In December 2019, Dr Li Wenliang wrote to 150 of his friends from medical circles about a number of cases of viral pneumonia coming into the Wuhan Central Hospital. They all seemed linked to the Huanan Seafood Market, the main source of seafood for restaurants in Wuhan. Five weeks later Li was dead, killed by the same virus he warned his friends about, passed away in the same hospital that had warned him not to tell people about what was happening.
A makeshift memorial for Li Wenliang, a doctor who issued an early warning about the coronavirus outbreak before it was officially recognized, is seen after Li died of the virus, at an entrance to the Central Hospital of Wuhan in Hubei province, China 7 February 2020 (Photo: Reuters/Stringer).An online tidal wave of reflection and grief followed.
After Li had written to his friends, he was forced to sign an unusual document designed to coerce him into silence. He later spoke to Chinese private media company Caixin, shedding light on the unfolding epidemic. Li became the face and name of a censorship phenomenon involving a number of other doctors.
People are in uproar about China’s security forces blocking Chinese doctors from sharing crucial public health information. The novel coronavirus has killed more than 2800 people. Li’s tragic death and the response it prompted reflect the failings of Chinese government censorship.
People are in uproar about China’s security forces blocking
Chinese doctors from sharing crucial public health information.
The novel coronavirus has killed more than 2800 people. Li’s tragic
death and the response it prompted reflect the failings of Chinese
But censoring Li and others did not alone worsen the outbreak of the virus. Rather, and what is far more worrying, it was the incompetence of the Wuhan government and the central health authorities in the two weeks that followed the censorship that made containing the outbreak far more difficult. Wuhan authorities failed to prepare a health system response and were preoccupied with a major political conference. When the virus took hold and became an epidemic, the health system was swamped.
On 29 December, the local Wuhan Centre for Disease Control notified its state and federal superiors that there was a suspected outbreak of a SARS-like illness. The following day the Wuhan Health Bureau sent all hospitals in the city an ‘urgent notification’ to report on any possible cases of the illness. It did not declare the disease to be a category one risk or tell doctors to wear protective clothing.
An expert team from the central government arrived in Wuhan and took samples for testing. Within a day they shut down the food market and labs around the country isolated the virus from the samples. On 5 January, the World Health Organization was notified and the results were soon posted to open source databases worldwide. This is world-class public health, and most probably the reason that the World Health Organization has praised China’s actions fulsomely.
However, government actions and inaction in the subsequent fortnight were reprehensible. In January, Wuhan city and Hubei each held their most important political meetings of the year. Wuhan media covered these meetings comprehensively but there was only one front-page story on the virus in that whole fortnight, in a small local newspaper. The Wuhan health ministry in its press conferences falsely claimed that there were no new cases and that there had been no cases of medical personnel becoming infected.
Wuhan authorities were occupied by the two political meetings, which took up government and Party resources and killed any air time for public health announcements. China lacked the capacity to test for the virus, making only 200 test kits per day and sending early tests to Beijing for results. On 20 January, Chinese President Xi Jinping shut down a whole province. Local governments were told to take any measures necessary. Airports and travel grinded to a standstill, most people are working from home and various countries closed their borders to Chinese nationals.
This cycle — slow identification of the problem, central involvement and prioritisation, all-out mobilisation — is a familiar pattern of Chinese crisis management. That is because China is not one government but 3000 local governments, united by their membership in China’s ruling Communist Party. Each of these local governments has a single person accountable for whatever happens in their locale.
Local officials know that their superiors will take credit for anything that goes well and they will take the blame for failures. Occasionally, top leaders send out signals instructing local leaders to follow a single objective. Running China like this, by call-and-response, makes it easier for leaders at the top 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 follow central instructions.
The censoring of doctors will be painted as a failing of local policing, the two weeks of inaction and lack of notification due to decay in Wuhan’s politics. China’s leaders will throw every resource they have at stopping the epidemic, knowing that inaction would look worse than incompetence. The danger now is that the pendulum has swung too far toward overreaction and away from trust in appropriate public health measures.
With faster information sharing among doctors, the spread of the virus could have been slowed. A stronger public health system and initial government response would therefore have meant that the virus was less damaging.
Dr Ryan Manuel is Managing Director of Official China Ltd., a Hong Kong-based research firm East Asia Forum