China is under increasing pressure to show that its disease control system is adequately coping with the outbreak of a deadly new coronavirus, as its confirmed cases rises above 4,000 and over 100 killed by the pneumonia-like disease.
Chinese officials have in recent days admitted shortcomings in their management of the outbreak, raising concerns of a possible global pandemic despite Beijing’s bests efforts to lockdown cities in Hubei province, including the reputed epicenter of the disease.
Zhou Xianwang, the mayor of Wuhan, a Chinese mega-city of 11 million people, even offered to resign on Monday after conceding that the city government’s disclosure of information had been “unsatisfactory.”
Despite a lack of reliable data about the still poorly understood coronavirus and a means of large-scale testing for it, officials in Wuhan had assured citizens that the virus was not widely transmissible after it was initially identified on January 10.
Chinese authorities have since offered stunning disclosures regarding the government’s delayed response.
Zhou disclosed that around five million residents had left the city ahead of the Lunar New Year holiday before a travel lockdown came into force on January 22, with scores of people rushing for the exits after the restrictive measures were announced and thousands more reportedly traveling abroad to Hong Kong, Thailand, Singapore and Japan.
Ma Xiaowei, the director of China’s National Health Commission (NHC), moreover claimed on January 26 that the coronavirus is capable of asymptomatic transmissions, meaning it can be contagious even during its approximately 14-day incubation period when respiratory symptoms and fever are not yet detectable.
“The Chinese government and Wuhan authorities had initially tried to calm the population down, and now they are swinging the pendulum to the other side by basically telling people to prepare for the worst,” said Wang Linfa, director of Emerging Infectious Diseases at Duke-NUS Medical School in Singapore.
The coronavirus epidemic is now being seen as one of the most challenging and multifaceted tests for President Xi Jinping’s government since he rose to power in 2012. As questions intensify over the nature and effectiveness of Beijing’s management of the crisis, Premier Li Keqiang has been assigned to oversee the nation’s response.
Chinese authorities have established the largest quarantine in human history, sealing off 13 cities in Hubei province and some 56 million residents in a bid to contain the contagion and prevent a global pandemic.
Though some global health experts believe this is likely to be more harmful than helpful to efforts stem the epidemic.
Critics of “cordon sanitaire” – a term used to describe restrictions on the movement of people into or out of a defined area to prevent the spread of an epidemic disease – say the approach exacerbates medical shortages and leads to overcrowding at hospitals, which raises the overall risk of transmission.
“Quarantine is taking specific individuals who are either infected or have a high likelihood of being infected and putting them in a bio-safety unit in a hospital capable of handling that. It works if you have a way of identifying high probability cases and provisions for separating those people,” said William Aldis, a former senior World Health Organization (WHO) official.
“Cordon sanitaire is the corralling of a physical geographic region. That’s what the Chinese are doing, putting an arbitrary circle around the given population that has cases and cutting the whole population off. I don’t think anybody recommends that now in international epidemiology and pandemic control,” Aldis said.
Doctors and nurses in Hubei province are reportedly having to cope with a lack of supplies including face masks and medicines, while a shortage of hospital beds has meant turning away patients who are likely infected. A shortage of testing kits for the virus, as has been reported, points to a still-ineffective process for detecting the contagion.
Public health experts such as Aldis, who coordinated the WHO’s response to avian influenza in Thailand the 2000s, believe Beijing should concentrate resources on traditional public health measures that have stopped other outbreaks, such as conducting symptomatic surveillance and isolating confirmed cases rather than closing off whole cities.
“Isolating the whole population always, I think always, fails to achieve success,” the former WHO official told Asia Times. “The cordon puts a horrible burden on people in the separated area. They are being contained unnecessarily and exposed to the virus unnecessarily, in order to keep the affected ones from getting out.”
To ease pressure on the city’s overburdened medical facilities, authorities in China have ordered the rapid construction of two hospitals in Wuhan to deal exclusively with patients afflicted with the coronavirus. The facilities will add a 2,300-bed capacity to the city when completed, though it’s not clear whether this will be sufficient to treat the rising number of cases.
If the coronavirus can be spread unwittingly by people who carry the infection but show no symptoms – so-called “hidden carriers” – experts say controlling the outbreak could become considerably more difficult.
It also remains unclear to what degree asymptomatic transmissions of the coronavirus, as claimed by China’s NHC, may now be taking place.
“It is getting more and more serious by the day. We know that with every virus infection, transmission during incubation is a possibility, but what matters is whether it is contagious in 1% of infected people, 10% or 20% of infected people. That has a huge bearing on our understanding,” said Wang of Duke-NUS Medical School.
“What’s the solid evidence to say that? In biology, nothing is ever 100% black or 100% white. All of this is buried right now and scientifically I cannot see the real data,” Wang, who specializes in the field of emerging zoonotic viruses and virus-host interaction, told Asia Times.
Health officials with the US Centers for Disease Control and Prevention (CDC), have recently claimed that there is no “clear evidence of patients being infectious before symptom onset,” though the agency said it is “actively investigating that possibility.” Five cases of coronavirus have so far been confirmed in the United States.
While some have faulted China’s cordon sanitaire containment strategy, questioning the efficiency of its testing regime and transparency of data, the country has also won praise for quickly isolating and sequencing gene information on the virus, data which it has shared with other countries.
“By most accounts, Chinese authorities are meeting international standards and isolating suspected cases and contacts, developing diagnostic and treatment procedures, and implementing public education campaigns,” read an editorial in The Lancet, a peer-reviewed top medical journal.
“Chinese public health authorities are under enormous pressure to make difficult decisions with an incomplete, and rapidly changing, understanding of the epidemic. The shutdowns may seem a drastic step – whether they represent an effective control measure deserves careful investigation,” it said.