The paradox of China’s containment
The emergence of a new Sars-like coronavirus could not have come at a worse time for China. The country was already 10 days into Chunyun — the Lunar New Year travel season that is also the largest annual human migration on the planet — when government officials finally confirmed human-to-human transmission of the as-yet-unnamed virus on January 20.
The city at the centre of the outbreak, Wuhan in Hubei province, went into lockdown three days later. By then, much of the city’s populace was already on the move across the country to enjoy the festivities with their families, an enormous outflow of people by road, rail and air estimated to total 5m — almost half of Wuhan’s official population — by the city’s mayor.
Given the scale of human movement, further spread of the virus across China seemed inevitable. And yet, nine months after the outbreak, province-level cases data reveal China’s remarkable success in containing it to the province of origin.
Although there are valid concerns about the reliability of China’s official figures, its success in containing the virus is largely explained by another factor — intensive contact tracing. But this, too, was subject to a curious paradox of its own: for a nation with a reputation for using cutting-edge technology to spy on its citizens, much of it was achieved with old-school methods such as questionnaires.
While China curbed the outbreak, the transmission of the virus overseas — and the differing responses of other nations to its arrival — meant that the real story of Covid-19 was only just beginning.
Two countries try different escapes from Covid-19
By late February new cases in China were in decline, and attention had shifted to two new areas of concern, one a regional neighbour and the other further afield.
Alarms were raised in South Korea in mid-February after a single super-spreader sparked more than 1,000 cases in the city of Daegu in a matter of days. Between February 17 and 25, the country’s confirmed case count rose from 31 to 1,146 — a 37-fold increase in just eight days, with cases doubling every day and a half.
Meanwhile, in Europe, all eyes were on Italy as a cluster of infections began spreading through the northern region of Lombardy.
Both trajectories looked bleak, but the countries’ fortunes quickly diverged.
South Korea acted quickly, taking advantage of legislation passed in response to the 2012 Mers crisis that allows for extensive surveillance of its citizens during an infectious disease outbreak. A comprehensive contact-tracing operation was put in place, partnered with a rapid expansion of testing. On March 20, South Korea was carrying out 100 tests for every positive one that came back, the same day it recorded its 100th death. It took Italy three more months and 34,000 deaths to reach the same testing levels.
Italy was slow to act at the outset, and Lombardy’s outbreak had already become an epidemic by the time the region was placed into lockdown on March 8. Once March and April had passed, 26,000 more people had lost their lives in the region than would typically die in the same months — more than half of Italy’s total toll of “excess deaths”.
Why a Covid-19 death may not be a Covid-19 death
In the weeks that followed the crisis in Lombardy, counting ever-increasing Covid-19 fatalities became a daily task across much of Europe — along with speculation about what the pandemic’s final death toll would be.
Patrick Vallance, the UK’s chief scientific adviser, told the health select committee on March 17 that keeping UK deaths to 20,000 or below would be a “good outcome”.
That figure proved to be overly optimistic — but it’s hard to say by precisely how much: establishing the number of Covid-19 victims has been a problem both in the UK and in other countries around the world.
By whatever measure the pandemic’s grimmest accounting is computed, the UK’s death toll — and particularly England’s — remains among the highest in the world. By its headline figure, 38,524 people in England have died within 28 days of a positive Covid-19 test, but this rises to 42,672 if you extend the cutoff to 60 days, according to the UK’s coronavirus dashboard.
The Office for National Statistics, meanwhile, has tallied 50,642 death certificates mentioning Covid-19 up to October 2, and, if you begin counting on March 6, the day that the 100th positive case was recorded, 56,537 deaths in excess of the average for the same period in the past five years. This figure includes deaths from all causes, including Covid-19.
The UK’s experience demonstrates how seemingly precise tallies of the virus’s victims can vary considerably using alternative definitions and administrative processes. This also explains why national headline death tolls are almost certainly undercounts of the pandemic’s true, but only imprecisely knowable, human cost.