Politico has an article that outlines 15 different times that President Trump praised China for its handling of the coronavirus epidemic, between January 22 and February 29. More recently, Trump has become harshly critical of China:
President Donald Trump yanked U.S. funding for the World Health Organization on Tuesday, complaining that the United Nations public health agency was overly deferential to China and had put too much faith in Beijing’s assertions that it had the coronavirus outbreak there was under control.
“Had the WHO done its job to get medical experts into China to objectively assess the situation on the ground and to call out China’s lack of transparency, the outbreak could have been contained at its source with very little death,” the president said Tuesday. “Instead, the W.H.O. willingly took China’s assurances to face value.”
Trump, however, echoed many of those same assurances regarding China and its response to the virus throughout January and February, as the unique coronavirus began to infiltrate countries around the world. Just days before the U.S. recorded its first death from Covid-19, Trump touted China’s government for its transparency and hard work to defeat the coronavirus that causes the illness.
China has responded with overheated rhetoric against any country that criticizes its behavior. What caused this war of words?
One possibility is that new information has appeared, showing that China mishandled the situation. China did mishandle the situation, as did the US and Western Europe, but no important new information has been revealed since January. We’ve known for months that China suggested there was no proof of human-to-human transmission for several weeks after that fact became overwhelmingly likely. And we’ve known for months that the Wuhan government censored local doctors who tried to raise the alarm. So that doesn’t explain the recently changed attitude toward China.
Instead, it seems likely that the US (and to a lesser extent other Western nations) are increasingly frustrated by their inability to handle the epidemic, at a time when East Asian nations have had far more success. Even a few weeks ago, there were widespread predictions that the epidemic would follow a sort of bell-shaped path in the US, with caseloads rising sharply and then falling sharply. That did happen in many nations, but not the US.
A few weeks ago, the death toll in the US was expected to eventually reach about 60,000. Instead, we have already passed 67,000 and in many states the death rate is still increasing. And yet some states are planning to reopen the economy, without first reducing the “R0” reproduction factor below one. The decision to re-open may well be justified, especially given that most states did not experience the overwhelmed hospital systems that many had feared. Nonetheless, it must be frustrating for policymakers to see the problem refuse to go away, despite shutdowns that are extremely costly to the economy.
It’s human nature to want to find scapegoats, and China makes an almost perfect target. The epidemic started in China. It was initially mishandled by China. The China government is arrogant and bullying. China is big. And worst of all, China’s been very successful in reducing the epidemic, while the US has failed.
Given all of the above, it would take an almost superhuman effort to avoid being tempted to scapegoat. And whatever you think of President Trump, it’s clear that he does not have a superhuman ability to refrain from blaming others when things go wrong.
To get a sense of how badly things are going in the US, consider Utah. Among states of more than 2 million people, Utah has been by far the most successful, with only 16 fatalities per million people. Utah also has a civic culture that viewed as unusually cooperative. But even Utah seems unable to reduce the rate of new infections:
Contrast Utah with New Zealand (or Australia), which has reduced new infections to a very low level:
What’s the difference? Auckland has an average daily high of 68 degrees in April, whereas Salt Lake City has an average high of 64. That doesn’t seem decisive. New Zealand is better able to control inflows from outside, but even within the US there was relatively little travel in April.
I’m puzzled. What do you think?
READER COMMENTS
Alan Goldhammer
May 3 2020 at 2:10pm
Scott – there is so much confounding information on this virus which makes it difficult to draw any conclusions. Take Israel for example. According to the Johns Hopkins site they have had 16,193 infections and 230 deaths for a mortality rate of 1.4%, well below what some other countries have seen. My sister lives over there and they have had a very strong lock down with major roads being closed. The country gets a lot of visitors during Easter and Passover but not this year. We also don’t know whether the infections/death occurred among the ultra-Orthodox who are resisting social distancing.
I don’t know how much testing New Zealand did or whether they rapidly identified cases and isolated them. It is just too curious.
Loquitur Veritatem
May 3 2020 at 2:12pm
China has been “very successful” in dealing with the virus? Has that been corroborated independently? The statistics about COVID-19 are unreliable and should all be taken with a huge load of salt. Consider, for example, that the CDC has just published its estimate of 37,308 COVID-19 deaths through April 25 (https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm), while the compilation of state-level statistics (https://en.wikipedia.org/wiki/Template:2019%E2%80%9320_coronavirus_pandemic_data/United_States_medical_cases) shows a total of 47,916 deaths as of that date.
Scott Sumner
May 3 2020 at 4:42pm
I agree the data is somewhat inaccurate, but that doesn’t change my argument here. I’m talking about perceptions, and there is an almost universal perception in discussions of this problem that China, and East Asia more broadly, have very little community transmission in recent days. That perception may be fueling resentment.
Dylan
May 3 2020 at 2:24pm
Scott,
This is off topic, but given you’ve had some questions around the clinical trial process in past posts, I thought you might find this post by my favorite pharma blogger to be of interest. It’s a long post, so posting the takeaway below.
Scott Sumner
May 3 2020 at 4:45pm
Thanks. But keep in mind that there is no “rule” against doing challenge studies—we do them all the time. Whatever we decide with Covid-19 will be consistent with how we do some vaccines, and not how we do others. There is no default option. It’s our (unavoidable) decision.
Dylan
May 3 2020 at 8:04pm
I did mean to say that the link wasn’t meant as a critique of your previous post, just meant to give the layperson a general sense of the level of difficulties that come with trying to figure out if a drug works.
I’m in favor of challenge studies, but I do think they need to be controlled. One potential issue, which we’ve seen with numerous vaccine candidates in the past, is that the vaccine induces a stronger response to the disease when a person gets infected. Since that is also a worry when you are dosing for a challenge study, since the participants get a more standardized dose than they would get in nature, you need a control to be able to tell if any cytokine storm issues you see are due to the vaccine or the controlled dose. For one example of why a control is important.
Scott Sumner
May 3 2020 at 8:58pm
Good point.
Gordon
May 3 2020 at 4:50pm
Perhaps New Zealand had enough testing in place to identify many of those who were asymptomatic or presymptomatic before they had much time to spread the virus to others. According to the Our World in Data site, New Zealand has performed 132.5 tests per every confirmed case while the US has only done 6.2 tests per every confirmed case.
Scott Sumner
May 3 2020 at 6:31pm
Yes, I suspect that testing is one important factor.
Gordon
May 3 2020 at 5:03pm
Here’s one more thing which may contribute to the difference between Utah and New Zealand besides testing. The average household size in Utah is 3.16 people while it’s 2.7 in NZ. So a person who’s sick in a household in Utah has more people to infect.
Brian
May 3 2020 at 7:28pm
Scott,
Yes, the plateau you mention in the Utah data is true across the United States. We’ve been at plateau nationally since early April, and it is very puzzling. I’m not aware of any model that predicted that. I’ also not aware of any other country with the same pattern, though I haven’t looked very widely at data from other countries. Whatever the cause, it implies that our social distancing policies haven’t been working. My guess (and it’s only a wild guess) is that the lockdown policies across the U.S. have had enough holes in them that people are still infecting others. Specifically, it doesn’t do any good to shut down businesses and other “nonessential” activities but still let people do “essential” activities (like food shopping) without protection. I think a better policy might have been to keep most businesses and activities open but enforce the wearing of masks and other protective equipment to reduce the spread. The analogy might be a sinking ship. It doesn’t do much good to patch some holes but not others. That might slow the ship from sinking (like trying to “flatten the curve”), but it doesn’t ultimately stop it from happening.
Scott Sumner
May 3 2020 at 9:03pm
I agree that mask wearing is better than shutting down businesses.
Radford Neal
May 4 2020 at 6:19pm
“I’ also not aware of any other country with the same pattern, though I haven’t looked very widely…”
The US isn’t the only one. In fact it’s true for the world as a whole, according to worldometers.info/coronavirus. As for countries, it’s true for cases in the UK (though deaths have recently started to go slowly down). It’s true for cases and deaths in Canada (actually, we have a slight upward trend). It seems to be roughly true for Poland, and for Romania. I haven’t checked them all.
I discuss this puzzle in a blog post at https://radfordneal.wordpress.com/ on “The Puzzling Linearity of COVID-19”. Some of the discussion is interesting; one possibility raised is that after a successful lockdown that reduces inter-household transmission, there will still for a while be transmission within households.
Brian
May 5 2020 at 7:57am
Radford,
Yes, there are a handful of other countries, such as Poland, with the same feature. You are also correct about UK’s cases, but as you note their deaths have been clearly falling. Canada and some other countries with upward trends don’t count because they haven’t clearly reached their peak yet.
The U.S. is basically unique in the length of its plateau, and in having that plateau exist in both the case and death data.
You are also correct about the world as a whole having a plateau, and maybe that provides a clue. The world’s plateau is probably caused by the wide range of different timings for the progression of the disease. As some countries are recovering (e.g., Italy, Spain), others are ramping up (e.g., Russia). It may be that the U.S. (and even some U.S. states) are roughly as diverse in their timings as the world at large.
The argument against that explanation is that most states implemented mandated social distancing in mid March, so the U.S., though undoubtedly diverse, should have been much better synced than the world as a whole. It still seems like a puzzle.
Lorenzo from Oz
May 3 2020 at 7:53pm
150 cases a day on a flat curve in a population of 3.2million going into winter is doing well, it is just not doing as well as New Zealand (pop.5m), an island country in summer. Remembering that this virus transfers better indoors than outside.
As for scapegoating, including foreign scapegoating, it is not as if that has been absent in the Chinese media. Indeed, Trump’s criticism of China seemed to coincide with the not-quite-official “blame the US” campaign in China, with the former happening before Trump started talking about ‘Chinese virus’ and dying away somewhat once Trump had established that as a meme. Which could, of course, be entirely coincidental: why would we think that a shameless media-savvy President would behave like that?
Scott Sumner
May 3 2020 at 9:02pm
Yes, I mentioned that China’s rhetoric has also been overheated, although in fairness their occasional scapegoating of the US has been in response to some irresponsible charges made by American officials. (Not that that justifies it.)
As I said, in April the weather in NZ and Utah is fairly similar.
Ross
May 4 2020 at 11:33am
New Zealand and Australia (and Singapore, Taiwan, South Korea) had, and still have, well organised and efficient contact tracing.
It’s possible Utah doesn’t.
The importance of contact tracing isn’t to identify symptomatic cases (testing does this). It is to notify individuals that have been in close contact with a symptomatic case, which ensures the majority of asymptomatic cases are also sent into 14 day quarantine.
Testing alone slows the spread, but does not push reproduction rate below 1.
Testing and contact tracing was effective in Australia when Sydney had a daily direct flight from Wuhan while their were 10,000 confirmed cases in late January. https://www.sbs.com.au/news/australian-airport-workers-call-for-all-flights-from-china-be-cancelled-amid-coronavirus-fears
The outbreak was slower to take hold and faster to contain because of contact tracing.
Contact tracing only ‘failed’ due to a wave of imported cases from Europe and the United States. The new cases were so numerous they overwhelmed the system which necessitated a travel ban and partial lock down. A similar problem happened in Singapore (where they blame migrant workers, but the real issue was unlimited and unregulated international travel in a time of pandemic).
Taiwan banned foreign travel over a week before Australia/New Zealand https://www.usnews.com/news/world/articles/2020-03-17/taiwan-to-ban-most-foreigners-from-entry-to-control-virus I rate this move as important to their relative success.
Perversely, I believe South Korea (and PR China) benefited from being early and being banned by Western governments weeks earlier https://www.abc.net.au/news/2020-03-05/coronavirus-travel-ban-korea-italy-china-iran/12027348
It’s my view that you need adequate testing and contact tracing to push the reproduction rate below 1, and travel bans to ensure contract tracing does not become overwhelmed. In time, I see travel bans being replaced by compulsory testing to enter countries where corona virus will be eradicated (Australia, NZ, Singapore, Taiwan, PR China, Iceland, Scandinavian countries ex Sweden, etc).
It’s also possible I am wrong. It may be the weather.
TMC
May 4 2020 at 3:24pm
All of Politico’s examples were in Jan and Feb. We’ve found out since then that China has been quite intransparent. It’s good to modify your behavior on new information.
Just reported today:” A new Department of Homeland Security report reveals that mainland China’s Communist rulers “intentionally concealed the severity” of the viral outbreak in Wuhan to corner the market on medical supplies and personal protection equipment (PPE). The report was marked “for official use only” and not released to the public, but the Associated Press was able to obtain a copy of the damning material.”
Mark
May 4 2020 at 10:32pm
The AP article said the DHS report’s “conclusions are based on the 95% probability that China’s changes in imports and export behavior were not within normal range, according to the report.”
https://apnews.com/bf685dcf52125be54e030834ab7062a8
This feels like grasping at straws. Of course imports to China would have increased and exports from China would have fallen in January when China had an outbreak and other countries didn’t. Moreover, the DHS Report says China’s intention was to ensure that it had an adequate supply of PPE. If that were the case, China would also have acted to prevent the spread of the virus to other countries, as that spread would have caused other countries to put limits on their exports of PPE to China.
JayT
May 4 2020 at 4:51pm
Auckland and Salt Lake City had similar average temperatures, but their weather in April was very different. Auckland’s lowest temperature last month was 48F, whereas Salt Lake City’s average low was 42F. SLC’s average temperature was below 50F 10 out of the 30 days, but Auckland never had a single day average below 50F. SLC had a heat wave at the end of the month that raised its average quite a bit, but Auckland was moderate the whole month through. In the first 20 days of the month SLC averaged 49F.
Also, I don’t know if it matters or not, but Auckland averaged 95% humidity compared to SLC’s 62%.
All that said, I’m not sure we can draw any weather-related conclusions from these two cities.
Matthias Görgens
May 5 2020 at 12:02am
I just checked whether people in Utah are perhaps fatter than people in New Zealand, and whether that might influence rates somehow. But according to a quick search, people in New Zealand are on average quite obese as well.
So you can probably remove that plausible cause from the list of things that might explain the puzzle.
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