December 2019 – March 13, 2020.
As early as mid-December 2019, word had it on Chinese social media that an unknown pneumonia was going on in Wuhan, the city in central China with 11 million population. As reports traced back later on, the very first case could be dated to 8 December 2019. On 26 December 2019, four new patients with similar syndromes caught the attention of a doctor, and the next day Wuhan government was notified about it for the very first time. Four days later, a confidential document from the Wuhan Health Commission leaked out on social media. It was ranked urgent, referring to this disease as ‘unknown pneumonia’ and giving instructions to relevant departments for dealing with and investigating into it. People started to become alert, yet did not know what to do. The next day, official media confirmed the confidential document in spread, referred to the disease as ‘viral pneumonia’, and announced that the central government had been notified and a special team had arrived in Wuhan. Exact numbers were also revealed by the Wuhan Health Commission on 31 December 2019: 27 cases, 7 in severe condition and the rest controllable, 2 getting better and ready for leaving the hospital. A seafood market was disinfected and closed the same day, suspected to be the source of this disease as all the patients had been there. At this stage, it is fair to say that the local hospital was fast in discerning and reporting and that the government, both local and national, was fast in reacting. Regarding the more-than-half-a-month period in between, epidemiologists commented that for a city of such a size, it is understandable that the small number of cases scattered in different hospitals was not noticeable enough to discern the emergence of a novel disease.
China immediately reported to the World Health Organization and had been closely engaged in public communication ever since. Reports from Wuhan Health Commission detailedly stated the number of new cases, altogether cases, suspected cases, severe cases, death cases, cured cases, etc. National Health Commission would also repost it. At first, the report was published every few days, on 31 December, 3 January, 5 January, 11 January, and after that, it became daily. The identification of the virus was also efficiently in process. 5 January 2020, China announced that flu, SARS, MERS, and several other known epidemics had all been excluded, and this virus was as yet uncertain. 11 January, China identified this virus as coronavirus, temporarily named as 2019-nCoV by WHO, n meaning novel. 20 January some Chinese scientists published a report on Nature and revealed that the genetic code of this virus is 80% identical with SARS, another type of coronavirus breaking out in Asia during 2002-2003.
The relation of COVID-19 with SARS is an interesting case in regard to public communication. The 30th December 2019, screenshots from a private chat group appeared on social media in which one doctor addressed this disease as SARS when discussing with his classmates from medical school. It was the earliest non-official account coming from an insider, on the same day when the confidential document also leaked out in which the authority addressed the disease as ‘unknown pneumonia’. The screenshots received huge attention and triggered massive panic. This is because during the previous SARS outbreak more than 700 people in China died and many people in Asia were somewhat traumatized. Four days later several official media denounced the SARS rumour to be false, and for the first half of January, the media kept telling people to stay calm and not to panic. Later on when the genetic resemblance of the two viruses was officially confirmed, WHO officially named the disease as COVID-19 and the virus as SARS-CoV-2 on 11 February, but still referred to the virus as ‘the COVID-19 virus’ when communicating with the public, in order to avoid “unnecessary fear for some populations, especially in Asia which was worst affected by the SARS outbreak”, as is stated on the official website of WHO.
Another case of public communication, also in order to prevent panic, was how the transmission of the virus was reported – but this time with serious consequences. From the first official report on 31 December to the fourth report on 11 January, each time it would be stated that no clear evidence of human-to-human transmission has been identified and that most of the patients had been to the seafood market. From 12 January onwards the government stopped mentioning how it transmitted, but by that time the media and the masses had already taken it for granted that this virus did not transmit between human to human and only infected those in contact with the animals sold in the seafood market which did not get properly vaccinated. Hence most people, even those living in Wuhan, took it as no big deal and made no precaution except for not going to the seafood market which had already been closed anyway. Later on, when it proved to be transmitted human-to-human and had an incubation period of up to 14 days, people were angry about the public communication strategy. They criticized that, even though no clear evidence of human-to-human transmission had been identified, the rhetoric could have been ‘not excluding the possibility of human-to-human transmission’, which logically meant the same – but the effect would have been hugely different.
The turning point was on 20 January, when Xi Jinping publicly gave instructions for the first time, addressing the severity and urgency of this crisis. On that day Wuhan reported 136 cases, and other regions in China and abroad also began to be contracted. The situation was severe now. The evening of that day, Zhong Nanshan, a prominent epidemiologist appointed as the head of the national investigation team set up the day before, received an interview on live broadcasting TV and confirmed that the virus is definitely transmitted human-to-human based on the evidence now. The next day, Mayor of Wuhan suggested people not to travel in and out of Wuhan. 24 January, State Council of China opened an online channel for individuals to report directly to the central government if any local institution was found poorly reacting or even misreporting cases. By that time there were 1287 cases from 29 out of 31 provinces in mainland China. As the outbreak accelerated into a national emergency, the central government began full intervention, requiring total efficiency and transparency. The media also changed the rhetoric, rapidly ending the “keep calm and carry on” strategy. Posters were hung up everywhere, calling people to stay at home, not to gather in groups, and put on face masks if having to go out.
Unfortunately, when the virus proved to be human-to-human transmitted, the previous few days had already passed with huge numbers of carriers travelling around in incubation period. People got infected and kept spreading it out, only realizing it later on when symptoms began to show. Worse off, the developing of the outbreak coincided with the approaching of Chinese New Year, 25 January 2020 (calculated by the Chinese lunar calendar, hence the specific date on the standard solar calendar would be different every year). The entire new year season would start off half a month before and last half a month after, during which people would take their winter break. The homecoming transportation during the Chinese New Year season is recognized as the largest annual human migration on the planet, and Wuhan, as the hub of transport in central China, enjoys an enormous passenger flow on railways, highways, flights and ferries that run throughout the whole country. Not to mention Wuhan’s own 11 million citizens, many of which are not permanent local residents and need to come home at the end of the year, as is the case for every metropolitan city. Students there alone count to millions, as Wuhan is the home for more than fifty universities and colleges. 26 January, Mayor of Wuhan revealed that more than 5 million people had recently left Wuhan. Such population mobility on a national level peaking at such a special time was bound to bomb the spread of this virus.
23 January 2020, people woke up to find an official order had come at 2 am in the morning that all the transportation going in and out of Wuhan city would be shut down from 10 am that day onwards, and people were required not to leave or enter Wuhan unless approved for necessary reasons. Public transportation inside Wuhan city was also shut down. The only alternative to private vehicles for commuting inside the city were 6 thousand cabs and Ubers assigned by the Wuhan government so that the gathering and close contact of people on transportation could be avoided. Disinfectants, protection suits and glasses were given to drivers, and cabs were required to be disinfected every time after use. As this was two days before the Chinese New Year Eve, most people were already at where they intended to stay, with food and groceries already stocked up for the new few days. Although the shutdown came unexpected, the special time mitigated the crisis to a certain extent. Among those Uber drivers in work, many were not appointed but volunteered to stay in service. Uber also set up a volunteer team picking up healthcare workers for free, not only in Wuhan but also in other cities. The Uber company covered special insurance for its drivers all around China and invested one hundred million Chinese Yuan for installing protection shield between the driver and the passenger. Uber also volunteered to work with local neighbourhoods, buying food and groceries for residents free of delivery, so that people need not gather in stores. The makeshift transportation plan in Wuhan is a perfect example of the cooperation between the government, the enterprise, the community and the individuals.
Two days before the shutdown, the Wuhan government already proclaimed that all confirmed cases would receive medical treatment free of charge, and seven hospitals had been allocated specially for receiving coronavirus patients. However, medical resources became a problem for quite a while. All of a sudden people flooded to hospitals asking for test and treatment, partly due to massive panic, partly due to large numbers of carriers previously in incubation period which were beginning to show symptoms. Patients in need of hospitalization overnumbered beds available and many people could not even get tested fast enough. Test kits for coronavirus require highly strict laboratory standards for production and operation, and by that time only three companies had permission from National Health Commission for manufacturing it (increased to 12 when this article is finished on March). Even though these companies worked nonstop to cover the demand, most hospitals were not qualified for running tests and could only send the samples of their patients to other institutions which were already overworked. Medical institutions all around Wuhan were lacking resources, including protection suits, protection glasses, face masks, medical gloves, disinfectants, even food. Now that as Chinese New Year came, most manufacturing factories were already closed. Even some immediately started manufacturing, protection clothing need to be put for a few days after production before it could be used in direct contact with the human body. Not having had anticipated such a crisis, hospitals had only stocked up their resources at the normal size – but which soon ran out. From the day of the shutdown, many hospitals in Wuhan were starting to call for help on social media, asking for donations not of money but of resources which were hard to purchase in large amounts and would take long if acquired and allocated by the government. Those who responded were mainly young generations from social media. Individuals from other regions were buying resources from local stores to send to Wuhan. Many manufacturing companies provided resources for free, and many express companies shipped such resources for free. At first, many donations were given to governmental charity organizations specially assigned for dealing with this crisis, but as its allocation soon proved to be not efficient enough as the urgency required, most people directly donated to hospitals. Those who had money mostly donate to small NGOs to let them deal with the purchasing and allocating of resources, notably charity funds of celebrities or fans groups doing good in the name of their idols. Some people with a channel to purchase and deliver in large size even urgently set up their own organizations and received donations. Those living overseas were donating mainly through alumni associations. The donations took place in well-functioning anarchy, not because the government did not exist but because it was largely overridden. When official channels proved impossible to purchase in large size and inefficient when dealing with enormous small donations, small organizations and individuals stood out taking their roles. It was exactly these enormous small donations accumulating together that mitigated the crisis of Wuhan.
The efficiency of the government played a vital role in huge projects requiring central planning. Regarding the lack of beds in hospitals, the mitigation plan was to construct new hospitals with unbelievably fast speed. It was not without precedents: during the time of SARS in 2003, a new hospital was built within one week in Beijing. The decision was made on 23 January, the same day when Wuhan was shut down. The next day a layout plan was finished, and nine days later Huoshenshan (Mount Fire God) Hospital was ready for service, built from scratch, with one thousand beds on an area of 3.39 million square meters. 25 January Wuhan decided to construct another hospital, and 14 days later Leishenshan (Mount Thunder God) Hospital was in service, with 1600 beds on an area of 7.97 million square meters. Except for new constructions out from zero, Wuhan was also converting facilities such as exhibition centres and stadiums into temporary hospitals. Confirmed cases without severe symptoms would be held here, which previously would be suggested self-isolating at home. The first three temporary hospitals were put into use on 5 February. Up to 21 February, thirteen such temporary hospitals were in use, with 13348 beds in total. Warm-keeping devices were installed on beds, meals were designed by nutritionists and provided by hotels. Some hospitals even had microwaves, televisions, and libraries. Videos of patients and healthcare workers dancing in large groups were spreading on social media. Medical teams from all around China were arriving in Wuhan, 72 teams with 7708 healthcare workers up to 20 February. 10 March, all thirteen temporary hospitals were closed as the number of patients was reducing. On that day only new 13 cases were detected in Wuhan, with 49978 Wuhan cases in total, 33041 having been cured and left the hospital, 14514 still in hospitalization. More than 1.2 million patients had received hospitalization in those temporary hospitals during the 35 days from the first one was put into use until the last one was closed. For suspected cases and people in close contact with confirmed cases, hotels were assigned to isolate them from 3 February onwards, with medical workers stationed there. China has always enjoyed a reputation for construction, and this time its ability to allocate huge resources and construct in a remarkably fast speed was vital in mitigating this emergency.
Regarding other regions in China, a top-level response under the planning of the central government was required on a national basis from 23 January onwards. The city where I live in is in southern China 795 km away from Wuhan, with zero cases when the order came, the first case on 26 January and altogether 37 cases up to now. It has stopped showing new cases since 13 February. Still, the quarantine in my city was very strict. From 5 February onwards all neighbourhoods were locked up, and residents were given tickets for going in and out with limited times to reduce the mobility of the population. Guards were stationed at entrances of neighbourhoods 24/7, constituted of social workers, government officials, community employees and volunteers, taking shift every 8 hours. Special needs of the residents were also dealt with by them. People visiting from other neighbourhoods were required to register their information and had their body temperature checked. People coming from other cities or even other districts in the same city were required to self-isolate at home for two weeks. Cars going in and out of the neighbourhood entrance were required to register on an online platform which can track their previous whereabouts. As the Chinese New Year season came to an end and many people needed to return to work, the government issued permission to those companies with urgent impact on the functioning of the city, and their employees were permitted to come in and out of neighbourhood entrance without limit. When the time came that schools should start, lectures were given through an online platform. From 20 February onwards the limit of times was cancelled, but people still needed a ticket issued by the neighbourhood proving they are residents here, otherwise information register and body temperature check would be required. Other regions in China were all responding in the same manner, monitoring the quarantine on a neighbourhood basis. From 21 February onwards, many provinces in China received an order to level down their response levels (there is a four-level response system for public emergencies in China). From 10 March onwards, 25 out of 31 provinces in mainland China stopped showing up new cases. When this article is finished on 13 March, only 8 new cases were detected from all around China the previous day. The highly strict quarantine proved efficient and fruitful.
However, as the situation inside China was stabilizing, the outbreak was rapidly spreading in other countries. On 11 March WHO declared that the disease had developed into a pandemic and that Europe was now the epicentre of the world. 125 out of all 195 countries in the world have reported cases up to 13 March when this article is finished, including all countries from the European Union. Italy is the world’s worst-hit country after China, with a total number of 17660 cases updated on 13 March, 17% of its population. On 9 March 2020, Italy imposed a nationwide lockdown, closing all shops except for food stores and chemists, restricting the mobility of the population except for necessary cases. Medical teams and supplies sent by China arrived in Italy on 13 March. Such teams had also been sent to Iran and Iraq during the previous days. Iran is the most severe in the Middle East, with 11364 confirmed cases and 514 deaths updated on 13 March, a mortality rate exceptionally high. More than 30 MPs and government officials in Iran were tested positive, including Vice President and Deputy Health Minister. In the USA a national emergency was declared by President Trump on 13 March, with 2033 confirmed cases when only less than ten thousand out of its 329 million population were provided test. At this point in time, there are approximately 7979 cases in South Korea, 4209 in Spain, 3117 in Germany, 2876 in France including its Minister of Culture, 1009 in Switzerland, 804 in the Netherlands, 798 in the UK including its Health Minister. In Canada, the wife of Prime Minister was tested positive, and the Prime Minister is now in isolation. The outbreak in many countries is still at the developing stage now, and how this pandemic will end is yet to be seen.