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Mitigating Fear and Regaining Trust: How to Understand China’s Response to COVID-19

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  • January-June 2020
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    There is a long history of human fears toward infectious disease and it doesn’t necessarily disappear with the development of medical science. The ancestral fear toward infectious diseases plays a due role and the emergence of a new virus tends to waken up that fearful memory. Collateral damage from human greed and government corruption will paradoxically lead to more infection and higher moral and physical death.1 Hence it is strange to find some argument goes that those from the pharmaceutical industry tend to sell the threat of infectious disease and benefit from the thus expanded public expenditures.2 Nonetheless, the outbreak of COVID-19 reminds the world of real threat and heavy lethality of an infectious disease.

    It calls for concrete measures to be taken to address and mitigate the stress thus caused to human beings by the pandemic. In the case of Zika, studies find that individuals who suppress their fears would have higher levels of fear later.3 The first thing a spreading virus destroys is people’s trust on the environment. Any working public health strategy should aim at maximizing the trust and minimizing the stress thus caused.4 For centuries, measures such as quarantine, lockdowns and contact tracing have been central in responding to infectious disease outbreaks.5 The same still applies today, albeit with much larger mega cities involved. That said, the root causes of fear is always the same, that is an uncertainty due to the increase of fatality and the lack of effective vaccine and cure.

    This paper tries to understand the logic and thus gives a critical analysis of China’s response to COVID-19 from the fear and trust perspective. There are different logics on how to mitigate public fear and regain trust among the people and with the government. The discursive approach stresses that the government should carefully design narratives to calm people down, and a functional approach that only concrete measures serving the control of disease matter. Be that as it may, the biggest challenge is how to strike a delicate balance between caring public sentiment and initiating exclusionary protective measures. China’s response against COVID-19 witnessed setbacks with a heavy human loss at the initial stage and recognition when it finally controlled the situation. Discussions in summarizing useful experiences and lessons become extremely relevant when a second or even third wave of contagion might occur before a working vaccine can be found.

    Mask-Wearing and its Comforting Effect

    There were debates in China whether people should wear masks in confronting COVID-19 and the Chinese government’s positive suggestion generated a discussion on whether and how to wear face masks could help to control a highly contagious disease like COVID-19.6 Similar discussions emerged when other governments were entertaining the same suggestion to citizens.7 With all the valid points on the measure, it is difficult to construct its positive logical links with the eventual control of the pandemic. The discussion does not have a solid conclusion yet from a medical science perspective, still, its psychological effects in addressing public fear and rebuilding the trust among people and with the government should be properly recognized.

    Wearing masks does not change the particular fact that the invisible virus is making the environment dangerous. But a psychological suggestion it carries is that others in the environment care your sense of insecurity and none in the environment would intentionally or unintentionally spread the disease. Even if there are no other visible effects, at least it provides a comforting effect. It is not about its effectiveness. Subconscious measures like this would distract individual stress and thus mitigate the fear caused by environmental uncertainty. It can work as an indicator to others that their chance of infection is reduced when people in the environment wear masks.

    When the Chinese government suggested and the public was willing to wearing masks, the next question was how the supply could meet the demand. In China, the National Medical Products Administration (NMPA) is responsible for ensuring medical supplies and in 2009 it has established standard procedures for emergent medical supplies for public health needs.8 On 7 February 2020, NMPA issued a further administration notice to expedite registration and approval procedures on PPE production.9 Then provincial and further local levels would take over to make detailed plans and local NMPA agencies were making guidelines and temporary measures on emergency and temporary approvals.10 But it was chaotic as the fear drove people to store masks at all costs, the supply chain was further severed when most manufacturers were on holiday leaves for Chinese lunar new year. Only when big players like SINOPEC as an example of state-owned enterprises and BYD of private companies launched mask manufacturing lines of massive capacities that the supply-demand gap was filled.

    It proved an equal challenge to transport PPEs to affected areas since major highways were closed due to holiday leaves and forthcoming lockdowns. The lack of intra-provincial coordination only made the situation worse when local governments were storing and competing for ready PPE products. Public opinion backfired when reports showed that some local governments took expropriation of pandemic prevention materials crossing their districts.11 These obstacles could only be dealt with when the State Council stepped in pressing provincial governments, and the latter pressing further local governments to ensure smooth transportation of anti-epidemic materials.

    Lockdowns and Physical Separation

    On 23 January 2020, Wuhan announced the lockdown. Later, several other cities announced the same, and the subsequent nation-wide social distancing measures were implemented to prevent epidemic spreading. Eventually, a quasi-national lockdown remained in place for about two months. On every count, it was a risky political decision to make. First, it might work to flatten the curve, but public stress would become more and more intense with the duration of lockdown and rising numbers of confirmed cases. The sooner the curve went to the other (declining) side, which nobody knew when the lower political costs there would be. Second, the Chinese New Year meant a lot of domestic and international travel, traditional processions and extensive visits from relatives and friends.12 The power of tradition should be properly understood here, no one could make sure the public would cooperate. You can understand it as asking people to stay at home during the Holi in India, and Christmas in the West. It would be a huge task to get a public understanding of this.

    The lens of fear and trust can help to understand the logic of the Chinese government’s choice of measures of high political costs such as massive quarantine and lockdowns.13 A counter-argument is that drastic measures themselves would create panic. However, its marginal effect would decrease to a minimum when there is a high level of fear in existence due to the contagion. With a spreading panic in sight, the counter-measure should be far harsher and a physical isolation strategy can serve as a stabilizer of public sentiment.14 Such drastic measures carried a message that as long as people stayed at home, they would be safe. With initial resentment, the public was quick to accept that it would be in their best interest to suspend social activities and thus cut short the transmission chains. Again, it helps to comfort the public in a time of high uncertainty.

    Quarantine and lockdowns are indeed ancient tools to conquer epidemic disease, modern technology only transforms these into more powerful public health weapons. In China, people got used to online shopping during the SARS quarantines, and COVID-19 would only further drive the public ascribing an online living in a largely cash-less society developed since then.15 Despite so, it is no easy task to ensure the basic supply of daily commodities and the sheer size of the population being affected is enough to demonstrate the scale of the challenge. After the initial mess, the big data technology and intelligent supply chain took the charge and the feature of door-to-door and zero-contact delivery regained public trust on the environment.

    Epidemiological source-tracking and Slow-down of Community Transmission

    Besides wearing masks and lockdowns, tracking close contact is “probably the most important thing” as noted by Dr. Zhong Nanshan on 21 January 2020.16 Dr. Zhong is the leading medical scientist to contain COVID-19 in China and a public health veteran who had led China’s campaign against SARS. Modern technology again intervened to make these ancestor toolkits more effective. In China, popular apps such as WeChat and Alipay were used to monitor and track the travel route, and possible contacts if needed. Colored health codes of green, yellow and red were generated after people filling out information about their temperature, whereabouts in the last 14 days in a quick health survey and these tools allow them to go to other cities or enter residential areas or official buildings.17 Some apps develop functions for people to check nearby infection and transmission status so that depending on the status they could feel relieved or keep high alert. Despite all the controversies over privacy invasion, the massive surveillance measures proved useful in tracking close contacts and places visited by confirmed patients.

    Combined with source-tracking, testing all close contacts and admitting all suspected and confirmed cases for treatment will be the ultimate tool to control the disease. Without proper testing, affected persons might have to delay seeking medical help and remain undetected in the community.18 In the case of a pandemic, the number of tests in discussion could have easily discouraged any attempt.19 Demand spurt of testing caused a huge shortage of testing kits, and a huge influx of confirmed patients overwhelmed hospitals and public health workers in pandemic epicenters such as Wuhan and Huangshi. In ordinary times, a city in China would only have dozens of beds, hundreds in the case of a megacity for infectious disease, but during the COVID-19 time, it was tens of thousands of confirmed patients we were talking, and the number would be multiplied if suspected cases were admitted.

    The situation was only partially addressed when differentiated and phase treatment plan was adopted that the situation stabilized. Suspect cases were quarantined in independent houses and hotel rooms; confirmed cases with light and modest syndromes went to temporary hospitals that were specially established to monitor and provide them basic medical care; and those with severe syndromes to designated hospitals with epidemiological experts and intensive care units.20 At a later stage, health workers from cities and regions that had largely controlled the situation came to help, with each province assisting one city or region of Wuhan, the city hit first and most by the disease.

    Concluding Remarks

    It is understood that both unlimited and limited governments have records in succeeding and failing the epidemic prevention and control on history, it is noticed that a people of limited government tends to rely more on themselves rather than receiving parental care from the government. Public resentment is obvious, for example, in the US against wearing masks and lockdowns. In Michigan, a supermarket security guard was shot dead when he asked a customer to wear a mask.21 It seems that cultural and historical factors make big differences in public acceptance. Chinese culture is full of stories about how ancient kings like King Shennong tastes a hundred herbs and Dayu tames the flood to conquer diseases and natural disasters. Such cultural background makes the public more cooperative in tolerating the cost and observing government measures.

    Psychological perspective is one of the lenses to understand the logic of China’s response plan against COVID-19, and other factors should get fair credits too. For instance, a higher public saving rate in China ensures allows the public more likely to get through the hardship of living thus caused. A public memory from the effective fight against SARS in 2003 when rural areas were cordoned off and kept untouched even though they were most vulnerable to the epidemic disease,22 assures a quick manner of public acceptance of similar measures. And the necessity of drastic measures was obvious in that week-long holiday and month-long vacation meant numerous human flow and gatherings, and immediate lockdowns would slow down, if not cut the community transmissions, tangibly.

    A public mindset also plays a role. Chinese people tend to prioritize the rights of development and survival before they can enjoy freedom and liberty rights in social life, and most of them tend to accept that there will be limits for latter rights. In the West, individual freedom and liberty come on top of other rights that the public would defend and protest any attempt to sabotaging their rights, and a pandemic won’t simply change that belief. A fair note is that this doesn’t mean in China people don’t have freedom and liberty and in the West, people don’t have development and survival rights, but differences in prioritizing rights tend to influence the acceptance of certain drastic measures to fight the pandemic. Therefore, mass surveillance tools for the source-tracking purpose were accepted as a temporary measure in China, and in the West, people are more critical of such measures and focusing more on the potential data abuse.

    Human history evolves forward by conquering numerous disasters and diseases and COVID-19 won’t be the last pandemic. The danger of second or even third wave of the pandemic is real until a vaccine comes out and hence discussions on proper public health strategies that suite countries of different national characteristics and their situations are extremely relevant. In the discussion, countries need to mitigate public fear and hence restore public trust among themselves and with the government. With a high cost, China has largely controlled the situations, but this does not mean its public health strategy can be simply copied by others. Besides domestic debates on the controversial decisions, China’s response against COVID-19 is under international criticism that it was still using medieval tool kits in the 21st century.23 Even now a haunting question for China is whether measures other than massive lockdowns could do the same effect.

    Xie Chao is an Assistant Professor at the Institute for International and Area Studies, Tsinghua University, and a visiting faculty scholar (2018-2020), Jindal School of International Affairs, O.P. Jindal Global University, India.