What Can Be Done to Stop the Wuhan Virus
In a special conference call with subscribers, science columnist Laurie Garrett and senior editor James Palmer discuss the potential global effects of the new coronavirus.
On Jan. 27, Foreign Policy hosted an FP Insider conference call with science columnist Laurie Garrett and senior editor and China Brief newsletter writer James Palmer in conversation about the outbreak of the new coronavirus. The conversation was moderated by managing editor Ravi Agrawal. Among the topics discussed: What can be done to stop the epidemic? What are the business and political impacts? And how can regular people stay safe?
A full transcript of the conference call is below. FP Insider subscribers can listen to the recording here.
Ravi Agrawal: Good morning, everyone. Welcome to our timely FP Insider conference call on the Wuhan coronavirus, how to stop it, and how to stay safe. My name is Ravi Agrawal. I’m the managing editor at Foreign Policy, and I have two excellent guests with us today to discuss the impacts of the coronavirus and where it’s all headed. I have Laurie Garrett, FP’s very own Pulitzer Prize-winning science columnist. She’s spent several months covering the SARS crisis nearly two decades ago. And James Palmer, FP senior editor and author of the China Brief newsletter. … And if you’re calling in, you can submit your questions to firstname.lastname@example.org as they arise. So let’s get started.
We’re here to talk about the Wuhan coronavirus today. Nearly 3,000 people have contracted the virus so far. The death toll has risen to nearly 80, most of those fatalities occurring in the Chinese province of Hubei, where the virus originated. Now Beijing has extended the Lunar New Year holiday by three days to prevent mass travel in the country, and around the world there are real fears about where this is headed. Just this morning, the Dow fell by about 1.5 percent. Oil prices have fallen, too.
So, Laurie, let me start with you. You covered the SARS outbreak 17 years ago. And back then, nearly 800 people died. And you’ve written in FP quite worryingly that one big change between then and now is the fact that China is just so much better connected. So a virus could, in theory, spread more quickly and more widely. How bad is this going to be?
Laurie Garrett: I think we’re in for a really rough ride, and I think it’s going to be quite definitely global in scale. We already see individual travel cases as people label them, meaning an individual acquired the infection in China and then traveled to Singapore, or to the United States, or France.
But what we haven’t yet seen a lot of is sort of secondary transmission in another country. We have a few cases of secondary transmission in South Korea, it looks like possibly also in Thailand. But I think that’s what’s kept the World Health Organization (WHO) from declaring a global emergency. At least that’s their logic, which is hard to fathom, to be honest.
The big, big difference, with the Belt and Road—this infrastructure of well over 8 or 9 trillion-dollar investment that China plans to make between now and 2030, to build this vast infrastructure of roads and highways, airports, shipping ports, and trains, high-speed trains—is that it extends into sub-Saharan Africa, all the way down right at the border of South Africa. And it extends as far north as all the way to Germany, through much of Central Asia, much of Siberia. And, of course, all the immediate neighbor countries. This means that you can actually get on a combination of high-speed train from Wuhan, and a couple of highways. And you’re in Yangon, or what Americans call Rangoon, Burma, in, you know, a couple of days. You don’t need to be on an airplane. This changes everything. It makes the world far more interconnected and the likelihood of spread far greater.
RA: Let me bring in James Palmer. And so given how easy it is for this to spread, given the connectivity, that’s obviously part of the reason why so many cities are under lockdown. It’s why there’s a mass quarantine in place. James, do quarantines work?
James Palmer: So they’re not normally that recommended by public health experts. Most of the focus is usually on education. And in this case, because the incubation period of the virus is so long, up to 10 days during which people are contagious, it really does look as though it’s sort of closing the stable door after the horse has bolted. We’re seeing a lot of impromptu quarantines being thrown up across China, not only from city authorities or the national government, but also villages, you know, turning away strangers, blockading their roads, rounding up people who have been to Hubei or even people who are just from Hubei, and quarantining them in improvised facilities, any number of things.
LG: I mean, I will say that the policies that China has adopted and is executing right now, that James is describing, are right from the SARS playbook. This is exactly what China had to do ultimately to stop SARS in 2003, and I was in the middle of it. You know, you’d be on a highway driving from, say, Beijing to Taiyuan, Shanxi, and you would be stopped every, oh, you know, 10, 12 miles and have a fever check at a police-run fever station.
RA: And are those effective?
LG: Well, it was for SARS, because it really was the case that most people were only really infectious when they had a fever. Now, this is the game-changer. This is the thing that could be hideous, if true, is that yesterday the Chinese minister of health said this virus is contagious before you have symptoms. That means that a huge effort is being executed to identify everybody with a fever and isolate them from the population. But if they are not the sole sources of contagion, this mission, this effort, will fail.
RA: And talk us through the incubation period, because if this was something that could become symptomatic in a day or two, it would be one thing. But we’re looking at about a potentially a 10-day, even a two-week incubation period. So it could be many days before we even realize the extent to which this has spread.
LG: Well, let me put this in a context that every one of your listeners can understand. If you think of influenza, and if you have a 5-year-old go into kindergarten, it’s almost guaranteed that influenza is going to come home from school, right? And you’re usually looking at influenza with a pretty quick incubation time.
It hits you like a thunderbolt. Your body sort of mulls around with it for about six to 12 hours, and then you’re sick—fast. So think how rapidly flu spreads, with that short incubation time. Now, double, triple, tenfold that incubation period for this new virus. And you’re talking about days when a person can unwittingly have no idea that they’re spreading a virus to their coworkers, to their family, to people randomly that they bump into.
RA: And so I guess the question then is how much faith and confidence do you have, Laurie, in the Chinese health care system? How well prepared are they to deal with an outbreak like this? How honest are they with each other? What are their communication and skill levels like?
LG: On the plus side, let’s start with the good news. It is an authoritarian society. So they can build a hospital in 10 days. They can mobilize an entire army to march into Wuhan with all their medical personnel to assist. They can mandate, and they do. They lock down doctors and say, “You’re not allowed to leave. You have to stay here and keep treating people till it’s over.” These are steps we wouldn’t ever be able to take—nor would we want to—here in the United States.
But on the downside, there is a long legacy that, you know, predates SARS, of average citizens not really trusting their health establishment. There’s a lot of bribery. It varies radically province by province. But there are situations where you have to pay to get a good bed for your loved one. You have to pay extra under the table to get the right surgeon, and so on and so forth. And if you don’t trust your health care workers, and you’re terrified, there’s a lot of possibility of violence, of negative interaction, of refusal to obey. So you know, during the SARS epidemic, they ended up having to execute a campaign, a propaganda campaign all over the nation. Love your nurse, love your doctor. They are here to serve you.
I think then, as far as expertise and science goes, I mean, China is, you know, racing to catch up with the United States or surpass us in terms of high-tech medicine and the availability of such things. But the problem is, none of that has anything to do with fighting this virus. This is a low-tech fight, and it’s really about supportive care. And if you’re going to survive, since there’s no treatment, it’s going to be: Did you get oxygen? Did you get intubated? Did somebody clean the fluids out of your lungs when you had pneumonia? And those procedures are very dangerous for the health care workers. Inserting something into somebody’s trachea and into their lungs, and withdrawing fluids, you need full body protection to not end up getting exposed as a health care worker. And so you can imagine, the health care workers—they don’t like them to begin with. They know that, they’re exhausted, and they’re personally terrified.
RA: I can only imagine. This is an FP Insider call. We’re talking about the Wuhan coronavirus, how to stop it, how to stay safe, what the world can do. And if you’re listening in, you can ask questions and put them to Laurie Garrett and James Palmer, our special guests today. It’s very easy to ask questions. If you’re on Zoom, click the Q&A button. A window will pop up, just type in your questions and we’ll take them live. Or if you’re calling in, you can just email email@example.com and we’ll take your questions there. I’m going to come back to Laurie with more now.
LG: Well, I actually want to ask James a quick question, if I may. James, how hard is it already in China to get food and sort of the basic necessities of life? And how long do you think most of the lockdown cities can go before this starts to become a crisis?
JP: So we’re seeing sporadic reports of shortages in Wuhan itself. Outside of Wuhan, I haven’t seen any reports of, you know, water or food being in short supply. It seems as though the logistics networks are holding up pretty well. And that it’s also a priority, like supplying Wuhan itself is clearly a priority. There are no lines upon lines of trucks going in. I think this may be one of the areas in which China’s expertise really comes into play, because, of course, the country has fantastic delivery networks. It has some world-leading logistics companies, such as Alibaba, now and huge experience in delivering supplies in crisis situations after the Sichuan earthquake and so on. And so I think this may be a better scenario than might occur in other countries at the same kind of development level.
LG: Well, that that really scares me. Imagine if it came here, would we rely on Amazon?
RA: I know. Can you imagine? I mean, that would be terrifying. I’m being told that we have a little bit of audio trouble with James. So we’re just trying to figure out how to fix that and then we will bring James back in.
So, Laurie, I’m going to keep grilling you until that point. Now, you know, who’s actually making decisions about quarantines? I mean, we know that Premier Li [Keqiang] has now sort of shown up in Hubei and he’s, you know, inspiring a sense of confidence in the people there that this is being taken very seriously. But just walk us through a little bit about the decision-making process, whether it’s radically different now from the way it was in years past, and what kinds of lessons they’ve learned.
LG: Well, for China, the hardest thing about the chain of command in a crisis like this is the difference between the individuals that are high up in the party—the Communist Party—versus individuals that have seemingly high positions in the government, so you can have a situation where a party boss, who is in the local Ministry of Health, may actually have more clout than the minister of health at the cabinet level in Beijing and may refuse orders. … And yesterday the mayor of Wuhan claimed this was at the root of why there were so many delays in Wuhan in responding appropriately to this outbreak, saying, “Look, the party bosses were saying, stay calm, shut up, cover it up. And we in the government side of the infrastructure were saying it’s time to sound the alarm.”
And this is a consistent problem. There are power struggles—in a sense, you have the real government, and then you have the shadow government. And the shadow government, which is all about political party affiliation, is much more powerful. And I think when Xi came out, President Xi [Jinping], issued a statement on Jan. 20 basically saying, “There will be no more of this, you shall behave, and you shall not cover up.” And he was really speaking to the party.
RA: Right. I have a question from Steve Elkington, who wants to ask you, Laurie, what worries you, particularly about the Wuhan virus as compared to others that you’ve covered, like Ebola or the avian flu? What are the increased dangers that you see in the coming days?
LG: Well, I think the important thing is to start with: What’s the thing that you always get every year, and somebody in your family gets every year, and sometimes many times a year. It’s a common cold. … It’s so contagious, it’s very hard to control inside your household and so on. Well, what is a common cold? They actually are two giant classes of viruses. One is rhinoviruses—rhino like your nose—and the other is coronaviruses. So this is a coronavirus.
If you think about how easily common colds spread inside of a school or inside of a workplace, this has the potential to be that contagious. What we know so far—and the science has been moving very quickly this time on this virus, so we do actually know quite a bit—is it’s fully genetically sequenced. We know what parts of the body that it latches onto as sort of lock and key mechanisms to get inside your lungs, and so on. And we have hints of where it came from. We know it’s descended from a bat lineage, a bat virus.
What we can see so far is it has the capacity to spread through the upper airways. So that can be contagious. But what we don’t know fully yet, which was the case with SARS, is your bodily fluids: You know, if you sneeze onto your hands and then your hand touches the tabletop, are the viruses in that mucus contagious to anybody who innocently touches that tabletop? In the case of SARS—yes, it was. Unless the tabletop was outside, and ultraviolet light was on it, which kills the virus. And it persisted for hours in the right kind of setting. And we don’t have that level of detail yet on this virus.
We have to assume, if I were there, if I were in China right now, I would take the kind of precautions that I would take to keep from getting a common cold. And I would assume that every doorknob was potentially contaminated, every shared device. If you handed me your cell phone right now, Ravi, I wouldn’t take it from you if we were in China.
RA: When I saw you this morning, I was struck by how you were wearing gloves. I wasn’t, and I shook your hand, so you’re clearly taking more precautions than I am. And I urge you to read Laurie’s excellent piece on our web site, it went up over the weekend. It was basically just 10 simple precautions to take to make sure that you do not contract the coronavirus. There are many simple suggestions in there that I didn’t even know about. And that piece has gone absolutely viral. It’s also being translated into Chinese so that we can circulate it among people there.
We have James back on the line for us. James, I’m curious what kind of political impact this crisis is going to have for Xi Jinping, because clearly the initial response was was quite slow, and there was a little bit of denial in the beginning. And then as often happens with China, when, you know, the larger party apparatus sort of springs into action and it moves with lightning speed.
JP: I think one of the really interesting things we saw was that the propaganda very much downplayed the virus until Thursday or Friday, even after the story had gone national, even after the quarantine was in place. It was in fifth place on the news. It was being buried on page four of People’s Daily. And then Friday, Saturday, we started to see the sort of machinery spring into action. We saw a seven-minute presentation of Xi addressing the standing committee.
So the nine-person sort of core group of Chinese leaders issuing commands. And we’ve just seen Li Keqiang, the premier, dispatched to Wuhan itself to do the kind of, you know, handshaking, ordering people around, all is well stuff. So I think the government is intensely aware of how big of a problem this could be, because this goes to the core of the promises that the Communist Party has made to the people: that you will be safe, that you will be secure, that you will be prosperous.
And we’re seeing this fake careful dance now by Xi to allow enough room between him and the control measures that if they fail, he can avoid some kind of measure of personal blame for it, that he can blame others. So we’ve already seen the scapegoating of the Wuhan government for not adequately reporting information immediately. And I think that sending Li is in some ways a measure by Xi to give himself that kind of room to operate, to make sure that he’s not personally responsible. I’m not saying that that will work. I think that lots of people will blame him, will blame the government if this gets out of control, whether fairly or unfairly. I mean, you know, there are obviously aspects that are unique to China’s problems. But this kind of epidemic could have happened in many other countries.
RA: And I guess that one difference between now and say, the SARS crisis is that China itself is at a moment where you have a leader who has consolidated power like never before, but also the economy is not growing at the same rate that it was then. And so I wonder, James, if that changes anything in terms of potential dissent or for other party leaders in terms of how they sort of interact with Xi or how they try to spin it in any way?
JP: Very much so. I think that one of the understated factors here is that, especially as things go on, Xi will be becoming very worried about the possibility of others moving against him. Because if these circumstances continue, they’re kind of the perfect setup for a clean coup. If the army can’t move, if people are restricted, if things are cut off, that’s an ideal chance for his enemies to strike at the leadership itself, to execute a takeover and have a good excuse for it, too.
And we know that he has enemies. We know that there’s been a sort of growing backlash against what many people have seen as the failure of his economic policies. The mishandling of Hong Kong, the mishandling of the trade war. And while that dissent has been largely silenced, and this is dissent coming from within the party itself at quite a high level, this could be the opportunity to express it. So you have somebody at the top who has these political worries, these very personal political worries preying on him, at the same time as he has all these concerns, you know, for the country, for safety and so on. That’s a pretty toxic mix.
LG: You know, it’s interesting to think about that in 2003 with SARS, the epidemic started at the end of the Jiang Zemin regime, and the party leadership had made a choice to have Hu Jintao take over. But it wouldn’t be ratified until the end of March in 2003 at the [National] People’s Congress. So the whole cover-up time was under Jiang Zemin and his loyalists at the local level. Right. And then as soon as Hu Jintao comes in, he starts the purge of the those who were covering it up. But in the end, the price that was paid, the people who lost their jobs were all government officials, not party leaders.
RA: Right. And in this case, there’s no party handover taking place anytime soon. If you’re listening, this is FP’s Insider call on the coronavirus out of China: what we can do about it, and the global response. If you would like to pose a question to Laurie Garrett or James Palmer and you’re on Zoom, just click on the Q&A button. Ask us a question and I’ll pose it to them. Or if you’re calling in, you can submit your questions to firstname.lastname@example.org.
I have a question from Dee Smith who asks: To what extent is there any evidence or suspicion—Laurie, this is for you—that China has pressured or prevented the WHO from making this a Public Health Emergency of International Concern, through either financial pressure or other means?
LG: Well, that’s, you know, the $60,000 question at the moment, although I don’t think $60,000 is much money anymore. Dr. Tedros [Adhanom] Ghebreyesus, the director-general of the WHO, is landing any minute now in Beijing. And I think it’s going to be very interesting to see.
And James, keep an eye out on this: who greets him at the airport and how high up his meeting goes; if he actually meets with Xi, if he’s flown to Wuhan and meets with Li. I think those will be very revealing points about how seriously China takes the WHO and vice versa. Last week, the WHO Emergency Committee convened for two days. Both days, they were locked in a 50/50 deadlock over whether or not to declare a public health emergency of international concern. And Tedros himself cast the deciding vote, saying, “No, we won’t.”
And if you listened in to the announcement, and the roughly 600 people that were in the room or on the phone listening, I think everybody was flabbergasted. This isn’t an international emergency? If this isn’t, what is? And now you have situations where countries are starting to deny the entry of Chinese through their airports, and it’s starting to have massive economic impacts. It just becomes impossible to not say this is a global phenomenon. Right. But obviously, if … if Tedros has made the decision to go to Beijing and meet with Chinese officials instead of reconvening his emergency committee, it means that the WHO is not going to declare an emergency anytime soon.
RA: Apologies for the audio problem with James earlier in this call, but we’ve got him now. James, when it comes to data from Beijing, in terms of the numbers that it’s putting out, how much do we trust those numbers, and their data, and their statements at this stage?
JP: I think we have to treat them with a lot of skepticism. And that’s not so much that the central government at this point is necessarily faking the numbers as that the problem of collecting the data itself is incredibly hard. Now you have this huge population, you have a real lack of diagnostic kits, and you also have official bodies that are used to covering up data, that are used to downplaying numbers. And [with] every Chinese disaster, every Chinese accident, the numbers are kept to the lowest total possible. If you look at things like the collection of flu data, the number of flu deaths listed in China is far less. I mean less by orders of magnitude than the United States, because most deaths are recorded as being from the symptoms of flu, rather than the flu itself.
So even when the central government has commanded people not to cover up, even when it’s opened a whistleblower line, there’s a culture of secrecy and a culture of concealment politically that makes that very hard. And you take something like the the whistleblower line that’s been established to report, you know, the failures by government officials, to adequately cope with or report data. Who in China is going to trust a whistleblower line if they don’t know exactly who it’s going to?
If they don’t know how that information is going to be used or who’s going to see it, whether the local police will see it, in a country that has spent the last five years or more—but particularly the last five years—crushing whistleblowers constantly; that, you know, has made public examples of people who have leaked information; that even in schools we’re seeing the whistleblower in the SARS case being held up as an example of what not to do.
LG: And remember, people were put in jail in early January for rumor-mongering about this outbreak. You know, as we’re talking, I’m thinking: What if this virus hits India? So we have two giant mega populations on the planet and they couldn’t be more different when it comes to health care. As I say it out loud to myself, I’m thinking, that would be the nightmare. The average Indian has no access to anything that can possibly be called decent health care. The average Indian has to pay for health care out of pocket more than they possibly can earn. Panic spreads very easily in India. Everybody’s on social media, but also it’s a panic-prone society, with a lot of contention between ethnic groups and religious groups across the whole of this vast nation. As I say it out loud to myself, I’m thinking, that would be the nightmare.
RA: Absolutely. And having lived in India for many years, I can tell you that every time we’ve pushed government sources there on how prepared they are, the answers never inspire much confidence. And this doesn’t just go for India, but more widely across South Asia. I mean, remember, Pakistan shares a long border and a lot of trade with China, as does India, as does Nepal. And so this would be a concern for all of them.
I’m getting some more questions in from our listeners. Steve Elkington, again, wants to know: Is this a worse possible pandemic, Laurie, than Ebola or Zika or past avian flu scenarios? And how confident are you about a vaccine being developed?
LG: Two-parter. So let’s take the vaccine first. We see an effort moving at record speed on trying to come up with a vaccine. Some have claimed they could have something available within three months. I would just tell you that we don’t have a SARS vaccine and that’s been many, many years: 17, 18 years. So I take it with a grain of salt.
On the the first part of the question—look, Ebola is so far a contained, horrible, nightmare phenomenon. I’ve been in three Ebola outbreaks, and there’s no understating how awful it is as a situation. It is the stuff nightmares are made of. But all the Ebola outbreaks so far have occurred in remote areas, with no international airport, except the West African situation—which then mobilized huge resources, specifically because there was the possibility of people leaving the Monrovia airport or Freetown airport and flying to, you know, London or what have you and taking Ebola with them. Also, Ebola has a very short incubation time. The symptoms are very pronounced, very obvious. An Ebola patient would not be easily confused with a flu patient, or a common cold.
In the case of SARS, you know, 37 countries eventually had cases, and it was really concentrated in a six-month period. If this is indeed transmissible, when you’re asymptomatic, unlike SARS, and has an upper respiratory infection, which means that it spreads like a common cold, I think all bets are off. I mean, I honestly think … You know, SARS in the end, the number count was a little over 8,000 cases worldwide. I honestly think we’ve already eclipsed that in China alone. And I would be very shocked if this didn’t last for many weeks, if not months, and become a phenomenon that every country in the world is having to try to address. And what worries me, of course, is what this means if thanks to the Belt and Road and so on, it reaches sub-Saharan Africa.
RA: I can only imagine, and to your point earlier, I remember during the H1N1 scare and crisis, when I was traveling around the region, there were airports such as the one at Kathmandu where you land and essentially the level of the checks in places like that are them just asking you, Do you have a cold? And there is no way of testing it. So people just say, “No, I don’t have a cold,” and you move on.
James, much of this and how it spreads also just depends on how China is able to truly sort of clamp down and control in the coming days, and also how it has in the last few days. A two-parter for you: Are people panicking, and how reliable do you think reporting from inside cities and regions that are under lockdown—how reliable do you treat reporting from those places right now?
JP: So I think that we have a relatively good picture right now, because we’re in this odd period when a crisis happens, when Chinese reporting really opens up, new lines haven’t come down yet from the propaganda ministry. So Chinese reporters are able to really bring all their considerable skills to bear, to report with relative openness and honesty, to get out and interview people, talk to experts, talk to ordinary people. And so I think we have a reasonably good picture right now. What I’m worried about is that that may change in the next few days as the government tries to establish a clearer line on the reporting itself as the government sets new limits for reporters.
And obviously, we have also just problems of scale. I mean, you know, we now have—I think—nearly 100 million people under quarantine. And a lot of those people aren’t in cities themselves. They’re out in the countryside where it’s difficult for reporters to reach, even under ordinary circumstances. It’s almost impossible for them to reach when they have to go through all these levels of quarantine, and check, and local village paranoia and so on.
One of the things that, you know, has really been worrying me is that we talk about health care in India or Nepal and so on. But a lot of rural China looks like that. A lot of rural China is extremely under-equipped, has shortages of basic equipment such as masks, has doctors who are trained at best to the B.A.-level, or even have only a two-year technical education. This health care system is deliberately tiered so that the best health resources are concentrated in the metropolises. And normally people head in from the countryside if they have serious illnesses to be treated in the first-tier cities. So while you have this population that’s going to get a lot of attention in the cities itself, it may be the countryside where the virus really sort of spreads, and where treatment becomes extremely hard for people to find.
LG: And you know what, during the SARS epidemic in rural areas, I encountered a lot of villages that set up their own quarantine, not keeping them in, but keeping the rest of the world out. And they would line their bulldozers up and block the road and not let anybody in. And this actually affected the movement of food from the rural areas into the cities, because a lot of the villagers were like, “You know what? We have plenty of food for us and we’re not letting you come in and take it, because we don’t want to get SARS.” James, here’s a nightmare potential: How many Uighurs are living in detention centers, and what would happen if this virus got in a Uighur detention center?
JP: I mean, yes, this is a horrifying possibility. You know, we have at the moment. probably something like 1.5 million Uighurs under some form of detention, whether it’s in so-called reeducation camps or in the prison system. And then we have many more Uighurs whose movement has already been highly restricted, who are being forced into coerced labor or so on. And we’ve seen cases in Xinjiang. If the virus makes its way into these closed environments where people are already in bad health, then we’re talking the kind of situation that you got with typhus in Nazi concentration camps, or in the Boer War under the British where you had these epidemics regularly sweep through the camp population.
RA: That is truly a terrifying thought to process. I’m afraid we’re out of time today, but thank you to all of our listeners for joining in. If I can leave you at a slightly happier note, it is just to say that please do try and read Laurie Garrett’s piece explaining just how simple it is to protect yourself from contracting the coronavirus. It’s on ForeignPolicy.com, along with several other articles by James and other writers we have passing through this for us. And our coverage, of course, doesn’t end here. This is a story we will be covering very closely in the coming days and weeks ahead, because we clearly haven’t seen the end of it.
Thank you all for joining us today. Be sure to stay with us on ForeignPolicy.com. Thank you.