China locked down millions in coronavirus-hit Hubei. Has it done more harm than good?
- Residents are struggling to get much-needed treatment and supplies in Wuhan and other closed-off cities, and the death toll is rising
- Independent economist Hu Xingdou says it’s time to lift the restrictions and ‘stop this human tragedy that is happening’
The streets remain eerily quiet in the central Chinese city that is home to 11 million people – more than New York or London. And people continue to fall ill, but they are struggling to get much-needed treatment and supplies.
All public transport into and out of the city, including trains, buses and ferries, stopped at 10am on January 23. Outbound flights were cancelled, private cars were ordered off the roads, and inner city public transport was also brought to a halt.
As the deadly virus continued to spread, at least 15 other cities across Hubei province were also locked down in the world’s biggest ever quarantine effort that is affecting more than 50 million people.
As the death toll continues to mount in Wuhan and the other cities under lockdown, questions have been raised over whether the drastic measures have left residents in a worse position given the chronic shortage of hospital beds and medical supplies in the province.
‘Open up these cities’
Independent economist Hu Xingdou called for an end to the restrictions in an open letter this week.
“The lockdown should be called off as soon as possible,” Hu wrote. “We should open up these cities to allow medical resources to get in, and to stop this human tragedy that is happening.”
Chinese social media has been flooded with desperate messages from the province, as residents seek urgent treatment for their loved ones, while public hospitals call for supplies of face masks, goggles and protective suits for their medical staff.
In Wuhan, where it is easier to access treatment than other places in Hubei, there were just 110 beds available for critically ill infectious disease patients in three hospitals when the outbreak began.
Fan Weihua, a 41-year-old accountant in Wuhan, said she had stopped checking the daily updates.
“I just don’t have the strength to see the numbers any more. I thought things would get better soon with the quarantine measures, but I was wrong,” Fan said.
“These are not just numbers – they’re the lives of friends and relatives,” she said. “I don’t feel like doing anything at the moment. I just lie on my bed and try not to think about it.”
Fan said she had been living on instant noodles she had stocked up on two weeks ago. Her food supplies are running low, but she does not want to leave her home to buy more as the family only has two surgical masks left and there are none in the shops.
Economist Hu described the situation in Hubei province as “apocalyptic”.
“It reminds me of the Great Famine from 1959 to 1961, when people were banned from leaving their hometowns and as a result, tens of millions of them starved to death,” he said.
“Chinese are educated to be ready to make personal sacrifices for the country. However, it’s unnecessary and unethical to ask [millions of] people to make this sacrifice in an ill-prepared region.”
The decision to lock down Wuhan was based on advice from a panel of experts from the National Health Commission who visited the city on January 18 and 19.
Li Lanjuan, a leading epidemiologist on the panel, later told state broadcaster CCTV that the decision was made after cases emerged of people travelling from Hubei to other provinces where they transmitted the virus to others. She said they were worried the situation would worsen with the annual mass migration of people for the Lunar New Year holiday just days away on January 24.
“It would’ve been very dangerous to let the contagion continue developing in other provinces,” Li said. “Without these controls, it would have dealt a heavy blow to China’s economy and seriously threatened our economic and social security.”
Asked how long the Wuhan lockdown would continue, Li said it would depend on the number of new cases. “If there are no new patients, then it can definitely end,” she said.
On Thursday, provincial officials reported 1,766 new patients in Wuhan, 424 in Xiaogan, 162 in Huanggang and 128 in Suizhou.
Ross Upshur, head of Clinical Public Health at the University of Toronto, said the Chinese authorities had to act at the time of the Wuhan lockdown.
“Given there is no vaccine, no effective antivirals and evidence of considerable transmission of a viral infection with serious morbidity and mortality, health authorities must do what they think is necessary to bring the outbreak to a halt as quickly as possible,” he said. “The international spread really made the need to intervene more pressing.”
The lockdown was announced as coronavirus cases had been confirmed in Thailand, Vietnam, South Korea, Japan, the United States, Taiwan and Singapore.
On the Hubei lockdown, Upshur noted there was no clear criteria on when to use quarantine, and only limited evidence on how effective it was. “[However] there is also symbolic effectiveness – doing something to show how seriously public health authorities are taking the situation,” he said.
In a 2018 report on handling epidemics, the WHO said that “many traditional containment measures are no longer efficient”.
“They should therefore be re-examined in the light of people’s expectations of more freedom, including freedom of movement,” the report said. “Measures such as quarantine, for example, once regarded as a matter of fact, would be unacceptable to many populations today.”
Quarantines were used extensively during Europe’s plague-riddled Middle Ages, and continued to be the primary means of controlling outbreaks until the early 20th century. Especially after the advent of antibiotics and diagnostic testing, the relative harms began to outweigh the benefits. International agreements were put in place to limit the practice as a matter of justice, because of the burden it placed on people and economies, in addition to basic questions of effectiveness.
“I would argue that there is a moral obligation to study the effect of the quarantine in terms of effect on disease transmission and on the impact on the population affected,” Upshur said. “Failure to do so would be a lost opportunity.”
‘Disproportionate, and possibly ineffective’
Nicholas Evans, a medical ethics expert at University of Massachusetts Lowell, said it was a “complete overreaction” to quarantine millions of people.
“A bigger concern is that because the disease largely does not transmit itself before symptoms show, then isolation of the patient is usually a sufficient response, combined with tracking a patient’s close contacts,” Evans said. “So in addition to being disproportionate, and possibly ineffective, it is almost certainly too restrictive compared to other effective measures.”
He said resources would be better spent tracing close contacts of patients and ensuring their symptoms were monitored, which would be much less disruptive but has in the past achieved similar results to large-scale quarantines.
Evans said people should be quarantined in small clusters, and for a limited time. Research had shown that isolating about eight people per case – usually the patient’s closest family and friends – was sufficient to stop the spread of respiratory disease such as a coronavirus, he said.
The isolation period could last for seven to 14 days in small clusters, whereas a mass quarantine could go on for months.
“[Quarantine] causes people to fall into despair, makes them afraid and more likely to engage in risky behaviour, and can even make them violent,” Evans said.
“It also gives people extra reasons to fear the government and hospitals, and to not seek treatment. This is a consistent pattern we see when large-scale quarantines are put in place,” he said. “Unless there is a pressing need, I don’t think it is moral.”
Alberto Giubilini, a medical ethics research fellow at the University of Oxford, said the least restrictive measure should always be taken to contain the contagion.
“In the face of uncertainty, it seems wise to err on the side of safety. So in this case, quarantine itself might be ethically justified as a precautionary measure, but only until we know exactly how dangerous the disease is and for which groups of people,” Giubilini said. “It is unethical to put people at significant disadvantage when alternatives are available and when they are making sacrifices for the sake of the community.”
Jonathan Moreno, a professor of medical ethics and health policy at the University of Pennsylvania, said the lockdowns could have knock-on effects – causing fear, and disruption to travel, critical supply chains, aid and communication – that were not helpful.
“A quarantine is in any case a clumsy approach,” he said. “It may succeed in some ways but is sure to fail in others. These failures will be widely recognised and further undermine confidence in the authorities’ decision-making and control over the situation.”