the politics of Covid-19: the China problem
So far we have no treatment for Covid-19, and can only use non-pharmaceutical interventions (NPIs) to stop or slow its spread. Evidence from Wuhan has conclusively shown that stringent NPIs have been effective in this regard. Not only did the case rate fall sharply from early February (after rising sharply from December to the end of January), but the proportion of critical cases was substantially reduced over the whole period. While recent very low numbers reported from China are creating an understandable skepticism due to the Chinese government’s tight grip on information, experts generally agree that the Wuhan data is reliable.
Reducing the rate of transmission is the goal of NPIs. Once the transmission rate (Rt) is reduced to less than 1.0, cases will reduce, and this will show in the statistics (while taking account of an incubation period of roughly 5 days and laboratory confirmation). Analysis in this JAMA article of the Wuhan measures, which became increasing stringent over a two-month interval, and which analysts divided into five consecutive periods, suggests that the period 3 measures (strict travel restrictions, including automobile travel, and home quarantine) were the likely determining factors in Rt reduction. This analysis, however, conveniently chimes with the fact that the more severe period 4 and 5 restrictions, involving heavily policed physical distancing measures, central quarantining, and door-to-door, individual-to-individual screening, would not go down well in an open society. I don’t want to cast doubt on the article, but this is China we’re talking about, and there are all sorts of political sensitivities in dealing with this heavy-handed economic giant.
I’ve long been thinking about this, but a Sydney Morning Herald article I found on my twitter feed (I virtually never tweet but it’s a useful resource) has prompted me to explore a bit more. It’s about Taiwan.
Taiwan’s experience re Covid-19 is worth comparing to Australia’s as their overall population is the same as ours. For a while I’ve been perhaps complacently touting Australia’s success in keeping the numbers down – we’re now the world’s 29th in number of cases, compared to 18th a couple of weeks ago. But Taiwan shits on us in this respect – 388 cases compared to our 6313, 6 deaths compared to our 61. It ranks 98th out of the countries and regions on Worldometer’s list.
The SMH article is essentially an interview with Professor Su Ih-Jen, the infectious diseases expert responsible for Taiwan’s response to Covid-19. He explains that this response, probably the most successful of any country, is all about Taiwan’s mistrust of China. The relationship between the two countries is about as bad as it can get, with China using its power internationally to stifle Taiwan’s voice in international forums such as the World Health Organisation. China has never recognised Taiwan’s nationhood, and is seen as an ever-present danger by the Taiwanese. So when word spread about the outbreak in Wuhan in December, Taiwanese experts assumed the worst and acted quickly, imposing quarantines and travel bans from China. The country had learned lessons from the first SARS outbreak, also from China, and substantially increased their numbers of ventilators and hospital beds. And have spent the past 17 years literally rehearsing for this new outbreak.
So while Taiwan’s success can’t be measured in any precise way in terms of its relationship to China, it has undoubtedly been a major factor. It’s worth considering in terms of other states influenced by the CCP. Hong Kong, for example, has a population of some 7.5 million, with obviously a very high population density. That’s somewhere between a third and a quarter of Australia’s population, yet it has less than a sixth of our confirmed cases – and we would be one of the most successful countries in containing the outbreak, by any measure. I hardly need to go into Hong Kong’s somewhat perilous relationship to China, but it’s worth comparing Hong Kong, with its 4 deaths so far, to New York State, the USA’s most hard-hit region, which has suffered over 10,000 deaths. That state has about 2.5 times the population of Hong Kong. It’s of course possible that there’s been suppression of data in Hong Kong, but it’s more likely that its preparedness, given its proximity to and intense suspicion of its powerful neighbour, provides a better understanding of its success.
A more complex case is that of South Korea. Having recently read a potted history of Korea, I’m now an expert haha. Korea, like Japan, has been massively influenced historically by Chinese culture, and generally recognises its debt. Of course there have been tensions, and battles, between the two nations, but they have generally been in uneasy alliance for centuries. Koreans adopted a variant of Chinese writing for their language, until the Hangul alphabetic script became popular in the 17th and 18th centuries. China is South Korea’s largest trading partner by far. It’s one of few countries that can boast a surplus in its trade with the economic giant. Tourism both to and from China has always been very popular, though the South Korean government introduced measures to reduce the flow of Chinese tourism in 2017. In the early days of Covid-19 reporting, South Korea was often mentioned as one of the most, if not the most, affected/infected nations outside of China. That has since changed dramatically, with the country receiving sometimes grudging, and certainly qualified, praise for its response. It developed effective testing kits in a matter of days, and is now exporting them to the world. Its rapid mobilisation of all government departments, its widespread testing of asymptomatic subjects, its quarantine measures, have been generally seen as exemplary. It seems South Korea has also learned from the SARS outbreak in 2003, though its late recognition of the dangers has sadly cost lives. Could this be because it was too trusting of China’s first muted reports of the virus? And couldn’t it be said that South Korea’s eventual forceful response, regarded as overly intrusive by some westerners, owed something to that of its largest trading partner?
So neighbourhood politics have definitely played a role in how the response to Covid-19 has played out in Hong Kong, Taiwan and South Korea, though the details are necessarily fuzzy. It’s also surely the case that complacency, even exceptionalism, in those regions far from what has been deemed the epicentre, has been very costly. In those regions, alertness about, and full preparedness for, the dangers of viral pandemics in general, setting aside China, should be the major lesson.
References
https://jamanetwork.com/journals/jama/fullarticle/2764656
https://www.worldometers.info/coronavirus/country/south-korea/
https://www.worldometers.info/coronavirus/country/china-hong-kong-sar/
https://www.worldometers.info/coronavirus/country/taiwan/
https://www.worldometers.info/coronavirus/country/us/
A brief history of Korea, by Michael Seth, 2019
https://en.wikipedia.org/wiki/Tourism_in_South_Korea
https://www.theguardian.com/commentisfree/2020/mar/20/south-korea-rapid-intrusive-measures-covid-19
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