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COVID-19 pandemic in mainland China

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COVID-19 pandemic in mainland China
COVID-19 attack rate in Mainland China.svg
Confirmed COVID-19 cases in mainland China per 100,000 inhabitants by province as of 3 October 2020[1]
  114.96 cases per 100,000 (Hubei)
  3–5 cases per 100,000
  1–3 cases per 100,000
  0.5–1 cases per 100,000
  >0–0.5 cases per 100,000
DiseaseCOVID-19
Virus strainSARS-CoV-2
LocationMainland China
First outbreakWuhan, Hubei[2]
Index case1 December 2019
(11 months, 3 weeks and 2 days ago)
Confirmed cases86,338[note 1][3]
Recovered81,319[3]
Deaths
4,634[3][4]

The COVID-19 pandemic originated with a cluster of mysterious, suspected pneumonia cases in the city of Wuhan, the capital of Hubei, China. A Wuhan hospital notified the local center for disease control and prevention (CDC) and health commissions on 27 December 2019. On 31 December, the Wuhan CDC disclosed to the media that there was a cluster of unknown pneumonia cases related to Huanan Seafood Market after the unverified documents appeared on the Internet. The potential disease outbreak soon drew nationwide attention including that of the National Health Commission (NHC) in Beijing who sent experts to Wuhan on the following day. Chinese authorities formally notified the World Health Organization on this same day.[5] On 8 January 2020, a new coronavirus was identified as the cause of the pneumonia.[6] The sequence of the virus was soon published on an open-access database.[7]

Public and media criticism has labeled responses by the Wuhan and Hubei authorities as delayed and as failing to contain the outbreak in its early stage.[8] By 29 January, the virus spread to all provinces of mainland China.[9][10][11] All provinces of mainland China initiated the highest response level to public health emergency.[12] The World Health Organization declared the outbreak a Public Health Emergency of International Concern on 31 January,[11] citing reasons of spread in other countries, particularly those without robust healthcare systems.[13][14] By 8 February, over 724 died from the coronavirus infection-associated pneumonia and 34,878 were confirmed to have been infected. In Hubei alone, there were 24,953 cases of infections and 699 related deaths.[15]

The Chinese government may have censored discussions about the outbreak since the beginning of its spread.[16][17] On 25 January, Chinese Communist Party General Secretary Xi Jinping warned about a "grave situation" facing China.[18][19] The Party Politburo formed a special leading group for epidemic control, led by Premier Li Keqiang. The 25 January Chinese New Year celebrations were cancelled. Passengers across the country have been checked for their temperatures.[20] Commands for epidemic control (CEC) have been formed in different regions including Wuhan and Hubei. Many inter-province bus services[21] and railway services have been suspended.[22] By 29 January, all Hubei cities were quarantined.[23] Curfew laws were implemented in Huanggang, Wenzhou,[24] and other mainland cities.[25] In February 2020, the region also saw a huge shortage of face masks and other protective gear despite itself being the world's manufacturing hub for these products.[26] Other countries donated medical supplies to help China deal with the epidemic.[27][28][29]

Fear, regional discrimination in China, and racial discrimination within and beyond China increased with the growing number of reported cases of infections despite calls for stopping the discrimination by many governments.[30][31] Some rumors circulated across Chinese social media, along with endorsements and counter-rumor efforts by media and governments.[32][33] The Chinese government has worked to censor and counter reporting and criticism about the crisis and portray the official response to the outbreak in a positive light. They have also provided humanitarian assistance to other countries dealing with the virus.[34][35][36] News outlets have reported concerns that the Chinese government has deliberately under-reported the extent of infections and deaths.[37][38][39]

On 25 February, the number of newly confirmed cases outside mainland China exceeded those from within for the first time; the WHO praised the effectiveness of measures taken in the country.[40] By 6 March the reported number of new cases had dropped to well fewer than 100 nationally per day, down from thousands per day at the height of the crisis. On 13 March, the number of newly imported cases passed the number of domestically transmitted new cases for the first time.[41] On 26 July, China saw its highest number of daily cases since March.[42]

Graphics

2020 coronavirus patients in China.svg
COVID-19 cases in Mainland China  ()
     Deaths        Recoveries        Tested        Clinically diagnosed (C.D.)        Tested or C.D.

Dec Dec Jan Jan Feb Feb Mar Mar Apr Apr May May Jun Jun Jul Jul Aug Aug Sep Sep Oct Oct Nov Nov Last 15 days Last 15 days

Date
Number of cases
(excluding C.D.)
Number of cases
(including C.D.)
2019-12-31
27(n.a.)
27(=)
2020-01-03
44(+63%)
44(=)
2020-01-05
59(+34%)
2020-01-10
41(n.a.)
41(=)
2020-01-16
45(+9.7%)
2020-01-17
62(+38%)
2020-01-18
121(+95%)
2020-01-19
198(+64%)
2020-01-20
291(+47%)
2020-01-21
440(+51%)
2020-01-22
571(+30%)
2020-01-23
830(+45%)
2020-01-24
1,287(+55%)
2020-01-25
1,975(+53%)
2020-01-26
2,744(+39%)
2020-01-27
4,515(+64%)
2020-01-28
5,974(+32%)
2020-01-29
7,711(+29%)
2020-01-30
9,692(+26%)
2020-01-31
11,791(+22%)
2020-02-01
14,380(+22%)
2020-02-02
17,205(+20%)
2020-02-03
20,438(+19%)
2020-02-04
24,324(+19%)
2020-02-05
28,018(+15%)
2020-02-06
31,161(+11%)
2020-02-07
34,546(+11%)
2020-02-08
37,198(+7.7%)
2020-02-09
40,171(+8.0%)
2020-02-10
42,638(+6.1%) 48,315[i](n.a.)
2020-02-11
44,653(+4.7%) 55,220(+14%)
2020-02-12
46,472(+4.1%) 58,761[ii](+6.4%)
2020-02-13
48,467(+4.3%) 63,851(+8.7%)
2020-02-14
49,970(+3.1%) 66,492(+4.1%)
2020-02-15
51,091(+2.2%) 68,500(+3.0%)
2020-02-16
70,548(+3.0%)
2020-02-17
72,436(+2.7%)
2020-02-18
74,185[iii](+2.4%)
2020-02-19
75,002[iv](+1.1%)
2020-02-20
75,891(+1.2%)
2020-02-21
76,288(+0.52%)
2020-02-22
76,936(+0.85%)
2020-02-23
77,150(+0.28%)
2020-02-24
77,658(+0.66%)
2020-02-25
78,064(+0.52%)
2020-02-26
78,497(+0.55%)
2020-02-27
78,824(+0.42%)
2020-02-28
79,251(+0.54%)
2020-02-29
79,824(+0.72%)
2020-03-01
80,026(+0.25%)
2020-03-02
80,151(+0.16%)
2020-03-03
80,270(+0.15%)
2020-03-04
80,409(+0.17%)
2020-03-05
80,552(+0.18%)
2020-03-06
80,651(+0.12%)
2020-03-07
80,695(+0.05%)
2020-03-08
80,735(+0.05%)
2020-03-09
80,754(+0.02%)
2020-03-10
80,778(+0.03%)
2020-03-11
80,793(+0.02%)
2020-03-12
80,813(+0.02%)
2020-03-13
80,824(+0.01%)
2020-03-14
80,844(+0.02%)
2020-03-15
80,860(+0.02%)
2020-03-16
80,881(+0.02%)
2020-03-17
80,894(+0.02%)
2020-03-18
80,928(+0.04%)
2020-03-19
80,967(+0.05%)
2020-03-20
81,008(+0.05%)
2020-03-21
81,054(+0.06%)
2020-03-22
81,093(+0.05%)
2020-03-23
81,171(+0.10%)
2020-03-24
81,218(+0.06%)
2020-03-25
81,285(+0.08%)
2020-03-26
81,340(+0.07%)
2020-03-27
81,394(+0.06%)
2020-03-28
81,439(+0.06%)
2020-03-29
81,470(+0.04%)
2020-03-30
81,518(+0.06%)
2020-03-31
81,554(+0.04%)
2020-04-01
81,589(+0.04%)
2020-04-02
81,620(+0.04%)
2020-04-03
81,639(+0.02%)
2020-04-04
81,669(+0.04%)
2020-04-05
81,708(+0.05%)
2020-04-06
81,740(+0.04%)
2020-04-07
81,802(+0.08%)
2020-04-08
81,865(+0.08%)
2020-04-09
81,907(+0.05%)
2020-04-10
81,953(+0.06%)
2020-04-11
82,052(+0.12%)
2020-04-12
82,160(+0.13%)
2020-04-13
82,249(+0.11%)
2020-04-14
82,295(+0.06%)
2020-04-15
82,341(+0.06%)
2020-04-16
82,692(+0.40%)
2020-04-17
82,719(+0.03%)
2020-04-18
82,735(+0.02%)
2020-04-19
82,747(+0.01%)
2020-04-20
82,758(+0.01%)
2020-04-21
82,788(+0.04%)
2020-04-22
82,798(+0.01%)
2020-04-23
82,804(<+0.01%)
2020-04-24
82,816(+0.01%)
2020-04-25
82,827(+0.01%)
2020-04-26
82,830(<+0.01%)
2020-04-27
82,836(<+0.01%)
2020-04-28
82,858(+0.03%)
2020-04-29
82,862(<+0.01%)
2020-04-30
82,874(+0.01%)
2020-05-01
82,875(<+0.01%)
2020-05-02
82,877(<+0.01%)
2020-05-03
82,880(<+0.01%)
2020-05-04
82,881(<+0.01%)
2020-05-05
82,883(<+0.01%)
2020-05-06
82,885(<+0.01%)
2020-05-07
82,886(<+0.01%)
2020-05-08
82,887(<+0.01%)
2020-05-09
82,901(+0.02%)
2020-05-10
82,918(+0.02%)
2020-05-11
82,919(<+0.01%)
2020-05-12
82,926(<+0.01%)
2020-05-13
82,929(<+0.01%)
2020-05-14
82,933(<+0.01%)
2020-05-15
82,941(<+0.01%)
2020-05-16
82,947(<+0.01%)
2020-05-17
82,954(<+0.01%)
2020-05-18
82,960(<+0.01%)
2020-05-19
82,965(<+0.01%)
2020-05-20
82,967(<+0.01%)
2020-05-21
82,971(<+0.01%)
2020-05-22
82,971(=)
2020-05-23
82,974(<+0.01%)
2020-05-24
82,985(+0.01%)
2020-05-25
82,992(<+0.01%)
2020-05-26
82,993(<+0.01%)
2020-05-27
82,995(<+0.01%)
2020-05-28
82,995(=)
2020-05-29
82,999(<+0.01%)
2020-05-30
83,001(<+0.01%)
2020-05-31
83,017(0.02%)
2020-06-01
83,022(<+0.01%)
2020-06-02
83,021(>−0.01%)
2020-06-03
83,022(<+0.01%)
2020-06-04
83,027(<+0.01%)
2020-06-05
83,030(<+0.01%)
2020-06-06
83,036(<+0.01%)
2020-06-07
83,040(<+0.01%)
2020-06-08
83,043(<+0.01%)
2020-06-09
83,046(<+0.01%)
2020-06-10
83,057(+0.01%)
2020-06-11
83,064(<+0.01%)
2020-06-12
83,075(+0.01%)
2020-06-13
83,132(+0.07%)
2020-06-14
83,181(+0.06%)
2020-06-15
83,221(+0.05%)
2020-06-16
83,265(+0.05%)
2020-06-17
83,293(+0.03%)
2020-06-18
83,325(+0.04%)
2020-06-19
83,352(+0.03%)
2020-06-20
83,378(+0.03%)
2020-06-21
83,396(+0.02%)
2020-06-22
83,418(+0.03%)
2020-06-23
83,430(+0.01%)
2020-06-24
83,449(+0.02%)
2020-06-25
83,462(+0.02%)
2020-06-26
83,483(+0.03%)
2020-06-27
83,500(+0.02%)
2020-06-28
83,512(+0.01%)
2020-06-29
83,531(+0.02%)
2020-06-30
83,534(<+0.01%)
2020-07-01
83,537(<+0.01%)
2020-07-02
83,542(<+0.01%)
2020-07-03
83,545(<+0.01%)
2020-07-04
83,553(<+0.01%)
2020-07-05
83,557(<+0.01%)
2020-07-06
83,565(<+0.01%)
2020-07-07
83,572(<+0.01%)
2020-07-08
83,581(+0.01%)
2020-07-09
83,585(<+0.01%)
2020-07-10
83,587(<+0.01%)
2020-07-11
83,594(<+0.01%)
2020-07-12
83,602(<+0.01%)
2020-07-13
83,605(<+0.01%)
2020-07-14
83,611(<+0.01%)
2020-07-15
83,612(<+0.01%)
2020-07-16
83,622(+0.01%)
2020-07-17
83,644(+0.03%)
2020-07-18
83,660(+0.02%)
2020-07-19
83,682(+0.03%)
2020-07-20
83,693(+0.01%)
2020-07-21
83,707(+0.02%)
2020-07-22
83,729(+0.03%)
2020-07-23
83,750(+0.03%)
2020-07-24
83,784(+0.04%)
2020-07-25
83,830(+0.05%)
2020-07-26
83,891(+0.07%)
2020-07-27
83,959(+0.08%)
2020-07-28
84,060(+0.12%)
2020-07-29
84,165(+0.12%)
2020-07-30
84,292(+0.15%)
2020-07-31
84,337(+0.05%)
2020-08-01
84,385(+0.06%)
2020-08-02
84,428(+0.05%)
2020-08-03
84,464(+0.04%)
2020-08-04
84,491(+0.03%)
2020-08-05
84,528(+0.04%)
2020-08-06
84,565(+0.04%)
2020-08-07
84,596(+0.04%)
2020-08-08
84,619(+0.03%)
2020-08-09
84,668(+0.06%)
2020-08-10
84,712(+0.05%)
2020-08-11
84,737(+0.03%)
2020-08-12
84,756(+0.02%)
2020-08-13
84,786(+0.04%)
2020-08-14
84,808(+0.03%)
2020-08-15
84,827(+0.02%)
2020-08-16
84,849(+0.03%)
2020-08-17
84,871(+0.03%)
2020-08-18
84,888(+0.02%)
2020-08-19
84,895(<+0.01%)
2020-08-20
84,917(+0.03%)
2020-08-21
84,939(+0.03%)
2020-08-22
84,951(+0.01%)
2020-08-23
84,967(+0.02%)
2020-08-24
84,981(+0.02%)
2020-08-25
84,996(+0.02%)
2020-08-26
85,004(<+0.01%)
2020-08-27
85,013(+0.01%)
2020-08-28
85,022(+0.01%)
2020-08-29
85,031(+0.01%)
2020-08-30
85,048(+0.02%)
2020-08-31
85,058(+0.01%)
2020-09-01
85,066(<+0.01%)
2020-09-02
85,077(+0.01%)
2020-09-03
85,102(+0.03%)
2020-09-04
85,112(+0.01%)
2020-09-05
85,122(+0.01%)
2020-09-06
85,134(+0.01%)
2020-09-07
85,144(+0.01%)
2020-09-08
85,146(<+0.01%)
2020-09-09
85,153(<+0.01%)
2020-09-10
85,168(+0.02%)
2020-09-11
85,174(<+0.01%)
2020-09-12
85,184(+0.01%)
2020-09-13
85,194(+0.01%)
2020-09-14
85,202(<+0.01%)
2020-09-15
85,214(+0.01%)
2020-09-16
85,223(+0.01%)
2020-09-17
85,255(+0.04%)
2020-09-18
85,269(+0.02%)
2020-09-19
85,279(+0.01%)
2020-09-20
85,291(+0.01%)
2020-09-21
85,297(<+0.01%)
2020-09-22
85,307(+0.01%)
2020-09-23
85,314(<+0.01%)
2020-09-24
85,322(<+0.01%)
2020-09-25
85,337(+0.02%)
2020-09-26
85,351(+0.02%)
2020-09-27
85,372(+0.02%)
2020-09-28
85,384(+0.01%)
2020-09-29
85,403(+0.02%)
2020-09-30
85,414(+0.01%)
2020-10-01
85,424(+0.01%)
2020-10-02
85,434(+0.01%)
2020-10-03
85,450(+0.02%)
2020-10-04
85,470(+0.02%)
2020-10-05
85,482(+0.01%)
2020-10-06
85,489(<+0.01%)
2020-10-07
85,500(+0.01%)
2020-10-08
85,521(+0.02%)
2020-10-09
85,536(+0.02%)
2020-10-10
85,557(+0.02%)
2020-10-11
85,578(+0.02%)
2020-10-12
85,591(+0.02%)
2020-10-13
85,611(+0.02%)
2020-10-14
85,622(+0.01%)
2020-10-15
85,646(+0.03%)
2020-10-16
85,659(+0.02%)
2020-10-17
85,672(+0.02%)
2020-10-18
85,685(+0.02%)
2020-10-19
85,704(+0.02%)
2020-10-20
85,715(+0.01%)
2020-10-21
85,729(+0.02%)
2020-10-22
85,747(+0.02%)
2020-10-23
85,775(+0.03%)
2020-10-24
85,790(+0.02%)
2020-10-25
85,810(+0.02%)
2020-10-26
85,826(+0.02%)
2020-10-27
85,868(+0.05%)
2020-10-28
85,915(+0.05%)
2020-10-29
85,940(+0.03%)
2020-10-30
85,973(+0.04%)
2020-10-31
85,997(+0.03%)
2020-11-01
86,021(+0.03%)
2020-11-02
86,070(+0.06%)
2020-11-03
86,087(+0.02%)
2020-11-04
86,115(+0.03%)
2020-11-05
86,151(+0.04%)
2020-11-06
86,184(+0.04%)
2020-11-07
86,212(+0.03%)
2020-11-08
86,245(+0.04%)
2020-11-09
86,267(+0.03%)
2020-11-10
86,284(+0.02%)
2020-11-11
86,299(+0.02%)
2020-11-12
86,307(+0.01%)
2020-11-13
86,325(+0.02%)
2020-11-14
86,338(+0.02%)
2020-11-15
86,346(+0.01%)
2020-11-16
86,361(+0.02%)
2020-11-17
86,369(+0.01%)
2020-11-18
86,381(+0.01%)
2020-11-19
86,398(+0.02%)
2020-11-20
86,414(+0.02%)
2020-11-21
86,431(+0.02%)
2020-11-22
86,442(+0.01%)
2020-11-23
86,464(+0.03%)
From 10 February 2020 onwards, the data includes the cases in Hubei that were not tested for the virus but clinically diagnosed based on medical imaging showing signs of pneumonia.[43]
The lab-tested data was also separately available for 10–15 February 2020.[44]
Data from 16 February 2020 onwards did not include a separate number of lab-tested cases.
From 19 February 2020 onwards, only new lab-tested cases were counted towards the total (but clinically diagnosed cases counted earlier were not discarded).[45]
On 17 April 2020, following the Wuhan government's issuance of a report on accounting for COVID-19 deaths that occurred at home that went previously unreported, as well as the subtraction of deaths that were previously double-counted by different hospitals, the NHC revised their cumulative totals dating to 16 April, adding 325 cumulative cases and 1,290 deaths.[46]
Data sourced from NHC daily reports. (In another link before January 25, on Wuhan MHC website before January 10)
  1. ^ The 02-10 and 02-11 clinically diagnosed data has been based on appendix in the 02-11 Hubei WJW data, with 02-10's data obtained from deducting the number of new C.D. cases on that day from the total.
  2. ^ The 02-12 data has been corrected based on the 02-13 NHC subtraction data and corresponding 02-13 Hubei data.
  3. ^ The 02-18 number of tested cases is calculated based on the 02-19 subtraction data.
  4. ^ Data from 02-19 excludes clinical diagnoses, so the calculation is made provisionally for ease of understanding the progression of the situation.


Context

New infectious diseases impose a serious threat to the health of the general public. Their origins are often mysterious despite intensive research efforts.[47] Although human coronaviruses (CoVs) had been known as major pathogens to cause the common cold,[48][49] a new species of coronavirus, namely SARS-CoV caused an epidemic involving 29 countries during 2002–03 which infected 8098 persons and killed 774 of them.[49] The evidence shows that the virus might have originated from an animal coronavirus, but somehow entered the human population.[49][50][51] Its outbreak also implies that animal coronaviruses could be a potential danger to humans.[49]

Since the 2003 SARS outbreak, the general public and the scientific community in China have been worried about the potential return of the deadly virus which motivated the Chinese government to reform its public health system to handle the next public health crisis.[52][53][54] As part of the reform, China expanded the laboratory networks to handle the pathogens of the infectious diseases which included a newly built BSL-4 laboratory in Wuhan and a national key laboratory to investigate into pneumonia with unclear causes.[55] Zeng Guang, the Chief Scientist at China CDC believed that a quicker publication of the epidemic information was a lesson that China learned from the SARS outbreak as the lack of information release worsened the outbreak.[55]

With the improved public health system, China managed to handle several public health emergencies. In coping with the 2009 H1N1 flu outbreak starting from Mexico, China developed and distributed vaccines to 100 million people within months as an active prevention.[54] During the 2013 H7N9 outbreak in East China, the country's health system identified the pathogen 5 days after the outbreak. Test kits for diagnosis were designed and distributed to all mainland provinces 3 days after the identification. Within months, effective vaccines were developed. Besides, Chinese academic Li Lanjuan and her group was the first to reveal the virus's transmission methods, molecular mechanisms and effective treatment.[56]

However, Southern Metropolis Daily stated that although people paid more attention to public health, the government's funding to the health system was far from enough as CDCs in smaller municipalities had to reduce their staff. 10 years after the SARS outbreak, few people wore a face mask when they had respiratory symptoms and the hospitals were cutting the fever clinics off.[57] Despite confidence in winning the next battle against SARS, Zhong Nanshan who earned fame in fighting the SARS outbreak in 2003 still held a conservative attitude to whether the Chinese officials would lie to the people about a disease outbreak.[54]

Early cases surrounding the animal market suggested potential animal-to-human transmission while later the virus was found to be able to transmit from ill people to others.[58] There have been cases where asymptomatic patients transmitted the virus to others.[59][60] According to China NHC, the virus transmits by droplets or close contact[61] while some proposed that feces could also be where the virus hides and transmits from.[62][63] The typical symptoms of the viral infection included fever, dry cough, dyspnea, headache and pneumonia[64] which are usually developed after an incubation time lasting as long as 2 weeks.[65] The existence of mild but infectious cases complicated the epidemic control efforts.[66] It is also noticed that patients might be able to transmit the virus even during the incubation period.[67]

Early response by Wuhan

Discovery

One of the earliest Wuhan MHC notices about the pneumonia epidemic. It was first posted on Weibo on 30 December 2019 and was confirmed by Wuhan CDC the next day (31 December).

The first confirmed patient started experiencing symptoms on 1 December 2019,[68] though the South China Morning Post later reported that the first case may have been a 55-year-old patient from Hubei province as early as 17 November.[69][70][71] More recently, on 27 March 2020, news outlets citing a government document reported that a 57-year-old woman, who started having symptoms on 10 December 2019 and subsequently tested positive for the coronavirus disease, was described in The Wall Street Journal on 6 March 2020, may have been patient zero in the coronavirus pandemic.[72][73] Although the first confirmed patient did not have any exposure to Huanan Seafood Market, an outbreak of the virus began among the people who had been exposed to the market nine days later.[74][75] It is possible the infection may have passed from bat to human; if so, it may be related to bat guano used in traditional Chinese medicine.[76] On 26 December, Shanghai PHC received a sample of a patient with unknown pneumonia from Wuhan CDC and Wuhan Central Hospital and started an investigation to the sample which was later confirmed to contain a new coronavirus.[74]

The outbreak went unnoticed until a cluster of unknown pneumonia cases was observed by Zhang Jixian,[77] director of the Department of Respiratory Medicine at Hubei Hospital of Integrated Traditional Chinese and Western Medicine,[78] whose experience fighting SARS in 2003 kept her alerted about a public health emergency. On 26 December 2019, a couple of seniors who lived near Zhang's hospital came to her for their fever and cough. The CT scan results of the couple's thorax showed unusual changes in the lungs which were different from those in any known viral pneumonia. Zhang saw the couple's son and found similar conditions. On the same day, a patient from Huanan Seafood Market that Dr. Zhang saw also had the unusual conditions.[citation needed]

On 28 and 29 December, three more patients who had visited the Huanan Seafood Market visited the clinic of the hospital. The hospital notified the provincial and municipal health commissions. The health commissions appointed Wuhan and Jianghan CDC and Jinyintan Hospital to undertake epidemiological research for the seven patients on 29 December. Six of them were transferred to Jinyintan, a specialized facility for infectious diseases. Only one patient refused the transfer.[77] Zhang's discovery was widely praised;[79] the Hubei government honored her and Zhang Dingyu, the president of Jinyintan, for their contribution to controlling the viral outbreak.[78]

Disclosure

Poster of Li Wenliang, doctor who was reprimanded for warning China about the coronavirus

On 30 December 2019, Wuhan CDC issued emergency warnings to local hospitals about a number of mysterious pneumonia cases discovered in the city in the previous week.[80][81]

The letters required all hospitals in Wuhan to report any pneumonia patient with unknown causes and related to Huanan Seafood Market. They also asked the hospitals to give proper treatment to these patients. Wuhan CDC told The Beijing News that the investigation was still underway and the experts from NHC were on the way to help the investigation[82] after a rumor about it circulated on the Internet.[74]

On 1 January 2020, the seafood market was closed down by Jianghan District's Health Agency and Administration for Market Regulation due to an environment improvement. According to China Business, the workers in hazmat suits were inspecting all around the market and collecting samples. The storekeepers at the market said that they were not told what the people were collecting and detecting. The urban management officers and police officers were on the spot to ask the storekeepers to finish up and leave the market.[83]

Several doctors were warned by Wuhan's police for "spreading misinformation" and eight "rumormongers" who were all doctors at Wuhan hospitals according to Wang Gaofei, Weibo's CEO[84] were summoned by the police on 3 January.[85][86] Li Wenliang, one of the whistleblowers died from the virus on 7 February[87] which was the same day when the discoverers of the outbreak, Zhang Jixian and Zhang Dingyu, were honored by Hubei's government.[88] The death of Dr. Li led to widespread grief and criticism toward the government.[89]

Measures and impact in Hubei

Most people on a bus wearing a mask, Hubei province, 23 January 2020.

Semi-log graph of new cases and deaths in China during COVID-19 epidemic showing the lockdown and lifting

Semi-log graph of 3-day rolling average of new cases and deaths in China during COVID-19 epidemic showing the lockdown on 23 January and partial lifting on 19 March.

Impact beyond Hubei

Number of cases (blue) and number of deaths (red) on a logarithmic scale.

Chinese Communist Party general secretary Xi Jinping warned that China was facing a 'grave situation'.[18][19] He held a Party Politburo meeting which promised resources and experts for treatment and supplies to Hubei[90] as more and more cases of the viral infection, mostly exported from Wuhan were confirmed in other cities in Hubei[9] and multiple parts in mainland China.[91] On 29 January, Tibet announced its first confirmed case, a male who traveled from Wuhan to Lhasa by rail on 22–24 January[92] which marked that the virus spread to all parts of mainland China.[9][10][11]

The 25 January Chinese New Year celebrations were canceled in many cities. The passengers were checked for their temperatures to see whether they had a fever.[20] Henan, Wuxi, Hefei, Shanghai, Inner Mongolia suspended trade of living poultry on 21 January.[93]

Financial Times described the outbreak as China's Chernobyl moment, increasing the pressure on its leader, Xi Jinping. A trade war with the US, Hong Kong protests, and an African swine fever outbreak that led to a pork shortage already placed pressure on the current government.[94][95]

Early responses by Henan

At the end of December 2019, Henan announced the suspension of passenger trains to and from Wuhan. In early January 2020, the local government of Henan Province with its complete disinfection measures, effective and intensive publicity, a strong awareness of epidemic prevention and quarantine among the people, the setting up of return spots at the village entrance and even the use of garbage trucks, the digging of trenches to block roads connecting Hubei and the hanging of slogans such as "return home with sickness is to dishonor your parents." #抄河南的作业 (lit.: 'copy Henan's homework') became a trending Weibo topic hashtag.[96][97][98]

However, cutting the roads off without authorization is illegal in mainland China as Xinhua and the Public Security Ministry pointed out.[99][100] The Ministry of Transport asked the local governments to take the principle of "block one, not three (Chinese: 一断三不断)", that is, to block the virus from spreading, but not to block roads, traffic and Internet access, the transportation of emergency supplies and the transportation of essential goods.[101]

Staff examining cars for epidemic control at Qujiang entry to Xi'an Bypass
Body temperature screening at Jishuitan subway station, Beijing

Public Health Emergency declarations

Doctor father and son encouraging each other to fight the virus in Chenzhou, Hunan

By 21 January, government officials warned against hiding the disease.[102]

On 22 January, Hubei launched a Class 2 Response to Public Health Emergency.[103] Ahead of the Hubei authorities, a Class 1 Response to Public Health Emergency, the highest response level was announced by the mainland province of Zhejiang on 23.[104][105] Guangdong and Hunan followed suit later on the day. On the following day, Hubei[91] and other 13 mainland provinces[106][107][108][109] also launched a Class 1 Response. By 29, all parts of mainland initiated a Class 1 Response after Tibet upgraded its response level on that day.[12]

The highest response level authorizes a provincial government to requisition resources under the administration to control the epidemic. The government was allowed to organize and coordinate treatment for the patients, make investigations into the epidemic area, declare certain areas in the province as an epidemic control area, issue compulsory orders, manage human movement, publish information and reports, sustain social stability and to do other work related to epidemic control.[110]

On 11 June, officials confirmed another outbreak of the infection in Fengtai, a south-western district in Beijing. Many of the cases had visited Xinfadi Market, the single largest source of the city's fresh food supplies. [111]

Cancellations, delays and shutdowns

Holiday extension

On 26 January, the State Council extended the 2020 Spring Festival holiday to 2 February (Sunday, the ninth day of the first lunar month) with 3 February (Monday) marking the start of normal work. The educational institutions postponed the start of school.[112] The different provinces made their own policies about holiday extension.[113]

Sporting events

For the 2020 Olympic women's football qualifier, the third round of the Group B matches for the Asian division was planned to be held in Wuhan and later Nanjing,[114][115] but the match was finally held in Sydney, Australia.[116] The 2020 Chinese FA Super Cup, to be held in Suzhou on 5 February 2020 was postponed.[117] The 2020 Asian Champions League play-off match between Shanghai SIPG and Buriram United were played behind closed doors.[118] The Chinese Football Association announced that the 2020 season is postponed from 30 January.[119] The Asian Football Confederation postponed all home matches for Chinese clubs in the Champions League group stage. The three of them had not played a single game yet as of 3 March 2020.[120]

The Olympic boxing qualifier[121][122] has also been rescheduled to March and the venue has been moved to Amman, Jordan.[123] The Group B of the Olympic women's basketball qualifiers, originally scheduled to be held in Foshan, Guangdong was also moved to Belgrade, Serbia.[124]

As for the other major sports events, FIS Alpine Ski World Cup, scheduled for 15–16 February 2020 was canceled due to the outbreak. The event was originally planned to be the 2022 Winter Olympics' first test. The 2020 World Athletics Indoor Championships, originally scheduled to take place in Nanjing from 13 to 15 March are postponed for a year and will be held at the same venue.[125] The Confederations Cup Asia Pacific Group I, scheduled to be held in Dongguan, Guangdong was moved to Nur-Sultan, Kazakhstan.[126]

The State General Administration of Sports announced a suspension of all sporting events until April. The Mudanjiang Sports Culture Winter Camp[127] and China Rally Championship Changbai Mountains[128] are both suspended. After the postponement of national women's basketball games, the Chinese Volleyball Association suspended all volleyball matches and activities.[129]

The 2020 Sanya ePrix, due to take place on 21 March as the third round of the Formula E season was postponed to a yet to be announced date.[130] On 12 February, the 2020 Chinese Grand Prix, due to take place on 19 April as the fourth round of the 2020 Formula One World Championship was also postponed.[131]

The Lingshui China Masters badminton tournament, scheduled to commence on 25 February to 1 March 2020 was postponed to early May.[132]

China's 14th National Winter Games, originally scheduled for 16–26 February were also postponed.[133]

Beauty Pageants

Miss Universe China 2020 was originally scheduled to take place on 8 March 2020; however, on 21 February 2020, the Miss Universe China Organization announced that the pageant was cancelled and postponed to a later date due to the pandemic.[134] The new date was later announced as 9 December 2020.

Tourist attractions

Ridership was significantly reduced at 4 May Square Station of Qingdao Metro Line 3 during the epidemic.

On 21 January, the Wuhan Culture and Tourism Bureau postponed a tourism promotion activity to the city's citizens. All qualified citizens will be able to continue the qualification in the Bureau's next activity.[135] On 23 January, the Bureau announced the temporary closing of museums, memorials, public libraries and cultural centers in Wuhan from 23 January to 8 February.[136] All tour groups to and from Wuhan will be canceled.[137][138]

On 23 January, the City Administration of Dongcheng, Beijing cancelled temple fairs in Longtan and Temple of Earth, originally scheduled for 25 January.[139] The Beijing Culture and Tourism Bureau later announced cancellations of all major events including temple fairs.[140] The tourist attractions in Beijing[141] and Tianjin,[142] including the Forbidden City and the National Maritime Museum closed their doors to the public from 24 January. On the evening of 23 January, the Palace Museum decided to shut down from 25 January[143] and the West Lake in Hangzhou announced shutting all paid attractions and the Music Fountain down and suspended the services of all large-scale cruise ships starting the next day.[144] Since 24 January, many major attractions are shut down nationwide including the Sun Yat-sen Mausoleum in Nanjing,[145] Shanghai Disneyland, Pingyao Ancient City in Shanxi, Canton Tower in Guangdong, the Old Town of Lijiang, Yunnan and Mount Emei in Sichuan.[146]

Education

On 21 January 2020, the Ministry of Education (MoE) requested the education system to do a good job in the prevention and control of pneumonia caused by novel coronavirus infection. After that, private education providers including New Oriental, NewChannel and TAL Education,[147] education departments in Hubei,[148] Zhejiang,[149] Shenzhen,[150] and Shanghai University[151] cancelled all ongoing courses and postponed the new semester. On 27 January, MoE advised all higher education institutions to postpone the new spring semester with all local education departments to determine the starting time of the new semester for K-12 education and local colleges according to the decision of the local governments.[152] The Ministry of Human Resources and Social Security also decided to put the new semester off for all vocational education facilities.[153]

The National Education Examinations Authority canceled all IELTS, TOEFL and GRE exams scheduled for February. The decision was first made for tests to be held in Wuhan and extended to those in all parts of mainland China.[154][155][156] MoE also urged the Chinese students studying abroad to delay their travels. For those who need to go abroad, MoE advised them to arrive earlier in case of any kind of health check and to stop traveling if they have any signs of coughing and fever.[157]

On 28 January, the National Civil Service Bureau said that it would postpone the 2020 civil service recruitment examination, public selection and public selection interview time.[158]

Marriage registration

Civil Affairs authorities in Shanghai, Hangzhou, Guangzhou, Jinan, Ningbo and Gansu announced on 25 January that they would cancel the special arrangement of marriage registration scheduled for 2 February 2020 to avoid the spread of the epidemic and cross-infection caused by the gathering of people.[159][160][161][162] Later, on 30 January, the Ministry of Civil Affairs ordered to cancel marriage registrations on 2 February.[163]

Parliament sessions

A temporary hospital constructed in Wuhan in February

The outbreak made an impact on the National People's Congress (NPC), China's national parliament and many local parliaments. On 27 January, the Provincial People's Congress Standing Committee (PPCSC) of Yunnan announced to postpone local Lianghui sessions scheduled for early February which was followed by the PPCSC of Sichuan on 28 January. The local parliament sessions of cities including Hohhot, Chengdu, Jinan, Qingdao, Binzhou, Zhengzhou, Pingdingshan, Anyang, Hefei, Changzhou, Ningbo, Wenzhou, Zhoushan, Ganzhou, Shangluo, and Jiangjin were also put off.[164]

The NPC's Standing Committee will discuss on 24 February to decide whether to delay its March session or not.[165] The 10-day session in March is an annual gathering of about 3,000 delegates from all parts of China where the major laws are passed and key economic targets are unveiled. The potential delay will be the first time since 1995 when the NPC first adopted the schedule for the March session.[166] Willy Lam, a political analyst at the Chinese University of Hong Kong believed that the sessions may not only increase the risk of infections but also "post hostile and embarrassing questions to the top officials about the outbreak." He also believed that canceling the meetings would be possible although this never happened after the Cultural Revolution.[167]

Religion

The government of China, which upholds a policy of state atheism, used the COVID-19 coronavirus pandemic to continue its antireligious campaigns, demolishing Xiangbaishu Church in Yixing and removing a Christian Cross from the steeple of a church in Guiyang County.[168][169] In the Shandong, officials issued guidance forbidding online preaching, a vital way for churches to reach congregants amid both persecution and the spread of the virus.[168][169][unreliable source?]

Economic impact

In late January, economists predicted a V-shaped recovery. By March, it was much more uncertain.[170] Millions of workers were stranded far from their jobs while the workplaces were short-handed. The data for February 2020—the first full month after the virus became a major factor in January—saw official indicators of economic activity fell to record lows. The Caixin manufacturing index (PMI) fell to 35.7 in February from 50 in January, showing a deep contraction. The nation's non-manufacturing index sank even further to a record low of 29.6 in February from 54.1 in January 2020. According to The Wall Street Journal, "The factory index indicated contraction for most of 2019, hit by a trade war between the United States and China. It didn't cross back into expansion until late last year when trade tensions between the two sides eased."[171]

China's economic growth is expected to slow by up to 1.1 percentage in the first half of 2020 as economic activity is negatively affected by the new coronavirus outbreak, according to a Morgan Stanley study cited by Reuters.[172] But, on 1 February 2020, the People's Bank of China said that the impact of the epidemic on China's economy was temporary and the fundamentals of China's long-term positive and high-quality growth remained unchanged.[173]

Due to the outbreak, the Shanghai Stock Exchange and the Shenzhen Stock Exchange announced that with the approval of the China Securities Regulatory Commission, the Spring Festival holiday was extended to 2 February and trading will resume on 3 February.[174][175] Before that, on 23 January, the last trading day of shares before the Spring Festival, all three major stock indexes opened lower, creating a drop of about 3% and the Shanghai index fell below 3000.[176] On 2 February, the first trading day after the holiday, the three major indexes even set a record low opening of about 8%.[177] By the end of the day, the decline narrowed to about 7%, the Shenzhen index fell below 10,000 points, and a total of 3,177 stocks in the two markets fell.[178]

The People's Bank of China and the State Administration of Foreign Exchange announced that the inter-bank RMB foreign exchange market, the foreign-currency-to-market and the foreign-currency market will extend their holiday closed until 2 February 2020.[179] When the market opened on 3 February, the Renminbi declined against major foreign currencies. The central parity rate of the Renminbi against the US dollar opened at 6.9249, a drop of 373 basis points from the previous trading day.[180] It fell below the 7.00 than an hour after the opening,[181] and closed at 7.0257.[182]

The sale of new cars in China was affected by the outbreak. There was a 92% reduction on the volume of cars sold during the first two weeks of February 2020.[183] According to the sources of Automative News, Chinese policymakers had discussed the extension of subsidies for electric-vehicle purchases beyond this year to revive sales,[183] while also discussing reducing requirements for zero-emission vehicle shares of production.[184]

By 13 March, most business outside of Hubei was active again.[185] The Caixin PMI increased to 50 at the end of March.[186]

In Q1 2020, China GDP dropped by 6.8 percent, the first contraction since 1992.[187]

In May 2020, Chinese Premier Li Keqiang announced that, for the first time in history, the central government wouldn't set an economic growth target for 2020, with the economy having contracted by 6.8% compared to 2019 and China facing an "unpredictable" time. However, the government also stated an intention to create 9 million new urban jobs until the end of 2020.[188]

Unemployment

In January and February 2020, during the height of the epidemic in Wuhan, about 5 million people in China lost their jobs.[189] Many of China's nearly 300 million rural migrant workers have been stranded at home in inland provinces or trapped in Hubei province.[190][191]

By the end of March, as many as 80 million workers may have been unemployed, according to an estimate by economist Zhang Bin of the Chinese Academy of Social Sciences; this estimate included migrant workers and people in rural areas, whom the official statistics from Beijing do not take into account.[192]

Face mask shortage and production

People in Wuhan lining up in front of a drug store to buy surgical masks.
A notice at a supermarket in Beijing, which says each person can only buy a pack of surgical masks and a bottle of 84 disinfectant liquid a day.

In China, face masks have been used widely by the general public during the pandemic, and have been required in many locations.[193] As the epidemic accelerated, the mainland market saw a shortage of face masks due to the increased need from the public.[194] It was reported that Shanghai customers had to queue for nearly an hour to buy a pack of face masks which was sold out in another half an hour.[195] Some stores are hoarding, driving the prices up and other acts so the market regulator said that it will crack down on such acts.[196][197] The shortage will not be relieved until late February when most workers return from the New Year vacation according to Lei Limin, an expert in the industry.[198][needs update]

On 22 January 2020, Taobao, China's largest e-commerce platform owned by Alibaba Group said that all face masks on Taobao and Tmall would not be allowed to increase in price. The special subsidies would be provided to the retailers. Also, Alibaba Health's "urgent drug delivery" service would not be closed during the Spring Festival.[199] JD, another leading Chinese e-commerce platform said, "We are actively working to ensure supply and price stability from sources, storage and distribution, platform control and so on" and "while fully ensuring price stability for JD's own commodities, JD.com also exercised strict control over the commodities on JD's platform. Third-party vendors selling face masks are prohibited from raising prices. Once it is confirmed that the prices of third-party vendors have increased abnormally, JD will immediately remove the offending commodities from shelves and deal with the offending vendors accordingly."[200] The other major e-commerce platforms including Sunning.com and Pinduoduo also promised to keep the prices of health products stable.[201][202]

Figures from China Customs show that some 2.46 billion pieces of epidemic prevention and control materials had been imported between 24 January and 29 February, including 2.02 billion masks and 25.38 million items of protective clothing valued at 8.2 billion yuan ($1 billion). Press reported that the China Poly Group, together with other Chinese companies and state-owned enterprises, had an important role in scouring markets abroad to procure essential medical supplies and equipment for China.[203] Risland (formerly Country Garden) sourced 82 tonnes of supplies, which were subsequently airlifted to Wuhan.[204]

By March, China has been producing 100 million masks per day to meet the demand of medical staff and general public.[205]

Lockdown and curfew

Government-issued permit for Jintan residents. Jintan announced that each family should only have one member to be outdoor for shopping life necessities for every 2 days.

Ever since Hubei's lockdown, areas bordering Hubei including Yueyang in Hunan and Xinyang in Henan set up checkpoints on roads connecting to Hubei to monitor cars and people coming from Hubei.[206][207] Between 24 and 25 January, the local governments of Shanghai, Jiangsu, Hainan and other areas announced to quarantine passengers from "key areas" of Hubei for 14 days.[208][209] Chongqing also announced mandatory screening of every person who arrived from Wuhan since 1 January, and set up 3 treatment centers.[210]

Since 1 February, a curfew law that resembles that of Huanggang, Hubei, was put in place by the city of Wenzhou in Zhejiang, which is the second largest center after Hubei. Each local family can appoint one family member who may leave their house to purchase essential goods every two days.[211] Since 4 February Zhejiang's capital, Hangzhou, announced the closure of all of its villages, residential communities and work units to guests. Those who enter and exit these places must show valid identification papers. Non-residents and cars will be checked strictly.[needs update][212][213] On the same day, Yueqing, Ningbo, Zhengzhou, Linyi, Harbin, Nanjing, Xuzhou and Fuzhou began to take the same approach.[214] Zhumadian, Henan, announced that each family were only allowed to have one member leave the house to purchase essential goods every 5 days.[215]

Workers having their temperatures taken as they enter an industrial park in Shenzhen in March 2020

Factories were closed or reduced production for a few weeks. When they opened again, measures were implemented to reduce risk.[216][217] During the pandemic, Uyghur workers were sent to resume work.[218][219]

Many local governments implemented restrictions to control the outbreak, including keeping schools closed, cutting off villages, and restricting travel.[220][221] A smartphone-based health-tracking system was introduced in much of the country.[222]

On 2 April 2020, the government ordered a Hubei-like lockdown in Jia County, Henan, after a woman tested positive for the coronavirus. It is suspected that she may have been infected when she visited a hospital where three doctors tested positive for the virus, despite showing no symptoms.[223] In early May, restrictions were tightened in Harbin.[224]

In mid-July, Xinjiang province and its capital Ürümqi were locked down in the wake of the discovery of new cases in the city.[225][226]

Impact on greenhouse gas emissions

The slowdown in manufacturing, construction, transportation and overall economic activity created a temporary reduction by about a quarter in China's greenhouse gas emissions.[227]

Further outbreaks

On 9 April, a COVID-19 cluster was detected in Heilongjiang Province, which started with an asymptomatic patient returning from the United States and quarantining at home. The US CDC reported that the infections were initially spread through a shared elevator used at different times, and led to at least 71 cases by 22 April.[228] On 10 April, Tianshannet reported that there had been no newly confirmed cases of coronavirus in Xinjiang for the preceding 53 days and that there were no coronavirus patients in Xinjiang.[229]

As factories and other businesses reopened, extensive measures were put in place to avoid infection, including temperature checks, handwashing, disinfection, mask wearing, a mobile phone health app, avoiding public transportation, staggered lunches, physical distancing, contact tracing, and opening windows for ventilation. Rules vary by location, with different local governments enforcing different measures.[230]

In June 2020, an outbreak with 45 people testing positive at Xinfadi Market in Beijing caused some alarm.[231] Authorities closed the market and nearby schools; eleven neighborhoods in the Fengtai District started requiring temperature checks and were closed to visitors.[232] By this time, public health technology included special leaf blower backpacks designed to vent hot air onto outdoor surfaces.[233] By the evening of 23 June, Chinese Vice Premier Sun Chunlan declared that the situation has been basically brought under control while China's traffic authorities vowed to strictly guard traffic out of Beijing: those with abnormal health QR codes or without recently-taken negative nucleic acid test proof will not be allowed to take public transportation or drive out of the capital; and started a new regulation to that effect, while 13 new cases were detected on that morning.[citation needed]

On 26 July, China saw its highest number of daily cases since March, mostly from outbreaks in Xinjiang and Liaoning.[42] with 61 new cases, up from 46 cases a day earlier,[234] This increased to 127 daily COVID cases on July 30.[235] The daily reported cases subsequently went down, to 16 on August 23.[236]

On October 11, officials in Qingdao urged to carry out contact tracing and mass testing after it 12 new cases were found connected to the Qingdao Chest Hospital. On October 12, it is announced that Qingdao will test all 9 million of its residents. [237]

In October, 137 asymptomatic cases were detected in Kashgar, Xinjiang and were linked to a garment factory.[238][239]

Response by the Central Government

Safeguarding 2020 Chunyun

Pictographic world map comparing the largest periodic human migration events [240]

Chunyun, known to host the world's largest human migration, is a 40-day period when people return home to spend the Chinese New Year with their families.[241] In 2020, it started on 10 January and was to end on 18 February. Before the coronavirus outbreak, the government estimated 3 billion trips to be made during the period.[242]

On 9 January, Wan Xiangdong, the Chief Pilot of the Civil Aviation Administration, said that the agency would keep a close watch on the outbreak and strengthen ties with the health authorities. Li Wenxin, the Deputy general manager of China Railway said that the railway authorities were paying attention to the situation and making sure to prevent the spread of the epidemic through the railway stations and trains and safeguard the health and safety of passengers. Wang Yang, the Chief Engineer of the Ministry of Transport said that the ministry would carry disinfection monitoring and protection measures out in areas with heavy passenger traffic including transport hubs, passenger stations, and cargo terminal factory stations.[243]

On 22 January, as the coronavirus outbreak escalated, Li Bin, the deputy president of NHC warned that Chunyun might speed the transmission of the new virus up. Li repeated the government's previous advice to the people, that is, stay away from Wuhan. George F. Gao, the Director of China CDC also admitted to the conference that the virus can transmit between humans and there were also cases of community-acquired infections. The Chinese health officials also promised to take strict measures to stop the virus from spreading and release information as soon as possible.[244]

Epidemic control efforts

Body temperature screening at the entrance of Beijing Subway
People in Guangzhou wearing facemasks

The NHC with the approval of the State Council announced 2019-nCoV-associated pneumonia as Category B Infectious Diseases with control measures of Class A infectious diseases as stipulated in The Law on the Prevention and Control of Infectious Diseases.[245] From 20 January, the NHC will publish daily data on confirmed and suspected cases in all provinces of the country (Including during the Spring Festival) until no longer necessary.[246] On 20 January, NHC set up a working group up to deal with pneumonia caused by novel coronavirus infection.[247] On 28 January, NHC sent seven supervision teams to seven provinces and cities in Beijing, Hebei, Shanghai, Henan, Hunan, Guangdong, and Sichuan to supervise the epidemic control measures in the areas.[248] China normally makes 10 million face masks per day, about half of the world production. During the crisis, 2,500 factories were converted to produce 116 million daily.[249] Delivery drones, artificial intelligence, and facial recognition systems has also been used to help fight the epidemic.[250][251]

In February 2020, Major General Chen Wei, virologist and medical doctor of the Chinese army, and her team were sent to the Wuhan Institute of Virology in order to develop a vaccine against COVID-19.[252][253][254]

In late March, the government severely restricted international travel, limiting the number of flights to the country and denying entry to foreigners with previously issued visas and residence permits.[255][256][257][258] The government also took steps to discourage Chinese people from returning from overseas.[258] These restrictions were partially relaxed in September,[259] then made stricter again in November.[260][261]

The end of March saw a new Hubei-style lockdown implemented in Jia County, Henan.[262] The lockdown was in response to a confirmed case of coronavirus by a woman who received treatment at a hospital where three doctors have now tested positive for the coronavirus, despite showing no symptoms.[263]

In June 2020, following an outbreak in Beijing tied to Xinfadi Wholesale Market, the Chinese government suspended meat imports from specific facilities in Germany and the United States that had also seen outbreaks.[264]

Financial supports and tax reduction

On 1 February, the People's Bank of China and other five departments jointly issued the notice on further strengthening financial support for the prevention and control of the epidemic of pneumonia caused by novel coronavirus infection, stating that relevant financial services will be further strengthened during the period affected by the epidemic. For those who are temporarily affected by the epidemic and facing difficulties, the document requires financial institutions to tilt their credit policies appropriately, flexibly adjust their loan repayment arrangements and reasonably postpone the repayment period. Those overdue due to inconvenient repayment during the epidemic period shall not be included in the record of credit investigation and breach of trust.[265]

On 30 January, the Ministry of Finance and NHC issued a notice on the financial guarantee policy for the prevention and control of the new type of pneumonia. The Central Government shall grant a subsidy of 300 yuan per person per day to those who are in direct contact with the cases to be investigated or confirmed who are involved in the diagnosis, treatment, nursing, hospital infection control, case specimen collection, and pathogen detection. For other medical personnel and epidemic prevention workers who take part in epidemic prevention and control, the Central Financial Department shall subsidize them at a rate of 200 yuan per person per day.[266]

The Ministry of Finance, the General Administration of Customs and the General Administration of Taxation issued a joint announcement that from 1 January to 31 March 2020, more preferential import tax policies will be implemented for imported materials used for epidemic prevention and control.[267]

Communist Party Politburo's leadership

Meetings on coronavirus outbreak

On 20 January, the Communist Party general secretary Xi Jinping ordered that great attention should be paid to prevention and control of the epidemic. The Party also vowed to guide people's opinions with intensive publicity strategies and interpretations of current policies to ensure social stability. Premier Li Keqiang urged relevant ministries and localities to take a highly responsible attitude towards the People's health and resolutely prevent the spread of the epidemic.[268][247] Premier Li Keqiang also called a meeting of the State Council's Executive Meeting and deployed the work of epidemic prevention and control.[269]

On 21 January, Premier Li urged protection and encouraged the health care workers. The National Healthcare Security Administration decided to adopt a special reimbursement policy for confirmed patients and temporarily bring relevant drugs and medical services into the reimbursement scope of medical insurance.[270] On 22 January, Vice Premier Sun Chunlan went to Wuhan to inspect the prevention and control of the epidemic.[271]

On 26 January, the first meeting of the Central Leading Group for the Response to the Epidemic of Pneumonia Caused by 2019-nCoV infection prioritized the provision of urgently needed medical and health forces, protective clothing and face masks for prevention and control in Hubei Province and Wuhan and attached importance to the transport of daily necessities for residents and relief supplies to Hubei. It urged the local governments to enhance epidemic control including cancelling meetings and events, strictly quarantining confirmed and suspected infection cases, extending the Chinese New Year holiday and supporting online office and teaching. The Central Government promised to crack down on hoarding and profiteering in materials for disease prevention and control. Public Finance at all levels should fully guarantee such funds as prevention and control of epidemic situations and treatment of the patients.[272]

Xi Jinping's absence

On 27 January, Chinese Premier Li Keqiang, entrusted by Party general secretary Xi Jinping according to Xinhua[273] arrived in Wuhan to inspect and guide the epidemic prevention and control work.[274][275] According to The Wall Street Journal, the appointment of Li who is considered a technocrat surprised some observers, given that he had been sidelined in recent years as Xi concentrated power and cultivated a populist ideological image. Some suggest that Xi was more at risk to the political fallout of the coronavirus while Li could be a convenient political scapegoat.[276] Li's visit to Wuhan earned high popularity on Chinese social media.[277] Xi Jinping said that he personally commanded the fight against the coronavirus outbreak when meeting with WHO director general in Beijing on 28 January, but according to a report by The Guardian, he has not made any public presence since then as the social media posts mocking Xi's absence were promptly deleted by the censors.[278][276]

Xi's first public appearance during the outbreak was at a residential community in Chaoyang, Beijing on 10 February.[279] Xinhua posted photos of Xi wearing a mask and said that the aim of Xi's visit was to learn about the situation of epidemic prevision and control at the grassroots level.[280] It was his first time to interact with the people since the outbreak after he paid a short visit to Yunnan during 19–21 January as a tradition that China's leaders observed to visit the smaller towns and villages before the Spring Festival. He was said to chair a meeting on 3 February by the state media, but no pictures or videos were released.[280] Xi also met Cambodian Prime Minister Hun Sen, the first foreign leader to visit China since the coronavirus outbreak on 5 February.[281]

On 10 March, Chinese Communist Party general secretary Xi Jinping visited Wuhan, over one month after Premier Li Keqiang's visit.[282][283]

Administrative supervision

Since the outbreak of the epidemic, a number of government officials have been publicly held accountable for their dereliction of duty in the epidemic prevention in 6 provinces.[284]

On 29 January, Director of Huanggang MHC Tang Zhihong failed to tell the capacity of the local hospitals including how many patients that they could handle, how many could be hospitalized and how many patients could be tested each day when asked about these questions despite being an administrator of the local hospitals.[285] A day later, the Party Committee of Huanggang proposed a removal of Tang from the post. On 1 February, according to the Mayor of Huanggang named Qui Lixin, the city authority disciplined 337 of its officials and removed 6 cadres who caused disadvantages to the epidemic prevention.[286][287]

On 2 February, Zhang Cong, Party Secretary of Xuanhua, Hebei was admonished. Zhang Guoqing, Deputy Party Secretary of Xuanhua and Guo Xiaoyi, the political commissar of the local police were given disciplinary actions by the Party.[288][289] On the same day, February, Xiangshui, Jiangsu reported three cases of misconduct. The cases were associated with illegal disclosure of personal data and dereliction of duty. Party secretary, Zhang Changyue and deputy director Gu Bing of the Zhangji Health Center and the director of the Xiangshui CDC were removed or disciplined.[290]

Tang Hu, the director of the Health Bureau of the Nanhu New District in Yueyang, Hunan Province was suspended. Cai Junfeng, the deputy director of the Lengshuijiang Municipal Committee and Yang Wen, the deputy director of the municipal government office are suspended. He Yong, the deputy secretary of the Gutang Party Committee and township chief was suspended.[289]

On 4 February, Zhang Qin, the vice president of the Hubei Red Cross, was removed from his post while Gao Qin and Chen Bo of the Hubei Red Cross were given a warning.[291] The deputy director of the Wuhan Municipal Bureau of Statistics, Xia Guohua was also removed from his post. The Secretary and Director of the Leading Party Group of the Wuhan Municipal Development and Reform Commission, the Secretary and Director of the Leading Party Group of the Wuhan Municipal Bureau of Statistics, Meng Wukang and the deputy director of the General Office of the Wuhan Municipal Government, Huang Zhitong are admonished.[292]

Leaders of the Shanghai Municipal Government mourning in front of the government building

On 15 February, Qiushi magazine documented a 7 January order by Xi Jinping, regarding the COVID-19 outbreak at a Politburo Standing Committee meeting.[293] However, a record of that same meeting released beforehand shows that there was zero mention of the epidemic throughout.[294][295]

National mourning

On 3 April, the Chinese government declared 4 April, the Qingming Festival of 2020, a national day of mourning for those who lost their lives in the coronavirus pandemic. At 10 a.m., people were asked to observe three minutes of silence while sirens and vehicle horns blasted out. Chinese flags were flown at half-mast across the country and at embassies overseas. All public entertainment were halted for the day.[296]

Planning of other government activities

China still plans to undertake its census in November 2020, but preparations have been affected due to COVID-19 and are being reviewed.[297]

International and regional relations

Information sharing

China's scientists have been praised for rapidly sharing information on the virus to the international community,[298][299] and leading some of the world's research on the disease.[300] Foreign Ministry spokesman Geng Shuang said on 21 January that the Chinese authorities would share information of the epidemic "with the WHO, relevant nations and China's Hong Kong, Macao and Taiwan regions in a timely manner including the genome sequence of the new coronavirus."[301] During the sidelines of the World Economic Forum, Germany's health minister Jens Spahn praised China for its improved transparency since 2003.[302] US officials and WHO also praised China for sharing data about the epidemic and keeping transparent. The US experts had been invited by China's NHC.[303] On 23 January, WHO director-general, Tedros Adhanom and WHO regional director for the Western Pacific, Takeshi Kasai arrived in Beijing to discuss the new coronavirus outbreak with the Chinese authorities and health experts.[304] China agreed on 28 January that WHO would send international experts to China.[305]

John Mackenzie, a member of the World Health Organization's emergency committee criticized China for being too slow to share all of the infected cases, especially during major political meetings in Wuhan after Tedros Adhanom praised China for helping "prevent the spread of coronavirus to the other countries."[306] US President Donald Trump said that China was "very secretive and that's unfortunate" regarding the information on the pandemic.[307] Yanzhong Huang, a health expert at Seton Hall University, said that China could have been more forceful and "when there was a cover-up and there was inaction".[308]

A number of other countries' governments have called for an international examination of the virus's origin and spread.[309][310]

Evacuations

Multiple countries evacuated or are trying to evacuate their citizens from Wuhan including South Korea, Japan, the US, the UK, Kazakhstan, Germany, Spain, Canada, Russia, the Netherlands, Australia, New Zealand, Indonesia, France, Switzerland and Thailand.[311] Korean media Channel A said that China asked the evacuation flights to arrive in the evening and leave Wuhan in the next morning so the evacuation would not be seen by the public.[312] According to BBC, any Chinese national, even with a UK citizenship is not allowed to be evacuated by the UK.[313]

Taiwan

After initially refusing to allow Taiwanese citizens to evacuate due to the One-China policy,[314] the Chinese government eventually allowed Taiwan to evacuate its nationals from Wuhan with the assistance of the local Taiwan Affairs Office.[315] There were around 500 Taiwanese trapped in Wuhan. The first flight to help them leave left Wuhan on 3 February.[316] All of them would be quarantined for two weeks after they enter Taiwan.[315]

The evacuation halted after the first flight was found to carry an infected case. The Taiwanese government said that the person was not in the evacuation list and the most vulnerable were not included in the first flight. It also said that it was not prepared to take these people with a high risk of viral infections home.[317] Tsai Ing-wen criticized China's attempt to rule Taiwan out in WHO and said, "The information obtained by the WHO was obviously inaccurate ... and could cause the WHO to make mistakes in dealing with the global epidemic."[318] Premier Su Tseng-chang called for a government-to-government negotiation for the following arrangement of chapter flights[319] despite the fact that the cross-strait communication mechanism between governments had been suspended since 2016 when Tsai was elected president.[320]

The State Council's Taiwan Affairs Office urged the Taiwanese government to stop impeding the evacuation.[321] The office said that before the flight, all of the passengers signed a personal declaration claiming that they have no contact with any confirmed or suspected cases and promising to comply with quarantine measures after returning to the island. All of the passengers are checked for their temperature three times before the flight and showed no abnormality. The office said critically that the Taiwanese government first expressed appreciation before the flight, but changed its attitude after the flight.[322] Wuhan's Taiwan Affairs Office asked Taiwan for more details about the infected case as the basic descriptions of the patient including age and gender were not given as previously 17 cases in Taiwan. The office also said that the patient's close relatives were not at all informed of the viral infection.[323]

Immigration control

Since 25 January 2020, all passengers entering or exiting mainland China in Beijing, Shanghai and Guangdong must write a health declaration where the individual must answer whether they have been to Hubei Province. This declaration form can also be filled by using WeChat.[324]

The State Administration of Immigration promised that the border inspection agencies at all ports of entry and exit in China would continue to provide necessary facilities and services for Chinese citizens returning home.[325] On 25 January, the General Administration of Customs reactivated the health declaration system where people entering or exiting mainland China are asked to write a health declaration. Border control staff shall also cooperate in health and quarantine work such as body temperature monitoring, medical inspection, and medical check-up.[326] On 31 January, the Ministry of Foreign Affairs said that it was arranging charter flights to take the Chinese citizens from Hubei and Wuhan back to Wuhan 124, given the practical difficulties that they faced overseas.[327]

Hubei suspended the processing of applications from mainland Chinese residents for entry and exit of mainland China. For those with a valid visa to enter Hong Kong and Macao, but fail to enter the areas due to the coronavirus outbreak, the Chinese Immigration Administration will issue a new visa for free on request of the visa holder after the outbreak is lifted. Some of automated border clearance systems will be shut down according to the needs of the epidemic prevention. After Wuhan declared lockdown on 23 January, the Tianhe Airport and Hankou River ports have been without passengers for several days.[325]

Since 25 January,[328] Taiwan's government banned anyone from mainland China entering the country with[316] the ban extended to mainland Chinese overseas.[329] Although the global health officials advised not to apply travel restrictions on China, the US and Australia restricted all Chinese citizens from China from entering their borders.[330] Travel restrictions were announced by Russia, Japan, Pakistan and Italy and other countries despite China's criticism of border control.[331][332]

Since 28 January, the Hong Kong government began to cut traffic down connecting mainland China.[305][333] On the same day, China's National Immigration Administration announced that with immediate effect, the application of mainland residents' visa to Hong Kong and Macau would be suspended.[334] On 3 February, Hong Kong closed most of its border to mainland China.[335][336] However, Hong Kong nurses still held a strike, demanding a complete closure.[337]

International aid

China received funds and equipment in donations from a number of other countries to help fight the pandemic.[27][28][29][338] The United Front Work Department (UFWD) also coordinated diplomatic channels, state-owned businesses and Chinese diaspora community associations in urging overseas Chinese to buy masks and send them to China. Jorge Guajardo, Mexico's former ambassador to China, suggested that "China was evidently hiding the extent of a pandemic...while covertly securing PPE at low prices", according to Global News. Guajardo called it a "surreptitious" operation that left "the world naked with no supply of PPE."[339]

China has also sent tests, equipment, and experts to other countries to help fight the pandemic.[340][36] European Commissioner for Crisis Management Janez Lenarčič expressed gratitude and praised collaboration between the EU and China.[341] Chinese aid has also been well received in parts of Latin America and Africa.[342][343] Chinese-Americans also marshalled networks in China to obtain medical supplies.[344]

On 13 March, China sent medical supplies, including masks and respirators to Italy, together with a team of Chinese medical staff.[345][346] While the head of the Italian Red Cross, Francesco Rocca said these medical supplies were donated by the Chinese Red Cross,[347] there were other sources that said that these were paid products and services.[348][349] Chinese billionaire and Alibaba co-founder Jack Ma also donated 500,000 masks and other medical supplies, which landed at Liege Airport in Belgium on 13 March and then sent to Italy.[346][350] Italian Prime Minister Conte thanked China for its support and assistance.[351] A former Mexican ambassador Jorge Guajardo said that masks sent to China in January and February were being sold back to Mexico at 20 to 30 times the price.[339]

A U.S. congressional report released in April concluded that "the Chinese government may selectively release some medical supplies for overseas delivery, with designated countries selected, according to political calculations."[339]

On 18 May 2020, the Chinese government pledged US$2 billion to help other countries with fighting COVID-19 and other development.[309]

Problems with equipment

Officials in Spain, Turkey, and the Netherlands have rejected Chinese-made equipment for being defective.[352] The Dutch Ministry of Health announced it had recalled 600,000 face masks which were made in China.[353][352] The Spanish government said they bought thousands of test kits to combat the virus, but later revealed that almost 60,000 did not produce accurate results. The Chinese embassy in Spain said that the company that made the kits was unlicensed, and that these kits were separate from the ones donated by the Chinese government.[352] The government of the United Kingdom paid two companies in China at least $20 million for test kits later found to be faulty.[354][355]

Discrimination

Fear, regional discrimination in China, and racial discrimination within and beyond China increased with the growing number of reported cases of infections despite calls for stopping the discrimination by many governments.[30][356] Some rumors circulated across Chinese social media, along with endorsements and counter-rumor efforts by media and governments.[357][358] The Chinese government has worked to censor and counter reporting and criticism about the crisis and portray the official response to the outbreak in a positive light. They have also provided humanitarian assistance to other countries dealing with the virus.[34][359][36] News outlets have reported concerns that the Chinese government has deliberately under-reported the extent of infections and deaths.[37][38][39]

Hubei residents

Although there has been support from Chinese online towards those in virus-stricken areas,[360] instances of regional discrimination have also arisen.[30] According to World Journal, there have been instances of Wuhan natives in other provinces being turned away from hotels, having their ID numbers, home addresses and telephone numbers deliberately leaked online or dealing with harassing phone calls from strangers. Some places also reportedly had signs saying "people from Wuhan and cars from Hubei are not welcomed here."[361] Numerous hotels, and guest houses refused entry to residents of Wuhan or kicked out residents of Hubei.[362] Multiple hotels purportedly refused a Wuhan tour guide to check in after she returned to Hangzhou from Singapore with one of them calling the police to give her a health check and asking the police to quarantine her. Amidst these incidents, various cities and prefectures outside of Hubei adopted resettlement measures for Hubei people in their region such as designated hotel accommodation for visitors from the province.[363] In Zhengding, Jingxing and Luquan of Shijiazhuang City, the local governments rewarded anyone who reported those who had been to Wuhan, but not recorded in official documents at least 1,000 yuan RMB. In Meizhou, residents reporting people entering from Hunan were awarded with 30 face masks.[364]

It was reported that on a scheduled 27 January China Southern Airlines flight from Nagoya to Shanghai, some Shanghainese travellers refused to board with 16 others from Wuhan. Two of the Wuhan travellers were unable to board due to a fever while the Shanghainese on the spot alleged that the others had taken medicine to bypass the temperature check.[361] One of the Wuhan tourists protested on Weibo, "are they really my countrymen?", to which a Shanghai tourist who was purportedly at the scene replied that they did it to protect Shanghai from the virus.[363] Many netizens criticized the Wuhan tourists for travelling with a fever, although some also called for understanding and for Shanghainese not to regionally discriminate.[365][366]

Outside mainland China

Mainland Chinese overseas have experienced discrimination and anti-Chinese sentiment during the coronavirus outbreak.[367] In Hong Kong, a Japanese noodle restaurant said it would refuse mainland Chinese customers and said on Facebook, "We want to live longer. We want to safeguard local customers. Please excuse us."[368] In Japan, a sweet shop in Hakone and a ramen restaurant in Sapporo posted "no Chinese" signs outside.[369] Similar events were reported in South Korea.[367] The French newspaper Courrier Picard published two articles titled "Yellow Alert" and "New Yellow Peril?" which may allude to historical racist tropes about the Chinese.[369]

Beyond only Chinese, Asians in general are affected by anti-Chinese sentiment. Disinformation about Asian food and Asian communities have circulated, and videos showing Asian people eating bats have gone viral along with dehumanizing comments and implications of the cause of the virus outbreak.[370]

Targeting of Africans

The City of Guangzhou issued an open letter after cases of discrimination of African nationals appeared, mentioning zero tolerance on racism and sexism.

Guangzhou has a sizeable community of black Africans including migrants, who were allegedly singled out by local authories during the COVID-19 pandemic. According to Chinese state media, five Nigerian men who had tested positive for COVID-19 broke quarantine and infected others, which triggered suspicion and anti-foreigner sentiment. Africans were forced to undergo coronavirus testing and quarantine, regardless of their travel history, symptoms, or contact with known patients.[371] Some restaurants – including a branch of McDonald's[372] – reportedly refused to service Africans, while landlords and hotels targeted Africans for eviction resulting in some becoming homeless.[373][374] Xinhua reported 111 Africans tested positive for the coronavirus in Guangzhou out of a total of 4,553 tested, also saying that 19 of the cases were imported from unspecified countries.[375][376][377]

It has been noted that public sensitivity in China to racism, particularly to Africans, has been low with little education against racism or use of political correctness, while government censors appear to tolerate racism online. In the preceding few years, many Chinese believed that foreigners have been given extra benefits, leading to concerns about unfairness and inequality.[376] Many Chinese internet users soon posted racist comments, including calls for all Africans to be deported, while a cartoon depicting foreigners as different types of trash to be sorted through went viral on social media.[378]

Local media in African countries were the first to report on the issue, while Beijing initially attempted to deny such reports as rumors and misunderstandings spread by Western media. As further incidents of Africans being targeted were shared on social media, the United States Consulate General in Guangzhou warned African Americans to avoid travel to Guangzhou. The governments of Nigeria, Ghana, South Africa, Kenya, Uganda and the African Union placed diplomatic pressure on Beijing over the incidents, and group of African ambassadors in Beijing wrote a letter of complaint to the Chinese government about the stigmatisation and discrimination being faced by Africans.[376] The Nigerian Speaker of the House Femi Gbajabiamila showed one of the social media videos to the Chinese ambassador while the Ghanaian Minister for Foreign Affairs Shirley Ayorkor Botchway described the incidents as inhumane treatment.[378]

In response to the diplomatic pressure and media coverage, the Chinese Ministry of Foreign Affairs issued an official statement on 12 April 2020 that the Chinese government attached great importance to the life and health of foreign nationals in China, has zero tolerance for discrimination, and treats all foreigners equally.[379][380] In a regular press conference on the following day, Ministry of Foreign Affairs spokesperson Zhao Lijian added that a series of new measures were adopted in Guangzhou to address the concerns of some African citizens and avoid racist and discrimination problems, while saying the United States was "making unwarranted allegations in an attempt to sow discords and stoke troubles".[381][382] China's state media later described the incidents as "small rifts", while officials made PR visits to quarantined Africans with flowers and food accompanied by television cameras, and Chinese envoys have continued to reassure their African counterparts that they would correct the misunderstandings and establish an effective communication mechanism with African Consulates-General in Guangzhou.[383][384][385]

Controversies and criticism

Censorship and police responses

A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December.[386] The early response by city authorities was accused of prioritising a control of information on the outbreak. A group of eight medical personnel, including Li Wenliang, an ophthalmologist from Wuhan Central Hospital, who in late December posted warnings on a new coronavirus strain akin to SARS, were warned by Wuhan police for "spreading rumours" for likening it to SARS.[387][388]

By the time China had informed the World Health Organization of the new coronavirus on 31 December 2019, Nicholas Kristof commented that the government was still keeping its own citizens in the dark in an opinion published on The New York Times.[389] While by a number of measures, China's initial handling of the crisis was an improvement in relation to the SARS response in 2003, local officials in Wuhan covered up and downplayed the initial discovery and severity of this outbreak. This has been attributed to the censorship institutional structure of the country's press and Internet, with Jude Blanchette of the Center for Strategic and International Studies quoted stating "under Xi Jinping, the inclination to suppress has become endemic and, in this case, contributed to a prolonged period of inaction that allowed the virus to spread".[390][391][392] William Summers, a Yale University professor of medicine, told Undark Magazine though that such silencing and downplaying tactics are not unique to China, and seems to be standard operating procedure worldwide.[393]

On 20 January, Xi Jinping made his first public remark on the outbreak and spoke of the need for the timely release of information.[394] Chinese premier Li Keqiang also urged efforts to prevent and control the epidemic.[395] One day later, the CPC Central Political and Legal Affairs Commission, the most powerful political organ in China overseeing legal enforcement and the police, wrote "self-deception will only make the epidemic worse and turn a natural disaster that was controllable into a man-made disaster at great cost," and "only openness can minimise panic to the greatest extent." The commission then added, "anyone who deliberately delays and hides the reporting of cases out of self-interest will be nailed on a pillar of shame for eternity."[396][397] Also on the same day, Xi Jinping instructed authorities to strengthen the guidance of public opinions, language which some view as a call for censorship after commentators on social media became increasingly pointedly critical and angry at the government due to the epidemic. Some view this as contradictory to the calls for openness that the central government had already declared.[398]

As part of the central government's bifurcated approach to diffuse discontent, while the propaganda machinery was going into "overdrive...to protect [Xi Jinping's] reputation", citizens were permitted to criticise local officials so long as they did not question the basic legitimacy of the party.[399] The Cyberspace Administration (CAC) declared its intent to foster a good online atmosphere, with CAC notices sent to video platforms encouraging them to not to push any negative story, and not to conduct non-official livestreaming on the virus.[400] Censorship has been observed being applied on news articles and social media posts deemed to hold negative tones about the coronavirus and the governmental response, including posts mocking Xi Jinping for not visiting areas of the epidemic,[278] an article that predicted negative effects of the epidemic on the economy, and calls to remove local government officials.[390][401][402][403] Chinese citizens have reportedly used innovative methods to avoid censorship to express anger about how government officials have handled the initial outbreak response, such as using the word 'Trump' to refer to Xi Jinping, or 'Chernobyl' to refer to the outbreak as a whole.[404] Younger individuals have also been creating digital archives of media concerning the epidemic – which is prone to deletion by censors – and posting them on the exterior web.[405] While censorship had been briefly relaxed giving a "window of about two weeks in which Chinese journalists were able to publish hard-hitting stories exposing the mishandling of the novel coronavirus by officials", since then private news outlets were reportedly required to use "planned and controlled publicity" with the authorities' consent.[406][404][403]

On 30 January, China's Supreme Court, delivered a rare rebuke against the country's police forces, calling the "unreasonably harsh crackdown on online rumours" as undermining public trust. In what has been called a "highly unusual criticism" by observers, supreme court judge Tang Xinghua said that if police had been lenient against rumours and allowed the public to have taken heed of them, an earlier adoption of "measures like wearing masks, strictly disinfecting and avoiding wildlife markets" might have been useful in countering the spread of the epidemic.[407] The Human Rights Watch reported that "there is considerable misinformation on Chinese social media and authorities have legitimate reasons to counter false information that can cause public panic," but also noted censorship by the authorities on social media posted by families of infected people who were potentially seeking help as well as by people living in cordoned cities who were documenting their daily lives amidst the lockdown.[408]

Journalists in China have worked to publish information about the outbreak. The government initially allowed greater leeway than usual to reporters investigating the crisis, but then cracked down with greater censorship than usual.[34] On 12 March, ten Tibetans were arrested for breaching control measures meant to prevent the spread of the virus. Dolma Kyab, a Tibetan writer and teacher, told Radio Free Asia that "the Chinese government is only using coronavirus as a convenient excuse to infringe on the human rights of Tibetans".[409]

On 19 February 2020, China announced the revoking of the press credentials of three Wall Street Journal reporters based in Beijing. China accused the “Wall Street Journal” of failing to apologize for publishing articles that slandered China's efforts to fight the COVID-19 pandemic, and failing to investigate and punish those responsible.[410]

Response to whistleblowers

Document issued by the Wuhan Police ordering Li Wenliang to stop "spreading rumors" about a possible 'SARS virus' dated 3 January.

On 18 December 2019, Ai Fen, director of the emergency department of Central Hospital of Wuhan came into contact with an unusual pulmonary infection from a delivery person of Huanan Seafood Wholesale Market. On 27 December, she received a second patient with similar symptoms, but who had no link to the wet market. In the afternoon of 30 December, upon seeing the words "SARS coronavirus, pseudomonas aeruginosa", Ai immediately reported to the hospital's public health department and infection department. She circled the word "SARS", and took an image of it and forwarded it to another doctor in Wuhan. From there it spread throughout medical circles in Wuhan, and reached Li Wenliang, an ophthalmologist at the hospital.[411] On the afternoon of the same day, Li sent a warning to former classmates over WeChat which was reposted widely.[412] In an interview with Renwu magazine, Ai said she was reprimanded after alerting her superiors and colleagues of the SARS-like virus in December. Li Wenliang would later be canonised on the internet as a heroic whistleblower, and Ai would be lauded as the one who provided the whistle.[411]

On 1 January, eight people were summoned for talks by Wuhan police for their claim that there were SARS cases in Wuhan.[8] Li Wenliang said he didn't know whether he was one of them or not. According to Wang Gaofei, Weibo's CEO, the eight people are all doctors at Wuhan hospitals who "are still fighting at the frontline".[84] The Supreme Court defended these doctors and pointed out in a WeChat article on 28 January,[84] delay and opacity in public information are the root of fake news and the information that is mostly factual and not subjectively malicious and causes no objectively severe consequences should be tolerated.[413] On 29 January, the eight doctors were also praised by Zeng Guang, Chief Scientist at China CDC.[414][415] Hu Xijin, the editor of the Global Times, complained about the local governments' low tolerance of differing online opinions and believed this weakened checks-and-balances of government powers through news media.[8]

Death of Li Wenliang

After Li Wenliang was warned by Wuhan police, the doctor was diagnosed with the coronavirus infection and died from it on 7 February 2020. He was said to be dead on the evening of 6 February, although the hospital said that he was still under emergency treatment. People speculated that authorities were trying to censor the news. After his death, people mourned his death and criticized the government.[416] some of the trending hashtags on Weibo such as "Wuhan government owes Dr. Li Wenliang an apology" and "We want freedom of speech" became trending topics on Weibo until the posts were deleted by censors.[417][418][419][403][excessive citations] While media outlets were allowed to report his death, the nature of the doctor's censorship which produced widespread public anger in the aftermath, in what has been described as "one of the biggest outpourings of online criticism of the government in years," was not a topic that was permitted for coverage.[420]

A group of Chinese academics including Xu Zhangrun of Tsinghua University signed an open letter calling for the central government to issue an apology to Dr. Li and to protect freedom of speech.[421] Professor Zhou Lian of Renmin University has observed that the epidemic has "allowed more people to see the institutional factors behind the outbreak and the importance of freedom of speech".[422] After attempts to discourage the discussion on Dr. Li's death further escalated online anger, the central government has been accused of reportedly attempting to co-opt the incident by "cast[ing] Dr. Li's death as the nation's sacrifice – meaning, the Chinese Communist Party's own".[423] The Financial Times believed Li's story fitted the historical archetypes in China where incorruptible Confucian scholar who speaks truth to the emperor but is persecuted and ultimately dies for his honesty.[94]

Later in March, Wuhan police apologised to Li Wenliang's family after National Supervisory Commission admitted the conduct of local officials is inadequate and praised the whistleblower's effort on raising public awareness.[424][425]

Zhang Ouya's criticism

In January, Zhang Ouya, the Chief Journalist of Hubei Daily called for the removal of the current leaders of Hubei and Wuhan on Weibo. But, he was asked to remove his post and the newspaper that he worked for apologized to the Wuhan authorities, promising that they will publish only positive content from now on.[8] Mayor Zhou of Wuhan said to the state media "As a local government, I could not disclose information until I get information and authorization which was not understood at the time."[426] His argument which hinted at the Central Government's responsibility,[426] was refuted by China CDC. Chief Scientist Zeng Guang said to Chinese tabloid The Global Times that what the scientists said was "often only part of their decision-making" and praised the eight whistleblowers who were warned by the Wuhan authorities before the epidemic.[414]

Undercounting of cases and deaths

On 1 April, two United States officials said that China had deliberately concealed its cases and deaths according to a report by United States Intelligence Community. The officials asked not to be identified because the report is secret, and declined to detail its contents.[427][428] The sources stated that the Chinese central government does not know the extent of the outbreak because lower-level officials reported falsified statistics to avoid losing their positions. The CIA is currently investigating in China to assess the coronavirus totals.[429]

During the pandemic, no reports of cases of the coronavirus in Xinjiang prisons or of conditions in the Xinjiang re-education camps emerged. A former Xinjiang resident raised concerns about the potential spread of coronavirus in the re-education camps.[218]

As of late March, users of the social-media site Sina Weibo widely shared an undated photograph showing long lines at the Hankou funeral home in Wuhan.[430] According to Caixin Global, the Hankou funeral home was operating 19 hours a day.[431] Caixin also reported that there were a number of people who died with COVID-19 symptoms but were not tested and were thus excluded from the official case-tally. Some patients died of other diseases due to a lack of proper treatment when hospitals were overwhelmed dealing with those who had the coronavirus.[432] Some social-media users have used the numbers of urns returned to families and the number of cremations conducted in Wuhan to estimate a death toll in Wuhan of about 42,000 or 46,800, compared to an official toll of 2,548 people attributed to the virus in Wuhan as of 27 March.[431] There were 13,856 cremations in Wuhan in the fourth quarter of 2019, according to Bloomberg calculations based on data from the city's civil-affairs agency. That was 2,419 lower than in the fourth quarter of 2018.[432]

Health experts, United States intelligence officials, British scientists, and British government officials have expressed doubts about the accuracy of the figures provided by the Chinese government relating to the epidemic, raising concerns that the Beijing government has deliberately under-reported the extent of infections and deaths.[433][37][38][39] Chinese Premier Li Keqiang reported on 24 March 2020 that the spread of domestically transmitted epidemic has essentially stopped and the outbreak has been controlled in China.[434][weasel words][435][436][437]

Asymptomatic cases (people who tested positive but did not develop symptoms) were not counted as confirmed cases before 1 March.[438][439]

On 17 April 2020 the Wuhan government revised the number of COVID-19 deaths, accounting for deaths that occurred at home that went previously unreported, as well as for the subtraction of deaths that were previously double-counted[440] by different hospitals, resulting in a net increase of 1,290 reported deaths in the city.[4]

Investigations of origins of the virus

The central government has imposed restrictions on the publication of academic research regarding the origins of the coronavirus.[441] The directive issued by the Ministry of Education's science and technology department stated that "academic papers about tracing the origin of the virus must be strictly and tightly managed", requiring that such papers be vetted by a State Council task force. A Chinese researcher who spoke on condition of anonymity due to fear of retaliation said "I think it is a coordinated effort from (the) Chinese government to control (the) narrative, and paint it as if the outbreak did not originate in China. And I don't think they will really tolerate any objective study to investigate the origination of this disease." The researcher said that such a move would obstruct important scientific research. Yanzhong Huang, a senior fellow for global health at the Washington-based Council on Foreign Relations, said "it is no surprise that the government seeks to control related scientific research so that the findings do not challenge its own narrative on the origin of the virus and the government response to the crisis".[442][443][444][445]

After interviewing virologist Shi Zhengli who had investigated bat coronaviruses including the latest one, journalist Gao Yu said "We learned later her institute finished gene-sequencing and related tests as early as January 2 but was muzzled." Shi said that Yanyi Wang, Director of the Wuhan Institute of Virology, had ordered staff not to disclose information on the disease arguing that "inappropriate and inaccurate information was causing 'general panic'". Furthermore, Wang directed that "The National Health Commission 'unequivocally requires that any tests, clinical data, test results, conclusions related to the epidemic shall not be posted on social media platforms, nor shall [it] be disclosed to any media outlets including government official media, nor shall [it] be disclosed to partner institutions'".[446]

The broad scientific consensus holds that SARS-CoV-2 originated in bats.[447] A member of Cabinet Office Briefing Rooms (COBRA) in the UK, tasked with dealing with crisis, has said that while British government intelligence does not dispute that the virus has a zoonotic origin, it also does not discount the idea of a leak from a Wuhan laboratory, saying that "Perhaps it is no coincidence that there is that laboratory in Wuhan" (the Wuhan Institute of Virology).[448] On 15 April 2020, US President Donald Trump announced that the US government was investigating whether the virus spread from the laboratory.[447]

Propaganda

Statements issued by Xi Jinping on 3 February declared the need for an emphasis by state media on "telling the moving stories of how [people] on the front line are preventing and fighting the virus" as a priority of coverage, while top official Zhang Xiaoguo said that his department would "treat propaganda regarding the control and prevention measures of the virus as its top priority".[404][403] For instance, state media organisations People's Daily and Global Times, along with deputy director of information Zhao Lijian from the Ministry of Foreign Affairs, have been observed to be publishing effusive praise on Beijing's response to the epidemic,[449] such as extensive coverage of the accelerated construction of the new hospitals in Wuhan (which Zhao said was completed in 16 hours),[8][450] the lock down of Wuhan with its population of 11 million, and the "unprecedented" quarantine of Hubei province. Though such efforts had a questionable effect on the epidemic, as the new hospitals were operating at under half-capacity due to shortages of beds and medical resources[451][452] while the lock down of Wuhan came too late to be effective as millions had left, the Financial Times and others noted that such widely publicised actions were a "PR coup" showing that the "overbearing, centralized government" of China was particularly suited to dealing with the outbreak,[453][391][454] creating the impression as if Beijing had directly intervened at Xi Jinping's request.[455][456][457][390][excessive citations]

Observers have warned that while "admiration of the front-line medical workers is widespread and sincere," the state media should also be highlighting the reality that many of those workers "lack protective gear" and that over 3000 have been infected since the outbreak so that media attention may bring them public support to obtain some much needed equipment. The New York Times has noted that such government propaganda attempts to control the narrative has been viewed with distrust among the younger individuals, who unlike older people depend less on state media and instead have sought "firsthand info and in-depth media studies concerning the epidemic on the web", suggesting that the central government was out of touch with the younger population.[405]

Outlets such as Politico and Foreign Policy have reported that China's efforts to send aid to virus-stricken countries are part of a propaganda push for global influence.[458][459] The European Union's diplomatic service, the European External Action Service (EEAS) has fought back against propaganda highlighting China's role in providing medical supplies to Italy, pointing out that France and Germany combined had provided more masks to Italy than China. The EEAS also noted that China's "state media and government officials promote not proven theories about the origin of Covid-19" while China state media coverage highlighted "displays of gratitude by some European leaders in response to Chinese aid".[460] China has been accused of opportunitism during the pandemic, alongside their donations and exports of faulty medical equipment to EU nations hardest hit by the virus, as their disinformation campaign "reputedly bid to denigrate Europe’s responses to cast its own in a more favorable light", such as on 12 April 2020 when the Chinese embassy in Paris published an article titled "Restoring distorted facts – Observations of a Chinese diplomat posted to Paris" claiming that careworkers in Western nursing homes had abandoned their jobs leaving residents to die.[461] The EEAS had toned down their report by omitting details of China's state sponsored disinformation campaign, which in turn led to allegations that the EEAS had bowed to pressure from China, as China reportedly threatened to withhold the shipment of medical supplies if the original report was released.[462]

Hubei and Wuhan governments

The exodus from Wuhan before the lockdown resulted in angry responses on Sina Weibo from the residents in the other cities who are concerned that it could result in the spreading of the novel coronavirus to their cities. Some in Wuhan are concerned with the availability of provisions and especially medical supplies during the lockdown.[84][463]

The World Health Organization called the Wuhan lockdown unprecedented and said that it showed how committed that the authorities are to contain a viral breakout. Later WHO clarified that the move is not a recommendation that WHO made and the authorities have to wait and see how effective that it is.[464] The WHO separately stated that the possibility of locking an entire city down like this is new to science.[465]

The CSI 300 Index, an aggregate measure of the top 300 stocks in the Shanghai and Shenzhen stock exchanges, dropped almost 3% on 23 January 2020, the biggest single-day loss in almost 9 months after the Wuhan lockdown was announced as the investors that are spooked by the drastic measure sought a safe haven for their investments.[466]

The unprecedented scale of this lockdown generated controversy and at least one expert criticized this measure as "risky business" that "could very easily backfire" by forcing otherwise healthy people in Wuhan to stay in close conditions with infected people. Drawing a cordon sanitaire around a city of 11 million people raises inevitable ethical concerns. It also drew comparisons to the lockdown of the poor West Point neighborhood in Liberia during the 2014 ebola outbreak which was lifted after ten days.[467][468]

The lockdown caused panic in the city of Wuhan and many have expressed concern about the city's ability to cope with the outbreak. It remains unknown whether the large costs of this measure, both financially and in terms of personal liberty will translate to effective infection control.[465] A medical historian named Howard Markel argued that the Chinese government "may now be overreacting, imposing an unjustifiable burden on the population" and said that "incremental restrictions, enforced steadily and transparently tended to work far better than draconian measures."[469] Others such as Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases defended the intent behind the lockdowns, citing that the lockdowns bought the world a "delay to essentially prepare better." A mathematical epidemiologist named Gerardo Chowell of Georgia State University stated that based on mathematical modelling, "containment strategies implemented in China are successfully reducing transmission."[470]

Nonetheless, after northern Italy became a new hotspot of the outbreak in late February, the Italian government enacted what has been called a "Wuhan-style lockdown" by quarantining nearly a dozen towns of 50,000 people in the provinces of Lombardy and Veneto.[471] Iran, another developing hotspot for the coronavirus as of 25 February came under calls to assume similar lockdown procedures as China and Italy. The security experts such as Gal Luft of the Institute for the Analysis of Global Security in Washington said that "The best way for Iran to deal with the disease is to do precisely what China did – quarantine." and "If Wuhan with its 11 million population can be under quarantine so can Tehran with its 8 million"[472]

Frozen case number

The early cases surrounding an animal market may suggest animal-to-human transmission, more evidence surfaced to support the human-to-human transmission of the virus.[58] However, despite the expert-led investigation and early signs of human-to-human transmission including a hospital-acquired infection (nosocomial) case confirmed on 10 January according to Caixin,[473] the local government of Wuhan denied any case of nosocomial infection and kept saying that "there was no clear sign of human-to-human transmission" until 15 January when Wuhan's Municipal Health Commission (MHC) said on its website that "the result of present investigation shows no clear evidence of human-to-human transmission, but this does not rule out the possibility of such a transmission. The risk of continuous human-to-human transmission is low."[474]

The reported case number froze at 41 during the Hubei Lianghui and Wuhan Lianghui, the local parliament sessions between 6–17 January, which the local authorities of Hubei and Wuhan said to be due to the lack of PCR test kits for the new virus. But, Caixin said that the other sequencing techniques can be used for diagnosis which usually takes two days without any need of PCR kits.[475] Meanwhile, an Imperial College group[476][477] and a Hong Kong University group[478] both estimated over 1,000 cases in Wuhan as cases were being exported and confirmed overseas. Perceived discrepancies in the official Chinese data for the number of cases left many netizens doubtful,[479] with some mockingly labeling the virus "patriotic" for its appearance of mainly infecting the Chinese after they left the country.[480][481][482]

"Manageable and preventable"

On 20 January, the Chinese National Health Commission announced that human-to-human transmission of the coronavirus had already occurred.[483]

Also 20 January, the number of reported new cases soared to 136 as major mainland cities including Beijing and Shenzhen reported their first cases.[484][485] Only the Wuhan authorities stopped saying that the virus had a limited ability to transmit between humans.[486] On the same day, the city formed a specialized command for epidemic control (CEC) to upgrade measures to cope with the epidemic including enhanced protection over the medical workers[487] and free treatment for all patients at the fever clinics.[488] On the evening of that day, Zhong Nanshan, one of the NHC experts sent to Wuhan who was well known for fighting against SARS in 2003, exemplified human-to-human transmission of the new virus with a cluster of 14 hospital-acquired infections in Wuhan and two familial clusters in Guangdong.[486]

However, the National Health Commission still insisted that the epidemic should be "manageable and preventable." At that time, the BBC said that not much public attention was drawn to the virus outbreak.[473] On 19 January, despite the virus outbreak, over 40,000 Wuhan families joined an annual potluck banquet[489] which was a community tradition observed for over two decades to celebrate the Kitchen God Festival. A community leader told The Beijing News that "everything is normal now" when asked about the virus outbreak.[490] According to the community committee of Baibuting where the banquet was held as of 4 February, a block of the community had at least 10 confirmed cases of the coronavirus infection, plus over 30 highly suspicious cases, but the community hospital also said that the incidents of the coronavirus was lower than that in the other communities.[491]

Zhou Xianwang, the mayor of Wuhan who was widely criticized by the public and media due to slow responses[492] said to the state media CCTV that the banquet was organized by the local community which had a long history of self-governance. He said that the government was not precautious enough to stop it because it was believed that the virus only had a limited ability to transmit between the people.[493]

Controversial commentary

On 20 January, Guan Yi, a Hong Kong-based expert in SARS epidemiology told Caixin that the local government should not play on words about transmissibility and he hoped that we could learn from the 2003 SARS outbreak. He continued, "transmissibility, adaptability, incidence and virulence of the virus highly resemble those of SARS at the early stage [of the 2003 outbreak]".[494] Guan's team travelled to Wuhan on 21 January and returned to Hong Kong the next day. He observed that the "epidemiology experts and scientists do not seem to be welcomed in the city."[495] On 22 January, Wuhan was still "an open city" to the virus outbreak where most people did not wear a mask although NHC announced the coronavirus-associated pneumonia as a notifiable disease. He believed that a pandemic was unavoidable as the virus spread with the annual mass migration of the Spring Festival.[496][497]

The statements of Guan which were apparently different from that in most Chinese media became highly controversial as the journalists of state media reposted his statement of 15 January in which he opined that the disease was manageable, whilst also peddling old news that his lab had been fined by the Chinese authorities in 2005. Wang Duan, the Caixin journalist who conducted the interview described such behavior as "personal attacks" and complained that no expert came forward to refute what Guan said so far.[498]

26 January press meeting

Hubei Government's press meeting on 26 January was described as a "scene of a massive car crash" by BBC which led to widespread dissatisfaction. Despite the compulsory face mask law, Governor Wang Xiaodong did not wear a mask while the other two official hosts including Wuhan Mayor Zhou Xianwang and Provincial Party Secretary Bie Bixiong wore masks incorrectly. The Governor said Xiantao, a Hubei city was capable to produce 10.8 billion masks annually after he made two corrections for the number hinted by someone else's notes. The Governor admitted a severe shortage of medical supplies in Hubei while Mayor Zhou of Wuhan said that the shortage had been fully alleviated.[499]

Science community

On 29 January, the Ministry of Science and Technology issued a notice, urging the scientists "to write their papers on the land of the motherland, to use the results to fight the epidemic" and the scientists should not focus on publishing their papers until the epidemic prevention and control task is completed.[500] Duowei News believed this was aimed to respond to the academic conflict between Zhang Yongzhen's group from Fudan University which published the first genomic sequence of 2019-nCoV and the Gao Shan group from Nankai University which published an analysis[501] on the sequence without authorization from Zhang. Before the notice, Nankai and Fudan, two of China's top universities had a fight over the alleged academic misconduct related to the analysis published by the Gao Shan group.[502]

On 30 January, Wang Liming, a neuroscientist from Zhejiang University expressed anger on a Weibo post about George F. Gao's latest NEJM article.[503] Wang believed that the article indicated that the Chinese CDC had clear evidence of human-to-human transmission in early January and kept it secret until three weeks later. Although the post was soon deleted, China CDC came under the spotlight. China CDC had to respond on the next day that the research was a retrospective analysis of the 425 cases reported to CDC on 23 January.[504] Jennifer Zeis of NEJM's media Relations Department told The Paper, a Chinese newspaper that it took only two days to publish the article, but she refused to give further details.[505]

The journal Nature reported at least 54 English-language papers about the new coronavirus in China were published by 30 January.[506] Zuofeng Zhang, a public health expert from UCLA interviewed by the mainland China-based magazine Intellectual, asked why the published data were not used in epidemic control even before their publication.[507]

Misinformation and conspiracy theories

There were conspiracy theories about COVID-19 being the CIA's creation to keep China down on China's Internet, according to London-based The Economist.[508]

Multiple conspiracy articles in Chinese from the SARS era resurfaced during the outbreak with altered details, claiming that SARS is biological warfare conducted by the US against China. Some of these articles claim that BGI Group from China sold genetic information of the Chinese people to the US, with the US then being able to deploy the virus specifically targeting the genome of Chinese individuals.[509]

On 26 January, Chinese military news site Xilu published an article detailing how the virus was artificially combined by the US to "precisely target Chinese people".[510]

Some articles on popular sites in China have also cast suspicion on US military athletes participating in the Wuhan 2019 Military World Games, which lasted until the end of October 2019, and have suggested that they deployed the virus. They claim the inattentive attitude and disproportionately below-average results of American athletes in the games indicate they might have been there for other purposes and they might actually be bio-warfare operatives. Such posts stated that their place of residence during their stay in Wuhan was also close to the Huanan Seafood Wholesale Market, where the first known cluster of cases occurred.[511][512]

In March 2020, this conspiracy theory was endorsed by Zhao Lijian, a spokesperson from the Ministry of Foreign Affairs of the People's Republic of China.[513][514][515] On 13 March, the US government summoned Chinese Ambassador Cui Tiankai to Washington DC over this conspiracy theory,[516] when he had called this theory "crazy" on Face the Nation on 9 February, and re-affirmed this belief after Zhao's tweets.[517]

The United States Presidential administration, including President Donald Trump, Mike Pompeo and others also pushed a conspiracy theory repeatedly asserting that the virus had originated from a laboratory leak in Wuhan, despite widespread rejection from the scientific community and by allied intelligence.[518]

On 5 March 2020, in response to the American Fox News host's announcement that the Chinese should "formally apologize" for the novel coronavirus pandemic, Zhao Lijian, a spokesperson from the Ministry of Foreign Affairs spoke of a "groundless and unreasonable" request. He said that the 2009 H1N1 flu pandemic broke out in the United States and spread to 214 countries and regions and caused at least 18,449 deaths that year, and the United States had not been asked to apologize.[519]

Statistics

The case count in mainland China only includes symptomatic cases. It excludes patients who test positive but do not have symptoms, of which there were 889 as of 11 February 2020.[520] It's also reported that there were more than 43,000 by the end of February 2020.[521][522][523] On 17 April, following the Wuhan government's issuance of a report on accounting for COVID-19 deaths that occurred at home that went previously unreported, as well as the subtraction of deaths that were previously double-counted by different hospitals, the NHC retrospectively revised their cumulative totals dating to 16 April, adding 325 cumulative cases and 1,290 deaths.[4]

COVID-19 pandemic in mainland China by provinces
Data released by Chinese provinces as of 24:00 (UTC+8) 14 October 2020[524][525]
Chinese provinces Pop. (mil.)
(2019)
Cases Deaths Fatality Recov. Active Cases
/1M pop
Deaths
/1M pop
Ref.
China (mainland) 1,400.0500 86,338 4,634 5.37 81,319 385 61.67 3.31 [526][525]
Hubei 59.2700 68,148 4,512 6.62 63,627 9 1,149.8 76.13 [527][525]
——Wuhan, Hubei 11.2120 50,340 3,869 7.69 46,471 0 4,489.8 345.08 [527]
Guangdong 115.2100 1,963 8 0.41 1,922 33 17.0 0.07 [528] [525]
Zhejiang 58.5000 1,291 1 0.08 1,279 11 22.1 0.02 [529] [525]
Henan 96.4000 1,288 22 1.71 1,259 7 13.4 0.23 [525]
Shanghai 24.2814 1,277 7 0.55 1,174 96 52.6 0.29 [525]
Hunan 69.1838 1,020 4 0.39 1,015 1 14.7 0.06 [525]
Anhui 63.6590 992 6 0.60 985 1 15.6 0.09 [525]
Xinjiang 25.2322 980 3 0.31 952 25 38.8 0.12 [525]
Heilongjiang 37.5130 949 13 1.37 936 0 25.3 0.35 [525]
Jiangxi 46.6610 935 1 0.11 934 0 20.0 0.02 [525]
Beijing 21.5360 947 9 0.95 932 6 44.0 0.42 [530] [525]
Shandong 100.7021 848 7 0.83 841 0 8.4 0.07 [525]
Sichuan 83.7500 783 3 0.38 735 45 9.3 0.04 [525]
Jiangsu 80.7000 676 0 0 666 10 8.4 0 [525]
Chongqing 31.2432 589 6 1.02 582 1 18.9 0.19 [525]
Shaanxi 38.7621 484 3 0.62 438 43 12.5 0.08 [525]
Fujian 39.7300 461 1 0.22 423 37 11.6 0.03 [525]
Hebei 75.9197 373 6 1.61 362 5 4.9 0.08 [525]
Inner Mongolia 25.3960 307 1 0.33 282 24 12.1 0.04 [525]
Tianjin 15.6183 289 3 1.04 266 20 18.5 0.19 [525]
Liaoning 43.5170 288 2 0.69 280 6 6.6 0.05 [525]
Guangxi 49.6000 260 2 0.77 258 0 5.2 0.04 [525]
Shanxi 37.2922 218 0 0 213 5 5.8 0 [525]
Yunnan 48.5830 217 2 0.92 209 6 4.5 0.04 [525]
Hainan 9.4472 171 6 3.51 165 0 18.1 0.64 [525]
Gansu 26.4743 181 2 1.10 177 2 6.8 0.08 [525]
Jilin 26.9073 157 2 1.27 155 0 5.8 0.07 [525]
Guizhou 36.2295 147 2 1.36 145 0 4.1 0.06 [525]
Ningxia 6.9466 75 0 0 75 0 10.8 0 [525]
Qinghai 6.0782 18 0 0 18 0 2.96 0 [525]
Tibet 3.5056 1 0 0 1 0 0.29 0 [525]

Notes

  1. ^ Excluding 613 asymptomatic cases under medical observation as of 14 November 2020.[3] Asymptomatic cases were not reported prior to 31 March 2020.

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