The coronavirus shows how badly China handles public health crises

This hospital was built in only 10 days in Wuhan, China, the epicenter of a new coronavirus that has become a global emergency. This is a livestream broadcast by the government for the whole world to see. Within the first few weeks, there were more confirmed cases of the coronavirus than the total number of SARS cases in 2003.
China put over 50 million people under an effective quarantine, the largest in human history. This type of drastic, almost draconian measure is typical of China’s strong government. But for about a month after the first confirmed case, authorities kept the public in the dark, in particular, about how contagious the virus is. The mayor of Wuhan even apologized.
Critical information isn’t communicated in time between the local and the central government or from governments to the people. It’s a mistake China has made over and over again. With SARS in 2003 and, most recently, the African swine fever in 2019.
So why do they keep making it? China is getting a lot of praise for reacting faster this time than it did during the SARS epidemic. In many ways, that is true. For example, Chinese scientists swiftly deconstructed the genetic sequence of the virus and developed test kits two weeks after. China also got the World Health Organization involved a lot quicker.
– We were very impressed with the level of engagement of the Chinese government at all levels. – The mobilization of the entire state to deal with a single problem is pretty remarkable. That’s John Yasuda. He studies China’s governance. He says the state has always been good at reacting to a crisis once they recognize it.
– But the same state, they’re not very good at dealing with emerging problems. This is apparent in almost every public health crisis in China in recent memory. During the first three months of SARS, China was a black box.
The government gagged reporters, detained whistleblowers, and refused to share information with the public or international authorities. By the time SARS was reported to the World Health Organization, it had already been spreading for at least three months, and likely reached thousands of people.
– The more people know during a crisis, the better prepared they will be. You need to build trust at this point. This exact dynamic happened again in 2018, when a deadly pig virus called African swine fever began wiping out hogs all over the country. Local governments minimized its severity, refused to confirm cases, and failed to update the public.
– Once SARS got dealt with and it kind of faded from memory, you had other major policy issues, like ASF, not realizing that, of course, that this is part and parcel of the same fundamental problem. And that problem played out again in Wuhan.
The government documented the first case of a “new, mysterious pneumonia” on December 8. A month later, the local government briefly detained eight people, including multiple doctors, for spreading rumors about a SARS-like virus.
While rumors continued to circulate, the city organized a Lunar New Year feast for 40,000 families. This whole time, the city repeatedly ensured that the virus was “preventable, controllable,” and there was no evidence of human-to-human transmission. We spoke with a Chinese journalist who’s been reporting on how underprepared the city was. He asked not to be named.
– By early January, many doctors already knew the virus could be transmitted human to human, but there was no official announcement. The public didn’t know for nearly a month the epidemic had been spreading. After the virus spread to other countries, international pressure began to mount, but the official number of confirmed cases in China stalled for days.
Then the central government stepped in. In the next few days, the official number of cases exploded. Once the central government intervened, Wuhan went from this… to this… within five days. Hospitals went up, resources were mobilized, and information started to flow more freely. But the virus had already spread to the rest of China.
– The question is why did we get to the same point again? The answer lies in how the Chinese government bureaucracy is set up. – Look at the central health authorities. I do believe they have strong incentives to be transparent. But the local governments, they are also concerned by social political stability.
That’s Huang Yanzhong, an expert on China’s public health policy. He says, ultimately, local governments are the ones implementing policies, and they operate under a mandate of putting social stability above everything else. There’s actually a term for it: weiwen.
This creates a strong incentive for local officials to minimize bad news and try to solve emerging problems locally. That means doing whatever it takes, silencing whistleblowers, scrubbing social media to downplay problems for their superiors. This plays out until the issue becomes clearly uncontainable. Then a different dynamic kicks in.
– Discretion moves away from the local level and moves up the hierarchy, which is generally more problematic because, especially in fast-moving crises situations like this, you want people on the ground with the knowledge to be able to make those decisions.
At this point, only high-level officials have the authorization to disclose politically sensitive information, creating more barriers for people on the ground. This type of inflexible communication is partly why China keeps struggling to contain public health crises.
– Unless there is a significant and fundamental change in the incentive structure of the bureaucrats, we are likely going to see this pattern of cover- up and inaction being repeated again and again. In the case of Wuhan, information vacuum ended up causing large-scale instability… in hospitals… on the streets… in China… and around the world.