A drone carrying a QR code placard is seen near an expressway toll station in Shenzhen, south China's Guangdong Province, Feb. 11, 2020. (Photo by Lai Li/Xinhua)

Opinion – Coronavirus and public health governance in China

The Chinese government’s all-out efforts at containing the spread of Coronavirus have illustrated some prominent weaknesses of public health governance and crisis management in Hubei province.

First and foremost, in the Hubei province, hospitals were quite centralized and specialized, with patients who had fever flocked to a few hospitals at the early period of the outbreak.

This phenomenon entailed a huge risk of infecting more patients. As mentioned by Dr. Zhong Nanshan, an authority dealing with infectious diseases such as the Severe Acute Respiratory Syndrome (SARS), the Wuhan city should separate two types of different patients: those who have a common fever and those who are infected with Coronavirus.

The implication is that as quarantine work was not properly and rigorously conducted by Wuhan hospitals, which appeared to be inexperienced in dealing with the containment work, cross-infections appeared to be very serious. As some citizens publicly complained to the media, their relatives seemed to be not serious when they were admitted to hospitals, but after admission their situation aggravated.

An urgent remedy for Wuhan’s hospitals is to separate two types of patients, namely those who appear to have mild fever, and those who are in serious conditions.

Indeed, the Coronavirus is a very virulent and tricky disease as its identification and diagnosis need an uncertainly long period of time, ranging from a week to even three months or, according to a report from an overseas Chinese media for a case in Henan province, ninety-four days.

Second, it is alarming that many hospital staff members were infected with Coronavirus is alarming. This shows serious gaps in hospital administration. Some hospital staff complained that they did not have enough protective masks and gear. A minority of them even used garbage bags to wrap up their shoes.

Clearly, the medical supplies could not reach all the hospitals concerned effectively and efficiently. If hospital staff were infected, there could be cross-infections among them and with patients. Although a makeshift hospital was built within ten days to accommodate patients, it demonstrated the absence of adequate and spacious hospitals that were specialized in dealing with infectious diseases. The urgent measures were taken, but they came a bit late. 

Third, the criteria used by hospitals to allow the less serious patients to leave are controversial and discretionary. The criteria of allowing those patients who can leave the hospitals include the following: whether they have been tested negative twice for the Coronavirus, whether their lungs can show stronger absorptive capability, and whether the patient’s illness has signs of recovering.

These criteria bring about some discretionary decisions on the part of hospital staff. It was reported that some patients who left could have their health situation look more serious that their earlier condition. The dilemma is that while new patients flock to hospitals, hospital staff members are under tremendous pressure to release some patients whose situation appears to improve.

The influx of patients into hospitals necessitates the discretionary decision of asking some existing patients to leave hospitals, but due to the tricky nature of the virus, there is no guarantee that those patients who left hospitals are really recovering.    

Fourth, the question of logistical supplies is directly related to the cooperation between local governments and the Red Cross. Some local authorities of Red Cross were replaced by the central headquarters in Beijing, but still, there were complaints about the lack of logistical supplies to all the related hospitals. A few Red Cross staff pointed their fingers at the responsibilities of local governments, while netizens criticized the local Red Cross as incompetent in providing effective supplies.

After the removal of some local Red Cross leaders and the dispatch of a work team from Beijing’s Red Cross to Wuhan, the situation appeared to take a turn for the better. Again, it highlights the serious implementation gap of how China copes with the public health crisis, especially as the local governments and local Red Cross authorities have little experience in coping with infectious disease.

Fifth, while the party secretaries of the Hubei province and Wuhan city were removed, the provincial governor and city mayor maintain their positions – a phenomenon reflecting the displeasure of the Chinese Communist Party at the central level with the performance of its party secretaries at both provincial and local levels.

A dual leadership of the fight against Coronavirus can now be seen: the ruling Party and the State Council. Sun Chunlan, the Vice Premier, went down to Wuhan city to direct the containment work, while the new party secretaries in both Hubei and Wuhan revamp the containment work and make it more effective.

This dual leadership in the fight against the Coronavirus – the Party and the government – is a characteristic raising the question of how both cooperate and coordinate. Given the interlocking leadership of the Party and the government, coordination appears to be smooth; nevertheless, the Party at the center was clearly unhappy with the party performance at the provincial and city levels.

It was reported that the Hubei People’s Congress and its Chinese People’s Political Consultative Conference continued to be held from 11 to 15 January, but participants noted that a few officials wore N95 masks – a testimony to the outbreak of the disease at that time. However, the party leadership at the provincial level appeared to take little action.

Sixth, China’s hospitals have been traditionally centralized and not decentralized to the level of clinics at the grassroots level. The result is that many people who have the sickness, like fever, go up to the hospitals, but hospitals specialized in dealing with fever were a few in Wuhan, making cross-infections much easier.

The recent Korean case of infection showed that a single patient could spread the disease to almost forty others. Inside a congested setting of some Wuhan hospitals, it was unsurprising that tens of thousands of patients were found infected with Coronavirus.

Seventh, the Centers for Disease Control at the central, provincial and local levels appeared to lack leadership and coordination when Coronavirus broke out in late December and January. Two directors of the Center at the provincial and a local level (Huanggang) were removed, but they were not medical doctors.

Both were non-medical experts who had led the centers, showing that generalists rather than specialists directed the centers for disease control at provincial and local levels. However, generalists are usually ill-equipped to deal with sudden crises, especially Coronavirus that demands the expertise of medical doctors, researchers and experts.

The failure of containing the Coronavirus in Hubei province and Wuhan city from late December to January illustrated the weakness of relying on generalists to lead these very specialized centers for disease control. Moreover, it is unclear how these centers communicated among themselves between the three levels: local, provincial and central.

Bureaucratic hierarchy could delay the process of reporting and any cover-up from the local and provincial centers meant that the center’s intervention could be too late.

Eighth, due to the shortage of logistical supplies, such as masks and medical equipment, there were reports from the overseas Chinese media that two localities in Hubei province were competing for the ownership of these supplies.

A group of non-governmental volunteers who moved logistical supplies, such as masks, from Xian Tao to another prefectural city was stopped on the road by the Xin Tao law-enforcement authorities. If this was true, then some local-level prefectural cities competed among themselves for logistical supplies. Local politics in Hubei province came up as an obstacle to the efficiency and effectiveness of containing Coronavirus.

Ninth, media self-censorship has been named as one of the reasons for the “loss” of at least a month from late December to January 20, when the central government ordered a lockdown of Wuhan, to stop the spread of Coronavirus.

Eight doctors who acted as whistleblowers in early January were warned by the local police for creating “false news.” One of them later died. Some angry netizens demanded that there should be freedom of speech in the ongoing combat against the Coronavirus.

Xian Tao prefectural city’s hygiene and health commission on February 18 issued a circular, banning netizens to chat about the disease and to receive media interviews. The circular was quickly withdrawn on the same night perhaps due to the anger of netizens. The new party secretary of Hubei province, Ying Yong, said that while “false news” had to be combatted, the local authorities should receive public criticisms in order to improve their work. Clearly, some local-level officials interpreted “false news” arbitrarily to the extent of exerting excessive media censorship.

Tenth and finally, some local police implemented the policy of requiring citizens to wear masks in an arbitrary manner. Internet videos showed that some local-level police and health authorities rounded up two citizens who refused to wear masks on a tree. Some local authorities beat up citizens who refused to wear masks, destroyed their furniture and smashed mahjong tables when residents played together. The official media had to appeal to some law-enforcement authorities to implement the policy of containing the virus in a “civilized” way.

In short, China’s public health governance amid the containment of Coronavirus showed a lot of gaps, ranging from the weaknesses of hospital administration to the deficiency in quarantine measures, from the lack of logistical supplies to the failure of delivering them effectively to hospitals, from local protectionism to the arbitrary abuse of power by law enforcement authorities.

Public health governance in China urgently needs modernization, reform, and leadership, particularly at the provincial and local levels in Hubei.