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2019–20 coronavirus pandemic in mainland China

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2019–20 coronavirus pandemic in mainland China
COVID-19 attack rate in Mainland China.svg
Confirmed COVID-19 cases in mainland China per capita by province as of 23 March 2020[1]
  0–0.5 cases per 100,000 people
  0.5–1 cases per 100,000 people
  1–1.5 cases per 100,000 people
  1.5–2.5 cases per 100,000 people
  114.39 cases per 100,000 people (Hubei Province)
DiseaseCoronavirus disease 2019 (COVID-19)
Virus strainSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
LocationMainland China
First case1 December 2019
(10 months, 3 weeks and 3 days ago)
OriginWuhan, Hubei[2]
Confirmed cases82,160[note 1][3]
Active cases1,156
2020 coronavirus patients in China.svg

Template:2019–20 coronavirus pandemic data/Mainland China medical cases chartThe 2019–20 coronavirus pandemic first manifested as a cluster of mysterious, suspected pneumonia cases in Wuhan, the capital of Hubei province, China. A Wuhan hospital notified the local center for disease control and prevention (CDC) and health commissions on 27 December 2019. On 31 December Wuhan CDC admitted that there was a cluster of unknown pneumonia cases related to Huanan Seafood Market after the unverified documents appeared on the Internet. The potential disease outbreak soon drew nationwide attention including that of the National Health Commission (NHC) in Beijing who sent experts to Wuhan on the following day. On 8 January, a new coronavirus was identified as the cause of the pneumonia.[4] The sequence of the virus was soon published on an open-access database.[5]

Delayed and controversial responses by the Wuhan and Hubei authorities failed to contain the outbreak in the early stage which led to criticism from the public and the media.[6] By 29 January, the virus spread to all provinces of mainland China.[7][8][9] All provinces of mainland China initiated the highest response level to public health emergency.[10] WHO declared the outbreak a "Public Health Emergency of International Concern" on 31 January[9] for fear that the virus spread beyond China to where there is no robust healthcare system despite its confidence that China was "doing all that it can".[11] By 8 February, over 724 died from the coronavirus infection-associated pneumonia and 34,878 were confirmed to have been infected. In Hubei alone, there were 24,953 cases of infections and 699 related deaths.[12]

The Chinese government has evidently censored the discussions about the outbreak since the beginning of its spread.[13][14] On 25 January, Chinese Communist Party General Secretary Xi Jinping warned about a "grave situation" facing China.[15][16] The Party Politburo formed a special leading group for epidemic control, led by Premier Li Keqiang. The Chinese New Year celebrations were cancelled. Passengers across the country have been checked for their temperatures.[17] Commands for epidemic control (CEC) have been formed in different regions including Wuhan and Hubei. Many inter-province bus services[18] and railway services have been suspended.[19] By 29 January, all Hubei cities were quarantined.[20] Curfew laws were implemented in Huanggang, Wenzhou,[21] and other mainland cities.[22] In February 2020, the region also saw a huge shortage of face masks and other protective gear despite itself being the world's manufacturing hub for these products.[23]

On 25 February, the number of newly confirmed cases outside mainland China exceeded those from within for the first time; the WHO praised the effectiveness of measures taken in the country.[24] By 6 March the reported number of new cases had dropped to well fewer than 100 nationally per day, down from thousands per day at the height of the crisis. On 13 March, the number of newly imported cases passed the number of domestically transmitted new cases for the first time.[25]

Fear, regional discrimination in China, and racial discrimination beyond China increased with the growing number of reported cases of infections despite calls for stopping the discrimination by many governments.[26][27] Some rumors circulated across Chinese social media, along with endorsements and counter-rumor efforts by media and governments.[28][29] The Chinese government has worked to censor and counter reporting and criticism about the crisis, portray the official response to the outbreak in a positive light.[30][31][32] News outlets reported concerns that the Chinese government may have deliberately under-reported the extent of infections and deaths.[33][34][35]

Detailed map of outbreak[edit source | edit]

Template:2019–20 coronavirus pandemic data/Mainland China medical cases map (dots)

Context[edit source | edit]

New infectious diseases impose a serious threat to the health of the general public. Their origins are often mysterious despite intensive research efforts.[36] Although human coronaviruses (CoVs) had been known as major pathogens to cause the common cold,[37][38] a new species of coronavirus, namely SARS-CoV caused an epidemic involving 29 countries during 2002–03 which infected 8098 persons and killed 774 of them.[38] The evidence shows that the virus might have originated from an animal coronavirus, but somehow entered the human population.[38][39][40] Its outbreak also implies that animal coronaviruses could be a potential danger to humans.[38]

Since the 2003 SARS outbreak, the general public and the scientific community in China have been worried about the potential return of the deadly virus which motivated the Chinese government to reform its public health system to handle the next public health crisis.[41][42][43] As part of the reform, China expanded the laboratory networks to handle the pathogens of the infectious diseases which included a newly-built BSL-4 laboratory in Wuhan and a national key laboratory to investigate into pneumonia with unclear causes.[44] Zeng Guang, the Chief Scientist at China CDC believed that a quicker publication of the epidemic information was a lesson that China learned from the SARS outbreak as the lack of information release worsened the outbreak.[44]

With the improved public health system, China managed to handle several public health emergencies. In coping with the 2009 H1N1 flu outbreak starting from Mexico, China developed and distributed vaccines to 100 million people within months as an active prevention.[43] During the 2013 H7N9 outbreak in East China, the country's health system identified the pathogen 5 days after the outbreak. Test kits for diagnosis were designed and distributed to all mainland provinces 3 days after the identification. Within months, effective vaccines were developed. Besides, Chinese academic Li Lanjuan and her group was the first to reveal the virus's transmission methods, molecular mechanisms and effective treatment.[45]

However, Southern Metropolis Daily stated that although people paid more attention to public health, the government's funding to the health system was far from enough as CDCs in smaller municipalities had to reduce their staff. 10 years after the SARS outbreak, few people wore a face mask when they had respiratory symptoms and the hospitals were cutting the fever clinics off.[46] Despite confidence in winning the next battle against SARS, Zhong Nanshan who earned fame in fighting the SARS outbreak in 2003 still held a conservative attitude to whether the Chinese officials would lie to the people about a disease outbreak.[43]

Early cases surrounding the animal market suggested potential animal-to-human transmission while later the virus is found to be able to transmit from ill people to others.[47] There have been cases where asymptomatic patients transmitted the virus to others.[48][49] According to China NHC, the virus transmits by droplets or close contact[50] while some proposed that feces could also be where the virus hides and transmits from.[51][52] The typical symptoms of the viral infection included fever, dry cough, dyspnea, headache and pneumonia[53] which are usually developed after an incubation time lasting as long as 2 weeks.[54] The existence of mild but infectious cases complicated the epidemic control efforts.[55] It is also noticed that patients might be able to transmit the virus even during the incubation period.[56]

Early response by Wuhan[edit source | edit]

Discovery[edit source | edit]

One of the earliest Wuhan MHC notices about the pneumonia epidemic. It was first posted on Weibo on 30 December 2019 and was confirmed by Wuhan CDC the next day (31 December).

The first confirmed patient started experiencing symptoms on 1 December 2019,[57] though the South China Morning Post later reported that the first case may have been a 55-year-old patient from Hubei province as early as 17 November.[58][59][60] More recently, on 27 March 2020, news outlets citing a government document reported that a 57-year-old woman, who started having symptoms on 10 December 2019 and subsequently tested positive for the coronavirus disease, was described in The Wall Street Journal on 6 March 2020, may have been patient zero in the coronavirus pandemic.[61][62] Although the first confirmed patient did not have any exposure to Huanan Seafood Market, an outbreak of the virus began among the people who had been exposed to the market nine days later.[63][64] On 26 December, Shanghai PHC received a sample of a patient with unknown pneumonia from Wuhan CDC and Wuhan Central Hospital and started an investigation to the sample which was later confirmed to contain a new coronavirus.[63]

The outbreak went unnoticed until a cluster of unknown pneumonia cases was observed by Zhang Jixian,[65] director of the Department of Respiratory Medicine at Hubei Hospital of Integrated Traditional Chinese and Western Medicine,[66] whose experience fighting SARS in 2003 kept her alerted about a public health emergency. On 26 December 2019, a couple of seniors who lived near Zhang's hospital came to her for their fever and cough. The CT scan results of the couple's thorax showed unusual changes in the lungs which were different from those in any known viral pneumonia. Zhang saw the couple's son and found similar conditions. On the same day, a patient from Huanan Seafood Market that Dr. Zhang saw also had the unusual conditions.[67]

On 27 December, the doctor reported her discovery to her hospital and the hospital soon informed Jianghan CDC, thinking that this might be an infectious disease as it was indicated by the familial cluster. As a precaution, she told her colleagues to wear protective gear and prepare a specialized area in the hospital to receive patients with similar conditions.[67]

On 28 and 29 December, three more patients who had visited the Huanan Seafood Market visited the clinic of the hospital. The hospital notified the provincial and municipal health commissions. The health commissions appointed Wuhan and Jianghan CDC and Jinyintan Hospital to undertake epidemiological research for the seven patients on 29 December. Six of them are transferred to Jinyintan, a specialized facility for infectious diseases. Only one patient refused the transfer.[65][67] Zhang's discovery was widely praised;[68] the Hubei government honored her and Zhang Dingyu, the president of Jinyintan, for their contribution to controlling the viral outbreak.[66]

Disclosure[edit source | edit]

On the evening of 30 December, the two emergent notice letters from the Municipal Health Commission of Wuhan began to circulate on the Internet which was soon confirmed by Wuhan CDC who admitted that there were 27 cases of pneumonia of unknown cause on 31 December. The letters required all hospitals in Wuhan to report any pneumonia patient with unknown causes and related to Huanan Seafood Market. They also asked the hospitals to give proper treatment to these patients. Wuhan CDC told The Beijing News that the investigation was still underway and the experts from NHC were on the way to help the investigation[69] after a rumor about it circulated on the Internet.[63]

On 1 January 2020, the seafood market was closed down by Jianghan District's Health Agency and Administration for Market Regulation due to an "environment improvement." According to China Business, the workers in hazmat suits were inspecting all around the market and collecting samples. The storekeepers at the market said that they were not told what the people were collecting and detecting. The urban management officers and police officers were on the spot to ask the storekeepers to finish up and leave the market.[70]

Several doctors were warned by Wuhan's police for "spreading misinformation" and eight "rumormongers" who were all doctors at Wuhan hospitals according to Wang Gaofei, Weibo's CEO[71] were summoned by the police on 3 January.[72][73] Li Wenliang, one of the whistleblowers died from the virus on 7 February[74] which was the same day when the discoverers of the outbreak, Zhang Jixian and Zhang Dingyu, were honored by Hubei's government.[75] The death of Dr. Li led to widespread grief and criticism toward the government.[76]

Measures and impact in Hubei[edit source | edit]

Impact beyond Hubei[edit source | edit]

Number of cases (blue) and number of deaths (red) on a logarithmic scale.

Chinese Communist Party general secretary Xi Jinping warned that China was facing a 'grave situation'.[15][16] He held a Party Politburo meeting which promised resources and experts for treatment and supplies to Hubei[77] as more and more cases of the viral infection, mostly exported from Wuhan were confirmed in other cities in Hubei[7] and multiple parts in mainland China.[78] On 29 January, Tibet announced its first confirmed case, a male who traveled from Wuhan to Lhasa by rail on 22–24 January[79] which marked that the virus spread to all parts of mainland China.[7][8][9]

The Chinese New Year celebrations were canceled in many cities. The passengers were checked for their temperatures to see whether they had a fever.[17] Henan, Wuxi, Hefei, Shanghai, Inner Mongolia suspended trade of living poultry on 21 January.[80]

Financial Times described the outbreak as China's Chernobyl moment, increasing the pressure on its leader, Xi Jinping. A trade war with the US, Hong Kong protests, and an African swine fever outbreak that led to a pork shortage already placed pressure on the current government.[81][82]

Early responses by Henan[edit source | edit]

At the end of December 2019, Henan announced the suspension of passenger trains to and from Wuhan. In early January 2020, the local government of Henan Province with its complete disinfection measures, effective and intensive publicity, a strong awareness of epidemic prevention and quarantine among the people, the setting up of return spots at the village entrance and even the use of garbage trucks, the digging of trenches to block roads connecting Hubei and the hanging of slogans such as "return home with sickness is to dishonor your parents." #抄河南的作业 (literally: 'copy Henan's homework') became a trending Weibo topic hashtag.[83][84][85]

However, cutting the roads off without authorization is illegal in mainland China as Xinhua and the Public Security Ministry pointed out.[86][87] The Ministry of Transport asked the local governments to take the principle of "block one, not three (Chinese: 一断三不断)", that is, to block the virus from spreading, but not to block roads, traffic and Internet access, the transportation of emergency supplies and the transportation of essential goods.[88]

Staff examining cars for epidemic control at Qujiang entry to Xi'an Bypass
Body temperature screening at Jishuitan subway station, Beijing

Public Health Emergency declarations[edit source | edit]

Doctor father and son encouraging each other to fight the virus in Chenzhou, Hunan

By 21 January, government officials warned against hiding the disease.[89]

On 22 January, Hubei launched a Class 2 Response to Public Health Emergency.[90] Ahead of the Hubei authorities, a Class 1 Response to Public Health Emergency, the highest response level was announced by the mainland province of Zhejiang on 23.[91][92] Guangdong and Hunan followed suit later on the day. On the following day, Hubei[78] and other 13 mainland provinces[93][94][95][96] also launched a Class 1 Response. By 29, all parts of mainland initiated a Class 1 Response after Tibet upgraded its response level on that day.[10]

The highest response level authorizes a provincial government to requisition resources under the administration to control the epidemic. The government was allowed to organize and coordinate treatment for the patients, make investigations into the epidemic area, declare certain areas in the province as an epidemic control area, issue compulsory orders, manage human movement, publish information and reports, sustain social stability and to do other work related to epidemic control.[97]

Cancellations, delays and shutdowns[edit source | edit]

Holiday extension[edit source | edit]

On 26 January, the State Council extended the 2020 Spring Festival holiday to 2 February (Sunday, the ninth day of the first lunar month) with 3 February (Monday) marking the start of normal work. The educational institutions postponed the start of school.[98] The different provinces made their own policies about holiday extension.[99]

Sporting events[edit source | edit]

For the 2020 Olympic women's football qualifier, the third round of the Group B matches for the Asian division was planned to be held in Wuhan and later Nanjing,[100][101] but the match was finally held in Sydney, Australia.[102] The 2020 Chinese FA Super Cup, to be held in Suzhou on 5 February 2020 was postponed.[103] The 2020 Asian Champions League play-off match between Shanghai SIPG and Buriram United were played behind closed doors.[104] The Chinese Football Association announced that the 2020 season is postponed from 30 January.[105] The Asian Football Confederation postponed all home matches for Chinese clubs in the Champions League group stage. The three of them had not played a single game yet as of 3 March 2020.[106]

The Olympic boxing qualifier[107][108] has also been rescheduled to March and the venue has been moved to Amman, Jordan.[109] The Group B of the Olympic women's basketball qualifiers, originally scheduled to be held in Foshan, Guangdong was also moved to Belgrade, Serbia.[110]

As for the other major sports events, 2019–20 FIS Alpine Ski World Cup, scheduled for 15–16 February 2020 was canceled due to the outbreak. The event was originally planned to be the 2022 Winter Olympics' first test. The 2020 World Athletics Indoor Championships, originally scheduled to take place in Nanjing from 13 to 15 March are postponed for a year and will be held at the same venue.[111] The Confederations Cup Asia Pacific Group I, scheduled to be held in Dongguan, Guangdong was moved to Nur-Sultan, Kazakhstan.[112]

The State General Administration of Sports announced a suspension of all sporting events until April. The Mudanjiang Sports Culture Winter Camp[113] and China Rally Championship Changbai Mountains[114] are both suspended. After the postponement of national women's basketball games, the Chinese Volleyball Association suspended all volleyball matches and activities.[115]

The 2020 Sanya ePrix, due to take place on 21 March as the third round of the 2019–20 Formula E season was postponed to a yet to be announced date.[116] On 12 February, the 2020 Chinese Grand Prix, due to take place on 19 April as the fourth round of the 2020 Formula One World Championship was also postponed.[117]

The Lingshui China Masters badminton tournament, scheduled to commence on 25 February to 1 March 2020 was postponed to early May.[118]

China's 14th National Winter Games, originally scheduled for 16–26 February were also postponed.[119]

Tourist attractions[edit source | edit]

Ridership was significantly reduced at 4 May Square Station of Qingdao Metro Line 3 during the epidemic.

On 21 January, the Wuhan Culture and Tourism Bureau postponed a tourism promotion activity to the city's citizens. All qualified citizens will be able to continue the qualification in the Bureau's next activity.[120] On 23 January, the Bureau announced the temporary closing of museums, memorials, public libraries and cultural centers in Wuhan from 23 January to 8 February.[121] All tour groups to and from Wuhan will be canceled.[122][123]

On 23 January, the City Administration of Dongcheng, Beijing cancelled temple fairs in Longtan and Temple of Earth, originally scheduled for 25 January.[124] The Beijing Culture and Tourism Bureau later announced cancellations of all major events including temple fairs.[125] The tourist attractions in Beijing[126] and Tianjin,[127] including the Forbidden City and the National Maritime Museum closed their doors to the public from 24 January. On the evening of 23 January, the Palace Museum decided to shut down from 25 January[128] and the West Lake in Hangzhou announced shutting all paid attractions and the Music Fountain down and suspended the services of all large-scale cruise ships starting the next day.[129] Since 24 January, many major attractions are shut down nationwide including the Sun Yat-sen Mausoleum in Nanjing,[130] Shanghai Disneyland, Pingyao Ancient City in Shanxi, Canton Tower in Guangdong, the Old Town of Lijiang, Yunnan and Mount Emei in Sichuan.[131]

Education[edit source | edit]

On 21 January 2020, the