China is slowing down the spread of the COVID-19 pandemic.
A Beijing datelined AFP said a few days ago:
China reported on Tuesday just one new domestic coronavirus infection but found 20 more cases imported from abroad, with more regions imposing quarantines on foreign arrivals in a bid to stem the disease being brought in from overseas.
The single case in Wuhan will boost China’s view that it has “basically curbed” the spread of a disease that is believed to have emerged in a live animal market in the central city in December.
Wuhan and its 11 million people were placed under strict quarantine on January 23, with the rest of Hubei province going under lockdown in the following days.
Authorities tightened restrictions in the city even further on February 11, confining people to their homes as health workers faced a daily deluge of well over 1,000 cases – a move officials say was critical in containing the virus.
Other cities across the country enacted further measures to compel most people to stay indoors, and no new domestic infections have been detected outside Hubei for many days in a row.
But the country is now concerned about an influx of cases from abroad, with an average of 20,000 people flying into China every day.
Beijing started on Monday to require almost all international arrivals to go into 14-day quarantine in designated hotels.
People who live alone, minors, the elderly, pregnant women and people with underlying conditions are allowed to confine themselves at home.
Shanghai extended its mandatory quarantine to travelers from 16 countries on Tuesday including the US, Australia and several European nations, but said travelers may quarantine either at home or at a designated location.
Shanghai and Beijing, and another seven provinces or municipalities announced that they would make international arrivals carry out a mandatory quarantine either at home or in central facilities.
China also reported 13 deaths Tuesday, raising its toll to 3,226.
China’s progress stands in stark contrast with the growing crisis in other countries, with the World Health Organization (WHO) saying there were now more deaths and cases outside China.
The new coronavirus was officially identified as the cause of an outbreak of illness in Wuhan on January 9.
Coronavirus’ death rate found to be lower than WHO estimates
The coronavirus’ death rate may be lower than the WHO estimated, research suggests.
At the beginning of March, the WHO announced the virus had killed 3.4% of patients worldwide, which other experts called a likely “overestimate.”
To learn more, scientists from The University of Hong Kong looked at the 48,557 confirmed cases that had arisen as of February 29 in the Chinese city Wuhan, where the outbreak emerged.
They found the average death rate among patients under-30 was 0.3%, rising to 0.5% for those between 30 and 59, and 2.6% for people aged 60 or above.
Overall, they calculated the fatality rate to be 1.4%.
Although “promising,” experts have stressed estimating death rates in the midst of an outbreak is “fraught with difficulties.”
Cases have been plateauing in China since the end of February, with Europe now the epicenter of the pandemic.
In an attempt to combat the infection, scientists quickly got to work uncovering how severe the infection could be.
Using “public and published information,” the Hong Kong scientists looked at the 48,557 cases in Wuhan, of whom 2,169 died.
Based on this, the scientists calculated the overall “symptomatic” death rate in Wuhan at the start of the outbreak to range from 0.9%–to-2.1%, averaging at 1.4%.
Compared to those aged between 30 and 59 , the patients aged 60 or over were on average 5.1 times more likely to die “after developing symptoms”, according to results published in the journal Nature Medicine.
Patients without symptoms would likely have gone unreported and not been included in the analysis.
“This is a detailed epidemiological analysis and the results are cautiously encouraging, in that they indicate a lower fatality rate from [the coronavirus] than has thus far been estimated,” said Professor Robin May from the University of Birmingham.
“Using patient data from the original epicenter of the outbreak, Wuhan, they show an overall death rate of around 1.4% of symptomatic cases, which is lower than previous estimates.
“They also show that mortality rates appear to be very low for people under 50 (around 0.3-0.5%) which is, again, promising.”
He stressed, however, the same results may not apply to other areas of the pandemic.
Death rates can vary according to the strength of the country’s health service.
“One important caveat, is this study is based primarily on data from Wuhan and therefore does not necessarily reflect mortality rates that may be seen in other areas of the world,” said Professor May.
“As with all epidemiological models, it also relies on various assumptions which, since we still know relatively little about the course of this infection in human populations, may not be entirely accurate.
“That said, however, this is a very important new piece of data that will help guide the public health response to this pandemic.”
Calculating death rate
The Hong Kong research comes after Dr Tedros Adhanom Ghebreyesus said on March 3: “Globally, about 3.4% of reported [coronavirus] cases have died.”
Death rates are defined as the percentage of cases that die.
This is different from the death toll, which is the total number of deaths.
On January 29, the WHO cited a likely death rate of 2%.
Just a few days later, the Chinese National Health Commission reported it appeared to be 2.1%, based on 425 deaths among 20,438 confirmed cases.
On February 20, a WHO-China joint statement put the death rate at 3.8% based on 2,114 deaths among 55,924 cases.
With early research suggesting the infection is mild in four out of five cases, many non-serious incidences in the community will likely go unreported, skewing the death rate.
“We do not report all the cases,” Professor John Edmunds from the London School of Hygiene and Tropical Medicine previously said.
“In fact, we only usually report a small proportion of them.
“If there are many more cases in reality, then the case-fatality ratio will be lower.”
Asymptomatic infections similarly confuse how the death rate is calculated.
“Since subclinical [an infection not severe enough to cause “observable” symptoms] and asymptomatic infections have been reported, [the] true case-fatality ratio cannot be estimated until population surveys can be undertaken to estimate the proportion of individuals that were infected but did not manifest symptoms,” Dr Toni Ho from the University of Glasgow previously said.
Taking into account those with mild or no symptoms, Dr Christl Donnelly from Imperial College London estimated a 1% fatality rate appears more likely.
“In an unfolding epidemic it can be misleading to look at the naïve estimate of deaths so far divided by cases so far,” she previously said.
“The infection-fatality ratio is the proportion of infections (including those with no symptoms or mild symptoms) that die of the disease.
“Our estimate for this is 1%.”
Death rates can also change if countries alter how they define a case.
Cases “spiked” in China when it started defining a patient as “definitely infected” if they presented with symptoms, alongside a CT scan showing a chest infection.
Beforehand, patients were confirmed via a nucleic acid test. Nucleic acids are substances in living cells, making up the “NA” of DNA.
As a result, cases appeared to spike overnight in mid-February, despite one expert stressing it was “solely an administrative issue.”
Quarantines and other interventions can also make the population less exposed to the infection, driving death rates down.
A lack of awareness at the start of the outbreak may have meant patients only sought treatment when their symptoms became severe.
Death rates could also reduce as patients start “self-identifying” their symptoms earlier on.
“The best estimates of case-fatality rates would have to occur once an epidemic was over,” Dr Tom Wingfield from the Liverpool School of Tropical Medicine previously said.
“Estimating in real time during the epidemic is fraught with difficulties.”
Is China’s virus strategy a model for the world?
The head of the WHO believes China’s battle with the coronavirus offers a beacon of hope, but others question whether Beijing’s strategy can be followed by other countries, particularly Western democracies.
China has reported only one new local infection over the past four days, a seemingly remarkable turnaround given the chaos that surrounded the initial outbreak in the city of Wuhan.
While some experts caution against accepting Beijing’s figures at face value, WHO chief Tedros Adhanom Ghebreyesus insisted China’s success “provides hope for the rest of the world.”
Close down and contain
In January, China effectively shut down Wuhan and placed its 11 million residents in effective quarantine, a move it then replicated in the rest of Hubei province, putting 50 million people in mass isolation.
Across the rest of the country, residents were strongly encouraged to stay at home.
Hundreds of millions of Chinese live in closed residential complexes where neighborhood committees can police movement in and out meaning compliance could be closely monitored.
“Containment works,” Sharon Lewin, professor of medicine at the University of Melbourne. “Two weeks after the closure of Wuhan, which is exactly the incubation period, the number (of infections) started to drop.”
Extreme social distancing and home quarantines have been used to differing degrees by a rising number of European countries, with some U.S. states following suit.
But an Imperial College London study warned that while that strategy appeared to have succeeded to date in China, it carried “enormous social and economic costs” in the short and long term.
“The major challenge of suppression is that this type of intensive intervention package …. will need to be maintained until a vaccine becomes available (potentially 18 months or more),” it said.
If the intervention is relaxed, transmission rates “will quickly rebound,” it added.
Mass mobilization
At least 42,000 doctors and medical personnel were sent to Hubei province to shore up the province’s health services, which had, according to public health professor Zheng Zijie from Peking University, essentially “collapsed” under the strain of the fast-spreading epidemic.
Health experts from China’s Red Cross are currently helping overwhelmed hospitals in Italy, which has fast overtaken China as the worst hit country in terms of coronavirus deaths.
China’s ability to mobilize small armies of medical workers did not come with protection from contagion. More than 3,300 medical staff were infected across the country and 13 have died from COVID-19, according to health ministry figures published early March.
Government efforts in China were backed by an arsenal of propaganda, with messages repeated incessantly in the media and large street banners calling on citizens to be hygienic and stay home.
In an extraordinary effort two new hospitals with a total capacity of 2,300 beds were built in Wuhan within 10 days.
Masks and checks
In cities, it quickly became necessary to wear a mask as apartment blocks, businesses and even parks barred entry without one.
Widespread mask use may have helped slow the spread of the disease, “particularly when there are so many asymptomatic virus carriers,” Zheng said.
During the crisis, China produced up to 1.6 million N95 respirator masks per day, according to the official Xinhua news agency. These are considered the most effective protection, but need to fit correctly and be changed often.
To boost detection rates, temperature checkpoints were installed outside buildings and shops, or in public places.
“If it’s higher than 37.3 degrees Celsius (99.1 Fahrenheit), you are put in isolation,” one guard at the entrance to a park in Beijing told AFP.
And in the high-tech country where privacy is limited, many localities require citizens to show a QR code on their phone that rates them as “green”, “yellow” or “red”.
This assessment, based on tracking of whether they visited a high-risk zone, is now an entrance requirement for many businesses.
Government announcements have made clear that the coding system will remain in use in some form even after the pandemic subsides.
China central bank official calls for stepped-up global policy coordination
A Chinese central bank official called on Sunday for stepped up global policy coordination to manage the economic impact of the coronavirus pandemic, and said Beijing’s recent policy measures were gaining traction while it had capacity for further action.
Chen Yulu, a deputy governor at the People’s Bank of China (PBOC), also told a news conference that PBOC Governor Yi Gang had exchanged views with U.S. Federal Reserve (Fed) Chairman Jerome Powell, the International Monetary Fund (IMF) and other agencies.
Chen said that while downward pressure on the global economy is increasing, he said he expects significant improvement in the Chinese economy in the second quarter.
While the coronavirus is expected to continue exerting upward pressure on China’s consumer prices in the near term, there is no basis for long term inflation or deflation, he said.
Chen also said he expects China’s yuan currency to remain stable around 7.0 to the dollar in the near term, due in part to ample foreign exchange reserves.
The country’s debt market is stable, with no significant rise in defaults, he said during a briefing where he was joined by other senior Chinese financial regulators.
Chinese officials on horseback traveling to the most remote areas to warn people
Even in China’s most remote regions, the police had to ride on horseback through snowy conditions to reach nomad communities and inform them about the dangers of the virus.
Striking photos that were taken February 19, when China was still recording thousands of cases a day, show what that looked like.
The Altay prefecture, located in China’s northwestern Xinjiang region, is one of the most remote areas in the world.
The region of Xinjiang is home to the Uighurs, a mostly Muslim ethnic minority.
Xinjiang’s major cities are easily accessible, but its more remote regions are not.
To travel from Urumqi, the capital of Xinjiang, to Altay, it takes about one hour by plane, nine hours by day bus, 12 hours by night bus, and about 14 hours by train.
On February 19, as coronavirus cases across China were spiking, authorities traveled through rough, snowy conditions to reach the prefecture’s most isolated nomad families.
Wearing face masks and even hazmat suits, police officers, military troops, and medical workers had to trek through deep snow, sometimes on foot … … and other times on horseback.
Once they reached the nomad families, the police measured their temperatures …… and also informed them about ways to try to prevent the virus from spreading.
The coronavirus
The coronavirus is a strain of a class of viruses, with seven known to infect humans.
Others include the common cold and severe acute respiratory syndrome (Sars), which killed 774 people during its 2002/3 outbreak.
The coronavirus tends to cause flu-like symptoms initially, such as a fever, cough or slight breathlessness.
It mainly spreads face-to-face via infected droplets coughed or sneezed out by a patient.
There is also evidence it can be transmitted in faeces and urine.
While most cases are mild, pneumonia can come about if the infection spreads to the air sacs in the lungs, causing them to become inflamed and filled with fluid or pus.
The lungs then struggle to draw in air, resulting in reduced oxygen in the bloodstream and a build-up of carbon dioxide.
The coronavirus has no “set” treatment, with most patients naturally fighting off the infection.
Those requiring hospitalization are offered “supportive care”, like ventilation, while their immune system gets to work.
Officials urge people ward off the infection by washing their hands regularly and maintaining social distancing.
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