Authors: Jinshan Wu PhD¹, Robin Nicholas Thompson PhD²

Affiliations: ¹Beijing Normal University, Beijing, P.R. China; ²University of Oxford, Oxford, UK

The outbreak of coronavirus disease 2019 (COVID-19) has been declared a global pandemic, with substantial person to person transmission in countries across the world. A variety of approaches have been employed to tackle the virus, with many countries now implementing widespread interventions such as social distancing measures that do not only target infectious hosts and their contacts but also have significant impacts on the rest of the population. These interventions change human behaviour and affect everyday life. Widespread interventions were implemented in China [1], where the outbreak appears to have now slowed with fewer than 200 reported cases in that country for each of the last 29 days, and fewer than 100 cases for each of the last 25 days [2]. Here, to inform widespread responses in other countries, we report the everyday experiences of the first author of this Commentary about the measures, and their costs to individuals, that eventually led to a decline in cases across China.

The first author is a university professor in Beijing, who lives and works on the university campus. The site has been divided into two parts because of the coronavirus outbreak. Professor Wu’s home is in one area of the campus, and his office lies in the other area. To travel between his home and his office, he is required to carry a permit that he must apply for every day, one day in advance. This permit is linked to his university identity card, and he must present it to the guards at the temporary gates between the two areas, otherwise he will be denied entry.

During the Spring festival earlier this year, the first author visited the village of his birth. Travel in China has been challenging during the outbreak, even prior to the most extreme public health measures being introduced. Travellers are required to declare any travel away from home to the local authority. If any individual has a history of recent visits to Hubei, they have been required to self-isolate for a period of at least two weeks, during which neighbours or local authorities provide food and other necessary supplies. Mobile phone records have been used to track where individuals have visited. The very strict isolation policy for travellers from Hubei has ensured infrequent transmission from those individuals in other regions in China. 

Many residential areas are only allowing individuals living in those areas to enter. While this is sometimes ordered by the authorities, when the outbreak in China was at its peak Professor Wu also observed ordinary citizens implementing such measures: the roads to many villages were blocked by local residents. As far as the first author can tell, most Chinese people understand and cooperate with interventions to stop this deadly virus, despite the social costs.

As well as the challenges of long-distance travel, everyday tasks are also difficult when widespread interventions are in place. Every time Professor Wu and his friends drive on the highway, there are checkpoints where nurses, doctors, security guards, policemen and volunteers measure every passenger's temperature and record where they are going to and from. While most restaurants are closed, supermarkets remain open but with a maximum number of shoppers allowed in at any time. The temperature of each customer is measured by employees who act as security guards. Most shops require shoppers to wear face masks, so Professor Wu and other residents are effectively mandated to wear masks. 

With such severe public health measures being implemented, organisation is critical. Local authorities, and sometimes volunteers, provide limited supplies of masks, food and other materials every day in designated places, which are usually supermarkets or gas stations. Factories have been re-commissioned to produce masks and medical supplies, or to manufacture machinery for producing these items. 

The first author knows from personal experience that the measures implemented throughout China have significant effects on people across the country, infected or not. While this has come at some cost to its citizens, and such interventions may not be desirable, three important lessons can be learnt elsewhere in the world even in places where such extreme measures are not implemented. First, widespread interventions have the potential to reduce transmission of SARS-CoV-2 substantially. Second, measures must be implemented consistently. Third, such efforts must be well-organised and coordinated between all levels of government, businesses and individual citizens. 

As the experience of COVID-19 in South Korea in recent weeks suggests [3], interventions as extreme as some of those implemented in China may not be essential to slow this outbreak down. Social distancing measures, as are currently being implemented elsewhere, are likely to make a substantial difference in terms of case numbers if followed consistently. Going forwards, many key questions remain. For example, it remains to be seen exactly what will happen to case numbers in China as interventions are relaxed. Nonetheless, what we have observed in China and South Korea is that a wide-reaching response to this pandemic comprising of many aspects has been shown – despite significant costs to individuals – to have the potential to lead to successful outbreak control.

References

1.        Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China. Summary of a report of 72,314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020.

2.        Worldometer. COVID-19 Coronavirus Outbreak Data [Internet]. 2020. Available: worldometers.info/coronavirus/country/china/

3.        Normile D. Coronavirus cases have dropped sharply in South Korea. What’s the secret to its success? Science. 2020