Current global health issues around Covid-19
THE MAIN ISSUES
with thanks to Prof. Therese Hesketh
This summarises discussions with policy-makers, academics and students in China, about the main issues of importance regarding Covid-19.
Preventability at the start: was Covid-19 preventable? Students in particular criticised the delay in the response, probably resulting from the silencing of whistleblowers, and felt it may have been critical to the subsequent trajectory. But many people do not believe there is any evidence that the Wuhan wet market was the source, that it could have come from elsewhere (i.e. other countries) and that China should not be blamed.
Response: The subsequent speed of response was extraordinary and meant that the spread within China, outside Hubei was very limited: less than 25% of the total 92,000 cases and 10% of 4750 deaths. Medical teams from all over China were sent to Hubei to manage cases. “Wuhan Jiayou!” meaning “Come on Wuhan!” became a national slogan of support. If the outbreak had been more serious, it is acknowledged that the system would have had great difficulty managing.
The lockdown was enforced (affecting over half the total population), with massive mobilisation of people, including volunteers. The lockdown was very strict in many areas, and was arguably a disproportionate response in some. But it seems to have been almost universally accepted. The reasons for this are a combination of socio-cultural norms, fear of the virus and of breaking the rules. Throughout there has been an overwhelming sense of trust in the government’s handling of the epidemic.
Now there are mainly random cases (two this week in Shanghai and Tianjin, respectively) which have triggered a major response, with tracking and testing of large numbers of people. A small outbreak in Qingdao last month led to 9 million tests being carried-out. The director of the CDC has criticised this level of response, as disproportionate and wasteful of resources.
Science: A great success has been the very rapid sharing of scientific findings throughout the pandemic, starting with the genome described within 10 days of identification of the new virus. A handbook of case-management was published in early March in Chinese and English. The very efficient track-and-trace system allowed for controlled relaxation of lockdown measures.
Despite having not completed Phase 3 trials, a vaccine has been used in China since July, initially in the military, then given to health workers and now being taken-up more widely by individuals going overseas, including students. At least two other Chinese vaccines are close to being released.
Propaganda: the epidemic has been a propaganda success for the Chinese authorities, from the 10-day hospital, (shown on live feed television) to the rapid control of the outbreak, praise by WHO for the approach to control measures, and the fact that the economy is back on track. Opportunities for self-congratulation have not been wasted, but this has undoubtedly instilled patriotism and pride.
Politics: much discussion centres around the assumption that in democratic countries where people are accustomed to freedom, controlling a disease like Covid-19 is very difficult.