Thread by @kakape

On Friday the report of the joint @WHO-China mission on #covid19 came out and I’m surprised there hasn’t been more coverage of it, since it seems one of the crucial documents of this epidemic. Story from @sciencecohen and me is here, short thread to come. sciencemag.org/news/2020/03/c…

@WHO @sciencecohen Remember: @drtedros has said several times that getting mission to China approved was one of the three main outcomes of his meeting with Xi Jinping on 28 January. Back then there were a few thousand cases reported in China, and less than 100 in the rest of the world combined.

@WHO @sciencecohen @DrTedros Situation is different now. This afternoon, @Tedros pointed out that in the last 24 hours there were 9 times more new cases reported outside China than inside. And that’s the key message of the report: What China did worked.

@WHO @sciencecohen @DrTedros @tedros Important to emphasize that this surprised the experts. Tim Eckmanns, who was on the mission, told me, he didn’t believe the drop in numbers was real, before he went. Others have said the same. They changed their minds.

@WHO @sciencecohen @DrTedros @tedros So how did China contain a widely circulating respiratory virus? According to the report with “the most ambitious, agile and aggressive disease containment effort in history”.

@WHO @sciencecohen @DrTedros @tedros That means (to pick a few things):

- intensive contact tracing. In Wuhan alone > 1800 teams of 5 or more people traced tens of thousands of contacts
- building two dedicated hospitals in Wuhan and pulling health care workers from all over the country

@WHO @sciencecohen @DrTedros @tedros - everyone had to wear a mask when leaving home (that’s why Aylward is wearing a mask in the photo, press conference was in China)
- aggressive social distancing: closing theatres and schools, cancelling gatherings, suspending public transport

@WHO @sciencecohen @DrTedros @tedros - the government used two mobile phone apps, AliPay and WeChat, to keep track of people’s movements and enforce restrictions
- and, of course, they locked down the whole city of Wuhan

@WHO @sciencecohen @DrTedros @tedros To be clear how lockdown worked: With households locked in, the virus had nowhere else to go but to other members of that household. Wait long enough and everyone in the household is exposed and transmission ceases.

@WHO @sciencecohen @DrTedros @tedros So China beat down the virus. Two things to watch now: 1. What happens as measures are relaxed? Mike Osterholm says it’s "like suppressing a forest fire, but not putting it out. It’ll come roaring right back.” This is why everyone is watching those China numbers so closely.

@WHO @sciencecohen @DrTedros @tedros 2. What can other countries take from this? @JeremyKonyndyk told me: “No one else in the world really can do what China just did.” @LawrenceGostin says: “China is unique in that it has a political system that can gain public compliance with extreme measures.”

@WHO @sciencecohen @DrTedros @tedros @JeremyKonyndyk @LawrenceGostin Of course countries can choose to implement some measures but not all. That decision cannot be based solely on what works. As @alexandraphelan says: "There are plenty of things that would work to stop an outbreak that we would consider abhorrent in a just and free society.”

@WHO @sciencecohen @DrTedros @tedros @JeremyKonyndyk @LawrenceGostin @alexandraphelan Sorry, this thread grew way too long, once again. One final thought:

@WHO @sciencecohen @DrTedros @tedros @JeremyKonyndyk @LawrenceGostin @alexandraphelan What measures a society deems warranted will also depend on how severe and how deadly the disease turns out to be. And there is still a wide margin of where that can end up. So: Really tough decisions in a situation of huge uncertainty. Welcome to an epidemic!