Josef Gregory Mahoney, PhD Professor of Politics Director, International Graduate Program in Politics East China Normal University Outbreak Overview The novel coronavirus outbreak first observed in Wuhan and now known officially as COVID-19 has infected a little more than 74 thousand people in China (and a little more than a thousand outside of China), the majority of which are located in the hard-hit Hubei Province. Of these, more than 16,100 have recovered and just over 2,100 have died (numbers reported by China Daily and South China Morning Post on February 20, 2020). For most infected, the presentation is comparable to a mild form of pneumonia or influenza. Like most infections, it is most dangerous to those who are elderly, immune-compromised, and/or suffering from other health problems; but as a highly infectious novel virus that mutates relatively quickly, extreme caution and robust counter-measures are justified. While public health scientists are still calculating case fatality rates (CFR), published numbers in leading health journals and the World Health Organization currently estimate it to be somewhere between .4% to 2.9%. In areas like Wuhan, the CFR has tended towards the higher end of the range. This is due in all likelihood to three reasons. First, in the early days of the outbreak little was known about COVID-19’s pathology, including how infectious it was or how it was transmitted. Second, because little was known, it was impossible initially to put in place the best forms of containment, control, testing and treatments. Third, the decision to seal off Wuhan and other parts of Hubei health supported national and even global health security, but placed additional pressures on the local people and local health system. The initial local response to the outbreak was mixed. On the one hand, the disease emerged quickly and both local officials and systems were overwhelmed. Although Wuhan is one of China’s leading cities and the major city in its region of Central China, its development level and COVID-19’s novel characteristics left it more vulnerable than cities like Shanghai or Beijing. Nevertheless, while the outbreak has tested Wuhan especially, it has also produced numerous examples of human courage and struggle to overcome this outbreak, especially frontline medical personnel, all of whom have endured the most difficult circumstances beyond normal breaking points, including many who were fatally infected. At the national level, the response to the outbreak has been met largely with praise. Central leaders acted quickly at President Xi Jinping’s direction to form leading groups to manage the outbreak, and moved top talents including Beijing’s Chen Yixin, Shanghai’s Ying Yong (Shanghai) and Jinan’s Wang Zhonglin into key positions in Wuhan and Hubei lead the local response and ensure national coordination. The Chinese New Year holiday was extended, transportation curtailed, and quarantine regimes established and enforced—all the way down to the neighborhood and village committee levels. Creating an emergency hospital in 10 days and mobilizing civilian and military doctors and nurses to staff it and relieve others were key accomplishments. These efforts stymied the virus’ spread nationally, and over the past few days numbers infected and deaths have also started falling in Wuhan. At the international level, the Chinese government has been praised by the World Health Organization and numerous leaders of foreign countries, including the United States, for China’s unprecedented transparency and aggressive response to the outbreak. Chinese Foreign Minister Wang Yi has met with Singaporean and Philippine leaders to thank them for their strong support during this crisis, and is helping lead an unprecedented emergency of ASEAN to share information and coordinate the broader international response in Asia. Nevertheless, China and Chinese nationals have also faced a number of well-documented forms of Sinophobia and discrimination, including a number of countries closing their borders to China, a number of airlines cancelling flight services, and gratuitous forms of racial and cultural racism directed at Chinese in media and against some Chinese abroad during the outbreak. Furthermore, despite official American praise for China’s handling of the outbreak, the ongoing frictions between the US and China—including continuing restrictions imposed by the US in the US-instigated trade war—have harmed cooperation and support, and contributed to an already poisoned public discourse about China in the US. Additionally, given the unexpected legal attacks in the past two weeks on members of China’s military and separately, Chinese tech-leader Huawei, the US appears to have exploited China’s focus on the outbreak as an opportunity to pursue aggressive foreign policies and contribute to the radical discourse of “decoupling” that is advanced in some Washington circles. While some European leaders have described these attacks as nothing more than malicious propaganda, the US appears to have accelerated efforts to turn others against China. Tentative Conclusions Tentatively, four general conclusions can be drawn at this point when the outbreak is increasingly under control. First, even at the high-end of 2.9%, COVID-19 is only slightly more dangerous than previous SARS outbreaks but substantially less deadly than some of recent bad influenza and pneumonia years, where case fatality rates have sometimes exceeded 10% ( as they did in the United States in 2017-18, according data from the US Centers for Disease Control and Prevention). While current estimates indicate an effective vaccine may not be available for 18 months, given what has been learned and the containment efforts employed, the ongoing heath danger has been mitigated substantially. Second, while the outbreak exposed a number of serious vulnerabilities in governance at the local level in Wuhan, it has reaffirmed the strengths and capacities of national governance. While this outbreak is more serious and emerged more quickly than previous outbreaks, including SARS, it is clear that many previous lessons were effectively institutionalized. While clear assessments have not been made yet, one area of improvement might be found in the national network for disease reporting built after SARS (中国传染病疫情和突发公共卫生事件网络直报系统), which might need reforms to accelerate reporting and analysis for a fast moving virus like COVID-19. Another matter to explore is whether stockpiles and locations of vital equipment are sufficient or should be expanded, including especially protective gear for medical personnel, and to ensure that production and distribution needs are met even in the midst of a crisis. Whatever and wherever the shortcoming, it will be incumbent on Chinese leaders to draw new lessons from this outbreak and make new reforms that will further strengthen governance. Third, in other Chinese locales, local governments moved quickly to suppress the outbreak and stage emergency medical resources. In Shanghai for example, an emergency medical facility was constructed at speed—a smaller version of those famously constructed in Wuhan—and new rules were put in place to help officials to protect public health. In the past week, with more and more returning to work to make up for lost time and economic output, local governments have worked closely with businesses, schools, transportation services and other groups to minimize health risks. Fourth, the outbreak underscores the increasing need for global cooperation and improving global governance, much akin to President Xi’s call to abandon unipolar thinking for a “shared future for all mankind.” While some forms of global cooperation during this outbreak have been effective and positive, others have not been, and the trend towards unilateralism if not decoupling is dangerous. International cooperation, like that advanced by China with COVID-19, is vital for protecting international public health, but also for addressing global concerns like climate change. Indeed, while not yet confirmed in this case, there is much scientific evidence to indicate that climate change will accelerate the emergence of new diseases, and that aggressive policies like trade wars increase everyone’s vulnerability to a multitude of negative outcomes. The need to move past aggression and towards more global cooperation will be both the biggest and most difficult lesson for many to realize. About the Author: Josef Gregory Mahoney is an internationally recognized expert in Chinese politics based in Shanghai at East China Normal University, where her serves as a professor of politics, the director of the International Graduate Program in Politics (IGPP), and the Executive Director of the International Center for Advanced Political Studies (ICAP). Prior to his academic career he was a public health officer with the US Centers for Disease Control and Prevention.