did the Chinese authorities react so slowly and who is the culprit?

I am not sure. It could be Wuhan municipal government or Hubei provincial government not wanting to rock the boat during the Party congresses in December and before Chinese New Year. My wife has a relative who works as a front line employee for the Wuhan branch of the Chinese CDC, as of 12/30 he was not even aware there was novel viral outbreak! He then was mobilized and had to work through the New Year long weekend. It could be the Chinese national CDC, who has the authority of declare public health emergencies, its head was stills stating publicly on 1/19 that “there is only evidence of limited human to human transmission”. It could be that the lower levels, including the national CDC, were silenced by the central leadership. I have relatives who work in hospitals in Nanjing, in the Jiangsu province. They told me they have heard through the grapevine that there situation in Wuhan was concerning as early as end of Dec., but were afraid of speaking out. Given they work in another province, it would suggest the pressure is coming from the national level.

However, January saw Chinese provinces move more quickly than Hubei at the center of the epidemic, before it was made widely public on 1/22. The neighboring province of Henan shut down all long distance bus service to Wuhan as early as 12/31, and mobilized villages and townships to what out for returnees from Wuhan and prepare for quarantines. Several provinces announced Level 1 (the highest) public health response, on the day of the wide public disclosure. Wuhan went to Level 2 the day after, and Hubei Level 2 the day after that. That’s on Wuhan and Hubei governments.

Now that the situation has reached crisis level in China, I do think the CCP with its Leninist structure and authoritarian nature, can mobilize and organize resources from the national to the grass root, and everything in between, in response. My belief is that the structure and dynamics of the CCP regimes makes it more likely for the situation to get out of hand (due to slow and muted response), but when the situation do get out of hand, the CCP regime has greater capacity to respond than any other government, regardless of the form. Vietnam Communist Party’s grass root organization is not as strong as the CCPs, and neither Vietnam or the DPRK have the PRC’s resources.

I saw a good Max Fisher column in the NYT a few days ago that discussed the CCP regime’s strengths and weakness, in context of the 2019-nCoV epidemic. Admittedly, he focused more on the weaknesses than the strength, but people should not underestimate the strength of the regime and the level of support it has.

How much should people outside of China, especially in the US, be worried?

No need to panic. There are choke points in people flow across national borders than can be manned or shut down. I actually agree with the decision to shut down commercial flights between China and the US, and the Do Not Travel advisory, but trust the Trump administration to screw that up and do it in an ill-considered manner. The long incubation period, and the potentially contagious people with no or slight symptoms make this epidemic very difficult to contain once there is a significant outbreak (see Wuhan). By the time authorities see a spike in cases, an outbreak probably has already happened.

If you are a medical or public health official, be extra vigilant. If you are elderly with medical complications, be extra extra careful, but you should be due to the flue season anyway. The Bloomberg article linked [here] has the best summary I have seen.

Worst case, the epidemic will die down in April or early May, due the onset of warm weather.

Here's a link to the artist's Weibo: https://t.co/4mbbmJCVbS

— Sneer Review (@TheSneerReview) February 1, 2020