China and the pandemic: why a success?

While the world is struggling with COVID-19, China has managed to control the pandemic rapidly and effectively. As of 4 October 2020, China confirmed 90.604 cases and 4739 deaths, while the USA had registered over 7 million cases and more than 200.000 deaths. Italy with a population more than 20 times smaller than China, has so far seen 25 times as many cases of COVID-19 and 17 times as many deaths.

Despite being the first place to be hit by COVID-19, China was well placed to tackle the disease. It has a centralised epidemic response system. Ageing parents tend to live with their children and only 3% of China’s elderly population lives in nursing homes, whereas in several western countries such facilities have been major sources of infection.

The first reported cases of the disease that came to be known as COVID-19 occurred in Wuhan, Hubei province, in late December 2019. China released the genomic sequence of the virus on the 10^th of January 2020 and began enacting a raft of draconian countermeasures later in the same month.

Wuhan was placed under a strict lockdown that lasted 76 days. Public transport was suspended. Soon afterwards, similar measures were implemented in every city in Hubei province. Across the country, 14.000 health checkpoints were established at public transport hubs. School re-openings after the winter vacation were delayed and population movements were severely curtailed. Dozens of cities implemented family outdoor restrictions, which typically meant that only one member of each household was permitted to leave the home every couple of days to collect necessary supplies.

Within weeks, China had managed to test 9 million people for SARS-CoV-2 in Wuhan. It set up an effective national system of contact tracing. By contrast, Italy’s capacity for contact tracing was overwhelmed soon after the pandemic struck the country.

As the world’s largest manufacturer of personal protective equipment, it was relatively straightforward for China to ramp up production of clinical gowns and surgical masks. Moreover, the Chinese readily adopted mask wearing.

On 5 February 2020, Wuhan opened three so-called Fangcang hospitals (quick-set up hospitals). Another 13 would be set up over the next few weeks. The hospitals were established within public venues such as stadiums and exhibition centres and were used to isolate patients with mild-to-moderate symptoms of COVID-19. Patients who started to show symptoms of severe disease were quickly transferred to conventional hospitals. The network of Fangcang hospitals, which held 13.000 beds, meant that patients with COVID-19 did not have to isolate at home, which reduced the risk of family members becoming infected.

By 10 March 2020, the Fangcang hospitals were no longer needed. From around the same time, the focus of China’s countermeasures shifted from controlling local transmission to preventing the virus from taking hold as a result of imported cases. Those who entered the country were tested and quarantined.