Nearly six weeks after China announced the coronavirus outbreak, there’s still a surprising amount we don’t know about this newly discovered disease. But one thing is becoming clear: China’s silence in the earliest days of the crisis may have made it worse.
Chinese authorities delayed informing the world about the severity of a deadly disease spreading within the country’s borders — even trying to muzzle whistleblowers, like the late Dr. Li Wenliang. Now hailed as a national hero, Li was forced on January 3 by police to sign a letter saying he spread “untrue speech” for warning colleagues about the virus that eventually took his life.
With more than 40,500 people infected and 910 deaths, China’s missteps early on seem increasingly fateful. The fact that the international community has not acknowledged those missteps is also consequential.
On Friday, President Trump applauded China. “They’re working really hard and I think they’re doing a very professional job,” Trump told ABC News. Meanwhile, the leading global health body, the World Health Organization, has stayed mum about China’s blunders — and is drawing criticism for failing to publicly criticize the country and creating “a false sense of security” about an emerging health crisis.
But the reality is this: China’s mishandling and the ensuing silence from the international community is emblematic of how the global system governing the international response to pandemics fails to work, half a dozen global health experts affirm.
Though we have global health laws — in particular, the International Health Regulations, or IHR — meant to guide countries dealing with outbreaks, they’re not actually enforceable. “You can’t penalize [countries that] don’t follow it,” said Devi Sridhar, the chair in global public health at the University of Edinburgh. Instead, the international community has to rely on “soft law and norms” — or “disease diplomacy.”
This means that when a pandemic threat looms, the world has little recourse to punish those that fail to live up to the IHR for not detecting a public health problem, or hiding a crisis, even when that mishandling imperils the health of billions. And with just about every outbreak, history repeats.
“Our global outbreak response system depends on the full participation of all actors at all levels of government,” Steven Hoffman, director of the Global Strategy Lab and a professor of global health at York University, summed up. “But our system is only as strong as its weakest link.” Understanding the IHR, and how disease diplomacy is done today, helps explain why.
How China bungled its response to the new coronavirus outbreak
Before we get into the international response, here’s a quick recap of how China delayed reporting the crisis and employed cover-up measures to play down the threat of 2019-nCoV, as the virus is known.
On December 31, when China first announced the outbreak of a mysterious pneumonia, officials there emphasized a few things. Most of the patients had been to a food market in Wuhan, the city that’s still the epicenter of the outbreak. They said there was “no clear evidence” of human-to-human transmission, meaning the virus wasn’t yet spreading from one person to another but instead, they suggested, from an animal to humans. And they said the earliest case had shown symptoms only recently — on December 12.
Yet, for weeks now, reports in both the scientific literature and local and international news have contradicted what Chinese authorities were telling the world. These reports show the outbreak started weeks or months sooner than China let on, and the virus was already spreading among people — and beyond the food market in Wuhan — in early January. Authorities also censored information and silenced the whistleblowers who tried to sound the alarm.
A study published on January 24in The Lancet showed that in the first days China acknowledge the outbreak, by January 2, more than a third of patients had no connection with the Wuhan food market, including the outbreak’s index (or first) case. What’s more, that person became ill on December 1, nearly two weeks earlier than Wuhan health authorities had said of the first case.
This means the virus could have been moving through Wuhan as early as October, Daniel Lucey, an infectious diseases physician and adjunct professor of infectious diseases at Georgetown University Medical Center, told Vox.
The Lancet paper also reported that the first person who died from the virus, on January 9, passed it along to his wife a week prior. Similarly, another recent report in the New England Journal of Medicine also shows there were already seven health care workers infected by January 11.
“This is the smoking-gun evidence of human-to-human transmission,” Yanzhong Huang, a China expert and senior fellow for global health at the Council on Foreign Relations, told Vox. “But the public was not kept informed about this situation until January 18,” Huang said. Instead, “People were still told there was no strong evidence of human-to-human transmission.”
Meanwhile, Li Wenliang, the physician who had tried to warn his colleagues about the severity of the outbreak back in December, was silenced by police and “forced to sign a statement denouncing his warning as an unfounded and illegal rumor,” according to the New York Times.
On February 7, he died of the coronavirus, the China’s People’s Daily reported. And his was just one tragic example of China’s attempts to control the narrative, quiet dissenters, and censor information. (The latest comes in news that Chinese lawyer and citizen journalist Chen Qiushi, who has been reporting critically on the conditions in Wuhan, has disappeared.)
That’s not all. Lawrence Gostin, a global health law professor at Georgetown University, pointed out that while China deserves credit for sharing 2019-nCoV’s genetic sequence shortly after announcing the outbreak, it “has not been forthcoming with additional information about the virus from different samples at different times in different regions.”
Nor have Chinese scientists shared the virus itself with other national labs. And yet this information is crucial for understanding “whether the virus mutated, how, and also about its transmissibility,” Gostin explained.
Ditto the 2014-16 Ebola epidemic, when the three West African countries at the center of the outbreak didn’t have the disease surveillance networks in place to quickly identify the spread of the virus, delaying the global response for months. Then other countries implemented travel and trade bans on West Africa, despite that not being recommended under the IHR. Again, WHO was criticized for doing too little, too late.
“We’ve seen travel restrictions with every major outbreak from SARS through to Ebola in West Africa,” Gostin said. With the new coronavirus outbreak, countries around the world — from the US to Russia to Australia — are putting travel bans in place and closing their borders to China.
“The IHR operates on mutual trust largely, and it is a mutual trust,” Eccleston-Turner said. “That mutual trust has been eroded over a number of outbreaks where member states have ignored the recommendations from WHO.”
There’s even a debate about whether the IHR should be called a set of laws, Sridhar said. “You can contest whether you call it binding legislation if there’s no consequence.” While there’s been some discussion about tying a country’s performance during a pandemic to financial levers, such as World Bank or International Monetary Fund loans, little has happened in the way of reform, Sridhar added. How many more outbreaks, how many more deaths, will it take to change that?