A critical stage in the COVID-19 outbreak

When WHO was notified of the disease on Dec 31, 2019, it was not known what the pathogen was.  Around Jan 15-20, 2020, when human-to-human transmission was finally evident, most people paid attention.  And on Jan 23 when Wuhan was placed in a lockdown, everybody in the world knew the severity.  Since then most of China has seen some kinds of movement restrictions.  New cases and deaths in China shot up, and then came steadily down on around Feb 15.  Now all provinces outside of Hubei have essentially experienced 0 new confirmed case for two weeks or longer.  Some businesses are getting up to speed.  But most restrictions are still in place, and people are still suffering.  For example, if you return home after being away, you still have to self quarantined for 14 days.  Which seems vastly overkill, and the folly must stop right away to avoid further harm to the economy.  Bad economy kills many, maybe more people too.  In fact, even in Hubei, cities outside of Wuhan have basically been in the clear for at least one week already.   Lockdown comes with a steep price.  It did stop the spread of COVID-19 in other provinces, but Wuhan and Hubei paid dearly.  It is my belief that many people died needlessly in Wuhan, while the rest of the country could have still managed without the lockdown.  But this is no longer the major problem of the world today.

For a while (until around Feb 20), the disease seemed contained mostly in China.  Newly confirmed cases came in slow or nil in other countries in early-mid Feb.  Japan was the worst hit, but it was mostly a fluke, because of the Diamond Princess cruise ship.  But then cases in South Korea, Italy, and Iran skyrocketed.  Now many countries have seen their first case or new cases in weeks, and patient numbers are increasing fast, including in the US, leading to a lot of finger pointing.  For example, the American CDC was criticized for testing too few people and giving out faulty kits.  But this is exactly what Wuhan was dealing with in Dec 2019 and early Jan 2020, while the rest of the world has had at least one month to learn and prepare!  China got a lot of bad raps for the response: too slow, hiding something, etc, despite the fact that in less than one month's time, a lot was learned and done, unprecedented in human medical history!  There might have been mistakes, someone could have acted faster, but the reasons are not necessarily insidious.  Yet in the eyes of Western media and opinions, China can do no good, and this disease is no exception.  Now let's see how somebody else does it.  Still, we should cut the CDC some slack.  Having criteria and testing select people was classic textbook knowledge-Wuhan and everybody else use the same textbooks.  If an explanation is needed, perhaps it is only because many infected people show no or mild symptoms, leading to COVID-19 having spread quicker than realized.  About CDC giving out faulty kits, we don’t know if the Chinese kits are any better.  China uses kits made by many companies, and it is not clear how good, reliable, or comparable they are.  In any case, we know the bottleneck is not the kit, but how, where, and when the patient samples are taken.   

Now the whole world is in crisis, and China, outside of Hubei at least, ironically is more concerned about imported cases.  The stock market, while positive until the latest global outbreak, has tanked since Feb 20.  Further lockdowns and restrictions spring up in many countries.  Problems previously described in Wuhan, like patients waiting for admission to hospitals, is now playing out in other countries like South Korea.  A recession, which I predicted last year, looks very much alive at the moment.  All recessions are man-made, but some are not inevitable.  This one is made possible not because of the disease but because of the responses to the disease, both inside and outside of China.  Also even before the disease, Trump’s policies.  

Still, there are a few things in favor of these countries.  First is that most countries don’t have the same population density and the unique situation in Wuhan.  Wuhan has over 10 million people, is a transportation hub in China, and mid Jan happened to be the Lunar New Year traveling time.   Most other countries are not like that.  Second, there has been two months’ worth of knowledge and experience dealing the disease from China.  We are no longer running blind like in 2019.  Third, the weather is getting warmer, and the cold and flu season is coming to an end.    

One thing the whole world has never declared explicitly is: what is the end game?  What do we want to achieve?  Ideally, of course, is to eradicate COVID-19, just like SARS in 2003.  The Chinese government's initial response was clearly aiming for this goal.  But it was likely too ambitious and absolutely too costly, and looks increasingly unattainable with the current global pandemic.  As my first blog in Jan 2020 predicted, COVID-19 will stay with us for a while, unless vaccines and drugs can be found, which will take some time.  But it will just join a long list of common cold and flu pathogens.  So the governments really need to adjust expectations and reactions accordingly. 

While the disease control is not completely out of hand yet, the human reactions are closer.  Of course the governments all advise against panicking,  but many politicians and figures are predictably mouthing nonsense, and some government policies are promoting just that.  That is the biggest threat we face right now.