China is back to normal — the US and Europe are not. Here's how it succeeded.
Chinese President Xi Jinping toasts at a banquet in Beijing, China on September 30, 2019. Naohiko Hatta - Pool / Getty Images
China has left the coronavirus pandemic behind and life has largely returned to normal.
During the Golden Week vacation of October 1-7, 637 million people traveled across the country in China without an increase.
Meanwhile, the US and many European countries are still struggling to suppress their outbreaks and are seeing new waves in the winter.
Experts say China's faster and more comprehensive testing approach, lockdowns in full swing, and simple, clear messages helped solve the problem.
Meanwhile, the U.S. and Europe have struggled to control their outbreaks due to mixed messaging, incomplete lockdowns, poor contact tracing, and a lack of experience with epidemics.
This week the US, France, UK, Poland and Belgium saw record numbers of new daily cases.
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China, where the novel coronavirus was first discovered, is clear by most standards today, and much of life is returning to normal.
It is an amazing reversal of January and February when China appeared to be in chaos as the rest of the world saw it.
China's recovery was particularly evident during Golden Week, one of China's biggest holidays, which ran from October 1-7.
Around 637 million people - or 46% of the country's population - traveled through China this week, spending $ 69 billion on vacations, shopping trips, weddings and visiting relatives, state media said.
Meanwhile, the US and a number of European nations are struggling to suppress their outbreaks and get their economies back on track after widespread job losses and recessions.
US Thanksgiving weekend is a little over a month away. On Wednesday, leading US infectious disease expert Anthony Fauci said Americans would have to "sacrifice" it if they hope to prevent further increases in cases.
Countries are now also facing the added pressures of winter which could lead to new COVID-19 cases due to its cold weather and weakened immune systems.
The US is far from emulating the success of Golden Week. On Tuesday, China reported 20 new cases, according to its National Health Commission. On the same day, the US reported 54,512 new cases, according to a New York Times tracker.
China was the first country to see the outbreak, so it should be the first country to pass out. But the speed with which it has done this shows that many Western nations are dealing poorly with the pandemic.
A man wears a face mask and surgical gloves on the New York subway on March 11, 2020. Tayfun Coskun / Anadolu Agency via Getty Images
The US of 328 million people recorded nearly 8 million coronavirus cases and more than 217,000 deaths on Friday, according to a Johns Hopkins University tracker.
Meanwhile, China, with a population of 1.3 billion, recorded 90,900 coronavirus cases and 4,739 deaths on Friday, according to Johns Hopkins.
China's success has been attributed to a number of factors.
Testing at speed
The first thing that made China successful was the commitment to testing and smart testing.
A test was quick and free. Those who tested positive were immediately sent to newly created isolation centers or nearby hospitals to reduce the risk of contracting people they live or work with.
Wuhan was quickly isolated and residents spent 76 days in jail.
"These are places that got out of hand in the beginning and China made this decision to protect China and the rest of the world," WHO deputy director-general Bruce Aylward told Vox, adding that China is doing well came from speed and serious contract tracing.
"The faster you can find the cases, isolate the cases, and keep track of their close contacts, the more successful you will be," he said.
"They have prepared their system for quick detection and quick reaction. They never want to be in another situation like a Wuhan - and they haven't."
A doctor examining a nucleic acid test in Qingdao, China on October 14, 2020. Costfoto / Barcroft Media via Getty Images
In connection with this, as Business Insider previously reported, hospitals have been built from scratch in a matter of days, non-urgent medical care has been delayed, doctor visits have been put online, fever clinics have been opened outdoors, hospitals have been walled by COVID-19 wards, and widespread contact tracing has gone introduced.
According to The Lancet Medical Journal, 14,000 health and temperature checkpoints have been set up at most major transportation hubs across the country.
In July, when China began to temporarily reopen its borders, the country's aviation authority said anyone entering from overseas must have a negative COVID-19 test within five days of boarding.
And in the final days of the outbreak, when hardly any new cases were recorded, China was still not taking any chances.
On October 9, the eastern city of Qingdao announced it would test all 9 million residents for the coronavirus in a five-day flash after 12 new cases linked to a local hospital were identified.
On Thursday, the state-run People's Daily reported that authorities had carried out 10.5 million tests. That's equivalent to testing everyone in the New York City area.
A health worker takes a swab from a resident during the COVID-19 mass testing in Qingdao on October 12, 2020. STR / AFP via Getty Images
It wasn't the first time China has tested an entire city at the first sign of a threat that the coronavirus is spreading again.
In May, Wuhan tested its 11 million residents over a period of 10 days. Those who did not submit for testing were told, according to the New York Times, that they would have to pay for all tests in the future.
Before that flare-up, Wuhan's COVID-19 test sites were processing an average of 46,000 tests a day, The Times reported. On the first day of mass testing in May, 1.47 million tests were processed, according to the Times.
It showed how seriously China still took the virus after weeks with no new locally transmitted cases. Some experts even said it was an exaggeration.
Xi arrives for the National People's Congress in Beijing, China on May 22, 2020. Andrea Verdelli / Getty Images
Jin Dongyan, a virologist at the University of Hong Kong, told the Times that a sample of about 100,000 people would have been sufficient, describing the mass testing regime as "scary."
To compare the level of testing in Wuhan with that in the US, The Times reported that New York State tested a total of 1.7 million people between March 4 and June 3.
During that period, on April 7, the state recorded a record 5,489 coronavirus deaths. 4,758 people died the day before.
Some US cities like Los Angeles and San Francisco have received praise for introducing fairly successful test drives, but none of them have matched the efforts made in China.
Meanwhile, the UK has a chronic testing problem where the government failed to meet daily testing targets on several occasions, most recently given increased demand.
Spain also struggled to speed up the tests in the spring. France ramped up testing this fall, but there have been several reports of widespread delays and overloaded laboratories.
Lockdowns and social distancing are strict
During the pandemic cities across China, lockdowns were strictly enforced and reintroduced when necessary.
Residents followed public health measures and local authorities visited households to make sure people were home and even forbade them to leave.
China is an authoritarian state that routinely monitors its citizens and suppresses dissent. During the outbreak, officials across the country monitored their residents using high-tech methods, from capturing people with a fever with facial recognition and thermal cameras to using flying drones to shame people for being outdoors.
A study comparing human interactions in the major cities of Wuhan and Shanghai before and after the pandemic, published in Science magazine in June, found that "daily contacts were reduced seven to eight times during the period of social distancing from COVID-19, with most interactions were household-confined. "
"We find that social distancing alone, as implemented in China during the outbreak, is enough to control COVID-19," the authors wrote.
The soldiers of the Honorary Battalion of the People's Liberation Army Honor Liberation Army stand in front of the photo of Xi Jinping in their barracks outside the Forbidden City of Beijing on May 20, 2020.
Another reason China enforced public health measures so well was that it had experience responding to outbreaks thanks to the SARS epidemic in 2003, according to an expert.
"It has a centralized system for responding to epidemics. Most Chinese adults remember SARS-CoV and the high death rate associated with it," Xi Chen, associate professor at Yale School of Public Health, told The Lancet in October.
"Society has been very attentive to what can happen in the event of a coronavirus outbreak. Other countries don't have fresh memories of a pandemic."
Meanwhile, the U.S. hasn't put in place a coherent federal plan to make social distancing or wearing masks the norm.
The White House alternated between endorsing the Centers for Disease Control and Prevention's advice on wearing masks and ignoring them. Last month, the White House allegedly prevented the CDC from enacting rules to make masks mandatory for public transport.
Dr. Leana Wen, the former health commissioner for Baltimore, told CNN in May, "We know that social distancing is most effective when used early, consistently and aggressively. This is not the case in the US."
Spring Breaker in Miami Beach in March 2020. Jeffrey Greenberg / Universal Images Group via Getty Images
Americans still don't wear masks
It is widely believed that masks are key to slowing the spread of the virus, and China, the world's largest manufacturer of personal protective equipment, was well placed to ramp up production quickly and provide protection to the frontline workers.
However, authorities in the US, UK and Europe reported shortages of PPE and it took months to admit that wearing masks helped curb the spread of the coronavirus. In May, the British government was still debating whether to tell the public to cover their faces in public.
On the contrary, "Compliance was very high in China," said Chen, the Yale professor.
He told The Lancet: "Compare that to the US, where even in June and July when the virus rose, people still refused to wear masks. Even in late September, President Trump dealt with wearing Joe Biden's masks still to be ridiculed as weakness. "
In the US, UK and Italy, officials blamed young people who they said avoided masks, even in cases where they avoided masks.
Several reports highlighted how young people enjoyed the summer weather, participated in spring break and held illegal raves.
Spring Breaker in South Padre Island, Texas in March 2020. KRGV / YouTube
The extent and intent of the lockdown in China have been difficult to replicate in the US and Europe.
When China banned Wuhan and nearby cities in January, some Western experts said the move was unethical. During the pandemic, citizens held anti-lockdown protests in London, Madrid, Belgrade, Denver, Austin and other countries.
There is also consensus among medical professionals that lockdowns in the US and Europe ended long before communities were free of the virus or equipped to suppress flare-ups.
When San Francisco closed in March - as one of the first urban areas in the US - residents largely followed government orders on wearing masks, social distancing, and limiting gatherings.
Two months later, the city recorded only 35 coronavirus deaths - according to Wired, there were 14,700 in New York City over the same period. (San Francisco has a tenth the population of New York City, so the comparable death toll would have been 1,470, Wired said.)
But when the Franciscans' patience waned in August, falls began to rise.
"What it bought us was 3 1/2 months of relative calm, relatively few cases, astonishingly few deaths, and the ability to build capacity," said Dr. Robert Wachter, chairman of the University of California at San Francisco's department of medicine, told the Washington Post on Aug. 3.
"What it bought us also was a bit of complacency."
A street in San Francisco during the city lockdown. Justin Sullivan / Getty Images
The case was similar in Europe. Experts said the continent was suffering from "pandemic fatigue".
Cases are on the rise this week and hit record highs. The UK hit a new high of more than 17,000 cases per day on Thursday. France reported a record 19,000 new cases on Tuesday.
Belgium and Poland have also set new records for daily cases, with infections also increasing in Germany, Ireland, Italy and Sweden. Paris, London and other large areas have been restricted again this week.
While high case numbers are partly due to increased testing that was missing during the peak of the continent's eruption this spring, there were also increased contacts in these locations, Business Insider's Aria Bendix reported.
However, experts have warned that lockdowns were lifted too soon in countries like the UK.
To make up lost ground, Prime Minister Boris Johnson imposed low-impact lockdowns on a number of urban areas in the north in late September and early October.
On October 13, it was revealed that Johnson's administration was ignoring government public health advice to enforce a two-week lockdown in late September. These measures would have helped stop the virus from being revived.
Alfresco dining in London. England allowed bars and restaurants to reopen on July 4, 2020. Dominic Lipinski / PA Images via Getty Images
On September 8, Chinese President Xi Jinping declared the coronavirus defeated in his country to be defeated.
"We are global leaders in economic recovery and the fight against COVID-19," he said at a ceremony honoring healthcare workers.
It also appears that the swift, sometimes harsh, action in China has resulted in China becoming the first major economy to return to pre-pandemic levels this summer.
China said its economy grew 3.2% in the second quarter of 2020, and former Goldman Sachs economist Jim O'Neill said the country is expected to make up for any 2020 economic losses over the next year.
In the meantime, the US and many European countries still have a lot to do to bring the coronavirus outbreak down to China's levels.
And as winter approaches, experts fear death will skyrocket if nothing changes.
The Institute for Health Metrics and Assessment forecast on Friday that the U.S. could expect a total of 389,000 COVID-19 deaths by February 1, 2021, if policies don't change - nearly double the current death toll.
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