The Coronavirus outbreak has sparked fear around the world, leading to quarantines, transportation shut downs, and disrupting trade, travel, and more. Reports are now emerging that the Chinese government initially tried to cover up the outbreak, threatening doctors and forcing whistleblowers to recant their statements. How has the initial response changed? And what does Coronavirus mean for China going forward? Jen talks to James Palmer about the domestic and international reaction, and what it means for Chinese citizens.
Jen Psaki: 00:00 I'm Jen Psaki. Welcome to The World Unpacked.
News Audio: 00:05 Chinese officials are racing to contain a quickly spreading virus that has now killed at least 17 people. Coronavirus. One "coronavirus". Current virus outbreak. Virus may be spreading even faster than previously thought. Coronavirus outbreak that has killed at least 26 people. More than 80 people have died. To more than 700. More than 800 fatalities. 900 deaths. The death toll from the novel coronavirus in China now stands at over 1000 for the first time.
James Palmer: 00:38 First the [inaudible] appeared be confined to a cluster of cases. It seemed as though it was a relatively small problem, but then later on in January, the numbers and the story exploded. Dr. Li Wenliang was a young ophthalmologist in Wuhan with a practice in one of the central city hospitals. Now in China, the medical resources are very concentrated in the big cities, so he would have seen huge numbers of cases every day.
Jen Psaki: 01:09 James Palmer is a senior editor for Foreign Policy magazine and a long time former resident of Beijing.
James Palmer: 01:16 On the 30th of December, he posted in a WeChat group, which is China's most popular social messaging app, consisting of his former medical school classmates, that he had seen a cluster of cases, I think he said seven, which showed symptoms of SARS, which was the coronavirus that swept China in 2003.
News Audio: 01:40 Panic grips Hong Kong as a deadly new virus sweeps through the city, one of the most densely populated in the world. The Amoy Gardens Estate are sealed off after hundreds of residents contract severe acute respiratory syndrome, or SARS.
James Palmer: 01:56 He intended basically to warn his fellow doctors about the need to take precautions such as mask wearing, extra hygienic precautions, gloves and so on. Particularly when seeing patients, and perhaps to try and get the word out a little bit further. But he wasn't a whistleblower in the classic sense. He wasn't somebody who was going to the media directly or who even knew that the information that he was talking about was forbidden or suppressed. He was just somebody concerned about a medical problem. Who was trying to talk to fellow professionals about it,
Jen Psaki: 02:44 Which is not, that either of us are medical experts, but not uncommon. Medical professionals often seek advice from fellow doctors on something they're seeing if they haven't seen it in the past. And there's lots of means to do that.
James Palmer: 02:58 Exactly. And China, there are websites such as dxy.cn that have played a big role in this. Obviously there are also any number of informal WeChat groups where doctors exchange information just as in the rest of the world. But what Li wasn't expecting was that the police would come to his door two days later.
James Palmer: 03:27 And he was one of a group of between eight and 10 doctors, we're not quite certain, who all independently saw the symptoms of the coronavirus, saw it as either SARS or as a SARS-like virus, and attempted to spread awareness of it. I wouldn't say that they even tried to raise the alarm about it. They tried to let fellow professionals know what was happening. They tried to make sure that people were prepared and the immediate response of the authorities was to threaten and suppress them, was to force Li and others to sign letters saying that they understood that they had done wrong, that they were spreading false information, that they wouldn't repeat the error. And so on.
James Palmer: 04:22 I think it's actually very unlikely that the police knew anything. I think this was almost like an automatic reaction by the Chinese system, particularly under Xi Jinping. And especially in the last three years or so, we've seen a massive awareness of what they see as the danger of information or as they call it, rumor, and an immediate reaction against any narrative that goes against the official line. So it wasn't even that they were specifically concerned about covering up something or about concealing something. This was an automatic response to somebody posting bad news online was to go and tell them, or threaten them, until they stopped talking about it.
James Palmer: 05:15 And this is why we've seen across the board in China people being really scared to talk in the last few years, because there's no telling when you might trust the line. It's not as if there are topics you can talk about and topics you can't talk about. There's topics you definitely can't talk about, like say Xingjiang, or Taiwan, in anything other than the official line. But then there's a whole massive gray zone of stuff that you might or might not be able to say depending on the shifting political winds and at any point you might cross that line. So it's always easiest to be quiet.
Jen Psaki: 05:50 Are there any precedents as it relates to health issues where we've seen the police crack down on sharing of information?
James Palmer: 05:59 Absolutely. In 2003, when SARS broke out, there was a real campaign then to restrain information about it to make it seem as though everything was okay until a whistleblowing Beijinger, quite a senior doctor, managed to reach the foreign press, managed to reach Susie Jakes at Time Magazine, and get his letter on it published. That resulted in a mass outcry that spurred an opening up on the topic and an emergency response. But that doctor was then later on put under house arrest on various occasions, has been listed as an example in Chinese school examinations of what not to do, because his narrative went against the state, because he acted independently.
Jen Psaki: 06:41 What happened to that doctor?
James Palmer: 06:42 He's been intermittently under house arrest. He's quite old. The authorities have often threatened him about speaking up more. There was a period when he was briefly celebrated, but then the system kind of snapped back into place.
Jen Psaki: 07:04 So the Chinese health system, I don't even know what the perceptions are of it from outside of China. How do people get access to healthcare there and how has that impacted the spread of the coronavirus?
James Palmer: 07:15 So the Chinese health system is a total mess. It's worse than the American health system, which is always, you know, setting a very low bar.
Jen Psaki: 07:22 That makes me feel a little bit better about the American health system. I don't know, maybe the bar is quite low.
James Palmer: 07:27 The out-of-pocket payments in China, for instance, are about 10 to 15% higher than in the U.S. So what you had originally was a socialized medical system with very few resources, but that tried to cover this huge population. In the 80s that system was effectively abolished and replaced with basically privatized health care. Now there is medical insurance, but that insurance is very limited. It's also often connected to your who call, your residence permit. So if you're a migrant worker for instance, who's traveled from, say, Anhui, Guangdong, who's gone hundreds or thousands of miles in order to seek work, you still only have the resident's permit for your place of origin. So you can't then use your insurance in other locations. You can't get access to that health care. One of the other problems is that it's extremely tiered.
James Palmer: 08:25 So the resources all go to the top hospitals in the city. There are networks of community centers, but they have largely untrained personnel. They have very few resources. And in fact, when the outbreak happened this time, we saw the community centers being shut down in order to direct people toward the main hospitals. So at the main hospitals, the experience, it's gotten a little better in some cases in recent years, but it's very grueling. And the other thing is because there's not really a regular GP system, there's not a doctor who you go to with a small practice. It's almost all hospital-based. So say you have food poisoning, you go into the hospital, you take a ticket to wait in line, you pay a small fee to register. Um, eventually your ticket number is called up. You're told which doctor to go and see, you traipse through the hospital to go and find them. They're surrounded by a cluster of other patients trying to get attention. You barge your way in, pay another fee. He sees you, tells you to go and get a blood test. You go across the hospital, you go to the blood testing center where you pay a fee in order to get your blood tested , to get your blood drawn. And you then carry that blood to the testing center, where it's tested separately, you pay another fee, you go back to the doctor with the results, he looks at them and he gives you a prescription, you go and you pay another fee for the prescription. So it's a process of just constant irritation and everybody is overworked. The doctor's always overpriced. Bribery is really common in order to jump the line.
James Palmer: 10:12 Bribery is normalized, particularly around surgery. You would give a hongbao, a red envelope of cash to your surgeon. So all of this puts immense pressure on the system, even at ordinary times. And there's a lot of anger from ordinary people about that. And we've seen a huge number of cases in recent years of people attacking doctors, either because they felt they were being overcharged or because the doctors had killed, as they saw it, their father or their grandmother or somebody. One of the other problems is that the people who have the title "doctor" in Chinese hospitals are generally not trained to advanced degree level, only about 15% of Chinese doctors and hospitals have the equivalent of MD education in Europe or America. Most of them have at best an undergraduate degree in a related subject like biology or chemistry, and have then received some amount of on the job training. Quite a lot of them don't even have a four year college.
Jen Psaki: 11:25 so James, the international community has taken a couple of different steps here, and some of them have also been taken within China including quarantines. There's also been travel bans that have been implemented. Tell us a little bit about those steps and the effectiveness of them, I guess, to the degree you can evaluate that.
James Palmer: 11:45 So all of these steps came after China took its own initial quarantine reactions, which was this very sudden shutdown of the city of Wuhan and environs. After that we started to see sort of ripple effects in other countries closing down flights. Often the airlines actually closing down flights. Sometimes shutting borders. In a lot of cases, like in the U.S., introducing a ban on people who had been in China within the last 14 days. And this has varied very widely, like there are all manner of different restrictions in place, from outright bans to mandatory quarantine to mandatory testing. Countries that are politically closer to China, such as Cambodia, have put fewer restrictions in place. Countries that feel the need to sort of differentiate themselves, or where there's public demand, have put harsh restrictions in place. And in some cases those are the countries that are close to China and have huge numbers of tourist traffic normally and countries that have big Chinese populations of their own. And those measures I think are only likely to increase in the coming weeks as we see the numbers of the coronavirus tick up and up. I wouldn't be surprised if at some point we're looking at a situation where in many ways China is cut off from the rest of the world, at least in terms of anything but essential transport and supplies.
Jen Psaki: 13:15 And we talked a little bit about SARS earlier. Are there any lessons learned that they've applied in China effectively, or are there things they haven't applied that you're surprised by?
James Palmer: 13:26 I think that the scientific community in China have responded more quickly in communicating more effectively with the rest of the world then in 2003. Partially because of expense then and partially just because the ties between China and the rest of the world are much stronger at this point than they were back then. I don't think that the authorities have really learned anything. It seems that the same factors that made SARS problematic, failure to allow free communication, over-action in panic in some cases, and a desire to first and foremost to control what people were saying even more than to control the disease itself. Those all seem to still be in place.
Jen Psaki: 14:15 There has been a line of argument from the CDC and even here in the United States, uh, you know, being used to attempt to calm down Americans saying that the flu is a greater health risk. You've been covering this very closely. What do you make of that, or what do you think of that?
James Palmer: 14:32 It's one of those things that for Americans is technically true right now but is basically meaningless. So look, the flu kills a bunch of people every year because the flu is super common and the flu is basically unstoppable. It's an endemic worldwide. But the case fatality rate of the flu, the percentage of people who die if they get the flu, is 0.01 or 0.02 in a particularly bad year. The best case scenario for the coronavirus right now seems to be that the case fatality rate is 1%, making it up 50 to a 100 times deadlier than the flu. It could well be that the case fatality rate is 2 or 3%. It's possible that it's as high as 10%, because we haven't really seen the cause of this disease play out. So we're talking about something that is literally hundreds of times deadlier than the flu on a case by case level.
James Palmer: 15:31 And that seems to spread very fast. Now of course, it doesn't kill as many people as the flu at the moment. In the same way as say, cars kill thousands and thousands more people than helicopters every year. But flying in a helicopter is still more dangerous than driving in a car. It's just that far fewer people fly in helicopters. And the danger here is if containment fails and the coronavirus spreads worldwide, or even just becomes epidemic in China, if we see these recurring bursts of cases, then that's going to be almost like second flu or deadlier. It's going to add tens of thousands of dead people every in the next few months or potentially even every year in the future if it gets out there.
Jen Psaki: 16:24 One of the other reactions has also been a rise in racism against people of Chinese descent here in the United States., certainly in other parts of the world as well. Have you seen that play out?
James Palmer: 16:41 So in the United States and Australia, in Europe, we've seen individual racist incidents. And often a callousness towards Chinese life expressed by popular media. So, you know, we've seen coronavirus themed parties, we've seen Dutch radio shows joking about the coronavirus. We've seen people being shouted at in the street for being Asian. But the most potentially dangerous forms of racism, I think at this point, toward Chinese communities in countries like Indonesia or the Philippines or Malaysia where there are, to varying degrees, existing tensions and hostility between the majority population and the Chinese population. And where, for instance in Indonesia, where of course tens of thousands of ethnic Chinese have been killed in the past in purges and pogroms and so on, this could very easily turn into more violence, directed violence. We're seeing conspiracy theories spread throughout Indonesian media. We're seeing in the Philippines both anti-Chinese and anti-American conspiracy theories all over the place. And those countries seem like the ones with the most sort of tinderbox potential at the moment. Especially with authorities that have mixed feeling about China themselves.
Jen Psaki: 18:13 So the Chinese response to the coronavirus, I mean skeptics will say they were late to respond, that they covered up information, which we know and has been reported by people like yourself. You've been skeptical about their reactions. Some have also said that it's been efficient. What's been your view as you've covered this very closely?
James Palmer: 18:35 So no country is going to react to handling an unexpected potential pandemic well. There are always going to be errors. You're handling hundreds of millions of people in China's case. The biggest problem I think was that the reaction went from zero to 60 in a few days. So on January 17th, we were still being told that there were 41 cases, that everything was under control. By January 20th, they were talking about 200 cases. By I think January 22nd or 23rd, a city of 11 million people was shut down and panic was spreading throughout the country. And that's very typical of an authoritarian system like China's, because for ordinary officials, you're going through this period of decision making where if you act too fast, you could be accused of jumping the gun and causing panic. But then there comes a point where if you're not acting, then your enemies could accuse you of failure, of being behind the times.
James Palmer: 19:39 So this line, you walk over it suddenly, and everything has to go into overdrive, and that's a pattern that we see throughout Chinese systematic behavior in government and so on. Do nothing, do nothing, do nothing. 120%. And that's caused huge problems. For instance, when the quarantine was announced, it was announced with, I think a 12 hour grace period, so that allowed hundreds of thousands of people to leave the city before it happened. It wasn't implemented gradually. There wasn't signaling that people should stay at home and then restrictions [inaudible] which would have allowed some kind of adjustment. It was just there. On top of that it's left Wuhan badly under-prepared in terms of diagnostic kits, medical materials and so on. Some of which is inevitable, some of which could have been alleviated if they had started taking the precautions there earlier and built up to the response now.
James Palmer: 20:45 But it's very hard to gauge these things because, if you're successful, than any reaction is going to look like an overreaction. Ideally you want it to look like an overreaction. If it looks like you've overreacted, then it means you've contained the disease. The number of cases has been low, the measures have succeeded. Right now it doesn't look as though that's the case right now. It looks as though the case numbers are ticking up. The number of cases that are confirmed is probably a fraction of the cases overall based on the best statistical modeling. And this is a problem that's going to haunt the country for months.
Jen Psaki: 21:23 You're also a very close tracker of Chinese social media. What's been happening online? I mean, how have individual Chinese citizens - to the degree that's a good tracker, and you can tell us - been reacting?
James Palmer: 21:37 Well, it's a mix, and it's always hard to tell because Chinese social media nowadays is so controlled and dissident speech is shut down so fast. We've seen a lot of fear, seen a lot of sadness from Wuhan itself. People trapped in their homes, people unable to get help. People whose parents are dying and who can't get to the hospitals. With reports of the system being completely overwhelmed. Citizen journalists who've been disappeared, who went to try and investigate. We had some excellent early journalism from Caixin and other Chinese papers, which has now been somewhat stomped on by the authorities. And then of course a lot of patriotism, a lot of rallying around the flag, we can overcome this. Not a lot of people picking up on one line the government tried, which was blaming America, not for the virus, but saying that America's response had helped cause panic, that didn't seem to get any traction.
James Palmer: 22:38 And then in the last few days a really amazing outpouring of grief and anger over Li Wenliang. After he was warned by the police, Li went back to work and on around the 30th of January, he posted the warning that he'd been given by the police online. He became hailed for having spoken out. People were angry about that, but then they became even angrier, when it was confirmed that he had the coronavirus himself had been on the front lines treating patients. And, unusually because he was only 34, though this isn't uncommon among frontline healthcare workers, he died on February 7th. Not only did he die, but the authorities farcically seemed to have attempted to cover up his death. So he died in the small hours of the Chinese morning, it was widely reported, but then there were claims that he'd been resuscitated and was still alive. And it looks as though they simply didn't have a narrative to respond to the wave anger that emerged on social media. And so they almost may have attempted to literally strap him back into the life support machines after he was either dead or brain dead.
Jen Psaki: 23:55 To take photos and push them out and presumably -
James Palmer: 23:58 Try and at least buy themselves time. But that failed. In fact, that just threw fuel on the fire. And so they declared him dead. I think 16 hours, 20 hours after he probably actually died. And the wave of anger has been almost unprecedented. We've seen people posting that they demand freedom of speech. We've seen people posting the police warning to him alongside his picture. It helps very much that Li was a very ordinary kind of man. He wasn't a dissident, who most Chinese distrust. He wasn't an unusual figure, one with connections to the West. He was just a nice 34 year old doctor who had a kid and wanted the best for his family and liked posting pictures of sausages and bacon and all this kind of thing. It was a very human story. And so I think his image kind of really captured people's feelings of being hard done by. That somebody who was completely blameless, even heroic themselves, had been in some ways destroyed by the system.
Jen Psaki: 25:16 It's obviously, I mean, we've talked a little bit about the long-term health consequences of the virus, although it's hard for us to really predict that, but there's also been some serious blow back internationally and some things that are out the control of the Chinese. I was reading this story about the impact on the Olympic team, for example. But even beyond that, financial implications. As somebody who's covered and followed and lived in Beijing for many, many years, how do you see the financial impact of the coronavirus on China?
James Palmer: 25:54 Well, China was already heading towards economic slowdown. Things were tight because of the trade war, and just also because it's burned through that sort of three decades that you get of relatively easy growth as you enter into modernity. The low hanging fruit has all been picked. But now I think this is going to hit really hard. I think we're going to see a lot of problems with debt, because local debts were already piling up, and they were contingent upon continued high growth. We're going to see growth for this quarter slashed. Even on the official figures, I would imagine the official figure, which is probably false in the first place, is 6%, it'll probably go down to 4% or so. Unofficially, I think we could be talking about what was really 3 or 4% growth going to zero or close to zero.
James Palmer: 26:53 We've seen supply chains being cut, so that South Korean car plants for instance had to shut down because of not being able to get parts from China. And so if the shutdowns continue and not just for the virus itself, but all the quarantine measures that have had to be put in place that are preventing people from returning to work, preventing people even from returning to their home cities because hundreds of millions of people had traveled for Lunar New Year, then we could be looking at people, as they did with the trade war, looking at alternate sourcing and permanently reconfiguring those supply chains. And then we don't know what the cost in terms of lost productivity, lost healthcare, all these things could be enormous costs in the medium term.
Jen Psaki: 27:47 Beyond the international reaction and obviously the financial piece, is there likely to be blow back domestically within China for the reaction or the perception of the management by the Chinese government?
James Palmer: 28:00 So people always obsessed with the idea of the Chinese government losing legitimacy, that people will suddenly suddenly be like, well, I don't like the communist party anymore. It's time to take to the streets. But the truth is 90% of the Chinese public could wake up hating the communist party tomorrow and they would have no way to signal to the rest of that 90% that they felt that way, and no ability to act on it. Legitimacy matters far less than power and there's no sign of the Chinese communist party surrendering any of that power and there don't seem to be any plausible ways for it to be forced to give up that power in the immediate future. I mean, we're not going to see street protests because everybody is off the streets.
Jen Psaki: 28:43 What about in Hong Kong or anywhere like that?
James Palmer: 28:45 Well in Hong Kong it's added yet another yet another sort of log to the flames. I mean Hong Kong is angry about everything at the moment and Hong Kong is perhaps even overreacting a little bit to the virus, in terms of runs on stores and so on, because they've so completely lost trust in their own government and their own authorities. But on the mainland itself, I do think that there's one thing that will happen and that's that this may be something that really helps produce a generation that believes the system has to change, but that generation won't emerge anytime soon. It might emerge in 10 or 15 or 20 years, but people who have been through this kind of embittering experience may come away really convinced of the need for reform, need for change, and as they move into positions of power within the system, begin to enact that themselves. I think that something like this, which has disillusioned so many people, is a much more convincing sort of argument for reform or does a much better job at turning people into reformers, then any amount of exposure to U.S. films or Harvard educations does, which were the things that people were always looking to as like, oh, well, this will make young Chinese reformers.
Jen Psaki: 30:01 Before I let you go, I just want to ask you, what will you be watching? I mean, you've been covering this nonstop and all of the implications and the impact. What, over the next few weeks, will you be watching? And people can read about on Foreign Policy of course.
James Palmer: 30:16 So I'll be looking in particular for whether we get epidemic outbreaks in other Chinese cities where the numbers have already reached several hundred. Now the question is, will the lockdown measures that have been put in place prevent that from significantly growing or will that sort of few hundred people and other cities become tens of thousands as it did in Wuhan? And I'm going to be watching the death rate very carefully because in most people, we haven't seen the course of the disease play out. So that'll give us some sense of how fatal this is and how much damage is being done to ordinary people in China. And then I'm going to be, I think, thinking carefully about how the Chinese government tries to handle the public's knowledge of the initial cover-up or the initial suppression of information.
James Palmer: 31:12 Right now, they're making a very strong attempt to put all the blame on Wuhan itself and the local authorities, the local officials. This was a fault of some as yet unnamed people, not the fault of the central government. But if it looks as though that narrative isn't holding, then we might see instead repression and censorship dialed up in order to try and control and squash that narrative. And one of the things to watch for there will be is if the internet gets turned off at points or if major platforms get shut down, that'll be a sign that they're more worried about not having lost control of the story.
Jen Psaki: 31:52 James Palmer, it's always a pleasure having you on The World Unpacked. Thank you so much for sharing your thoughts and views and perspective.
James Palmer: 32:00 Thank you.
Jen Psaki: 32:03 Thanks for listening to The World Unpacked, which is produced by the Carnegie Endowment for International Peace. You can find us on iTunes or wherever you get your podcasts. For more information and to subscribe, you can find us at worldunpacked.com. Don't forget to rate the show. It helps other people find us. Our audio engineer is Tim Martin and our executive producer is Lauren Dueck.