Coronavirus: is aggressive containment the most appropriate policy response?

  • Draconian measures taken to stem the outbreak’s spread may work in the short-term, but their wider impacts must be carefully assessed

  • In dealing with risks, included health-related ones, the appropriate policy responses are those that are proportionate

The daily number of new cases of confirmed Covid-19 infection in China has dropped sharply in the last few weeks – from more than 15,000 on February 12 to just 99 on Friday. Many Chinese provinces and cities have for days, even weeks, reported no daily increase in confirmed infections.

There is now clear evidence that the draconian containment measures employed by the Chinese government have worked to curtail the spread of the virus in the world’s most populous country. China’s efforts have been lauded by international agencies such as the World Health Organisation, which described them as “the most ambitious, agile and aggressive disease containment effort in history”, as well as by governments and political leaders elsewhere.

While there is little doubt that China’s efforts to control the viral outbreak and save lives have been largely effective, their wider impacts must be carefully examined given the complexity of the problems inside and outside the public health arena. Indeed, such an assessment is needed not only to inform the way forward for China as the situation stabilises, but also for understanding policy responses to control the spread of the virus in places where the number of confirmed infections has increased, exponentially in some cases, in recent days.

Hidden costs

To appreciate the hidden costs of China’s containment efforts, consider how in hard hit areas of China – especially Hubei province and it capital, Wuhan – the lives of haemodialysis patients are put at risk not by coronavirus infection, but because the services they need are no longer available in hospitals where treating patients with coronavirus infection has become the only priority.

Leukaemia patients in critical condition must forego or delay treatment because of concerns at hospitals that such patients may become either sources or victims of infection. More importantly, they are deprived of the option to seek treatment elsewhere because of the complete lockdown imposed by local governments. More lives may be lost in the name of saving lives by containing the spread of the virus.

The “aggressiveness” of the disease containment effort in China is indeed unprecedented, and it is a tough act to follow for the rest of the world. Aside from cities where lockdowns are imposed, many others have imposed measures to force people to stay at home even if they are cleared of the need for self-quarantine. Many communities operate their own entry permit systems in which limited permits are given to each household for daily necessities.

Mask-wearing is compulsory even in places with no confirmed cases of infection, and people not wearing masks are harassed and discriminated against. The dire need for surgical masks in hard hit areas, especially among medical workers on the front line, suggests that such aggressiveness everywhere may run the risk of devastating stocks of medical supplies in hotspots with far more critical need.

Assessing policy appropriateness

So how should governments go about determining the appropriateness of policy measures?

First, while much attention has been focused on the direct impacts of the coronavirus outbreak, the policy question that is just as relevant for the governments in China and other countries is the overall impacts – both intended and unintended – of policy responses to contain the outbreak. The impacts of a particular policy response or containment strategy also often vary across time; what was once appropriate may no longer be when the context changes.

For example, many governments may have been right to introduce travel bans on people travelling to and from China in January and February as the cases there skyrocketed. But as the situation in China stabilises and the Chinese government looks to reduce the risk of the disease coming back from elsewhere, those same governments may soon find themselves seeking to persuade China not to impose travel bans on them.

Second, the economic costs of this “most aggressive containment effort” are likely to be astronomical. There is serious concern that the Chinese economy may shrink for the first time since 1976. In fact, impacts much smaller than this can already have an enormous effect – one per cent of GDP in China is about US$270 billion, adjusted for purchasing power parity. How many lives could be saved with that money if it had been put into combating global warming, poverty alleviation, treating other illnesses, or even finding cures for infectious diseases?

Third, the appropriateness of the chosen policy response is a key consideration in assessing China’s containment efforts. While the crisis has brought to the fore the urgent need to contain the spread of the virus, the welfare of all citizens – including their physiological and psychological well-being, privacy and security – should remain at the heart of any policy responses. Otherwise, responses that are effective in one dimension – in containing the spread of the virus, say – may lead to disastrous consequences in other areas, sooner or later.

Fourth, policymakers should be mindful of the long-term impacts of their strategies. For example, the containment effort has worked well in China in part because fear was widely inculcated among the general public; fear was helpful in ensuring compliance with the extreme measures taken to contain the disease. But as China looks to boost its stalling economy, that fear can be a significant obstacle as people worry about whether it is really safe to resume life and business as usual.

Fifth, science must play a key role in the design of appropriate policy responses and in the communication of risks to the public. We live in a world where we are confronted with numerous risks, including many health-related ones. Seasonal flu claims hundreds of thousands of lives annually. Dengue fever and malaria are among the leading causes of death in many tropical countries. Clearly, the appropriate policy responses are those that are proportionate to the level of risks and their consequences at any point in time. Communicating such scientific knowledge to the public also takes on much greater importance in a social media age where fake news often travels faster and wider than scientific facts.

Sixth, and related to the above, public trust is usually essential for the appropriate policy responses to be chosen. If societies are distrustful of their governments, then the authorities may be forced to adopt more draconian or extreme measures than necessary, and for longer periods, to deal with the public’s criticism that the government is taking chances with their lives or safety.

Finally, once the expectation is created that the government shall spare no effort to contain the disease, policymakers and institutions may find that they have no room to relax the extreme measures that have been imposed. Policymakers often fear being punished if they take the risk to do something – in this case, scale back some of the containment measures – which later turns out to be wrong, secure in the knowledge that they are seldom punished for not taking any risk. This omission bias often results in inappropriate policy measures staying in place longer than necessary.

Xun Wu is a professor and head of the Division of Public Policy at the Hong Kong University of Science and Technology, where Donald Low is senior lecturer and professor of practice in public policy and director of its Leadership and Public Policy Executive Education.

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