Estonia, Latvia, Lithuania
Estonia, Latvia, Lithuania
Last week, the World Health Organization (WHO) declared coronavirus a global health emergency. In the same statement, the agency said it
welcomed the leadership and political commitment of the very highest levels of Chinese government, their commitment to transparency and the efforts made to investigate and contain the current outbreak.
Indeed, Chinese authorities have put in place unprecedented measures to slow the spread of coronavirus, including quarantining Wuhan and surrounding cities, home to over 45 million people.
While some have praised Chinese authorities for these tough measures, others have criticised the local and central governments for cover-ups, a lack of transparency, being slow to react and mishandling the early stages of the outbreak.
For some, China’s authoritarian political system is to blame for making the situation worse and delaying action until it was too late.
Now, the crisis is being seen as a key test of President Xi Jinping’s leadership and the ability of the Communist Party to effectively respond to and manage a health emergency.
Suspicions of the new virus first emerged in early December. But it wasn’t until the end of the month that the Chinese government reported 27 cases of pneumonia to the WHO. The state media mentioned this only briefly.
A day later, police in Wuhan detained eight doctors for spreading “rumours” about a new outbreak of suspected SARS.
China reported the first death from the outbreak on January 11, but without accompanying warnings to the public to take extra precautions. No new infections were reported until January 20, when Xi issued a directive for party committees and governments at all levels to take effective measures to combat the outbreak.
During this time, it was business as usual in Wuhan, with the government organising a New Year banquet for 40,000 families.
By the time Xi issued his directive, it had been seven weeks since the virus was first recorded and three weeks since it was reported to the WHO.
Crucially, it was also 10 days after the official start of the Spring Festival (Lunar New Year) travel period, the largest annual human migration in the world.
At this point, the central government finally sprang into action, locking down Wuhan, shutting down public transport, building new hospitals and giving more leeway to the media to report on the unfolding crisis.
But it may have been too late. According to some estimates, five million people had already left Wuhan before these measures took effect.
The initial reaction of the Chinese authorities to the outbreak was to rely on traditional forms of censorship rather than transparency.
This is clear from the initial suppression of whistleblowers – the detention of the eight doctors for spreading “rumours” – as well as the subdued reporting from the state media before January 20.
One possible reason for the silence is Beijing believed it could contain the outbreak without any extra measures, particularly at the start, when the nature of the virus was uncertain. The authorities may have believed mass panic would do more harm than the virus itself.
But after containment appeared unlikely, the central government wasted crucial time deciding what to do. Without clear direction from Beijing, the authorities in Wuhan chose not to act, which allowed the infection to spread.
Media coverage of the outbreak finally exploded after Xi’s January 20 directive, including by non-state media. However, strict censorship returned after two weeks, ostensibly to combat misinformation.
As anger deepens over how the crisis has been handled, the public will want to see officials lose their jobs and even be prosecuted.
The process of finding people to blame has started within the Communist Party. And already, we are seeing local government officials being sacked.
But the central government’s role should also be scrutinised. Beijing must have known about the outbreak by December 31, when it reported the cases of pneumonia to the WHO. Serious questions need to be asked, then, about why the central government chose not to respond publicly for another three weeks.
When things go right in a dictatorship, the credit goes to the leader. But when things go wrong, the blame can also rise to the top.
In the late 1950s and early 1960s, the party was able to push the blame for the Great Leap Forward and the subsequent Great Famine onto local cadres. However, Mao’s prestige within the party also suffered greatly as a result.
Xi has followed Mao’s leadership style in many aspects, not least the cult of personality he has built around himself. He has also been consolidating power since he became party general-secretary in late 2012.
Sensing the potential political damage from the current crisis, the state media is now trying to shield Xi from direct criticism and blame.
Instead, it is focusing on the responses of other top leaders, particularly Premier Li Keqiang. In fact, for nearly a week from late January to early February, Xi did not appear on the front page of the party mouthpiece, People’s Daily, in stories related to the outbreak.
All propaganda must have heroes and villains. The virus is the villain in this story, and the biggest heroes are the front-line doctors who are working long hours in dangerous conditions to fight it. The people, government and party have also been cast as heroes, united against a common threat.
The party knows the public has low trust of authorities when it comes to transparency, as it has an extensive history of cover-ups of everything from natural disasters to accidents to outbreaks of other diseases like SARS.
It hopes the focus on unity and heroes, coupled with more timely updates, will restore people’s trust in the government’s handling of this outbreak.
However, this is unlikely given the scale of public anger at the moment. This, in turn, may explain the state media’s search for other villains, particularly the US and other western countries that are shutting their borders to China.
The party’s prestige and legitimacy are both on the line. Crises like this are a serious test of the party’s assertions about the inherent superiority of China’s political system.
Ultimately, the Chinese people are likely to judge the party harshly, despite its efforts at narrative control.
One thing is for certain: the unfolding crisis is a human catastrophe, and Beijing has much to answer for.
We usually think of viral respiratory infections, like the common cold, as mild nuisances that pass in a few days. But the Wuhan coronavirus has proven to be different. Of those infected, around 2% are reported to have died but the true mortality is unknown.
There’s much we’re yet to learn about this new virus, but we know it often causes pneumonia, an infection of the lungs which produces pus and fluid and reduces the lungs’ ability to absorb oxygen.
Of the first 99 people with severe infection, three-quarters had pneumonia involving both lungs. Around 14% appeared to have lung damage caused by the immune system, while 11% suffered from multi-organ system failure, or sepsis.
Others are at risk of complications from being treated in hospitals, such as acquiring other infections.
At this stage, we know some people develop only a mild infection, while others become critically ill, but the exact proportion of each is not yet clear.
Overall, there are four key ways the Wuhan coronavirus can cause severe disease – and some can occur at the same time.
For the SARS (severe acute respiratory syndrome) coronavirus, direct viral damage was probably the most common way the infection caused disease. This is likely the case with the Wuhan coronavirus.
Early studies have found the Wuhan coronavirus attaches to a particular receptor found in lung tissue. This is like a lock and key mechanism allowing the virus to enter the cell, and is the same receptor the SARS coronavirus used.
Viruses “hijack” the host cell’s mechanisms to make more copies of itself. Damage results from either viruses taking over the cell completely and causing it to die, or immune cells recognising the viral infection and mounting a defence, triggering cell death.
If large numbers of cells die, then the affected organ can’t function effectively.
Studies from patients who died from SARS coronavirus showed the virus caused damage to not only the lungs, but also other organs in the body. Early research suggests the Wuhan coronavirus can also damage other organs, including the kidneys.
While we’re still piecing together the relationship between the Wuhan coronavirus and pneumonia, there’s much we can learn from influenza.
Influenza is a virus but it commonly leads to bacterial pneumonia – this is what’s known as a secondary infection.
It’s thought the influenza virus weakens the usual protective mechanisms of the lung, allowing bacteria to establish and multiply. This is especially true in children, older people and those with compromised immune systems.
Secondary bacterial pneumonia is more severe than influenza alone – in hospitalised patients, around 10% of those with influenza and pneumonia die, compared to around 2% of those who don’t have pneumonia.
The Wuhan coronavirus appears to cause pneumonia in two ways: when the virus takes hold in the lungs, and through secondary bacterial infections, however, the first way appears to be more common.
Sepsis is a serious condition that can be caused by many infections.
When we get an infection, we need to mount an immune response to fight off the pathogen. But an excessive immune response can cause damage and organ failure. This is what happens in the case of sepsis.
What is sepsis and how can it be treated?
Although it can be difficult to determine whether organ damage from the Wuhan coronavirus is a result of direct viral infection or indirect “collateral damage” from the immune system, initial reports suggested around 11% of people severely ill with the Wuhan coronavirus experienced sepsis with multi-organ failure.
So far no drugs or interventions have been able to dampen this immune response. Although several treatments have been proposed for Wuhan coronavirus, none have yet been shown to work.
Finally, patients who require hospital care may have complications. These include infections from intravenous lines (for drips/medication) or urinary catheters (flexible tubes inserted into the bladder to empty it of urine), pneumonia, or non-infectious complications such as falls or pressure sores.
Studies have found 10% of patients in hospital have some sort of health care-acquired infection, and around 5% have a pressure sore.
Hospitals work hard to try to prevent these complications, by making sure health care workers disinfect their hands and other equipment. However, complications still occur, particularly in patients who are debilitated from long hospital stays.
While most respiratory viral infections are mild, some can trigger serious complications, either directly or indirectly. It’s too early to tell how often this occurs with the Wuhan coronavirus. While we have initial data on those who were severely affected, many others may not have required medical care.
Cases of the Wuhan coronavirus have increased dramatically over the past week, prompting concerns about how contagious the virus is and how it spreads.
According to the World Health Organisation, 16-21% of people with the virus in China became severely ill and 2-3% of those infected have died.
A key factor that influences transmission is whether the virus can spread in the absence of symptoms – either during the incubation period (the days before people become visibly ill) or in people who never get sick.
On Sunday, Chinese officials said transmission had occurred during the incubation period.
So what does the evidence tell us so far?
Influenza is the classic example of a virus that can spread when people have no symptoms at all.
In contrast, people with SARS (severe acute respiratory syndrome) only spread the virus when they had symptoms.
No published scientific data are available to support China’s claim transmission of the Wuhan coronavirus occurred during the incubation period.
However, one study published in the Lancet medical journal showed children may be shedding (or transmitting) the virus while asymptomatic. The researchers found one child in an infected family had no symptoms but a chest CT scan revealed he had pneumonia and his test for the virus came back positive.
This is different to transmission in the incubation period, as the child never got ill, but it suggests it’s possible for children and young people to be infectious without having any symptoms.
This is a concern because if someone gets sick, you want to be able to identify them and track their contacts. If someone transmits the virus but never gets sick, they may not be on the radar at all.
It also makes airport screening less useful because people who are infectious but don’t have symptoms would not be detected.
The Wuhan coronavirus epidemic began when people exposed to an unknown source at a seafood market in Wuhan began falling ill in early December.
Cases remained below 50 to 60 in total until around January 20, when numbers surged. There have now been more than 4,500 cases – mostly in China – and 106 deaths.
Researchers and public health officials determine how contagious a virus is by calculating a reproduction number, or R0. The R0 is the average number of other people that one infected person will infect, in a completely non-immune population.
Here’s how a virus with a R0 of two spreads:
If the R0 was higher than 2-3, we should have seen more cases globally by mid January, given Wuhan is a travel and trade hub of 11 million people.
Of the person-to-person modes of transmission, we fear respiratory transmission the most, because infections spread most rapidly this way.
Two kinds of respiratory transmission are through large droplets, which is thought to be short-range, and airborne transmission on much smaller particles over longer distances. Airborne transmission is the most difficult to control.
SARS was considered to be transmitted by contact and over short distances by droplets but can also be transmitted through smaller aerosols over long distances. In Hong Kong, infection was transmitted from one floor of a building to the next.
Initially, most cases of the Wuhan coronavirus were assumed to be from an animal source, localised to the seafood market in Wuhan.
We now know it can spread from person to person in some cases. The Chinese government announced it can be spread by touching and contact. We don’t know how much transmission is person to person, but we have some clues.
Coronaviruses are respiratory viruses, so they can be found in the nose, throat and lungs.
The amount of Wuhan coronavirus appears to be higher in the lungs than in the nose or throat. If the virus in the lungs is expelled, it could possibly be spread via fine, airborne particles, which are inhaled into the lungs of the recipient.
The continuing surge of cases in China since January 18 – despite the lockdowns, extended holidays, travel bans and banning of the wildlife trade – could be explained by several factors, or a combination of:
increased travel for New Year, resulting in the spread of cases around China and globally. Travel is a major factor in the spread of infections
asymptomatic transmissions through children and young people. Such transmissions would not be detected by contact tracing because health authorities can only identify contacts of people who are visibly ill
increased detection, testing and reporting of cases. There has been increased capacity for this by doctors and nurses coming in from all over China to help with the response in Wuhan
substantial person-to-person transmission
continued environmental or animal exposure to a source of infection.
However, with an incubation period as short as one to two days, if the Wuhan coronavirus was highly contagious, we would expect to already have seen widespread transmission or outbreaks in other countries.
Rather, the increase in transmission is likely due to a combination of the factors above, to different degrees. The situation is changing daily, and we need to analyse the transmission data as it becomes available.
The Wuhan coronavirus has had a significant human toll. More than 100 people have died and nearly 3,000 are known to be infected, including some in Australia. The number actually infected will be higher. People experiencing only mild symptoms often don’t report them.
The economic cost is as hard to tease out as the health cost, but there are clues.
They suggest the coronavirus will have little impact on the global economy, quite a bit in China, and some in Australia, which will most likely be short-lived.
Confirmed cases of Wuhan coronavirus
The impact in China is already apparent, with 35 million people under effective lockdown, air travel curtailed, and some tourist destinations closed. In a sign the virus might spread, five million people reportedly left Wuhan before the lockdown.
The Shenzhen and Shanghai composite stock market indexes fell 3.52% and 2.75% before they closed for what turned out to be an extended Lunar New Year break.
While China’s steps to contain the coronavirus will hurt its economy in the short term, in longer term they might contain the damage.
The world has changed significantly since the the Spanish Flu pandemic of 1918, the Asian Flu pandemic of 1957-58 and even the Severe Acute Respiratory Syndrome (SARS) pandemic of 2002-04.
On one hand the world has become better at containment and treatment; on the other, it has become more connected. But previous pandemics can tell us a lot.
1918 Spanish Flu: According to the US Centers for Disease Control and Prevention, the Spanish Flu hit 500 million people worldwide, killing as many as 50 million worldwide, including 675,000 in the United States.
The US Congressional Budget Office believes such an event in 2006 would have cut US gross domestic product 4.25% below where it would have been.
World Bank calculations suggest a severe pandemic, killing 71 million people, would cut world GDP by about 5%.
The Congressional Budget Office believes a recurrence would cut United States GDP to about 1% below where it would have been. Similar countries would be affected in a similar way. The World Bank believes such a scenario would cut world GDP by between 1% and 2%.
2002-04 SARS pandemic: According to the US CDC, SARS infected around 8,100 people, with 774 dying, which was a 9.4% mortality rate. Its economic impact is open to debate. SARS mainly affected mainland China and Hong Kong, with one study estimating it cut their GDPs by 1.1% and 2.6%.
But because the event coincided with the recovery from a global recession, the effect is hard to estimate. Other estimates are less pessimistic.
The economic impact was limited, with little impact outside of China and Hong Kong, as Australia’s Treasury noted at the time.
Here’s what we know.
It’s not yet severe. Fewer than 100 people have died so far. The mortality rate is just under 3%. China has moved aggressively to contain the virus meaning it should have have less impact on gross domestic product than earlier pandemics.
There’s been minimal global impact. There have been few cases outside China. The countries with few if any reported cases are likely to suffer little impact, as correctly predicted by a Treasury discussion paper on the impact of SARS.
China and Hong Kong are the worst hit. The impact is likely be less than SARS because the coronavirus is less severe, because of China’s forthright containment efforts and because the outbreak has coincided with the Lunar New Year break. However, the aggressive steps taken to contain the virus might have a significant short term impact. Travel has declined significantly. Tourist attractions, such as Disneyland in China have closed. Wuhan is likely to see a significant economic decline.
The impact should be short-lived. With SARS, the economies of both China and the rest of the world rebounded shortly afterwards. To some extent, this coincided with the world emerging from an economic downturn. But other estimates suggest that even the impact of the severe 1918 pandemic was short-lived.
Different industries will be impacted differently. In impacted regions, tourism and consumer spending are likely to be the most significantly hit, as was the case in 1918. China has already suffered a significant reduction in travel expenditure. Other industries, including medical industries, will experience positive impacts. But given that the coronavirus is relatively contained, the impact is unlikely to spread those industries in other countries.
Taken together these points suggest the coronavirus is unlikely to significantly affect the world economy.
Based on what we know so far, the impact on China is likely to be short-lived.
The flow-on effect to countries with a relationship with China such as Australia is likely to modest and and also short-lived.
Should infection or mortality rates spike, the impact could worsen.