Note: This thread is related to #Coronavirus #COVID19

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Nicholas A. Christakis+ Your Authors @NAChristakis Sterling Professor of Social & Natural Science at Yale. Physician. Author of Blueprint: The Evolutionary Origins of a Good Society. Luckily wed @ErikaChristakis Mar. 09, 2020 7 min read + Your Authors

If we want to understand how powerful an opponent SARS-CoV-2 (COVID-19) is, let’s take a look what has been required to stop it in China. The Chinese government has essentially used a social nuclear weapon in its efforts. Let’s talk about this, to understand what US is facing. 1/

The Chinese have had the most COVID19 cases so far (80,859), but the number of new cases has dropped from 100's per day a month ago to ~46 per day now — in a country of 1.4B people. This is an astonishing achievement from a public health point of view.  https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200308-sitrep-48-covid-19.pdf?sfvrsn=16f7ccef_4  2/

We can get a sense of how strong something is by getting a sense of what sort of force is required to stop it, to borrow a Newtonian physics metaphor. COVID-19 requires a powerful force to stop. This is clear from the Chinese response. 3/

Of course, China has a collectivist culture and an authoritarian government, both of which have allowed this enormous, widespread response. It is well suited to fight a pandemic, if it indeed takes in factual information and responds rationally. (Evokes Chernobyl @clmazin) 4/

Ably assisted by some Chinese students in my lab #HNL, we quantified what Chinese government has been able to achieve. Beginning January 23, they imposed movement restrictions (typically with people staying at home, leaving just once a week) on provinces with >930M people! 5/

The imposition of such public health measures on such a scale for such a duration has never been seen before. Here are links to the websites for many of the provinces into which China is divided, indicating what the rules for movement, imposed on 930M people, have been. 6/

Most Chinese cities are still implementing these types of quarantine at the community-level, now over *six weeks* in, depending on the severity level of the situation in their cities. This is called "closed-off management" 封闭管理 by the government and media). 7/

Common features of "closed-off management” include: movement of people & vehicles is checked with an exit-entrance permit; body temperature at entrance of community is checked; disinfection of vehicles; food delivery; permits for only one person per household to go out. 8/

The licenses for personal travel in China, being used by many millions of people, look like this. Some of them have a slogan “It is everyone’s responsibility to fight the virus.” 10/

In many cities, workers have been organized on a vast scale to deliver food to homes; residents can only go out to shop if they have a permit; & shops are open at limited times. In Chongqing, for example, only one person per household can go out shopping, only occasionally. 11/

Schools have moved online. Jokes circulate: Parents complain to upstairs neighbors: "Could you please have your kids stop jumping? It is too noisy and our kids are taking an online math class now.” The neighbors reply: "Oh sorry! But my kids are taking a sports class now.” 12/

As a result, the Chinese have dropped the Re (the Effective Reproductive Rate) of COVID19 from ~3.8 new cases per extant case to ~0.32. When this number is below 1.0, the epidemic extinguishes (at least it will, for a while, within China).  https://www.medrxiv.org/content/10.1101/2020.03.03.20030593v1  13/

My lab, #HNL, has been studying this topic in another way, along with Chinese collaborators. We are also developing forecasting tools. NB @BillGates @niranjanbose (with gratitude). More about that in a future thread. 14/

The Chinese government is slowly beginning to lift restrictions, but it is continuing to implement many quite inventive procedures, on a large scale. For instance, elevators in a Beijing building only allow four people at a time, as marked by tape on the floor. 15/

The sign in the elevator says: "No more than four people in the elevator. Please be patient and wait for the next elevator.” Below, it says "Let's unite together to fight the virus in this special period." This type of collectivist slogan is very common throughout China now. 16/

Currently, some provinces are adjusting their emergency level downwards according to their risk-level evaluations. As of March 2, 7 provinces adjusted to second-level, 9 provinces to third-level, 4 provinces to just the within-province emergency level.  http://www.bjnews.com.cn/news/2020/03/02/697916.html  17/

China has a collectivist culture and an authoritarian government, so its success fighting COVID-19, while deeply impressive, will not be easy to reproduce elsewhere. The USA must prepare to combat the virus using tools at its disposal. It will not be easy. 18/

Here is a map and a timeline describing the imposition of "closed off management" restrictions at the provincial level across China as part of the effort to cope with #COVID19. 19/

Another example of social distancing, widely employed in China, thanks to @aoziparis. This is a photo from Henan province, just to the north of Hubei, one month ago. Shoppers, when they are allowed out, wait in a line, 1.5m away from each other, before entering grocery store. 20/

More examples of line-forming with social distancing in China via @ECtHRwatch 21/

Working with industry, Chinese authorities encouraged delivery companies to distribute goods, and the companies vouched that their drivers were wearing masks and did not have a fever. The app used noted such details as the driver approach. 22/

This article  http://news.cctv.com/2020/02/20/ARTIqdzcHtncA8Vphq0nnAII200220.shtml  says that, as of late February, in low risk locales, delivery companies should resume service but minimize risk during the whole delivery process -- by wearing face masks, disinfecting vehicles, & checking body temperature daily. 23/

As workers in China return to offices, many systems are being put into place, such as at restaurants and cafeterias, to maintain social distancing. These include rules to eat fast, one-person-to-a-table, cardboard dividers, and admonitions not to talk to each other. 24/

Gallows humor prevails among Chinese coping w COVID19. Re procedures now in use for eating out, many are saying "This one table per person experience reminds me of my old school days while taking exams." "I feel like I was taking exams in my high school while having lunch." 25/

Fabulous detailed description of the Chinese system of dealing with COVID-19 suspected cases, with testing facilities, isolation, and treatment. Down to a science. Via @maddow  https://m.youtube.com/watch?v=Ljc7n0V3Vt8&t=1541&feature=youtu.be  h/t @mqdicer 26/

I will continue to add to this thread as I get more photos from my Chinese students and colleagues about how China experienced and coped with COVID-19. Many of these anecdotes are useful, amazing, and even amusing. Here goes: 27/

People use small sticks to push the elevator button (the text reads "The elevator has been disinfected. Please use the stick to push the button. Please discard the stick in the box below after you have used it." 28/

Interrupting my narrative about China, here are similar photos in Korea ( https://attracttour.com/2020/02/hotel-in-seoul-south-korea-use-toothpick-when-pressing-elevator-in-attempt-to-contain-coronavirus/ ) and Iran ( http://english.alarabiya.net/en/News/middle-east/2020/03/05/Over-3-500-coronavirus-cases-in-Iran-107-deaths-Health-ministry.html ). I think the USA should start doing this. #elevatorsticks #fomites /29

In China, apparently the young were more concerned initially about COVID19 than the old, who were nonchalant. Images like this circulated. It's good not to panic or be alarmist; but it's also good not to be complacent. #gallowshumor 30/

This image became a meme, and was transformed. This made me laugh out loud, as it reflects a bit the transition in my own family and friends. More #gallowshumor related to COVID19 in China. 31/

Religion and the Buddhist tradition were enlisted, too, emphasizing civic duty. This article was forwarded hundreds of thousands of times.  https://mp.weixin.qq.com/s/e4ruQmt91sQ46BR65OH4og  "Buddha teaches us that we should create good karma. Preventing disease is also creating good karma." 32/

Many millions of Chinese have not forgotten Dr. Li Wenliang who first sounded the alarm and was ignored and called before the police to be accused of "rumor mongering" (lest we forget the authoritarianism of China). He ultimately died of COVID19.  https://www.bbc.com/news/world-asia-china-51403795  32/

Thousands still comment on Wenliang's social media every day ( https://www.weibo.com/u/1139098205?is_hot=1 ). His last message was that he tested positive for COVID19. People share what they are doing, as if Wenliang were still alive; they say good night/good morning to Wenliang every day. 33/

How Beijing reframed the coronavirus narrative. I’ve been very clear re China’s government being authoritarian and its failings. But COVID19 control was dramatic. @gideonrachman doesn’t spare our political leaders either.  https://www.ft.com/content/20ab52d8-676a-11ea-800d-da70cff6e4d3?campaign=march20&segmentID=09d3ed8b-33db-132b-eb60-c9f2617cc2e5  | @financialtimes (not 34:) /35

More #gallowshumor from China's period of COVID19 home confinement. This image describes people's routine (adapted from the style of Beijing railway map, with English and French). Some students added "this station does not have a stop" at the "textbook" station. /36

As of March 20, 2020, China has begun to lift "closed off management" rules for many provinces. Schools are resuming. To be clear, what China has done is stop transmission of COVID19, NOT eradicate it. The virus will come back. But they will now have time to plan for it. /37


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