On the morning of January 18th, a seventy-nine-year-old resident of the central Chinese city of Wuhan, whom I’ll call Li, eagerly awaited the arrival of his daughter and her family, who were travelling from Shanghai to join him for the most important holiday on the Chinese calendar: the Lunar New Year. The festivities revolve around family meals, and, that afternoon, according to Phoenix Weekly, a political and cultural weekly magazine based in Hong Kong, Li rode his bicycle to the store to buy groceries. Halfway there, he began to feel weak, and fell off his bike. He was taken to a district clinic, where, owing to a lack of medical equipment—only X-ray machines were available—it was recommended that he go to a larger hospital. Around 5 P.M., he arrived with his daughter at the Wuhan Central hospital, where he waited five hours to see a doctor, who told him that he needed a CT scan of his lungs, for which there was a four-hour wait. Li went home, and, when he returned later, he was told to wait to see someone in the pulmonology department, where he finally got a scan. A pulmonologist said that the scan was worrying and told him to go to the emergency room, but there was a six-hour wait there, so Li went home again. The next day, a report showed an infection in sixty per cent of his lungs. Doctors suspected that he had contracted the new coronavirus, known as 2019-nCoV, the first cases of which had been reportedly identified in December, but they could not perform the tests to confirm it. The hospital was not an infectious-disease hospital, and, furthermore, Li’s family was told, staff members didn’t have the authority to make diagnoses themselves; they had to report cases to superiors and seek further consultation. Nor were there any quarantine rooms available.
Thus, according to Phoenix Weekly, began an ordeal, during which Li was bounced from one medical institution to another without being given a diagnosis or a bed. One night, when his fever had climbed and he had trouble breathing, Li’s daughter called the equivalent of 911—in China, the number is 120—for an ambulance. The dispatcher told her that, without confirmation of a diagnosis from a receiving hospital, he could not help her. Finally, an ambulance was sent, but Li was turned away from a couple of hospitals, which were already full. One told him that he should go back to Wuhan Central and insist on being admitted there, or get a transfer notice from it. Finally, at the fourth hospital the family tried, Li’s daughter and her husband, despondent and frustrated, started shouting in the E.R. waiting room. “If you don’t take my father,” she said, “he will die.” The family camped out in the waiting room, along with a crowd of other people.
Li’s story is not unique. Phoenix Weekly also reported on a thirty-six-year-old Wuhan resident who said that he had been refused by six hospitals in two weeks while battling symptoms of the coronavirus. Discussions of the virus have been censored on the Internet, but in recent days many people have posted similar accounts.
Early cases of the virus were thought to have originated in a wholesale seafood market in Wuhan, a city of more than eleven million people, where live animals such as dogs, cats, rats, hedgehogs, and marmots are also sold. It is closely related to coronaviruses found in horseshoe bats, and health officials thought it may have migrated to humans from one of the species in the market. The coronavirus, which gets its name from crown-like spikes on its surface, is a type of common virus that causes pneumonia. Those who contract this strain report fever, coughing, and difficulty breathing. Its incubation period is thought to be between one and fourteen days, and it can be passed by a sneeze or a cough before symptoms appear. As of Tuesday, it had claimed more than a hundred lives in China, and more than forty-five hundred cases had been confirmed across the country. The virus has also found its way to Taiwan, Hong Kong, Macao, Vietnam, Singapore, Malaysia, Cambodia, South Korea, Thailand, Japan, Nepal, Australia, Canada, France, Germany, and the United States, where there are five documented cases. So far, there have been no deaths outside of China.
The Wuhan coronavirus belongs to the same family as severe acute respiratory syndrome, or SARS, which broke out in the southern Chinese province of Guangdong, in November, 2002, and spread, through infected travellers, to twenty-six countries, killing almost eight hundred people around the world. It was finally contained in the summer of 2003, by isolating suspected carriers around the world and breaking the path of person-to-person transmission. SARS created a global panic and caused an estimated forty billion dollars in losses to the global economy, owing to sharp drops in travel and consumer spending. China concealed the epidemic for several months. (Scientists in North America were only able to sequence the genome that caused the virus that April, following intense pressure from the international community for China to share information about the virus.) Its severity was a source of immense embarrassment for Beijing; at a moment when it was attempting to prove its economic prowess to the world, its mismanagement of a public-health emergency called into question the health of its political leadership.
Last week, when President Xi Jinping urged an “all-out effort” to contain the “grave situation” of the coronavirus, and to disseminate information about it in a timely fashion, he was almost certainly thinking about the comparisons that would be made between this epidemic and SARS. In many respects, Beijing has learned from that experience. The World Health Organization has credited Chinese officials with identifying and sharing the genome sequencing of the virus just days after the illness was first reported. The government leaped into action with a series of bold and sometimes unnerving experimental measures. Travel in and out of Wuhan and nearby cities was banned. The largest lockdown in modern public-health history has been put into effect, which, essentially, has isolated fifteen cities in central China, with a combined population of more than fifty-seven million people. All tour groups and the sale of flight and hotel packages for Chinese citizens headed overseas have been suspended. The government plans to erect within weeks two emergency hospital facilities to accommodate thousands of patients. Meanwhile, Beijing has sent four hundred and fifty military medical staff to Wuhan to assist exhausted doctors and nurses in the effort.
An ability to marshal resources and initiate massive undertakings has often been viewed as one of the few advantages of an authoritarian regime. But it is part and parcel of a government that concentrates power so formidably at the top that regional officials tend to become more political lackeys than leaders attuned to the changing needs of their constituents. Since Xi abolished term limits on the Presidency, and began waging an aggressive war on dissent, he has accelerated the top-down approach to governance, maintaining that a diversity of opinion creates chaos, and that only his firm, steady hand will guide the country through peace and prosperity.
But this imperious style of rule deters lower-level bureaucrats from playing decisive roles that can make a meaningful difference in a fast-moving crisis. On January 9th, the World Health Organization issued a report on the virus. But, early that month, rather than raise public awareness about the virus, the Wuhan authorities detained eight people whom they alleged had spread rumors about the virus. For days afterward, local officials insisted there was a low probability of human-to-human transmission, a claim that proved to be false. Dali Yang, a China expert at the University of Chicago, wrote that “the failure to act promptly after the coronavirus was identified on January 9th helped make the number of infected swell.” Any government faced with a serious epidemic might seek to control the flow of information for the sake of averting panic. But, in a repressive regime, inaction can become the local default position. As Jude Blanchette, the Freeman Chair in China Studies at the Center for Strategic and International Studies, in Washington, D.C., notes, “Central-local relations in the Xi era have seen a severe diminishment of local-level autonomy, which has led to municipal and village officials waiting for clear signals from above before they take action.”
From a bureaucratic perspective, such reluctance makes a certain kind of sense. In this situation, to diagnose a case of 2019-nCoV would mean alerting one’s superiors, arranging a medical quarantine in hospitals that are already overwhelmed, and being held accountable for a patient with a deadly, unfamiliar virus. It is far simpler to give a more general diagnosis, such as “viral pneumonia,” which is, in fact, the illness listed on the charts of many patients since the epidemic began. Under normal circumstances, the centralized system perpetuates a cycle of inefficiency and frustration. In an emergent global-health crisis, however, it could cost lives.
Li’s current status is not known. His daughter and her family members had colds, according to the Phoenix Weekly; she didn’t know whether they had caught any infections at the hospital. Meanwhile, the situation has continued to worsen. On Monday, the U.S. Centers for Disease Control and Prevention advised American citizens to avoid nonessential travel to China. Chinese financial markets are closed, but the stock market saw its largest decline since last year.
Public-health crises are the unbidden stress tests of governance. On Monday, when the mayor of Wuhan, Zhou Xianwang, and the secretary of the Wuhan Communist Party, Ma Guoqiang, offered to resign amid “public indignation” over their response to the outbreak, Mayor Zhou sounded almost relieved. “Comrade Ma Guoqiang and I are willing to accept responsibility. If in the end you say someone has to be held accountable, you say the masses have opinions, then we’re willing to appease the world by resigning,” he said, in an interview with state television. So far, no one has leaped at the opportunity to take over their jobs.
All Rights Reserved for Jiayang Fan