On December 31, 2019, the Wuhan government announced an outbreak of viral pneumonia. Until January 19, Wuhan authorities would maintain there was no proof of human-to-human transmission but the following day, China’s government would reveal otherwise. Decisions taken by authorities during those vital 21 days would come to affect the lives of millions in China, and around the world. Studies suggest while China’s January 23 lockdown of 50 million people averted an additional 7 lakh cases outside Wuhan, interventions one week and three weeks earlier may have brought down the number by 66% and 95% respectively. In an interview with The Hindu , Dali Yang, professor of political science at the University of Chicago, and a leading expert on China’s political system, explains how an epidemic slipped through the many layers of China’s system during those 21 days. Edited excerpts:
We now know by end-December, many doctors in Wuhan were aware of a serious outbreak which some suspected was contagious, and by December 31 they had alerted the Wuhan Centre for Disease Control and Prevention (CDC). What should have happened next?
First, we should understand the structure of the system in China. Every province, city and even district has its own CDC, but these are subordinate to the health commission at every level so they do not directly report to the national level. They belong to the municipal or provincial health administrations. The Wuhan CDC’s December 31 statement [saying no proof of human-to-human transmission] was clearly a massive error. The biggest error, however, was the crackdown from that day telling doctors they could not speak about what was happening. It appears from the start, everything was done to down play the severity of the situation rather than say, lets err on the side of caution in terms of the contagiousness.
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At what level would the decision have been made to play it down?
There was clearly a political issue here. If you look at their behaviour, the [national] CDC people suspected something was much worse and reported it to the WHO the same day through the National Health Commission, which was the right protocol. They also shared the genetic sequence with the world relatively soon [by January 12] which allowed countries to begin designing their own tests. But at the same time in Wuhan, consistently for so many days they were saying this is not a serious issue. There were zero cases reported all the way until January 16, so you are talking about more than two weeks.
What explains the reporting of zero cases for those two weeks?
Well, they did have zero cases because they used such restrictive criteria! New infections could not be counted as cases if they had no exposure to the seafood market [where the first cluster was reported]. The Wuhan municipal leadership instituted the new criteria to keep the numbers down. In fact, quite remarkably the US made the same mistake as well later. Did they intentionally hide the situation or did they make a bad decision? My hunch is maybe it’s a bit of both. They were not thinking in the right way from the start, but in retrospect it looks extremely misguided.
How relevant was the fact that Wuhan was hosting its annual Party Congress sessions from January 6 to 17 in their decision-making?
This was crucially important. This system has gotten used to the idea that you cannot allow anything to upset the political atmosphere during those times. Ironically, in 2003 during SARS, it was the national meetings that were happening.
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What would have been the role of the national leadership in this time?
We know the national authorities sent a team to Wuhan on December 31 which stayed for several days. They sent another team in middle of January. There is an issue of accountability here. One, could they have done better? Two, could they have made better sense of the information? I think they have emphasised the local authorities are the primary unit of responsibility, so they claim they deferred to the provincial leadership. There is also an issue in terms of ranking. Even if you sent the vice minister from the National Health Commission, the provincial leader outranks the vice minister. Even if you send the minister, he cannot simply order the provincial leader. So structurally, it’s a situation such that the national ministry cannot simply come in and dictate. It is a great irony actually, this is not a federal system but in this issue the local authorities in particular are responsible, until of course they couldn’t hide it. Then we later had the municipal leadership come and say they had no authority from above to announce anything. What we have is a system of complexity where all the parties are shirking their responsibility, and in this case everybody is culpable.
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Going forward, what’s the fix?
Accidents in such systems are bound to happen again and again. It cannot become failsafe. There were major missed opportunities in this case but in the future there will still be a problem. The nature of the Chinese system is you tend to have this kind of shirking but when things get big, its capable of decisive action, as in this case they did by locking down a city with 9 million people. That’s not a decision that most other countries could have taken, which is why the Chinese are actually congratulating themselves, but the problem is by the time they locked it down 5 million people had left. They were of course able to lock down the rest of the country and were able to control the virus in China.
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Does the fact that President Xi went ahead with a visit to Myanmar on January 17 and 18 tell us something about how aware Beijing was of what was happening in Wuhan?
The visit was already scheduled. Just like India is a large country, China is a large country and something was happening in one city. Until the middle of January, there were eminent people in the public health community who were looking at zero new cases being reported and thinking that with another wave of zero cases, we would be done! I do think people fell for what was being reported out of Wuhan. I also think without international inquiries, the situation could have ended up much worse. The Thailand case [on January 13] was significant, when the WHO realised this person wasn’t at the seafood market. That put pressure on China and they sent another team in.
China’s CDC has internationally respected scientists and virologists, including its director Gao Fu. What explains why they were unable to react earlier?
Keep in mind that Gao Fu is the director general but not the Party Secretary of the CDC. The CDC raised an alert on January 6. Clearly there was a lot of politics involved and significant debates, and I think the National Health Commission [which the CDC reports to] was the decisive factor. Also, the China CDC is not like the US CDC, which has its own issues, but is more powerful. The China CDC is smaller and much more subordinated to the National Health Commission. When China did respond nationally [after January 20], they were able to get a lot of people who dealt with SARS involved and that mattered hugely in their response. Only it was too later for the world. If they had acted earlier, say by January 7, it may have been an entirely different equation.
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The most important lesson is there has to be more transparency and an open environment for sharing and discussion. It was remarkable how you saw that doctors were cowed into not speaking. It became almost like a group-think situation where even when everyone saw it was contagious, yet there was no public airing. No one was willing to shout this was contagious, we have to take action in Wuhan. And that, to me, is just tragic.
