Last year, in late December, Li Wenliang, a young ophthalmologist, wrote 150 of his friends from medical circles. He said he had seen a number of cases of viral pneumonia come into the Wuhan Central Hospital, where he worked, and that they all seemed linked to the Huanan Seafood Market, the main source for restaurants in Wuhan, a metropolis of 11 million people, and the most important city of the central regions of China. Five weeks later, Li was dead, at 34, killed by the same virus about which he warned his friends in the same hospital that had warned him not to tell people what was happening.
An online tidal wave of reflection and grief that I’ve never seen before resulted. My own personal WeChat feed was flooded with comments and tributes to him, ranging from poems to cartoons of him eating his favorite meal of fried chicken. The rage was directed largely at Wuhan city officials. After Li had written to his friends, he had been called into a police station, where he was forced to sign an unusual document designed to coerce him into silence. Later, he spoke to Chinese private media company Caixin, shedding light on the unfolding epidemic which, having engulfed first Wuhan and its surroundings, is now front page news across the world. Li became, as a result, the face and name of a censorship phenomenon involving a number of other doctors.
The Wuhan authorities knew that the epidemic was of grave concern yet did not notify the public nor begin preparing.
Rightly, people are in uproar about China’s security forces blocking Chinese doctors from sharing crucial public health information. To date, the coronavirus, a respiratory illness that begins with a fever before escalating to attack the lungs, has killed more than 1,300 people. Is Li a representative case of the failings of Chinese government censorship? Yes. Being punished for sharing information about a virus among medical professionals changes the incentives for everyone wishing to report the virus, cooling relations and slowing information.
But did censoring Li and others make the outbreak of the virus much worse, leading to many more deaths, as many Chinese people believe? Not so much. The censorship, and its subsequent chilling effect, is not what is killing people: What is a far more proximate cause of these deaths is the incompetence of the Wuhan government and the central health authorities in the two weeks that followed the censorship. They failed to prepare any sort of health system response, and the Wuhan authorities were preoccupied by a major political conference. When the virus took hold and became an epidemic, the health system was swamped. People were unable to access health services, and in some cases, people were contracting the virus when already sick or weak, making them more likely to succumb.
While Li and others were being censored, however, health authorities were not only active but effective. On December 29, the local Wuhan Centre for Disease Control (CDC; China has a centralized system whereby all hospital entries are available to a CDC review team) notified its state and federal superiors that there was a suspected outbreak of a SARS-like illness. At the end of the following day, as doctors sent messages to their WeChat groups, the Wuhan health bureau sent all hospitals in the city an “urgent notification” to report on any possible cases. It did not, however, declare the disease to be the highest risk (a category 1), nor tell doctors to wear protective clothing or masks. The next day, an expert team from the central government arrived in Wuhan and took samples for testing. Within a day, they had shut down the most likely source of the virus, a major food market, and it wasn’t long before a number of labs around the country managed to isolate the virus from the samples. On January 5, the World Health Organization (WHO) was notified and the results were soon posted to open source databases worldwide.
There can be no complaints about any of these actions. They are probably what the WHO had in mind when they fulsomely praised China’s response to the epidemic. But, these actions all occurred at the same time that local police were sanctioning doctors for talking among themselves about the virus, reducing the flow of information among professionals. More importantly, government actions in the subsequent fortnight were reprehensible. In mid January, Wuhan city and its higher-level provincial government Hubei each held their most important political meetings of the year. Wuhan media covered these meetings, yet there was only one front-page story on the virus. The Wuhan health ministry made a number of false statements about the illness in its press conferences. It said that there were no new cases when there were, and also told the public that there had been no cases of medical personnel becoming infected, even though doctors, including Li, were already manifesting symptoms and quarantining themselves.
The pendulum has now swung too far toward overreaction rather than trusting public-health measures.
The Wuhan authorities knew that the epidemic was of grave concern, yet did not notify the public nor begin preparing. It seems most likely that they were completely occupied by the two political meetings, which took up all government and Party resources, and killed any air time for public health announcements—thus negligently wasting two vital weeks to prepare for any possible outbreak. For example, they lacked the capacity to test for the virus at the necessary scale, making only 200 test kits per day, and sending early tests off to Beijing for results. On January 20, Xi Jinping got involved and the vast Chinese bureaucracy kicked into gear, shutting down a whole province. Local governments were told to take any measures necessary. For the past three weeks, we have seen the overreaction: airports and travel grinding to a standstill, most of China working from home (around half of China’s citizens are unable to move), and various countries closing their borders to Chinese nationals.
This cycle—slow identification of the problem, central involvement and prioritization, all-out mobilization—is a familiar pattern of Chinese crisis management. That’s because China is not so much one government as 3,000 local governments, united by their membership in China’s ruling Communist Party. Each of these local governments must have a single person able to be held accountable for whatever happens on their watch; the performance of this individual—and their standing committee, usually made up of 10 to 12 other leaders—is measured on thousands of indicators. Local satraps pick which indicators to focus on. They know that their superiors will take the credit for anything that goes well, and they will take the blame for failures. Occasionally, such as right now, top leaders send out signals so powerful that all local leaders know to drop everything and focus only on that sole objective.
Running China like this, by call-and-response, makes it easier for the top leaders to stay in power. China has five levels of government, and should something go wrong, one can always say that it was caused by a failure to properly heed or follow central instructions. Blame is local, glory national. The censoring of doctors will be painted as solely a failing of local policing, the two weeks of inaction and lack of notification due to decay in Wuhan’s politics. And China’s leaders will throw every resource they have at stopping the epidemic, knowing that inaction would look worse than incompetence. Indeed, the danger now is that the pendulum has swung too far toward overreaction rather than trusting appropriate public health measures. When the call is strong enough, everyone responds, and the fear is that the economy and also the health system will become paralyzed. The cure may be worse than the disease.
It is perhaps likely that with freer speech, and faster information sharing among doctors, some of the harm the virus caused could have been diminished. A stronger public health system and government response would almost certainly have meant that the virus was less damaging. Both things would be boons to Chinese society. And Chinese people themselves seem to recognize this. In the aftermath of Li’s death, many posted a line from the poet Lu Xun, which, roughly translated, means that those stuck in a storm need to make sure those fetching firewood for them don’t freeze to death. What wasn’t posted, but instantly springs to mind, was the succeeding line, which says that those who clear a path toward freedom should not be forced into dire straits by difficult times. While the storm of this epidemic will pass, there is much to be done to protect the next generation of people fetching the wood.
Ryan Manuel runs a research firm in Hong Kong. He holds a doctorate in medical sciences from Oxford University, where he wrote his thesis on Chinese public health as a Rhodes Scholar. He was previously an academic at Hong Kong University, Oxford University, and The Australian National University, and a Senior China Analyst with the Australian government.
Lead image: Dpongvit / Shutterstock