With the last week’s news many people have come to realize that COVID-19 is unlikely to be contained. Just as Korea, Iran and Italy are grappling with outbreaks, the same might happen here in the United States. Given that the US is currently incapable of testing at scale, as Canada or Korea has, when the outbreak is first detected here, it might be larger than in Singapore. If so, contact tracing might not be feasible any longer. So how can people prepare and not panic? The best guide that I’ve seen so far for individuals and families is this blog post by Australian virologist Ian Mackay. This is a pandemic and now is the time to take reasonable steps.
I am very grateful to Jim P. for this guest blog post.
One Expat’s Life In China In The Time Of Corona Virus
A PSU Alum’s observations
A few things to get out of the way up front. I moved to China after graduating from PSU in the summer of 2015, and getting my Type Z (Foreign Expert) visa which took a few months. I finally arrived here in late December of 2015. I live and work in the city of Yantai, on the northeast coast of the peninsula portion of Shandong Province. The city has a population of ~7 million, though it feels much smaller than Portland because it is spread out over a much larger area, and there are large swaths of agriculture (namely corn) between different areas of the city.
When the Corona virus was first announced, I was getting off work before the beginning of the two week long Spring Festival holiday (which is what most English people think of as “Chinese New Year”). The next day, I came down with a cold. Nothing like having a nasty cough when everyone is freaked out by a disease that’s major symptom is a cough (I didn’t have a fever, or flu-like symptoms). At first it seemed like most things were still open, and much like life as usual for the beginning of the holiday (except everyone had masks on). However, as soon as the fireworks were over, everybody went back inside, and ventured out rarely (mostly to take out trash). …
Today seems to be the day in which the words and numbers that international organizations and national governments used to describe the COVID-19 pandemic increasingly diverged from facts. To begin there was an overall context in which the virus rapidly spread in the Middle East, while cases dramatically climbed in Korea (833). In the Middle East, there were new cases in Afghanistan, Bahrain, Egypt, Iraq, Israel, Lebanon, and the United Arab Emirates. Most of these cases were tied to Iranian travelers. In Italy the number of cases rose sharply. Venice ended the remaining days of Carnival. Italians in northern Italy rushed to stores, some of which were cleaned out and left with empty shelves. In the United States, ongoing problems with testing for SARs-CoV-2 has meant that health authorities have been unable to test at scale, as in Korea, Singapore and Canada. Finally, in China the rate of increase has slowed, but the nation still has over 77,000 cases. But neither the rising number of cases nor other problems caused corresponding expressions of concern by WHO or the Iranian government.
First, Dr. Tedros at the World Health Organization (WHO) said at a press conference that the WHO would not call COVID-19 a pandemic. Indeed, the WHO has stated that it no longer uses “pandemic” as a category. At the current time, there is ongoing transmission of a novel virus in multiple world regions, with a case fatality rate of perhaps two percent. If this is not a pandemic, what would be? The goal of deleting the term pandemic seemed to be more to avoid causing fear than to accurately describe reality. If the WHO does not play the role of declaring a pandemic, then who does? The risk of this is that the public in different nations may begin to lose confidence in the WHO. The pandemic exists even if the category does not. …
I am very grateful to our guest blogger, who teaches at a university in China, for this powerful guest blog post:
January 24th is the biggest holiday of the year in China: the lunar Chinese New Year. As usual, most Chinese prepared for it several weeks before the occasion: food, candies, tickets back home…Nobody expected this New Year would become a most unforgettable one even in his/her whole life. The coronavirus became a household word almost overnight and quarantine also came suddenly before people realized. Over the past almost a month, people, especially those in epidemic areas, went through hard times. On the other hand, we are moved by one story after another about the devoted doctors, nurses, volunteers and all those in the whole world that extended their hands to help.
The spring term in our university originally planned to start on February 17. At the end of January, it was clear that the starting date had to be postponed. The school administration sent some documents early in February notifying all the staff and faculty to make a plan for the month. We were asked to make better use of the online platforms and resources. As a result of the encouragement from the Ministry of Education and development of online courses, there have been thousands of moocs available on the Internet for free, which in my opinion cover nearly all disciplines. As for my course (college English), we have been utilizing the online platforms for the textbook developed by the publishing press over the past five years. Therefore, what we need is to transfer the platforms from kind of self-learning to more guided learning. At the same time, we selected some relevant moocs either as a required component of the course or as recommended resources. …
Canadian health authorities have announced a positive test for SARS-2-COV in a returning traveler from Iran. Yesterday, Iranian authorities announced two deaths from COVID-19. There are eighteen confirmed cases, which are spread across the country, and include a case in Tehran. It would seem plausible based on a the death count so far, and a case fatality rate of two percent, that there are over a hundred cases circulating in Iran. It is telling that one of the Iranian cases is a doctor, which suggests transmission within the health care system. Given that a case has appeared in Canada, which likely has fewer travelers than Iran’s neighbors such as Iraq, we can expect that health authorities will announce new cases in these nations in coming days. Unfortunately, two of Iran’s neighbors -Afghanistan and Syria- are in the midst of civil wars, and have damaged health care systems. Sadly, the cases in these countries will likely first be detected in critical cases, which will make it unlikely that these countries can control community transmission. …
I want to say my deep thanks for today’s guest blogger, who looks at the questions that Chinese middle school students have about nCoV in China:
Middle School Teacher
Resident in China since 2017
My CoN experience started prior to leaving Hangzhou in January. Reports were filtering out over WeChat concerning a virus in Wuhan similar to SARS. While I wasn’t overly concerned, I did pay attention to the news as I had been planning to travel to China prior to the SARS epidemic and had also been in the Middle East a year or so after the MERS outbreak. Suffice to say, these diseases were on my radar.
While visiting Portland during Chinese New Year, I was kept abreast of the situation by my school, the US Consulate in Shanghai, and news coming out of China and the Western news media. As the days progressed, my concerns grew and led to questions as to whether I would be able to return let alone whether I should return. After assessing the Chinese response to the outbreak, I made the decision to return based on many factors, including the seriousness with which the Chinese government was working to mitigate the spread and help Wuhan.
I am neither naïve nor uneducated. I know that my access to the internet and information is more limited in China due to a variety of factors I will not be addressing here. What I’d like to focus on at present is my students’ questions in response to the CoN. I teach grades 7 through 9 at a private school here in Hangzhou, Zhejiang Province, China. Our students come from a variety of socioeconomic backgrounds as entrance to the school is based on entrance exams and not the ability to afford tuition.
Prior to my return, my middle school head of department sent out these questions that the students were asking in regards to the Con outbreak.
- Why can’t the medical supplies get to the hospital?
- Where does my money go?
- Why can’t we go out for walks or to appreciate nature in unoccupied areas?
- Did the closure of Wuhan really isolate the disease? Is closure good or bad?
- How can Chinese people help during this time?
- What will be the impact on those who left the city hours before or after the closure?
- Should the city have been closed or not?
- Should foreign countries open their doors to China during this time?
- How can we continue eat wild animals without getting sick?
- Why did it spread quicker than SARS?
- Why are there so many false statements being circulated?
- How will this affect our country’s economy and international status after it is fully resolved?
- How many people are likely to lose their jobs after this?
These questions led me to think about what is being said on the media the students have access to, what their parents might be sharing, the freedom they felt in inquiring, and their understanding of how the CoN affects not only themselves but their country as a whole and its place in the global community. These questions posed by 12-14 year old students range from concrete to abstract thinking.
Our biggest issue at present aside from fighting the CoN is fighting erroneous information. My students are asking in-depth questions. The country is fighting rumors and inflammatory news reporting, none of which help people get the accurate information they need to avoid transmission or understand the situation. This is not unique to China, as we see it in the Western world as well. Our biggest obstacles are fear and greed.
This week my Mandarin homework was to write tips to avoid novel coronavirus. I cheated and used Google Translate at points, so don’t think that my Chinese is this good. Here is what I wrote (after editing from my teacher) in Chinese first and then English. More importantly, please remember, I am not a doctor or scientist. I have written this assuming that the reader lives in a place with active coronavirus cases in their local area:
In order to keep you and your family safe from coronavirus, you should:
- Be careful to avoid Fake News, especially on social media. There are many rumors. It’s best to trust experts.
- Practice social isolation. Work from home if possible. If not, try to keep more distance from people at work.
- Wash your hands frequently. Avoid touching your eyes.
- Get as much sleep as you can. Take good care of your overall health.
- Get a flu shot. This may keep you out of the doctor’s office where people are sick. It will also help to keep you from catching both the flu and the novel coronavirus at the same time.
- If you have asthma (or another respiratory disease) or are sixty-five or older, talk to your doctor about the pneumonia vaccine. This will help you to avoid pneumonia (and meningitis and other infections) even if you are never infected with the new coronavirus.
For the record, I have no tie to (or investments in) any company that makes vaccines for pneumococcal vaccines. You can also see the Center for Disease Control’s advice on this topic here. And you can see my blog post about nCoV and quarantine here.
As I write these words nurses in Hong Kong are on strike to protest the fact that the Chief Executive, Carrie Lam, will not close the border to China. To be clear, the executive has sharply restricted entry to Hong Kong, closed most crossings, and forbidden entry from the most affected Chinese state, Hubei. But there are still strong calls for a complete border closure coming from within Hong Kong’s medical community. Similarly, the United States has restricted flights from China to U.S. citizens only; some U.S. airlines had already canceled service to China. All such quarantine measures are controversial.
On social media, such as Twitter, and in the press, a number of experts have denounced all quarantines as being not only ineffective but also in violation of WHO guidelines. These authors worried about panic overcoming good judgement, the economic costs of restricting travel, the stigma imposed on those from affected areas (Chinese in particular, but also all Asia), and the importance of upholding International Health Regulations. These are valid and important points. Some authors have also pointed to studies based on computer models showing that quarantines are ineffective with highly contagious respiratory diseases.
Recently the tone has shifted in the discussion, as it has become clear that some cases of the virus are being spread asymptomatically. The number of cases has grown quickly. Some apparent facts (such as no human to human transmission) that seemed true in mid-January are no longer true. So the stridency of the debate about quarantine has declined, but the debate continues.
So is there any role for quarantines to manage such a pandemic? And is there some other way to make a judgement that relies less on computer models? I would suggest that looking at the past history of respiratory pandemics, such as the 1918 influenza pandemic, might be useful. Can history suggest particular circumstances in which quarantines may work? …
As we track the spread of the coronavirus outbreak, it’s helpful to have maps and other data visualizations to understand the data.
One useful site is Ncov2019Tracking, which says that it: “taps into the Twitter Streaming API and monitors tweets mentioning keywords related to the Novel coronavirus (2019-nCov) outbreak. A machine learning system trained with the supervision of experts filters informative tweets. Geographical entities mentioned in tweets – such as country and city names – are identified using the GeoNames database and used to place tweets on a global map.” This tool provides a useful means to track where people are discussing the epidemic on Twitter. It’s very clear (based on the map on January 31, 2020) that there is a lot of discussion related to the coronavirus taking place that concerns Indonesia and the Philippines.
Researchers at Johns Hopkins Center for Systems Science and Engineering have also created an excellent map and dashboard which shows the geographical location of 2019-nCoV cases (we need a better name). A dashboard also shows total deaths (213 at today’s right), the total number of recovered (222 today) and the total number of confirmed cases (5,806). On the left hand side of the screen there is the total count of cases (9,925) and their geographical locations. At this time, there are 9,783 cases in mainland China, 19 in Thailand, 15 in Japan, and 13 in Singapore. There are also an eclectic group of countries that have a single case: Cambodia, Finland, India, Nepal, Philippines, Sri Lanka, and Sweden.
While technology has made it easier to track the outbreak, authorities in China are reportedly also using drones to chastise people who go out in public without masks, as this video purportedly shows. Lastly, you can read a blog post about quarantine and nCoV here, with some historical context on this question based on the 1918 influenza pandemic.
There is so much discussion of the coronavirus epidemic in the media that it can be hard to find reliable information. One good source of measured, thoughtful information is this podcast, “Coronavirus Infections—More Than Just the Common Cold,” which is an interview with Anthony, S Fauci, the director of the National Institute for Allergy and Infectious Disease. You can also find this podcast on Stitcher and other podcast platforms. To listen to it on Apple podcasts, please search for “JAMA Author interviews,” and go to January 27, 2020.
If you are interested in learning more about live markets, you can read my work here. And this blog posts discusses quarantine and nCoV based on some historical context from the 1918 influenza pandemic.