Inside Observations on the Coronavirus Epidemic

I’ve been in China for the past while, and can say that I’ve seen the coronavirus outbreak from the inside (albeit from Shanghai and not from ground zero, thankfully). Here are my observations and my take on the situation.

At the time of writing, it has been exactly one month since the 2020 Chinese New Year (Spring Festival) holiday – the annual mass migration (largest in the world) of people from major cities back to their hometowns. The outbreak of the coronavirus (now called “COVID-19”) was only made public about one week prior to the Spring Festival holiday. At the time, information was very limited and the risk was not taken very seriously – the Spring Festival migration occurred as per usual, with billions of people traveling by train, bus, and planes back to their hometowns.

Based on some back-of-the-napkin estimations using traffic outflow numbers, approximately 5 million people left the virus epicenter of Wuhan in the month of January, mostly returning to smaller towns and villages in the province of Hubei (where Wuhan is the capital). Using the number of people evacuated from Wuhan by foreign government planes as a sample study, the infection rate (# confirmed infected/sample size) was approximately 1%. Extrapolating that same infection rate to Wuhan means upwards of 50,000 infected people may have left Wuhan during the month of January, carrying the virus outwards towards other parts of the world (80+% to within Hubei province).

Since many infected cases may go unreported, it is difficult to determine an accurate value for R0, the reproductive/transmissive coefficient. I have seen studies estimating the R0 for COVID-19 to be between 2-3, meaning that an infected patient would on average infect 2 or 3 other people. If this is the case, then the estimated 50k people that left Wuhan in January could do some serious damage worldwide.

Many subsequent studies have seemed to agree on the fact that this coronavirus is highly contagious, unlike previous viral outbreaks such as SARS and MERS which were more deadly but much less contagious. With that in mind, and the current death rate (# dead/# confirmed infected) being about 2%, it is clear that this is a serious viral epidemic and something that should be taken seriously worldwide. In comparison, the seasonal flu’s death rate is only about 0.05%, based CDC data from the United States government. Those aged over 60 or have underlying medical conditions are especially susceptible to the deadly effects of COVID-19.

Even though the numbers have not been too bad outside Hubei province with the exception of a couple other hard-hit regions (Henan, Hunan, Guangdong), the magnitude of the containment measures being taken by officials and businesses clearly indicate the seriousness of the matter.

China, being a highly economically motivated nation (and culture), practically allowed its economy to grind to a complete halt. This cost is too high to justify for some simple flu. Some analysts have speculated that the number of cases (infected, deaths) in Hubei province were much higher than given in the official data, and judging by the data we have now (1 month later), that speculation was likely justified.

Wuhan, a city of 11 million people, would have had up to 110k infected, based on the estimated infection rate of 1%. Following the simple math we established earlier, at a death rate of ~2%, Wuhan alone would have seen ~2k deaths by the end of January alone, without considering subsequent infectious cycles. The official numbers for January 31 were: ~12k confirmed cases, ~250 deaths. It certainly would not seem farfetched that the official numbers from the early days of the outbreak were underreported by ~10x. Coupled with the numerous on-the-ground whispers out of Wuhan, of infected people dying at home (because hospitals are over-capacity) and people who died but were “not diagnosed,” it is reasonable to believe that the actual damage was indeed much higher than reported, certainly in Wuhan city.

Thankfully, for China, things have begun to look up a bit. Based on official data, the daily increase of newly confirmed infected COVID-19 cases and number of deaths have both peaked as of mid-February. Newly confirmed cases and deaths are going down (as of the last week of February) and the number of patients recovered have increased significantly. However, some recent reports of patients who have “recovered” but were still carrying and transmitting the virus after 14 days have surfaced, complicating the situation even further.

Regardless, it appears as if China’s peak infection period may have been reached, which is positive news. There is no doubt that having the epidemic peak within 1 month of its initial alert was largely down to the swift and blanketing measures China was able to take to forcefully or voluntarily restrict human traffic flow and to keep everyone at home. Yes, there were videos and reports of people being forcefully locked in their apartment complexes, or of people (whether infected or not) being dragged away to “quarantine,” but regardless of how Orwellian the measures may seem, it has overall been effective in reducing and containing the potential outbreak. There is no doubt also that social media played a huge role this time around (compared to previous epidemics), as fearful information was able to spread quickly, motivating people to be self-aware and take the appropriate measures to minimize risk (e.g. wearing masks, self-quarantine at home, etc.).

Fortunately, for those living in the less affected Chinese cities, things were not as bad as depicted in some media. Thanks to a swift and combined effort of central warning and citizens self-confinement, human flow was reduced significantly everywhere in China. Schools remain closed and work-from-home has been the de facto arrangement for most offices since the end of the Spring Festival holidays. Cities such as Shanghai resembled tidy ghost towns during the entire month of February, much contrary to the usual crowded and bustling metropolises that they are.

On major streets of Shanghai, even on gorgeous sunny days, you can count the number of people you see on one hand. (Feburary 2020)
Temporary medical tents set up in front of a hospital in Shanghai. (February 2020)

Despite some reports of drastic Orwellian measures to lock residents inside of their homes, they do not accurately reflect the situation on the ground. Numbers such as “700 million people on lockdown in China” are grossly over-exaggerated by sensationalist media, when the fact is people in the majority of Chinese cities are still free to move around if they choose to, but people are simply playing it safe and staying home. Most local communities and residential compounds have enforced their own check-in/check-out systems to track the movement of residents, and temperature checks are enforced at the majority of places. All in all, the measures are taken in a reasonable way that is not overly disruptive to the freedom of residents.

Most residential complexes in Shanghai were handing out check-in/out slips for when people go out, to track the flow of residents.
Aldi supermarket in Shanghai during the peak of the epidemic, freshly out of meat and poultry. (February 2020)

Using Baidu’s big data for tracking the nation’s migratory flow, it’s evident that after people went home for the Spring Festival and news of the breakout became a national emergency, they cancelled or postponed their plans to return to their cities of work. Using Shanghai, the economic hub of China, as an example, the number of returnees to the city on the first day after Spring festival this year is ~4x lower than what it had been in 2019. What has traditionally been the peak day of the year for incoming human flow to the city is no different than an average day for 2020.

Incoming migration flow to Shanghai, with the graph comparing between this year’s (yellow) and the previous year’s (white) 7th day of Chinese New Year.

In order to minimize exposure and cross-contamination, companies and institutions across the country have taken extraordinary measures to keep facilities closed for two weeks or more after the end of the holidays. In terms of people’s daily lives, this has led to a wave of “work from home” practices and people getting used to cooking at home again. In terms of the nation’s economy however, the impact has been significant. Manufactured products, exports, oil demand, car sales, etc. are all down significantly, and the domino effect on the supply chain is affecting transnational businesses across the world.

It doesn’t just end there either – China, being the nation of the nouveau riche and now one of the largest exporters of tourists worldwide, has seen its tourism outflow effectively go to zero. This has put major economic dents in several nations that depend heavily on Chinese tourism, such as France and Thailand.

Incoming migration flow to Shanghai continues to be magnitudes lower than last year, nearly one month after Chinese New Year.

As of late February, things are showing early signs of returning to normal in China. The outbreak numbers seem to have peaked, and some companies are allowing their employees to return to the office. More and more restaurants are opening their doors once again, if only to serve by delivery services. Now, as things are looking more optimistic and human flow starts to increase again, will this lead to a second wave of outbreaks? We’ll find out. At the meantime, it’s wise to continue staying home if possible, and to tread with caution.

Meanwhile, outside China, it looks like things are starting to get messy. Clusters of viral outbreak have gotten out.

The past week (starting mid-February) alone saw drastic increases in confirmed cases in various countries across the globe, most significantly in South Korea, Japan (largely thanks to the Diamond Princess cruise ship), Iran, and Italy. Stories of a 38-year-old “superspreader” being the origin of half of Italy’s confirmed cases certainly paints a grim picture.

The next 2-4 weeks will be crucial in determining whether or not COVID-19 turns into a global pandemic. On one hand, many countries took swift measures early on to reduce flight traffic, especially to/from China, and so far cases are mostly isolated within a few nations. On the other hand, however, the latest explosive growth in countries like South Korea and Italy is very concerning.

In my opinion, the thing that’s even more concerning is that, for the majority of countries around the world, it won’t be easy to implement blanketing measures of containment. China is a special case due to the nature of the country and its system, and actions of massive scale can be implemented very quickly. Countries in the EU on the other hand, for example, will likely have difficulty putting any sort of effective collective measure in place in a timely manner. This means that a lot of the containment and prevention efforts will have to come down to each and every individual.

While we all eagerly watch the daily COVID-19 statistic updates, everyone, please make sure to wash your hands regularly and wear a face mask when out in public, and avoid unnecessary travel. Oh, and, be prepared for the impending economic impact.

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