An essay analysis of tragedy, corruption, loss, caution and hope in a year marred by pandemic.
This piece discusses the background of COVID - what steps led to its global spread? Various mitigation strategies - which nations experienced relative success and failure in controlling the virus? What can be learned to prevent this international catastrophe from occurring again - steps taken via scientific diplomacy.
Prevention takes Accountability
2020 is a notably tragic year. Countless lives and a decade of economic growth across all nations was upended by the Coronavirus COVID-19 pandemic. As of November 2, 2020, over 1.2 million people were recorded dead and nearly 50 million infected. Economic growth has been in free fall, political relationships in disarray, hardly anybody feels secure about the future. What led to such global catastrophe? The simple answer is human contingency through a breakdown of domestic and international government communication. However, the true reasons are far more complex. At the onset of COVID in Wuhan, China, local leaders hid critical information from Chinese health authorities in a desire for political capital. During the early months of COVID’s spread, a region’s ability to mitigate the outbreak was dependent upon political leadership, cultural norms and attitudes toward basic scientific guidelines. Some nations were relatively better at viral control than others. Unfortunately, when broadly examining the international community’s response to COVID, nations must learn to more efficiently communicate, support and cooperate. Future pandemics are inevitable. There is now a responsibility upon the current generation to establish an improved response protocol.
The most ineffective response to COVID was from the United States. The country’s failure revealed an important reality – spending more money and hoping the disease disappears while disregarding health experts is not a viable solution. This truth will become more apparent as the effects of human induced climate change, which is evidenced to increase infectious disease vulnerability, materialize. Through collective international response via scientific diplomacy, prevention rather than restorative cure must be the solution against zoonoses and other infectious diseases.
While urbanization stimulates economic growth and generally leads to a reduction in poverty, cities also act as transmission hubs for infectious disease. The United Nations estimates the urban population in 2050 will stand at 6.3 billion people, twice the 2007 figure of 3.3 billion. This population increase will occur mostly in developing countries. International travel and migration into cities from rural areas will further exacerbate disease vulnerability. According to Emilie Alirol,
Several rural pathogens have adapted to urban environments and others have emerged or re-emerged in urban areas. The heterogeneity in health or urban dwellers, increased rates of contact, and mobility of people, results in a high risk of disease transmission in large urban populations. Cities become incubators where all the conditions are met for outbreaks to occur” (131).
Many rural migrants lack necessary disease immunity, thus making them more susceptible to infections in urban areas. In addition, the poorer and typically denser populated areas of cities often experience outbreaks first. This effect exacerbates the relationship between vulnerability risk and economic status. The World Health Organization currently estimates 137 million people in urban areas lack safe drinking water and 600 million do not have adequate sanitation. This statistic is particularly troublesome in cities located within sub-Saharan Africa. Therefore, socioeconomic status, place of residence, race and ethnicity are all factors which determine an individual’s vulnerability to infectious disease.
No place on Earth experiences more vulnerability to these risk factors than China. A nation of 1.2 billion people, China saw a mass exodus from rural areas to urban cities in the last 20 years, thus creating dozens of breeding environments for disease. Tong Wu argues, “in many Chinese cities, public health management has not kept pace with demographic and economic changes” (21). The Chinese health care system faces a number of weaknesses. These include an under-coverage of rural areas, lack of professional health training specifically in poorer regions and a low per capita level of health funding. In the Pearl River Delta, 80% of migrants do not have access to medical insurance. Furthermore, the cultural practice of wet markets - places where live or freshly killed animals are bought and sold - is quite common in China. This increases vulnerability to zoonotic diseases - those caused by the transfer of germs spread from animals to people. As Chinese cities grew, mitigating disease spread was in both China and the entire global communities’ interest. Therefore, maintaining urban health through sensible city expansion planning must also be of global concern. As Alirol states, “The improvement of local capacities to identify, control, and prevent communicable diseases that have the potential to spread widely is of international interest. Surveillance is of primary importance” (137).1 The breakdown of accountable governmental disease surveillance in Wuhan led to COVID’s outbreak and occurred due to inexcusable governmental practices.
Ineptitude and political corruption thwarted effective communication between China’s local and national governments. A study conducted by Chinese, American and British scientists cited by the Wall Street Journal found if control measures were taken 3 weeks prior to the virus leaving Wuhan, total cases would have been reduced by 95% in China. George Gao, the head of China’s CDC, was unaware of the virus’ existence until after COVID spread rampantly through Wuhan. How could the top Chinese health expert be so blindly unaware of a potential threat? In a WSJ analysis reporter Jeremy Page lists three striking reasons. China’s national CDC missed early signals because hospitals did not enter details into real time tech systems, local Wuhan authorities were intent on hiding bad news from China’s leaders in an effort to elevate Wuhan politically and lastly, officials were forbidden to publish any virus research or news of a potential outbreak. Two heroes in the early response to the virus – Dr. Ai and Dr. Li – attempted to alert national authorities about the danger of the detected virus. According to the article, Dr. Ai, “confirmed in an interview that she had alerted her hospital’s management about four cases on Dec. 28th, and they had then informed the Jianghan District disease-control office. She added a detail not mentioned by the Chinese government: She also sent a sample for laboratory testing, and the results, which arrived on Dec. 30th, identified as a SARS-like coronavirus.” When Dr. Li received these messages, he alerted over a hundred medical school classmates, cautioning them not to leak this information further. The leak occurred regardless. As these events were developing, Wuhan spent billions of dollars hosting the Military World Games and invited President Xi to speak at the opening ceremony. Upon Xi’s arrival, local leaders were campaigning for Wuhan to join megacity status, so the city’s party chief could have a seat on the Politburo comprising China’s top 25 leaders. When Dr. Li’s information was leaked, local leaders quickly deleted the findings and reprimanded Dr. Li and Ai. Soon after, Dr. Li would die from COVID, sparking domestic and international fury.
Although China initially failed at controlling the virus’ spread, once the disease escaped Wuhan, the nation achieved remarkable mitigation success. The necessary steps China enacted, however, required authoritarian measures to impose strict nationwide lockdowns. As of November 3rd, 2020, China had recorded just over 86,000 cases - this is remarkable compared to the U.S.’s logged 9.38 million. In an academic report, Talha Burki explains the drastic measures China was able to quickly implement. These same measures would not as effectively be executed in democratic states,
Wuhan was placed under a strict lockdown that lasted 76 days. Public transport was suspended. Soon afterwards, similar measures were implemented in every city in Hubei province. Across the country, 14,000 health checkpoints were established at public transport hubs. School re-openings after the winter vacation were delayed and population movements were severely curtailed. Dozens of cities implemented family outdoor restrictions, which typically meant that only one member of each household was permitted to leave the home every couple of days to collect necessary supplies. Within weeks, China had managed to test 9 million people for SARS-CoV-2 in Wuhan. It set up an effective national system of contact tracing.
China, as the leading global manufacturer of personal protective equipment, largely increased distribution to citizens and ensured compliance, and constructed COVID designated hospitals within in ten days.
These measures were viewed as extreme by many Western democratic nations. Most notably U.S. President Donald Trump, who coined COVID as the “China Virus”, incited confusion, distrust and misinformation regarding the disease’s effects. Burki cited a survey conducted by the Pew Research Center which found, “two-thirds of Americans believe that China had done a bad job dealing with the COVID-19 pandemic. It is clearly not an opinion shared by the W.H.O.”4 This survey, conducted in July, demonstrates the anger Americans have towards China for letting the virus escape. President Trump exploited this anger and guided Americans to believe China had not controlled the virus well. While autocratic measures were taken by the Chinese government, this belief is clearly false.
In contrast to China, the United States’ response in pandemic mitigation was so atrocious that critical analysis is difficult. The first diagnosed patient with COVID in the United States occurred on January 20th, 2020 in Washington State. Shortly thereafter, on February 14th, President Trump claimed, while giving a speech to the National Border Patrol Council Members that COVID would, “weaken when we get into April, in the warmer weather – that has a very negative effect on that, and that type of virus.” The lie did not materialize, and Trump’s careless attitude toward the disease was, and still is, too pathetic to seriously discuss in an academic essay. In short, the President decided not to have a centralized control strategy, opting instead to let individual states handle the disease themselves while praising whatever steps Republican governors took, and criticizing Democratic governors’ actions, regardless of mitigation outcome. Those who do not support President Trump typically follow the leadership and protocols stated by Dr. Fauci, director of the U.S. National Institute of Health. Effective leadership is crucial in combating a pandemic, and hopefully the American democratic process will correct itself on November 3rd – after stressful days of counting, democracy did correct itself.
Once the coronavirus hit its first big U.S. spread during March, the American economy and stock market collapsed, unemployment soared and stimulus packages, while helpful to struggling Americans, did not slow the disease. In response to the first wave, the Federal Reserve Bank, Congress and President Trump released approximately 3 trillion dollars in stimulus to support the ailing economy. While these funds certainly helped recently unemployed families due to the virus, the disease never should have initially spread to make such measures necessary. This is perhaps the strongest reason why prevention, rather than restorative cure, is better for virus control – fewer people die, and countries save trillions of dollars’ worth of economic wealth. In this sense, the package was a colossal waste of money, and will certainly incur crippling debt effects on economic performance in the future. Even worse, the package did nothing to mitigate or slow the viruses spread – the U.S. experienced a record number of cases this week - over a hundred thousand were logged on multiple days. While the intent of this stimulus was not to fight the disease, funds should have been more efficiently directed to the health care sector for disease control. Examples of wasted stimulus money abound, especially amongst those in higher income brackets. Many high-income households, who did not depend on stimulus checks for maintaining their livelihood, still received funds. In a report released on July 23rd, Angela Rachidi explained how those of higher socioeconomic status spent these checks,
Even among households that reportedly used the economic impact payment mostly for expenses, it was still more common for higher-income households to say they used a portion of their payments to pay down debt or bolster savings or investments than their lower-income counterparts. Higher-income households likely have less need for government payments to cover basic expenses, which explains why they would be more likely to spend this money building savings or reducing debt. This finding is consistent with prior research on similar economic stimulus payments made in 2008, as well as tax rebates made in 2001, which shows that higher-income households were more likely to allocate the payments they received toward savings or debt.
Not only could the American government improve its distribution of stimulus money, the United States was already spending relatively way more than other nations on its Center for Disease Control. In his WSJ article, Page cites the U.S. having a C.D.C. budget of 6.6 billion dollars with nearly 12,000 employees.3 In contrast, China’s CDC has a budget of a mere 41 million dollars with only 2,120 personnel. This statistic reveals spending money during a pandemic, and hoping the disease disappears is not a practicable solution. This is especially true when much of the original stimulus package is sent to those who do not require extra money for survival. What then does successful disease mitigation in a democratic nation require?
Through a blend of technology, testing, centralized control, effective communication, cultural practices and a constant fear of failure, South Korea managed to halt mass virus transmission better than almost any other country. From early April to September 25th, South Korea averaged only 77 daily cases. After missteps taken in a 2015 outbreak of Middle East Respiratory syndrome by way of poor communication, testing backlogs and an unclear national strategy, South Korea learned valuable lessons for its response to COVID. In 2016, South Korea began training virus outbreak simulations twice a year. As soon as cases appeared in South Korea, the government seized control of face mask production, giving first access to those who most required protection. In February, drive-through testing was implemented throughout the entire country, and testing capacity multiplied over a hundredfold. Throughout the response, South Korean President Moon Jae-In maintained a low profile, letting health experts hold briefings in order to gain the public’s trust in governmental response. According to a report by the Wall Street Journal, health officials were able to acquire access to individuals’ private mobile data. This would never happen in the United States under the current administration. Using this data, texts were sent to individuals’ phones notifying them about infections found near their tracked GPS location. Every confirmed patient is required to isolate either at hospitals or dormitories, and treatment is free. Culturally, nearly everybody wears masks as they are encouraged within South Korean society. South Korea never had to shut down its economy or impose major lockdown orders.
After Korea’s initial success, reporter Dasl Yoon quoted the deputy director of Disease Control and Prevention Agency, Kwon Jun-wook, “In the past, we had treated the regulations from the World Health Organization and the U.S. as the Bible. But I had to apologize to our citizens because it was time for us to create our own regulation based on our own evidence.”7 The South Korean regulatory shift demonstrates irresponsible political leadership within the United States will create long lasting negative affects regarding the international standing and perceived intellectual status of American health institutions. When a U.S. president jokingly suggests drinking bleach will cure infected patients, America will rightfully lose respect from the global community. The ability for South Korea to acknowledge and adjust their health standards in response, reveals a possible future trend – countries will continue to lose confidence in American guidelines, and therefore, create their own. This shift will exacerbate if considerable numbers of American politicians continue to denounce climate change and evidenced scientific discourse as hoax.
Climate change has long helped evolve a wide variety of pathogens, and a growing body of research suggests human induced global warming is further accelerating this bacterial evolution. The relationship between human induced global warming and increasing viral development may be disastrous for future global pandemics. In his essay on climate change and infectious diseases, Seyed Hasnain cites Julia Walochnik, a medical researcher at the University of Vienna, who, “presented a general view on climate change as a driving force for evolution. Starting from the early carbon cycle to the RNA world and the virus world, evolution progressed to establish prokaryotes followed by the eukaryotic world which subsequently diversified. This evolution coincided with the shrinking of rainforests and glaciation of the Northern hemisphere resulting directly from direct or indirect effects of climate change.” Fast changing weather patterns create breeding grounds for viruses and has the potential to create a plethora of new arboviral diseases. This disease type refers to arthropod borne viruses, many of them zoonotic like COVID.
Arboviral diseases account for over a hundred human diseases. Lyle R. Peterson of the C.D.C. cites epidemiological studies which attribute a vast range of contributing factors to emerging global viruses across the world. These include the development of new disease strains, population growth, container societies, inefficient control measures, globalization, travel, ineffective vaccination and human encroachment in enzootic areas. While all of these factors may potentially contribute to climate change’s effects, Peterson is not totally convinced of a direct relationship between human induced global warming and new emerging diseases. He states, “It was clear that climate change is altering the distribution and incidence of arboviral disease. However, the impact of climate change depends on many interacting anthropogenic and natural factors, the evolution of which will require long term ecological and epidemiological research, including surveillance of vectors, hosts and pathogens.” In response however, Elisabeth Carniel of the W.H.O. collab center studied the effects of global warming on the bacteria Yersinia Pestis which may cause plague. She concluded, “drought and increased precipitations, as a consequence of global warming, altered the pattern of plague epizootics and prevalence of flea vector.” While more research on this topic is required, climate change certainly alters infectious disease. The question is to what extent human induced climate change will impact this evolutionary process, the risk extent of new viruses towards the ecosystem and how the international community can most effectively mitigate the spread of infectious diseases amongst the global population.
While some countries experienced success in controlling the virus’ spread, the overall global community must be more effective in mitigating future pandemics. This can only happen through cooperative reform based on the premise of scientific diplomacy. In 2004, China experienced an outbreak of the SARS virus. Although SARS did not cause a global pandemic on the same scale as COVID, Chinese health response was shoddy. Through scientific diplomacy, which is the use of scientific collaboration among nations to address common problems and build constructive international partnerships, the U.S. CDC posted diplomatic scientists in Beijing to train hundreds of Chinese CDC staff. The stated goal was to prepare China, a global disease hotspot, for new emerging pathogens. By 2013, the average reporting time for disease surveillance was reduced to four hours from five days. This system was in place during the onset of COVID, but as Adam Chen, a health-policy professor at the University of Georgia, stated in the WSJ, “a world class reporting system is fantastic only if it’s put in use properly.”3 The effects of political corruption are detrimental to effective communication, and are totally inexcusable in any circumstance, especially in regard to potential infectious disease outbreaks.
How then can the international community build more geopolitical trust through scientific collaboration? The answer certainly was not President Trump’s isolationist policies. Beginning in 2017, the Chinese CDC began experiencing financial and personnel problems. A lack of funding diminished the CDC’s ability to attract top health staff due to reduced wage rates. Doctors and disease experts took their knowledge to the private sector where they received higher salary pay. This trend was exacerbated by U.S. withdrawal of funding and staff training in 2018, enacted during President Trump’s trade war with China. Curtailing information, training, funds, research methods and staff is not effective scientific diplomacy. Collective response must be built throughout the entire world to mitigate international disease risk. While relations between China and the U.S. are crucial, the rest of the world must not be forgotten. Many other countries are disease hotspots vulnerable to infectious outbreaks, most notably India, Indonesia, Latin America and West African Nations. In truth, an outbreak can occur from anywhere. Because of this, the global community must learn from mistakes made during the COVID pandemic by establishing new institutions implemented on the basis of scientific diplomacy to establish collective international cooperation.
Collective response for fighting infectious diseases must be built throughout the international community if we are to avoid another global pandemic. Global cooperation must be achieved through scientific diplomacy as the next global pandemic may be deadlier than COVID. This pandemic will most likely come from the effects of human induced global warming, as changing climates foster evolution of new infectious diseases. Currently in China, climate induced changes of the El-Nino Southern Oscillation are expected to increase human vulnerability to a vast spectrum of infectious diseases, most notably malaria, dengue and Japanese encephalitis. In addition, natural disasters will continue to displace mass groups of relatively low socioeconomic status people, typically in developing countries already more prone to disease vulnerability. In order for disease mitigation, preventative measures based upon scientific evidence rather than restorative cures must be implemented. If society is able to prevent future pandemics by controlling viral outbreaks at the source, the global economy will not only save trillions of dollars and continue economic development, countless lives will be spared.
 Alirol, Emilie. "Urbanization and Infectious Diseases in a Globalized World." The Lancet, doi:10.1016/S1473-3099(10)70223-1. Accessed 29 Oct. 2020.  Wu, Tong. "Economic Growth, Urbanization, Globalization, and the Risks of Emerging Infectious Diseases in China: A Review." The Royal Swedish Academy of Sciences Accessed 29 Oct. 2020.  Page, Jeremy. "China's CDC, Built to Stop Pandemics like Covid, Stumbled When It Mattered Most." The Wall Street Journal.  Burki, Talha. "China's Successful Control of COVID-19." The Lancet, 8 Oct. 2020 Accessed 3 Nov. 2020.  Rieder, Rem. "Trump's Statements about the Coronavirus." FactCheck.org, 18 Mar. 2020, www.factcheck.org/2020/03/trumps-statements-about-the-coronavirus/.  Rachidi, Angela. "Making the Stimulus Checks Count: How Congress Can Better Target a Second Round of Economic Impact Payments." American Enterprise Institute Accessed 3 Nov. 2020.  Yoon, Dasl. "How South Korea Successfully Managed Coronavirus." The Wall Street Journal Accessed 29 Oct. 2020.  Hasnain, Seyed. "Climate Change and Infectious Diseases - Impact of Global Warming and Climate Change on Infectious Diseases: Myth or Reality?" International Journal of Medical Microbiology Accessed 30 Oct. 2020.