The Wuhan dilemma

Unless like one deliberately waging a war to profit from it, humans can’t predict the future.  The Wuhan dilemma is the same China dilemma: when lockdown was imposed on Jan 23, what did it want to achieve, and how will it affect the future?  In retrospect, is there a more cost-effective way?  This will help dealing with COVID-19 down the road, since COVID-19 lurks around.

A few governments have had strong approaches against COVID-19, like India country-wide and some countries banning all domestic trains and flights, which China never did.  But Wuhan lockdown, at its height, employed the harshest measures in modern history.  Why did it?  Almost certainly, when the Chinese government made the decision on Jan 22, it wanted to stamp out COVID-19, just like SARS in 2003.  While it succeeded within its border, for factors outside of China’s control which it could not have foreseen (SARS was the only reference), COVID-19 remains active globally.  But nobody knew that on Jan 22, so one can only judge by looking at Wuhan and China.

The lockdown order led to initial chaos in Wuhan, as tens of thousands of residents flooded the hospitals.  Most of them only had cold/flu, but many acquired COVID-19 as a result.  When they went home, for they were waiting for a result, tested false negative, or turned away because of bed shortage, they might infect their family members.  Clearly this downside can be predicted but nevertheless impossible to eliminate.  Panicking is inevitable, whether on Jan 23 or Jan 20.  An earlier lockdown might have fewer COVID-19 cases to spread, but also fewer test kits and less preparation.  Perhaps the central and local governments could have communicated and prepared better to lessen the panic, but since neither the officials not the public had experienced anything remotely like this in their lifetimes, and all must act quickly, it is both hard and unfair to fault anybody. 

Still, is there a better, less drastic way, knowing what we know now, and if COVID-19 comes back later?  The second COVID-19 wave will not elicit the same response since everything is now in place, but would a lesser lockdown sufficed in Wuhan on Jan 23?  Based on the experience of other countries (which has the benefit of hindsight), it was possible.  The local quarantine measures changed throughout Jan to March.  The government and medical experts could have explained the situation and stressed social distancing better, if not on Jan 23, at least on Jan 24 or soon after.  City-wide traffic restrictions should have relaxed, since fewer people would venture out, and those who did would likely stay away from each other.  A more flexible environment would have helped Wuhan residents.  Of course, much is speculation based on what we know now, not we knew then.  For on Jan 23, when little was known about COVID-19, many people feared if you get it you will die.  No amount of persuasion could help them and the panicking.

Anyway, COVID-19 was practically eradicated by the end of March in Wuhan, or a month earlier in China outside Hubei.  For a whole month the Chinese government took a beating domestically, for the infection and death numbers appeared unheard of.  Which is false, since seasonal cold/flu and other illnesses kill more people each year.  Things turned around only when other countries, especially the more developed ones, started dealing with COVID-19 themselves, one month or more later than Wuhan.  Most Chinese would never imagine these countries fared worse than China, but they did.  There was no panicking in those countries, only loose lockdown if at all, and the infection and death figures exceeded China’s.  Now the Chinese think: OK, the lockdown was bad, but it could have been much worse.  If a country of 60 million has a figure like that, what would happen in a country of 1.4 billion people?

Now that a few countries have more infections and deaths than China, some people would like to think China got it easy or China was hiding something, which is ludicrous, or Monday morning quarterback at best.  When China was first dealing with COVID-19, nobody else was doing it, and almost nothing was known about the disease.  Thus China was under immense pressure and scrutiny, both domestically and internationally.  This was signified by the unprecedented Wuhan lockdown, and later the whole country.  Had anybody else alive had done it before Jan 2020?  China can’t predict the future either.  As the deaths shot past the whole SARS toll in early Feb, the only reference at the time, who knew how COVID-19 would turn out eventually?  When one looks at how much resource and how fast China mustered in Jan and Feb, one will say the intensity has been matched by no one since.  And all this was reported on TV and online in real time.  So if one thinks anybody was underreporting the severity of COVID-19, he should ask himself this question first: if a country has supposedly "fewer" cases, is it because the disease is not as dangerous, or is it simply because the country contained COVID-19 better?       

      

Nevertheless, the “success” of China and a few other countries like South Korea presents a dilemma because of the ongoing global pandemic.  If a country does well to contain COVID-19, it means a lower percentage of people are “immune”, compared to those doing worse.  The so-called herd immunity, although plenty of uncertainties about that, and no country has achieved it.  In any case, however, it is fair to assume that more Italians and Americans, percentage wise, are resistant to COVID-19 than Chinese.  Right now almost all countries have a foreigner entry ban, which can’t go on forever.  Then without a vaccine, how will China or anybody deal with COVID-19 importation?  The current measure is to quarantine every overseas traveler for 14 days, which is infeasible on a large scale and long term.  

This dilemma has no easy answers sans vaccine.  China and South Korea are working on a mechanism such that the respective travelers won’t need the 14-day quarantine, but this is fragile, since nobody knows what might happen to either country a month later, and it only solves a tiny problem.  Serological studies are underway in China, Italy, UK, US and other countries, to estimate how many people have been infected.  But much is unknown: How good are the Ab kits?  Does everybody ever infected produce Ab?  How long does Ab last?  Does Ab protect you?  If an infected has no detectable Ab, will he still be immune (not impossible)?  Quite frankly, so much is unknown, on Jan 23 as well as now, a lot of measures could be viewed as gambles.  If it turns out one wins, it doesn’t mean he is brighter or can predict the future, perhaps just lucky.  The Chinese gamble on Jan 23 paid off, as least by preventing a worse disaster.  But will it continue to work?  Obviously people and governments need to adjust.   The old way shouldn't be applied blindly to new situations, and China should have had reopened more quickly now already.  At the end, science is the ultimate solution.