Monday, November 16, 2020

The Pandemic in China: a Governance Lesson to the West

 

China:  Oct 1st, 2020, celebrations of the national day. From this and other pictures, it is clear that the Chinese are not too much worried about getting close together, even without wearing face masks (source)

 

The text below is the translation of a post I published in Italian on the Facebook site "Pills of Optimism" on Oct 26th. There are still many things we have to understand about how China managed to control the COVID-19 epidemic. But one thing is certain: it was controlled and it is still under control. 

In China, stopping the infection required little more than a regional lockdown that interested a small fraction of the Chinese territory: the Hubei province, about 4% of the total population of China. Coupled with aggressive tracking and isolating, it was enough to get rid of the virus. There have been no COVID-related deaths in China since March 2020. The Chinese economic machine is in motion, people move, travel, shop, walk around, often without face masks. In short, life is normal. And it has been normal during the past six months, at least.

In comparison, the epidemic in the West has been so badly mismanaged that one feels like crying of rage. A threat that never was overwhelming was magnified to the point that it risks destroying the very fabric of the Western economic machine. How could it happen?

Within some limits, the collapse of the Western economy was unavoidable for reasons related to the decline of the availability of natural resources. But that it happened so fast is bewildering. So surprising that some people maintain that it was a conspiracy against the West concocted by China or even a plot by the evil Western elite to get rid of their useless Untermenschen

Maybe, but it is more likely that, simply, the West lost control of its governance system that went on by itself like an individual immune system that suddenly attacks its host

What can we learn from this story? Mainly, that we can't afford to be dominated by the waves of self-reinforcing hysteria that go through the media and the social networks. How can we manage that? Well, good question. Imitating China would mean giving most of the power to the Communist party, and that doesn't sound so viable, nowadays, in the West. But, seriously, we must rethink our governance system, otherwise the next serious crisis will truly destroy us. (supposing that we survive the current one)

 


China: the epidemic is over. How did they manage that?

Di Ugo Bardi, University of Florence, Italy (1) - 26 Oct 2020 

(translation slightly readapted for an international readership).

💊💊💊 From the data arriving from China, it seems that things are going very well with the COVID epidemic. In China, as well as in all of East Asia, mortality was much lower than in Europe and no deaths have been reported since March. There are still many things to clarify in this story, but China can teach us that it is possible to stop the spread of the virus without harming the economy. 💊💊💊

Do you remember when, in January, the Chinese (or those who looked like Chinese) were insulted in the street in Italy by people who believed they were spreading the plague? Things have changed quite a bit and today it is the Chinese who believe that we Italians are the plague spreaders. In China, there have been no deaths from COVID-19 since about mid-March. As for positive cases, there have been only occasional outbreaks of a few dozen cases, almost all of them imported (2). The Chinese economy has restarted to move and is now running at full capacity. 
 
From what we can read in the international media and from what colleagues who live and work in China tell me, the country is completely open. All commercial and industrial activities are in operation. The shops and restaurants are open and there are no restrictions on internal travel. Wearing face masks is optional and many people don't wear them. From the photos that come from China, we see that people do not pay much attention to the gatherings of people without masks. (below, celebrations of the National Day in Wuhan, Oct 1st)
 
 
 
Of course, the authorities are still on their guard and they intervene as soon as small outbreaks emerge. For example, the authorities of the city of Qingdao recently discovered an outbreak that, according to the international media, may be related to a batch of imported frozen cod on which someone would have observed viruses still whole. True or not, hard to say, but in any case, the local government is committed to testing all the 9 million inhabitants of the city! (3). 
 
But, overall, it is clear that in China and elsewhere in Asia the epidemic is under control without the need for a lockdown or other harsh measures of containment. Not only does the epidemic seem to have disappeared in China. It also created very little damage, at least according to the government data. The total number of victims is reported to have been about 4,600 out of almost one and a half billion people. That means 3 deaths per million against about 600 in Italy and other Western countries. Even if we only consider the European regions where the virus has hit the hardest, we find that the province of Hubei still did better. (4) 
 
How is such a thing possible? We often read on social media and on the media that the Chinese cheated us and that they are continuing to cheat us. Since China is a dictatorship, it is said, it follows that everything the Chinese government tells us is false by definition - including the fact that the epidemic is gone. Could it be that people are still dying of the COVID in China, but the government doesn't tell us?
 
Governments are not known to be reliable sources of information. We saw in a previous post how at least one European country, Belarus, may have partially falsified the data on the epidemic (5). As for China, there are previous cases of falsified data. For example, an analysis of fisheries data arriving from China in the 1990s indicated obvious falsifications to hide the depletion of stocks (6), (7)). But an epidemic is a far more serious and more extensive business than a fraud in a specific commercial sector. It would also be very difficult for the Chinese government to hide it if there was one in progress. 
 
So, if we want to believe that the Chinese are telling us lies about the epidemic we must bring some evidence on this. Remaining with the example of the fishery data, one of the reasons that led to mistrust the validity of the Chinese data were the anomalies that were noticed when comparing with data from other similar regions. Can we find any such anomaly for the pandemic? Apparently not: the data on the spread of COVID-19 in China are comparable to data from other neighboring Asian countries which, in general, have had minimal or no mortality. 
 
For example, Taiwan did even better than mainland China with a total of 7 deaths per 23 million inhabitants (less than one death per million). Other countries did a little worse but still remained at very low mortality levels. Singapore reports 5 deaths per million, Hong Kong 13. Neighboring Japan also suffered only 13 deaths per million. Then, both Mongolia and Macao even report zero deaths. Sure, one might say that Mongolia doesn't count because it's a country of camel drivers living in tents in the middle of the desert. But, of course, that's not the case. The capital of Mongolia, Ulan Bator, is a metropolis with over one million inhabitants. Macau, then, is a city of 700,000 inhabitants with a very high population density, perhaps the highest in the world. And the epidemic went through both Ulan Bator and Macau without leaving a single victim! It is hardly credible that all these governments have agreed to hide an ongoing epidemic from the rest of the world. 
 
But why are things so much better in Asia than here? Did the Chinese have used particularly effective containment measures? In some ways, this year's Chinese lockdown may have been more drastic than the Western one, but it didn't last longer than in Europe. It is not even possible to say that it was more timely if, as the Chinese themselves say, the virus was already circulating in December. The lockdown was established in Wuhan only on January 23 and a few days later for the entire province of Hubei.
 
In terms of "social distancing," we all know that in Asia there is a tendency to avoid physical contact between people. But it is also true that if you have ever taken the subway in an eastern city (for example in Tokyo (8)) you will have a very specific idea of ​​the meaning of the expression "squeezed like sardines". If you never had this experience, take a look at this link to an impressive video of the Beijing metro (9). Eastern metropolises are extremely crowded and, under certain conditions, it is simply impossible to avoid physical contact.
 
Could it be then that the trick was in contact tracking and isolating? From what we can read, it seems that Asian countries have been very aggressive in tracking and isolating people who have been in contact with people affected by the virus (10). This is an interesting explanation, but tracking and isolating was done in Europe, too. Maybe we haven't done it well enough? It is possible, but we have no quantitative comparisons that can tell us if this is the only explanation for the whole story. 
 
There is also another possible interpretation that has nothing to do with what governments have done or not done. It may be that the Chinese have been exposed to the virus for longer than we in the West and therefore approached herd immunity first. You probably heard of Li Wenliang, the Chinese doctor who first noticed cases of abnormal pneumonia in December and who later died of contracting the infection himself. Initially, he was not believed, but today he is considered a hero in China. 
 
Li had begun to sound the alarm towards the end of December 2019, but nothing prevents us from thinking that the virus had already existed in China for some time, perhaps even in slightly different forms from the one that then hit Europe. It was just that those affected were diagnosed as normal cases of pneumonia. Is it possible that the Chinese population had been exposed to the virus long before the declaration of the emergency? There is a fact that could give us a strong indication in this regard: excess mortality. If the epidemic already existed in November-December 2019, or even earlier, we should see an abnormally high mortality in China, compared to the average for that period. 
 
Good idea, but with a problem: nowhere on the Web we can find data on the additional mortality in China during the COVID pandemic. Note that this does not mean that the Chinese government is hiding anything from us. Hardly any government in the world disseminates these data in an easily accessible form. Europe is an exception with a database on excess mortality called "Euromomo" managed by a network headed by WHO, but there is no such thing for East Asia. So, for the moment, the idea of ​​an early start of the epidemic in China remains a hypothesis.
 
There are other factors we could look at but this virus has accustomed us to the fact that predictions and interpretations always turn out to be wrong. Even in a recent article in Nature (11), the authors frankly said that "we are not yet able to provide a generalized explanation for the observed quantitative mortality differences between countries". Thus, we must content ourselves with saying that the epidemic has done much less damage in Asia than it did for us for some reason that, at the moment, we cannot identify with certainty. 
 
But let's stick with what we know, which is that at the moment things are going very well in China and in the whole East Asia, just while the West is experiencing a "second wave." At least, we can conclude that we are not facing an invincible enemy. It is possible to beat the Sars-Cov-2 without necessarily having to destroy the economy with prolonged and generalized lockdowns. Of course, we are in a very difficult moment here, in Europe, but there is no reason to think that we will have to continue living in terror for centuries to come. 
 
 The author thanks Chandran Nair for his comments on the situation in China. 

1. https://ugobardihomepage.blogspot.com/2016/04/ugo-bardis-personal-home-page.html 

2. http://www.nhc.gov.cn/xcs/yqtb/202010/2fbce5a9836d4b09a89a0d85a2e05ac2.shtml

3. https://www.globaltimes.cn/content/1203836.shtml

4. https://www.facebook.com/permalink.php?story_fbid=176464484012617&id=111172767208456 

5. https://ugobardi.blogspot.com/2020/10/pandemia-e-possibile-che-qualcuno-ci.html

6. https://pubmed.ncbi.nlm.nih.gov/11734851/

7. http://www.fao.org/3/Y3354M/Y3354M00.htm

8. https://www.youtube.com/watch?v=E7kor5nHtZQ

9. https://www.youtube.com/watch?v=9ulY7N3dZ9k

10. https://www.bloomberg.com/news/articles/2020-07-25/these-elite-contact-tracers-show-the-world-how-to-beat-covid-19

11. https://www.nature.com/articles/s41591-020-1112-0

12 comments:

  1. Is there any info on China testing? Do they use PCR and at what cycle count (bless you Albert Bartlett for teaching me about exponential function)?

    I have recently read that the median age for Covid-19 deaths is 80 years old. 70% of deaths are over 75, the demographic mortality curve for Covid-19 matches the curve of historic natural mortality (not the number but curve). The virus is killing primarily old and unhealthy "hosts".

    The answer to your implied Q might be that the US and some other regions, have a lot of unhealthy and elderly people.

    "The U.S. Obesity Rate Now Tops 40%"

    https://www.usnews.com/news/healthiest-communities/articles/2020-02-27/us-obesity-rate-passes-40-percent

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    1. Obesity is a known factor that increases the COVID mortality, but it is not a very large effect. About the testing, the PCR test can be "tweaked." If you want reasonable results you stop below 35 amplification cycles. Italy now is testing at 45 cycles (!!). How many cycles in China? Ah.... good question!

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    2. People who have obesity, compared to those with a normal or healthy weight, are at increased risk for many serious diseases and health conditions, including the following:

      All-causes of death (mortality)
      High blood pressure (Hypertension)
      High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)
      Type 2 diabetes
      Coronary heart disease
      Stroke
      Gallbladder disease
      Osteoarthritis (a breakdown of cartilage and bone within a joint)
      Sleep apnea and breathing problems
      Many types of cancerexternal icon
      Low quality of life
      Mental illness such as clinical depression, anxiety, and other mental disorders4,5
      Body pain and difficulty with physical functioning.

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  2. "Of course, we are in a very difficult moment here, in Europe, [Middle East, Russia, Australia, etc,] but there is no reason to think that we will have to continue living in terror for centuries to come - thankfully, fossil fuels will run out soon and the whole world will switch back to the style of how the 1800s Baghdad fought plague...

    Then, life for the masses went on in their natural struggle with hunger - who lives lived and dies died.

    A plague-nany civilisation, like ours, is no more than a reflection on abundant excess energy supplies - so put abundant, it seems as if looted.

    Can Ugo Bardi or anyone else tell our civilisation that it is not humans who will deplete fossil fuels to the last drop, chunk and blow, but rather the nany-civilisation trying to controlling reality?

    Physics rules!

    Wail.

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  3. We knew exactly what might/will happen;

    Two early simulations involved biological attacks, in which other countries unleashed smallpox in the United States. Operation Dark Winter, in 2001, and Atlantic Storm, in 2005, were orchestrated by biosecurity think tanks in the United States and attended by influential leaders, such as the former head of the World Health Organization (WHO), Gro Harlem Brundtland, and Madeleine Albright, the secretary of state under former president Bill Clinton (see ‘Games without frontiers’)."

    If no one remembers Madeleine Albright she is the one who said that killing 500,000 Iraqi children was necessary for American interests.

    2001: A simulation of a smallpox bioterror attack, called Dark Winter, precedes a series of US anthrax attacks by several months.

    2003: Severe acute respiratory syndrome (SARS) is reported in Asia. Caused by a coronavirus, it spreads to more than two dozen countries.

    2005: The World Health Organization revises its International Health Regulations, including an agreement by countries to improve disease surveillance and reporting.

    2009: H1N1 influenza (‘swine flu’) emerges in the United States.

    2014: An outbreak of the Ebola virus is reported in West Africa.

    2015: A Zika virus outbreak is confirmed in Brazil.

    2017: A pandemic simulation takes place at the World Economic Forum meeting in Davos, Switzerland.

    2018: Two separate Ebola outbreaks begin in the Democratic Republic of the Congo.

    2019: Event 201, a simulation of a novel coronavirus pandemic, is held in New York City.

    2020: The SARS-CoV-2 pandemic kills more than 670,000 people in the first half of the year.

    Who could of node?

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  4. I think you dismissed contact tracing too quickly, by contact tracing one means the whole cycle: tracing and isolating. In italy we don't do either efficiently. You mention the city of Quingdao, a handful of cases, millions of tests, when the cases are limited the firepower of even a modest reaction does the job, we have missed the opportunity in the summer discussing phony privacy issues and now we all locked down.

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    Replies
    1. I thought that it was obvious that isolation is the result of tracking. Otherwise why would you bother tracking? But maybe it is not so clear to everybody. So, I corrected it to be clearer. Thanks for the note.

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    2. Actually, upon reviewing, I found that I had written "From what we can read, it seems that Asian countries have been very aggressive in tracking and isolating people who have been in contact with people affected by the virus (10)" So, it should have been reasonably clear. But you never know.....

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  5. I can think of 3 huge differences. There was no massive transfer of wealth to any oligarchs in China as a result of the lockdowns forcing small businesses under for fire sales, so releases of covid to create waves of fear had no use in regard to their covid. Further in fact, Jack Ma of AliBaba had to shut down his IPO, signaling that the Chinese govt was not going to allow more wealth accumulation through financialization. Then, the Chinese do not appear to be considered prey by their pharmaceutical industries. In fact, although China is supposedly ready to sell vaccines to the West, there appears to be no vaccine campaign for China or any of those countries mentioned...nor drug pushes. Finally, there's no Great Reset program to rearrange lives for whatever particular reason. Xi has a 90% favorable rating in his country. He's kept the people from being victimized. That's the difference.

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    1. I would imagine that it is exactly like that. It is for this reason that I say that the Chinese governance system turned out to be superior to the Western one with this crisis.

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  6. A vietnamese friend was in a quarter of Danang where they had some cases a few months ago. It was interesting to see how they directly reacted at the first signs. Closed the city, quarantined the quarter where sick people were found, no possibility to go out. Isolate cases and test everybody during 2 weeks, multiple time. After 3 weeks it was back to zero cases. You have to be reactive in the beginning, not once the pandemic is spreading everywhere in the country. That's one point where Asian countries did better.

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  7. The difference, I strongly suspect, is the effectiveness of lock downs. One is under communist control, heavily and strictly enforced by police\military apparatus. And the people are also more compliant due to the harsh penalties and in general the conformist pressure. On the other hand these are not present in the Western countries, where individual freedom is sacrosanct, even when survival of the larger community is threatened as it is now.

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Who

Ugo Bardi is a member of the Club of Rome, faculty member of the University of Florence, and the author of "Extracted" (Chelsea Green 2014), "The Seneca Effect" (Springer 2017), and Before the Collapse (Springer 2019)