• Friday, November 22, 2024
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Coronavirus: the cost of China’s public health cover-up

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On January 18, roughly six weeks after China’s deadly coronavirus started to spread in Wuhan, the city’s Baibuting district was preparing for its annual mass banquet. On the 20th anniversary of the event, the organisers would be attempting to break a world record for the largest number of dishes served.

Long tables in 10 locations were laid out with a total of 13,986 dishes, some bearing patriotic names such as Motherland in My Heart (cucumber and ham), and One Belt One Road (vegetable salad). The platters were prepared by members of some 40,000 families, according to media reports, with many of them showing up to eat the food and smile for the cameras.

Despite those happy scenes, the Baibuting banquets now stand as a symbol of China’s mishandling of a viral outbreak that has killed 565 and infected more than 28,000 and spread to at least 27 countries and territories.

The district is now facing a rising toll of infected citizens. Notices saying “fever block” in red and black letters were pasted this week on 57 communal stairwells in the district, according to local reports and photographs seen by the Financial Times.

“I feel very lucky I didn’t take part in the banquet, as I have two young kids and thought it was inconvenient to bring them along,” says Sally Zhang, a Baibuting resident. “There are now more than 10 infections among my neighbours”.

The epidemic ranks as the biggest crisis to have hit Xi Jinping, China’s Communist party leader since he took power in 2012. Not only has the outbreak brought large swaths of the world’s second-largest economy to a grinding halt, but it also undermines the party’s aura of competence.

Piecing together the events in Wuhan shows that for at least three weeks before the banquet, city authorities had been informed about the virus spreading in their midst but issued orders to suppress the news. In effect, they engineered a cover-up that played down the seriousness of the outbreak, according to officials and medical professionals.

The most fateful consequence of the official silence was that it facilitated the exodus of some 5m people in the weeks before the city was quarantined on January 22, thus helping to transport the virus all over the country and overseas. The slow and contradictory statements of the World Health Organization, which is responsible for warning the world of public health emergencies, also hampered efforts to combat the crisis.

Just as with China’s Sars outbreak that killed 800 people worldwide in 2002-03, the central shortcomings in China’s response have derived from its rigidly hierarchical political system.

“There is no question that the Wuhan government underestimated the disease,” says a senior adviser to China’s central government, who declined to be named. “The mayor of Wuhan has neither the expertise nor the willingness to follow health experts’ advice. His concern is that an escalation in disease prevention may hurt the local economy and social stability.”

He adds: “In the current political atmosphere, which values obedience more than competence, local officials have an incentive to avoid taking responsibility.”

Jude Blanchette, a China analyst at CSIS, a Washington-based think-tank, also sees a political dimension behind the health emergency. “There’s a natural inclination for party officials at all levels to bury negative information and censor dissenting views irrespective of who’s in charge in Beijing,” says Mr Blanchette. “But under Xi Jinping, the inclination to suppress has become endemic and, in this case, contributed to a prolonged period of inaction that allowed the virus to spread.”

Dec 8
The first patient to be later diagnosed with Wuhan coronavirus presents with symptoms. Chinese medical experts later trace an earlier case of a patient who experienced the symptoms of the virus on December 1.

Dec 30
Li Wenliang, a Wuhan doctor, informs fellow doctors in an online chat group of seven new pneumonia cases. But Wuhan medical authorities forbid doctors from making public announcements and order them to report cases internally.

Jan 2
Hospitals admit 41 patients in Wuhan, 27 of whom had direct exposure to a local seafood market which is regarded as one of the sources of the virus.

Jan 10
Scientists publish the first gene sequencing data on the virus, showing it to be from the same family as the Sars coronavirus.

Jan 18
The number of infected patients rises to 62. Wuhan city government holds an annual mass public banquet in Baibuting with some 40,000 families making and sharing food.

Jan 21
The US reports the first laboratory-confirmed case as the virus starts to spread beyond mainland China.

Jan 23
Wuhan suspends all public transportation from the city, including bus, metro and ferry lines. Additionally, all outbound trains and flights are halted.

Feb 5
The count of countries and territories to have reported confirmed cases rises to 27.

Several claims made by the Wuhan authorities about the virus, which began to spread as “pneumonia of unidentified causes” from early December, conflict with the testimonies of health professionals. The first issue was the repeated claims by officials that human-to-human transmission of the virus was limited.

Zhou Xianwang, mayor of the city of 11m, was still citing this explanation in a state television interview on January 21, when the number of cases had risen to 312. “The reason why the Baibuting community continued to host the banquet this year was based on the previous judgment that the spread of the epidemic was limited between humans, so there was not enough warning,” he said.

But Wuhan authorities had been informed weeks earlier that the virus could indeed be spread between humans. In an interview with Huxijie, a medical website, Zhao Jianping, a pulmonologist at Tongji Hospital in Wuhan, said he diagnosed patients with suspected coronavirus as early as December 27.

“We didn’t expect the disease to be so severe,” said Mr Zhao. “But we were sure it could spread from human to human.” Mr Zhao said he immediately reported the situation to the Wuhan Centre for Disease Control and Prevention.

In addition, the Wuhan Municipal Health Commission, a body that reports directly to the mayor, said as early as January 16 that the virus may have been spread by human contact — two days before the banquets were held and six days before the city was finally quarantined. Scientists in the New England Journal of Medicine said there was transmission between humans in close contact from the middle of December.

The other glaring inconsistency in the Wuhan authorities’ account is why the official number of patients identified as having the disease did not rise between January 2 and January 16 — a crucial two-week period when millions of Wuhan residents were starting to return home for Chinese new year.

This period coincided with key dates in the city’s calendar. Between January 6 and 11, cadres from across

Hubei province gathered in Wuhan for the annual session of the local People’s Congress. At this time, too, Wuhan authorities handed out some 200,000 free or subsidised tickets to local attractions.

Nevertheless, several accounts have emerged to show that even though the official count of coronavirus cases did not rise, the number of people becoming infected was surging. A radiologist in a Wuhan public hospital was quoted by Caixin, a Chinese news website, as saying he identified 50 new cases on January 15.

The official Xinhua news agency, meanwhile, ran a story on a doctor who fell ill with the virus on January 11.

Reinforcing such accounts of a cover-up, Li Wenliang, a doctor at the Central Hospital of Wuhan, informed fellow medics in an online chat group on December 30 of seven new pneumonia cases. But on the same day that Dr Li mentioned his cases, the WMHC was forbidding hospitals from making public announcements and telling hospitals to simply report cases internally.

This approach was causing consternation in Dr Li’s chat group, with one writing that “the government still hasn’t determined whether to announce”. The same person added in a subsequent post that “last Friday [December 27], our department was the first to report it to the city centre for disease control”.

But in spite of the authorities’ attempts to control the flow of information, news of the virus soon got out. By the evening of December 30, a hashtag of “Wuhan Sars” was trending on the popular Chinese microblog Weibo, before censors removed it.

The information crackdown continued with Dr Li being reprimanded by Wuhan police, who made him sign a document saying his statements were inaccurate, according to a photo of the document he shared with Chinese media. At least seven other medical professionals were similarly warned over “rumour-mongering”.

Dr Li was by no means the only Wuhan resident to realise something was amiss as early as December. One resident, who identified himself only by his surname, Wu, says: “I heard about it in December, but it wasn’t clear what was going on. There were small news items online, but the government said it wasn’t a problem so we didn’t pay too much attention.”

Mr Wu says the moment of realisation in the city was when Zhong Nanshan, an epidemiologist who became famous for his work during the Sars epidemic, confirmed on state television on January 20 what many other health professionals had been saying in private or in online chat groups for weeks: the virus could be spread from human to human.

When the FT arrived in Wuhan on January 19, the streets were busy, restaurants and shops were open as usual. The mood transformed overnight on January 22, when the city announced it would close its public transport links the next day. Suddenly, the streets became quieter and almost everyone who ventured outside wore a mask. Most businesses began to close and tens of thousands of people streamed into hospitals with suspected symptoms.

Eventually, China’s supreme court acknowledged that the suppression by Wuhan authorities of Dr Li’s warnings over the virus along with those of seven others had been wrong. On January 29, the court said the Wuhan police should have been “tolerant” rather than accusing them of rumour-mongering.
On the same day, Zeng Guang, chief epidemiologist at China’s Centre for Disease Control and Prevention, criticised local governments for failing to consider public health issues from a pure science perspective.

“What we said is only partially incorporated into the decision-making process,” Mr Zeng was quoted by the official Global Times newspaper as saying. “[Local governments] take a political perspective and consider social stability, the economy and whether people could happily enjoy Lunar New Year.”

A tweet on Thursday from China’s official television station, CGTN, said Dr Li had died in Wuhan after contracting the coronavirus. He leaves a pregnant wife, who has also contracted the disease.

Despite the evidence of a cover-up, some aspects of China’s response to the crisis have been impressive. By January 10, researchers at Fudan University in Shanghai had sequenced the coronavirus gene, a key step in understanding the characteristics of the epidemic. In addition, authorities in Wuhan moved fast to build two new hospitals. A 1,000-bed facility called Huoshenshan, was constructed in just 10 days.

Nevertheless, the enormous human and economic costs of censorship — both for China and for the rest of the world — are starting to come into sharp relief. Several respected scientists have estimated that the true number of people infected by the coronavirus may be several multiples higher than the official figures from China suggest.

Gabriel Leung, Dean of the University of Hong Kong’s medical school, said on January 31 that in Wuhan alone some 75,800 people may have been infected. Mr Leung’s estimate compared with an official number of confirmed cases in all of China of 11,791 on the same day.

The economic cost is also mounting. Li-Gang Liu, chief China economist at Citi, forecasts that the country’s first-quarter growth will slow to 4.8 per cent compared with a full-year rate of 6.1 per cent in 2019. Disruptions to global supply chains are set to deepen.

But as the world counts the cost, the WHO’s conduct faces increased scrutiny. It declared a global health emergency on January 30, by which time the virus had spread well beyond China, reversing its own decision of a week earlier to hold off on such a declaration.

This was its second public reversal. On January 14, the organisation said there was “limited” human-to-human transmission of the virus but later that day retracted the statement to say there was no evidence of human-to-human transmission.

“The WHO is so much in thrall to China’s influence, they have felt compelled to stay close to China’s line on this crisis,” says one UN diplomat who spoke on condition of anonymity. “China wanted to downplay this virus and the WHO felt it had to fall into line, at least until its position became untenable.”

However, John Mackenzie, a member of the WHO’s emergency committee, laid the blame for the slow response at China’s door. He told the FT that China must have been withholding information on new cases from the WHO. “Had they [Beijing] been a bit stronger earlier on, they might have been able to restrict the number of cases not only in China but also overseas,” he said.

Mr Xi, however, claimed at a meeting in late January with Tedros Adhanom Ghebreyesus, director-general of the WHO, that the Chinese government had “always adopted an open, transparent and responsible attitude to the timely release of information on the epidemic”, according to Xinhua.

But much closer to the outbreak’s centre have a different view. Li Kun, a resident of Huanggang City close to Wuhan, where more than 1,400 cases have been confirmed, has cut his number of daily meals from three to two after the local government last week ordered every family to send no more than one person out once every two days. “I believed in the government when the disease first broke out,” he says. “Now I think twice whenever officials say something.”

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