Chinese regional dishes cheering on Wuhan's signature noodle dish. Their little signs say "keep fighting, Hot Dry Noodles"*. I can't fucking take these emotions. pic.twitter.com/AyrYPvb3fj
— Sneer Review (@TheSneerReview) February 1, 2020
With permission, from longtime lurker / new commentor YY_Sima Qian:
(Caveat, what follows are entirely my experience and my opinions from my observations, I am not a medical professional and do not work in public policy)
What is life like in Wuhan under lock down?
To date, most people are just hunkering down to ride out the storm. I don’t sense mass panic or groundswell for social unrest. People are anxious, glued to TV and phone screens, news outlets and social media platforms for updates. Of course, we are early into the lock down (I can’t believe it’s only been a week). If it persists, then the level of disquiet could rise rapidly, but the epidemic will prevent people from congregating physically. So far there is not a significant shortage of food or basic necessities, no disruption of utilities. The supermarkets are mostly open, but shopping needs to be done in the morning, or a lot of shelves will be empty by afternoon. We are planning to order via APP and have grocery delivered to our building, to avoid the crowds. Prices are generally stable and align with historical norms, as the government has vowed to severely punish any price gouging. Medical supplies (masks, alcohol, sanitizing agent, etc.) are more difficult to get, but I understand it may actually be easier to obtain in Wuhan than the rest of China.
The exception to the above are families of those diagnosed or suspected to have contracted the 2019-nCoV. The medical services are overwhelmed, despite herculean efforts to date. Lots of horror stories to be found on Chinese social media or even digital platforms of state media (but not print or TV). More on that later.
How is the medical care situation in Wuhan?
Dire. Hospitals are completely overwhelmed with people seeking treatment, both actual infected and those suffering from common flu (because this winter there has been a widespread flu epidemic in China, too). There are not enough beds in isolation ICU in all of Wuhan to take in all of the people with severe symptoms (2019-nCoV or not). Respiratory infectious diseases require rooms with negative pressure, so total number of hospital beds available is meaningless as a metric.
In my wife’s admittedly large circle acquaintances, we are aware of two cases where the elderly infected developed severe and life-threatening symptoms, but could not get tested with the 2019-nCoV test kit and be admitted into the isolation ICU. One died in the hall way of the overcrowded ER. We are also aware of two cases where the elderly infected have severe enough symptoms that would warrant going into ICU, but cannot due to lack of beds. Nothing anyone can do but hope and pray they either pull through or hang on long enough for beds to become available.
Wuhan’s response started too late, and has been desperately playing catch up. I think they are taking the right courses of action on paper, but several steps too late and often executed poorly to date. When the public became really aware of the epidemic on 1/22, people with symptoms (2019-nCoV or not) all rushed to hospitals (especially the five or six biggest ones with the best reputation), leading to massive overcrowding and likely significant cross-contamination. The day after the lock down was declared, a number of hospitals were designated for treatment of suspected 2019-nCoV cases. However, they often do not have large isolation wards built, and the conversion take time. To relieve overcrowding at hospitals, the government then instituted a system asking people to go to community clinics first for initial screening. Those with light or moderate symptoms are asked to stay home and self-quarantine (which I think is what the WHO recommends as well). If people develop severe symptoms, they are to report the neighborhood committee and the community clinic, and arrangements will be made for transfer to one of the designated hospitals. Select people are given lists of people to check up on daily (via phone). Both my wife and my mother-in-law are responsible for such lists. Looks great on paper, but in practices the medical staff and the community clinics are poorly trained to identify moderate symptoms from severe ones, and 2019-nCoV symptoms from the common flu, so they are not yet performing the filtering function as intended. Furthermore, I have seen cases reported to neighborhood committees and community clinics, but no follow up from the authorities. I can only imagine the chaos behind the scenes.
Hopefully, when the two temporary hospitals are build and come online next week, the bed availability issue can at least be relieved. Construction is being live streamed, with 20 – 40 million viewers at any given time. Huanggang, another city in Hubei, is also building such a facility.
Medical supplies (masks, suits, goggles) are in dire shortage. Lots of stories of doctors and nurses on the front lines in close contact with patients have to make do with masks that are not quite rated for the job, but they do it anyway. To minimize consumption of masks/suits/goggles, doctors and nurses are working 6 hour shifts without meal or bathroom breaks. Medical staffs are exhausted, working extended, even with thousands transported in from hospitals around the country, but seems to be better than this time last week.
Test kits are also in dire shortage, leading to slow confirmation of cases.
What about the situation in the rest of Hubei province?
I don’t really know. The focus of new media and social media in China has been understandably on Wuhan. The other cities in Wuhan have even less medical service resources than Wuhan, and people from the province have tended to go to one of the top hospitals in Wuhan for major illnesses. On the other hand, the reported cases are also much lower than Wuhan, relative to the respective populations. I haven’t seen many horror stories on social media from other cities in Wuhan.
How about the rural areas? Are they able to cope?
Medical care in the villages are much more limited than in the cities, and they would not be able to handle a significant outbreak. However, Chinese villages are mostly close-knit, self-contained and self-sufficient communities. As soon as awareness became widespread and containing the epidemic became a national priority, villages in China essentially raised their draw bridges – raising road blocks and manning check points to prevent outsiders from entering. Anyone returning from Wuhan or Hubei province for the Chinese New Year are quickly identified and families placed into virtual quarantine, or convinced to go back.
On the plus side, I think these measure will actually prove effective in containing the spread of the virus. On the down side, all the road blockages is wreaking havoc on regional logistics. I just read a story today that said 600 million chickens in Hubei are at risk of starving to death, since the chicken farm operations are having difficulty getting the feed to their chickens.
How about the rest of China?
Even without official lock downs, people across China are strongly encouraged to stay at home, and most people seem to be obeying most of the time (further encouraged by inability to purchase masks). Public places are much more sparse. From the WeChat messages of my friends and colleague across the country, people are bore out of their minds and are counting down the days to when they can return to work. Chinese government has delayed the end of Chinese New Year break to 2/2, and a number of provinces and municipalities have further delayed it to 2/9. Most people I am in contact with (they invariably live in large cities) are dealing with the situation with humor, if sometimes black humor.
The hospitals outside of Hubei are not over-stressed. If you develop light to moderate symptoms, there is a good chance you will be relatively quickly diagnosed and treated. People from Wuhan and Hubei are required to stay home and self-quarantine.
Can we trust the numbers from China?
The numbers from Hubei and especially Wuhan are not accurate, useful for only looking at the trend, at best. Not necessarily because the government is trying to suppress the numbers (although there could be pressure for that). In Wuhan, at least, people with light to moderate symptoms are staying home to self-quarantine. They are not captured in any statistic. Even the severe cases or deaths, if they have not been confirmed by test kit, are not counted as confirmed cases (some may not be even counted as suspect cases). They will likely end up in the flu or other pneumonia column as causes of death.
My WAG (and that’s all it is) is that the number of infected in Wuhan could easily be north of 10K, with tens of thousands not out of the realm of possibility. However, I suspect that the vast majority of the uncounted are likely to be the younger and healthier people with light to moderate symptoms before they fight the virus off, despite the horror stories we have heard or read. At least in Wuhan and possibly Hubei province, most of the reported suspect cases are likely to be 2019-nCoV cases (essentially just waiting for confirmation via test kit), but Chinese data does not break down suspect cases by location, only confirmed cases, deaths and cured cases. The number deaths reported due to 2019-nCoV in Wuhan is certainly too low, due to the factors I stated before. (2 – 3X higher is my WAG). On the other hand, accurate data could actually show that the severe case and death rates are lower than currently reported (~ 20% and ~ 2%, respectively).
I think data from provinces other than Hubei are probably more reliable, since the government and medical institutions are not nearly so over-stressed. The data overseas should be reliable.
The next few days will be critical. If the confirmed + suspected cases in other provinces in China reaches inflection points, then we know the lock downs and public awareness campaigns are effective. It will take longer to reach inflection in Wuhan and Hubei. The rapid increases we saw in the past few days has already been baked in, will likely continue for at least a few more days.
How do I see Chinese government’s (at various levels) response?
Well Wuhan municipal and Hubei provincial have certainly come off as incompetent and paralyzed, even other provinces put them to shame. I get that quarantining 50 million is unprecedented in human history, and a great deal of chaos and ad hoc is to be expected. However, a disturbingly large number of measures appear to be right in the broad directly but not at all thought through in detailed execution.
Why did the Chinese authorities react so slowly and who is the culprit?
I am not sure. It could be Wuhan municipal government or Hubei provincial government not wanting to rock the boat during the Party congresses in December and before Chinese New Year. My wife has a relative who works as a front line employee for the Wuhan branch of the Chinese CDC, as of 12/30 he was not even aware there was novel viral outbreak! He then was mobilized and had to work through the New Year long weekend. It could be the Chinese national CDC, who has the authority of declare public health emergencies, its head was stills stating publicly on 1/19 that “there is only evidence of limited human to human transmission”. It could be that the lower levels, including the national CDC, were silenced by the central leadership. I have relatives who work in hospitals in Nanjing, in the Jiangsu province. They told me they have heard through the grapevine that there situation in Wuhan was concerning as early as end of Dec., but were afraid of speaking out. Given they work in another province, it would suggest the pressure is coming from the national level.
However, January saw Chinese provinces move more quickly than Hubei at the center of the epidemic, before it was made widely public on 1/22. The neighboring province of Henan shut down all long distance bus service to Wuhan as early as 12/31, and mobilized villages and townships to what out for returnees from Wuhan and prepare for quarantines. Several provinces announced Level 1 (the highest) public health response, on the day of the wide public disclosure. Wuhan went to Level 2 the day after, and Hubei Level 2 the day after that. That’s on Wuhan and Hubei governments.
Now that the situation has reached crisis level in China, I do think the CCP with its Leninist structure and authoritarian nature, can mobilize and organize resources from the national to the grass root, and everything in between, in response. My belief is that the structure and dynamics of the CCP regimes makes it more likely for the situation to get out of hand (due to slow and muted response), but when the situation do get out of hand, the CCP regime has greater capacity to respond than any other government, regardless of the form. Vietnam Communist Party’s grass root organization is not as strong as the CCPs, and neither Vietnam or the DPRK have the PRC’s resources.
I saw a good Max Fisher column in the NYT a few days ago that discussed the CCP regime’s strengths and weakness, in context of the 2019-nCoV epidemic. Admittedly, he focused more on the weaknesses than the strength, but people should not underestimate the strength of the regime and the level of support it has.
How much should people outside of China, especially in the US, be worried?
No need to panic. There are choke points in people flow across national borders than can be manned or shut down. I actually agree with the decision to shut down commercial flights between China and the US, and the Do Not Travel advisory, but trust the Trump administration to screw that up and do it in an ill-considered manner. The long incubation period, and the potentially contagious people with no or slight symptoms make this epidemic very difficult to contain once there is a significant outbreak (see Wuhan). By the time authorities see a spike in cases, an outbreak probably has already happened.
If you are a medical or public health official, be extra vigilant. If you are elderly with medical complications, be extra extra careful, but you should be due to the flue season anyway. The Bloomberg article linked [here] has the best summary I have seen.
Worst case, the epidemic will die down in April or early May, due the onset of warm weather.
Here's a link to the artist's Weibo: https://t.co/4mbbmJCVbS
— Sneer Review (@TheSneerReview) February 1, 2020