This article was updated on April 9.
China is both the cradle of the Covid-19 epidemic and the country that has taken the strongest measures to contain it, so far with success. This is in spite of a late start, and a remaining deficiency of testing in spite of efforts. The Chinese solutions are distinctive by the rigor of the lockdowns, the use of digital tools and the mobilization of medical industries. The economic cost has been sharp. China now promotes its response and emerges as the world’s major manufacturer of needed medical equipment.
- November 17, 2019 – First case retrospectively detected in China
- December 8 - First confirmed case according to the Chinese official statement to the WHO
- December 30 - Li Wenliang, a doctor working at Wuhan Central Hospital, sends a warning to fellow medics. One day later, he is made to write a self-criticism to reflect on the topic of “not spreading misinformation”.
- December 30 - An “urgent notice on the treatment of pneumonia of unknown cause 关于做好不明原因肺炎救治工作的紧急通知” is issued by the Wuhan Health Commission, highlighting the increasing number of patients in Wuhan showing symptoms, and urging all medical institutions to report relevant information
- December 31 – The Wuhan Municipal Health Commission issues the official communication of pneumonia cases of unknown cause at Wuhan’s Huanan Seafood Market. Arrival of a National Health Commission expert team in Wuhan to investigate the pneumonia outbreak, which is reported to WHO on the same day
- January 3 - The work unit at a Wuhan hospital is required to not discuss the diseases through public and private communication channels.
- January 5 - The virus from Wuhan is fully sequenced in Shanghai; publication of a report by the Wuhan Municipal Health Commission with updated numbers of cases but "no clear evidence of human-to-human transmission"
- January 7 - Xi Jinping gives verbal and written instructions on the outbreak at the CPC Central Committee Political Bureau meeting, as he retrospectively indicated in his February 3 speech.
- January 14 - First temperature checks at Wuhan’s airport, train station, coach station, and ferry terminal. Installation of 35 infrared thermometers, complemented by around 300 handheld models of infrared thermometers
- January 20 - Start of the Lunar New Year mass migration and first public address of Xi on the crisis situation; COVID-19 recognized as a Class B infectious disease and preventive and control measures of Class A to be applied. The policy allows medical institutions to isolate and observe COVID- 19 patients. China confirms human-to-human transmission of the virus.
- January 21 – Establishment of the Joint Prevention and Control Mechanism of the State Council (肺炎疫情联防联控工作机制), composed of 32 departments coordinated by Vice Premier Sun Chunlan
- January 23 – Lockdown announcement of Wuhan, followed by other nearby cities (Xiaotao, Chibi, Huanggang, Ezhou). Announcement of emergency construction of the first temporary in Wuhan, operational on February 3. A second project is announced two days after, operational on February 5.
- January 24, 2020 - Suspension of group travel within China. First nucleic acid test kit passes legal inspection
- January 26, 2020 – First meeting of the Central Leadership Group for Epidemic Response (中央应对新型冠状病毒肺炎疫情工作领导小组), chaired by Li Keqiang. Four nucleic acid test kits approved by the National Medical Products Administration (Speedy approval channel for medical devices)
- January 27, 2020 – Suspension of group travel to foreign countries; individual travel remains open
- February 08, 2020 - State Council issues the Notice on Orderly Resuming Production and Resuming Production in Enterprises
- February 10, 2020 - A guideline stipulates that confirmed and suspected carriers of the virus can be charged with endangering public security if they refuse quarantine or leave before their quarantine time is up, enter public places or use public transportation.
- March 16, 2020 - All overseas travelers entering Beijing are transferred to a centralized observation point for 14 days of isolation observation.
- March 19, 2020 - China reports zero new local cases for the first time since the outbreak
- March 23, 2020 - All international flights to Beijing are diverted to 12 cities, only qualified travelers can then continue their journey to Beijing.
- March 25, 2020 - All inbound passengers arriving in Beijing are required to receive nucleic acid tests and undergo centralized quarantine
- March 28, 2020 - Temporary entry suspension by foreign nationals holding valid Chinese visas or residence permits,
- March 29, 2020 - Each Chinese airline is only allowed to keep one route to each foreign country, while each foreign airline is only allowed to operate one route to China. A maximum of one flight per week per route is applied.
- March 31 - Ministry of Commerce, General Administration of Customs and the National Medical Product Administration jointly issue “Notice on the Orderly Conducting of Medical Materials Export”.
- April 8, 2020 - End of Wuhan lockdown, after 76 days, but various local control and preventive measures remain in place.
Three phases can be identified in China’s overall response: the initial period of denial and lack of proper measures to confine the epidemic; a policy reversal on January 20 defined above all by the strongest lockdown measures in the world on January 23 with corresponding means of residential control and digital tracing tools; and from March 19, the claim of victory against the virus, with the accent on imported cases. As China’s production capacities of personal protection equipment are eagerly sought, China aims to reshape the global narrative regarding COVID-19. Yet any final narrative must start from the epidemic’s initial rise.
The tragic cost of denial
The first phase of responses, or lack of responses, is reported by the cover story of China News Weekly. A number of people at Wuhan’s Huanan Seafood Market (which also sells wild animals) were infected as early as December 8, 2019, but the Wuhan Municipal Health Commission only issued the official communication of pneumonia cases of unknown cause at Wuhan’s Huanan Seafood Market on December 31. The market was only closed the day after, on January 1, 2020. Later investigation will backtrack and find infected patients from December 1, and later November 17, with no identified relation to the seafood market. Patient zero has yet to be found.
The 23 days between the December 8 infection cases and the market closure expose numerous Wuhan residents to the virus, contributing to a major outbreak in Hubei province, in China and then globally. Although national medical authorities are informed very early, neither the provincial nor the central government move quickly enough. Locally, information is withheld. Public gatherings and events continue until January 20. Li Wenliang, a doctor working at Wuhan Central Hospital, is one of the doctors who raises the alarm among his colleagues about this SARS-like disease. He is silenced. After his widely commented death from the epidemic and the January 20 turnaround by the leadership, the cost of denial is reassessed. China’s Supreme Court makes an explicit reference to Li Wenliang’s case on January 28. It tempers the definition of 'false information', noting that some of it may actually be true, or fill a gap left by a lack of public disclosure, and that it may not be malicious.
On January 31, Ma Guoqiang, Wuhan’s party secretary until February 13, acknowledges that if decisions and strict control measures had been taken earlier (such as putting Wuhan under lockdown on January 12 or 13 instead of January 23), the situation would have been contained better. He also blames the central government rules that prevented him from disclosing information related to the disease at an earlier stage, as he had to wait for authorization from Beijing.
The moment of truth and drastic measures
On January 20, the virus is recognized as a Class B infectious disease (which includes SARS and influenza A), requiring preventive and control measures of Class A (plague and cholera) to be applied. The upgrade of measures from Class B to A is crucial, since Class B requires faster reporting and stronger isolation measures. One day after, the Joint Prevention and Control Mechanism of the State Council 肺炎疫情联防联控工作机制 is established, comprising 32 departments under the coordination of Vice Premier Sun Chunlan. Guidelines are issued to medical institutions on January 22 urging them to keep the infection within medical institutions under control.
On January 23, as hundreds of millions have already arrived at their Lunar New Year destinations, a travel blockade begins in Wuhan and is sequentially adopted in other major cities. The Lunar New Year Holidays are now referred to as a “window of opportunity” for mass isolation and mass disinfection (大隔离、大消毒) on the prevention and control plan published by the National Health Commission (NHC) on January 28, and the official holidays period will be extended several times. Much migration has already happened by that time however: the mayor of Wuhan estimates that almost 5 million people had left the city before enforcement of the travel ban A restriction on group travel to foreign countries is only implemented on January 27, three days after the suspension of domestic group travel. The travel ban is also enforced by many informal local blockades. Confinement and complete lockdown follow - with varying degrees of severity according to time and place. Complete isolation of suspected cases is enforced. Emergency hospitals are delivered and put into operation in 10 days. Operated by the Chinese People’s Liberation Army, they provide 2600 beds in total. By February 28, 16 cabin hospitals (方舱医院), which are movable medical spaces, are also built in Wuhan to treat mild symptom patients, adding 13,000 beds. The aim set by the NHC at this point is to concentrate patients, experts, resources, and treatment (集中患者、集中专家、集中资源、集中救治)".
While confirmed patients are subject to hospitalization, all individuals in close contact with confirmed patients, or arriving from a high-risk area, undergo a compulsory quarantine. There is mandatory compliance with the investigation, testing, collection of samples and isolation. Public security organs and digital surveillance tools are massively used. Medical treatment is free for individuals, covered by insurance and other government subsidies. Confirmed and suspected cases face charges of endangering public security if they refuse or do not respect quarantine.
Masks and other medical equipments - A production leap
Several provinces and cities make masks compulsory. In addition, there is major social pressure on individuals to wear masks. The Chinese Center for Control and Prevention’s guidelines also advise wearing medical surgical or N95 masks in public spaces and public transportation, as well as keeping at home as “daily necessities” masks, thermometers, and disinfectant. To ensure the mask supply, duties on mask donations from abroad are waived, and subsidies are provided to companies importing masks.