China deserves credit, not abuse for epidemic management
European nations appear to be so overwhelmed by active cases that they have had little opportunity to see the COVID-19 presentations in epidemiological context. The Chinese have begun publishing some papers on their experience – and with a good many properly expressed reservations about their data, but most of their material depends on their experiences with people, or groups (such as young people) who got sick. In China, lots of people got sick. But lots did not, whether because of quarantine or other active measures designed to reduce the chance of exposure, or, perhaps because the disease simply did not take. As yet we have no understanding of why some won and some lost.
Although the Australian incidence is rising, the prevalence is still small. We must keep sufficient screening tests for those presenting as sick, but we now have the time, and the scope, for extensive latitudinal and longitudinal studies among different populations, temperature zones, and social groups. And even if most Australians are, in theory, following similar rules designed to reduce exposure, there might be scope too to look at the impact of particular containment regimes.
Some other countries which ought to have been well placed to conduct epidemiological studies will inevitably be badly behind our capacity. The US was very slow to get going, and, although the number of cases is beginning to mount, in part as a consequence, still has no real idea of how bad the problem is. That is because of serious shortages of testing materials, and failures to do proper testing of many early cases presenting with acute pneumonia conditions, a good proportion of which was almost certainly COVID-19. Likewise, Britain lost the plot for a while, in part because of the chaos, disorganisation and indiscipline of the Boris Johnson government, and in part because of nutty – indeed dangerous – misunderstandings of medical advice about the development of herd immunity. South Korea and Japan have the expertise and the experience to add to the body of knowledge necessary for an understanding of strategies.
As does China. Because the Chinese government is communist and totalitarian, and is seen by some rival nations as being in a dangerous and expansionist mood, there is a tendency for some observers to dismiss anything emanating from China, particularly if it contains statistics as deeply suspicious, and probably propagandistic if not consciously misleading. COVID-19, or “the Chinese virus” as President Trump calls it, is simply another stick to beat China with. And it goes without saying that the nation’s leadership responded too slowly, with too much concern for appearances, and thus, by negligence, allowed the disease to get out of control.
Perhaps, but I am not convinced that it is a total disaster story. Indeed, I doubt that the US (or Australia) would have mobilised as quickly as China, or as effectively, within the time that China did. Indeed the shambles we are still seeing in the US, three months after the first cases, suggests the US was too political, too complacent, and suffered from an anti-intellectual stripping of the capacity, resources and access to power of its systems for dealing with epidemics. As a result, the US is not leading the world in itself handling the disease, nor in leading the search for global solutions. Indeed, as Australia is discovering, it is now a major source of export of the virus.
China might have been slow to take the people into its confidence, but had notified WHO within weeks of discovering a pneumonia of unknown origin in the Wuhan area. Within three weeks, its quarantine and containment systems had reduced the rate of spread of the disease, and its rate of growth. That’s a formidable achievement. Perhaps it might have done better, but its measures have been, so far, better than in most of the First World. And the scientific reviews it has published, as well as the WHO reviews, are credible, and consistent with the experience elsewhere. It does not appear to have been sanitised, or bent to some propaganda purpose.
But even with China, we do not know how the disease spread among the general population, or much about its true incidence. Initially, its focus was on strange new presentations of acute respiratory disease at regional hospitals. In due course, following up of cases led to an understanding that the severity of the disease, among those who had or, or were thought to have it, varied enormously.
We know from the aetiologies and published guidance materials that the disease is most severe in older people, particularly those with already compromised respiratory or immune systems, including chronic smoking, and that many younger people, particularly children, seem to survive exposure without showing symptoms, or only very mild symptoms. We are learning, if slowly, about when a patient is infectious – at least, apparently, for a day before symptoms are evident, and how long an ultimate survivor has the virus before it passes out of the body, with, apparently, at least some temporary immunity.
We also know some ways of establishing those people who seem to be most at risk, and about sorting out whether particular symptoms – fever say, or pneumonia, or gastroenteritis – are symptoms of COVID-19 or some other flu or condition.
And we can now use serology and other pathological evidence to positively identify the disease. Around the world, scientists, big pharma and other parties galvanised by the disease, or the profits to be made from useful COVID-17 technology, are looking for quicker, cheaper ways of dividing those who have got the virus from those who have not. Others are working on vaccines – a number are already in testing – and others are already testing new drugs which appear to help reduce the intensity, or, it is to be hoped, fatality of the condition. Sooner, rather than later, the most valuable tool may prove to be a device rather like a Breathalyzer – about to tell from a puff whether one has the disease or not.
Jack Waterford is a former Editor of The Canberra Times