Viral signs

What coronavirus teaches India about China’s public-health system

On 24 May 2018, paramedics in protective gear buried one of the victims of the Nipah virus, in Kerala’s Kozhikode city. The outbreak killed 17 people in Kerala that month. In 2020, the state has been at the forefront of containing the outbreak of COVID-19. K Shijith/AP Photo
29 February, 2020

Sometime in the third week of February, social-media networks lit up with the revelation that a little known 1981 book, The Eyes of Darkness, by the American author Dean Koontz, had predicted the outbreak of COVID-19—a new coronavirus discovered in central China’s Hubei province in December last year. Koontz’s book referred to a lethal man-made virus, created as a biological weapon, called “Wuhan-400.” Wuhan is the capital city of Hubei and ground zero for the ongoing epidemic of the pneumonia-like disease that was declared a global public-health emergency by the World Health Organisation on 30 January. As the relevant passages of the book spread online, it did not take long before it was revealed that the original edition of the book named the virus as “Gorki-400,” a reference to several rural Russian localities, and it was many years later that the name was changed. The damage, however, was done, and the idea that China had created the virus and then lost control took hold.

The ease with which the narrative around Wuhan 400 was accepted is symptomatic of the mistrust towards all pronouncements coming from China in the aftermath of the outbreak of the severe acute respiratory syndrome coronavirus 2, or the SARS-CoV-2. The 2019 coronavirus belongs to the same family of viruses responsible for the SARS outbreak of 2003, which occurred in China, and the Middle East Respiratory Syndrome outbreak of 2012, first reported in Saudi Arabia. The mistrust is not completely unjustified—in 2003, China orchestrated a massive cover-up, took five months to announce the disease to the public and did not report the outbreak to the WHO for 158 days.

The Chinese response to COVID-19 has been markedly different. The WHO was brought on board within four weeks of the first cases being reported in Wuhan; the state publicly acknowledged the outbreak in less than a month; and, on 10 January, China published the genome sequences of the new virus on open-source platforms to allow researchers from across the world to analyse the data coming from the first wave of patients. However, China announced its quarantine only by 22 January, almost two months after the first cases—16 cities and approximately 60 million people were eventually isolated—and several reports suggest that initial attempts by doctors to warn the authorities were met with reprimands by the police. By the end of February, COVID-19 had spread to 51 countries, infected over 83,000 people globally—over 94 percent of the infections have been recorded in China—and caused nearly three thousand fatalities, of which 67 people have died in countries other than China. Faced with such an exigency, it is pertinent to critically examine the role of a state when encountered by a health emergency.

In China, following the success of the communist revolution of 1949, healthcare was nationalised and all private health services prohibited. Public-healthcare policies became important instruments of political propaganda and attempted to influence the masses. Working with limited financial, technological and manpower resources, the country managed to create grassroots-level initiatives that were scaled up rapidly—by the 1980s, China was sending medical-intervention teams to several African countries. Around this time, as the economic reforms of the 1970s started becoming visible in urban areas, China changed tack. Joint ventures in healthcare were set up with western entrepreneurs and pharmaceutical companies allured by a large market. China was not averse to these investments in the healthcare system as it led to global pharmaceutical majors setting up laboratories and factories in China. The consequence was that within two decades, a health divide was apparent in China. Over fifty percent of hospitals in China today are private joint-ventures and concentrated in urban areas, while public hospitals are more common in the suburbs of big cities and in towns.