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China still has 92 percent of the world’s cases of the novel coronavirus known as COVID-19, and all but 118 of the nearly 3,000 deaths from the virus have occurred within its borders. But the events of the last few days have shown that COVID-19 will not remain a primarily Chinese story for long.
The number of new cases of COVID-19 reported daily outside China now exceeds the number of new cases inside China for the first time. In the last week (since February 24), more than 30 new countries have reported their first COVID-19 cases, including Brazil in South America, Afghanistan in South Asia, and Bahrain in the Persian Gulf. Almost none of these countries’ cases came directly from China. Over the weekend, Washington State reported the first death in the United States from COVID-19, the first health-care worker to be infected with the disease, and, most worrying, the first known outbreak of the disease in a long-term care facility for the elderly.
As this coronavirus proliferates in countries far beyond its origin, national governments must consider carefully which parts of China’s experience will be generalizable to their countries.
Officials should begin by asking whether COVID-19 will have similar health effects on their populations as those it has had on people in China, where the virus has killed roughly three percent of its victims and caused serious illness, such as pneumonia and shortness of breath, in one of every seven people infected.
Understanding the factors that affect a person’s immune response to COVID-19 will likely matter as much as or more than understanding the virus itself. Poor lung health abounds in China more than in other nations. One out of two adult men in China smoke. The effects of smoking on COVID-19 have not yet been determined, but previous studies have shown that smoking increases the severity of influenza and Middle East Respiratory Syndrome, another coronavirus. The extraordinarily high smoking rates might help explain why Chinese men account for 64 percent of COVID-19 deaths. They die from the virus at much higher rates than Chinese women, only two percent of whom smoke.
Heavily urbanized China also has some of the world’s highest levels of air pollution, and the crowds and brown skies may further increase the rates at which people become infected with COVID-19 and the severity of the consequences. But while unhealthy habits and environmental factors may be worsening the spread and severity of COVID-19 in China, some insights about the virus from that nation’s outbreak are likely to be broadly applicable—for example, that it spreads easily and is particularly deadly for the elderly. COVID-19 hits hardest people over the age of 65, a population that has nearly doubled in China since 2000.
Many nations will not have enough hospital beds and ventilators to support severely ill patients in a COVID-19 outbreak.
Other nations should take careful note of China’s experience with the demands of a COVID-19 outbreak on the national health-care system. Here, the grim likelihood is that many countries may fare worse. This novel coronavirus has so overwhelmed the health-care system in Hubei Province, which includes Wuhan and is the epicenter of the outbreak, that it is killing people there at a rate four to six times greater than that in the rest of China. There are reports that doctors are donning diapers because they have no time for breaks and that thousands of volunteer nurses are working around the clock with shaved heads and insufficient supplies of masks. Meanwhile, patients with other conditions, such as cancer, are complaining of neglect. This shortage of care is occurring even though China is constructing new hospitals, taking whole hospitals out of general service and devoting them to COVID-19 response, and mobilizing thousands of respirators and other pneumonia-support equipment.
Undoubtedly, some countries with stronger health-care systems than China’s might do better. Singapore has so far navigated community spread of COVID-19 and more than 100 cases without a single fatality. But many nations will not have enough hospital beds and ventilators to support severely ill patients in a COVID-19 outbreak. Iran has confirmed 978 COVID-19 cases in a week and already suffered 54 deaths from the virus, currently the greatest number of COVID-19 fatalities outside China.
Other nations will likely consider whether they should emulate the extraordinary measures that China has taken to arrest the spread of COVID-19. China has restricted the movement of 760 million people, a population equivalent to all the residents of the United States and Canada twice over. It has imposed a brutal system of quarantine, shifting suspected but often untested cases into gymnasiums, sports arenas, and other makeshift holding centers, where they are subjected to regular fever checks and compelled to share shower and toilet facilities with hundreds of other possibly infected people.
Last Tuesday, a senior World Health Organization official finishing a mission in China told reporters that other countries could learn from China’s “rigorous approach.” “They know what they’re doing,” this WHO official said, “and they’re really, really good at it.” South Korea, which has the highest number of cases outside of China, has announced that it will institute “maximum” quarantine measures in its fourth-largest city, Daegu.
No other nation can or should seek to replicate China’s actions. The disregard that the government now demonstrates for the civil liberties and rights of its citizens is inseparable from the policies and actions that contributed to the outbreak in the first place. These behaviors include the government’s refusal to share information about the human-to-human transmission of this virus in a timely manner, its punishment and censorship of doctors and other whistleblowers who sought to raise alarm over the novel coronavirus, and its slowness in sharing the basic public health information that might have helped thousands of Chinese people avoid infection. China is still refusing to share information with the WHO on the number of Chinese health-care workers infected, thereby putting those heroic doctors, nurses, and orderlies at even greater risk.
What lessons, then, should other nations take from China on COVID-19? Speed, transparency, and accurate, science-based risk communication matter. China’s most effective measures against this virus have also been those that can be undertaken without trampling on human rights: suspending public transport, closing entertainment venues, and limiting public gatherings. Health-care facilities and departments in the United States and other nations should be preparing now—with training, equipment, and detailed operational plans—for the surge in COVID-19 patients, especially among the elderly, that China’s example shows will soon come.
Editor's Note: A previous version of this article stated that the South Korean government was moving to lock down the city of Daegu. South Korea has not isolated the city.