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<\/figure><\/div>\n\n\n\nEditor\u2019s note:<\/strong><\/em> On Jan. 23, 2020, Wuhan and its surrounding cities\nlike Ezhou and Huanggang announced the suspension of all public transportation\nsuch as bus, subway and ferry, temporary cancellation of all flights and trains\ndeparting from Wuhan, and temporary closure of all highway entrances to slow\nthe spread of the new virus. The announcement shocked the world. On Jan. 24,\nHubei province launched the level I public health emergency\nresponse, with other parts of China following suit until all provinces,\nautonomous regions and municipalities were in the highest level for a public\nhealth emergency by Jan. 29. At the press conference of the Joint Prevention\nand Control Mechanism of the State Council held on Feb. 8, the new infectious\ndisease was named as the Novel Coronavirus Pneumonia (NCP). Later the World\nHealth Organization (WHO) renamed the disease as COVID-19 on Feb. 11.<\/p>\n\n\n\n As the first big city to confront the COVID-19\noutbreak, Wuhan saw a surge in coronavirus infections that crippled its medical\nsystem. As the virus continued to spread around the world, many cities saw a\nheavy blow to their medical services. On March 11, the WHO declared COVID-19 a\npandemic.<\/p>\n\n\n\n In a study of the medical system overwhelmed by the\npandemic, I on April 20 published an article titled \u201cCOVID-19: Why is medical\nsystem in metropolises so vulnerable?\u201d (Hereafter referred to as the April\narticle)[1]<\/a>.\nThe article explains why metropolises are so vulnerable to the COVID-19\npandemic and how effective Wuhan was in response to the new disease. It was\npublished on China.com.cn and reposted by over 100 media outlets like\npeople.com.cn, xinhuanet.com and gmw.cn.<\/p>\n\n\n\n On April 21, the English version of the article was\npublished on China.org.cn[2]<\/a>\nand later reposted by English media outlets both at home and abroad including the\nwebsites of the State Council Information Office of China and China Daily.<\/p>\n\n\n\n On May 12, the Japanese version was published on\njapanese.china.org.cn[3]<\/a>.<\/p>\n\n\n\n The article analyzes the good practices and lessons\nlearned from Wuhan\u2019s COVID-19 response as well as major concerns and measures\nthat should be taken by the medical system amid the pandemic. It serves as a\nreference for cities around the world in their battle against the novel\ncoronavirus.<\/p>\n\n\n\n After six months, I write this article to explore\ndifferent measures and effectiveness of the global COVID-19 responses based on\nthe April article with some statistical updates, new diagrams and endnotes.<\/p>\n\n\n\n 1. 2019 ranking on\nhealth care radiation of Chinese cities<\/strong><\/p>\n\n\n\n As part of the China Integrated City\nIndex, Cloud River Urban Research Institute has released the 2019 ranking on\nhealth care radiation based on a research of 297 cities at prefecture level and\nabove across China. The top 10 are Beijing, Shanghai, Guangzhou, Chengdu,\nHangzhou, Wuhan, Jinan, Zhengzhou, Nanjing and Taiyuan. The following 10 are\nTianjin, Shenyang, Changsha, Xi’an, Kunming, Qingdao, Nanning, Changchun,\nChongqing, and Shijiazhuang. And the next 10 are Urumqi, Shenzhen, Dalian,\nFuzhou, Lanzhou, Nanchang, Guiyang, Suzhou, Ningbo and Wenzhou. Please note\nthat Wuhan, the first city to confront COVID-19, ranked sixth.<\/p>\n\n\n\n Jointly developed by Cloud River Urban\nResearch Institute and the Development Planning Department of the National\nDevelopment and Reform Commission, China Integrated City Index is a system that\nevaluates growth performance of cities across the country. The institute has\nbeen publishing the city index annually since 2016. <\/p>\n\n\n\n The index measures urban development in\nthree dimensions: the environment, society and economy. Under each dimension\nlies many indicators that support its three sub-dimensions at different layers.\nThe health care radiation is among those indicators. <\/p>\n\n\n\n All of its indicators are supported by 785\ndata sets, which come from statistical data, satellite remote sensing data, and\ninternet data. China Integrated City Index is a multi-modal index[4]<\/a> to\nanalyze and measure a city\u2019s development through statistical resources of\ndifferent fields.<\/p>\n\n\n\n The radiation index measures a city’s\ncapacity in providing goods and services in certain areas. A high radiation\nscore means the city has the capacity to sell its goods and services, while a\nlow radiation score means that it needs to purchase certain goods and services\nfrom other places.<\/p>\n\n\n\n Evaluating a city\u2019s health care radiation\nmainly focuses on the number of physicians and the 3A-grade hospitals. The top\n30 cities account for 15% of the certified physicians, 30% of hospital beds and\n45% of 3A-grade hospitals in the country. China’s medical resources, especially\nthe best hospitals, are mainly concentrated in cities higher in the ranking,\nwhich serve local residents as well as people from all around China.<\/p>\n\n\n\n The\nquestions raised in the April article are: Why cities like\nWuhan, equipped with one of the top medical resources in China, could be so\nvulnerable to the COVID-19 outbreak and even overwhelmed by the influx of patients? What should cities do to prepare\nfor future epidemics?<\/p>\n\n\n\n Chart 1: List of top 30 Chinese cities by health care radiation in 2019<\/strong> 2. A test for the\nhealth care system<\/strong><\/p>\n\n\n\n Wuhan was the first to confront the COVID-19 outbreak. The\ncity climbed one place to the sixth in the 2019 health care radiation ranking,\nas it boasts 27 3A-grade hospitals, nearly 40,000 physicians, 54,000 nurses and\n95,000 beds. It is hard to expect that a city with such strong health care\ncapacity could be overwhelmed by the coronavirus epidemic.<\/p>\n\n\n\n Other metropolises like New York and Milan are equally\nvulnerable to the pandemic. Tokyo, which\ndeclared a state of emergency on April 7, was also facing a\nbreakdown of its medical system. The novel coronavirus is indeed a test for the\nhealth care system in all global cities.<\/p>\n\n\n\n In the April article, I believe that three reasons are\nattributed to the breakdown of the cities\u2019 medical system.<\/p>\n\n\n\n (1) Overloaded\nhospitals<\/strong><\/p>\n\n\n\n One feature of the COVID-19 epidemic is the exponential\ngrowth of infections. Especially during the early stage of the outbreak, the\nsurge in infections and social panic have driven a lot of people, whether they\nwere infected or not, to seek testing and treatment in hospitals. This has\ncaused disorder, leaving those who are critically ill unable to receive\nefficient and quality care. It is also a reason for its high fatality rate.\nMoreover, the overcrowded emergency rooms, with confirmed cases, suspected\npatients as well as their families, can also lead to many hospital-acquired\ninfections (HAIs).<\/p>\n\n\n\n Table 1: A comparison of medical resources in China, European countries, the U.S. and Japan in 2019<\/strong> As is seen from Table 1, the density of physicians in the\nU.S., Japan and China are only 2.6, 2.5 and 2 per 1,000 people respectively,\nmuch lower than that in Germany (4.3), Italy (4) and Spain (4).<\/p>\n\n\n\n Wuhan, with a large concentration of medical resources, has\n4.9 physicians per 1,000 people, which is much higher than the national\naverage. But the city\u2019s medical system was still overstretched by the outbreak.\nBy May 11, the day before the April article\u2019s Japanese version was published,\n83.3% of the COVID-19 deaths in China had happened in Wuhan[5]<\/a>,\nwhich is believed to be caused by the overloaded hospitals.<\/p>\n\n\n\n Just like in Wuhan,\nmedical workers in the U.S. are also concentrated in big cities. The New York\nstate has 4.6 physicians per 1,000 people, but it is still not enough to avoid\na massive breakdown in its medical system.<\/p>\n\n\n\n Italy, one of the\nhardest-hit countries in the pandemic, has a relatively high density of\nphysicians, counting 4 per 1,000 people, but the country still suffers seriously\noverloaded hospitals and a breakdown in its health care system. In the Lombardy\nregion where Milan is located, the number of infections has quickly risen from\n1,000 on March 2, to over 10,000 on March 14, and to over 40,000 by the end of\nMarch. Many patients with critical conditions could not be treated in time due\nto overcrowded emergency rooms. By May 11, a total of 220,000 people in Italy\nhad tested positive for COVID-19, and the death toll was 31,000, driving the\nfatality rate to 14%.<\/p>\n\n\n\n Japan’s Tokyo has 3.3\nphysicians per 1,000 people, lower than the level in Wuhan and the New York\nState. Therefore, the Japanese government has been trying to avoid overcrowded\nemergency rooms as a key part of its COVID-19 response. The government has\nestablished a pre-testing approval procedure to limit the number of testing and\nadvised residents not to go to hospital during the pandemic to reduce\nhospitalization. [6]<\/a>.\nJapan’s measures are so far effective to reduce the number of HAIs and lower\nthe fatality rate as the medical resources are mostly given to those with\ncritical conditions. By May 11, Tokyo\u2019s fatality rate was 5.3%, compared to 7.9%\nin New York State.<\/p>\n\n\n\n Table 2: A comparison of numbers of COVID-19 confirmed cases, deaths, and death rates in China, European countries, the U.S. and Japan<\/strong> Table 2 compares\nstatistics between May 11 and Oct. 11, showing the COVID-19 infections, death\ntoll, fatality rate and the number of deaths per 100,000 people in China, Japan, the U.S. and major European countries, as well as cities like\nWuhan, Tokyo and New York.<\/p>\n\n\n\n By May 11, Spain had 56.9\ndeaths per 100,000 infections, Italy had 50.5, France 40.4, the U.S. 24.4, and\nJapan only 0.5. In this sense, Japan successfully controlled the number of\ndeaths in the first outbreak after it avoided a breakdown in its medical\nsystem.<\/p>\n\n\n\n From the statistics by May\n11, France\u2019s COVID-19 fatality rate was up to 19.1%, and the U.K., Italy, and\nSpain also recorded double-digit fatality rate, while the rate in China and\nJapan were only 5.6% and 4%. At the same time, the global average COVID-19\nfatality rate was up to 12.4%, which dealt a heavy blow to the human society.<\/p>\n\n\n\n However, from May 11 to\nOct. 11, those countries and cities had seen a significant drop in COVID-19\nfatality rate. During that period, China had zero COVID-19 death cases, while\nJapan controlled the rate at 1.4%. France and Spain which previously had very\nhigh fatality rate managed to lower it under 1%. Even the U.S. which had over\n200,000 COVID-19 deaths also lowered the rate under 2.1%.<\/p>\n\n\n\n The reduction was\nattributable to less crowded emergency rooms compared to the early stage of the\nCOVID-19 outbreak. Though there is no specific medicine that can cure the\ndisease, each country has, to some extent, found ways to treat their patients, which\nis also key to lowering the rate. Moreover, mass testing is another important\nreason.<\/p>\n\n\n\n In a period of five\nmonths, the global fatality rate lowered to 2.2%. It seems that the new virus\nis becoming less intimidating. Actually, the rate varies widely between\ndifferent age groups. Chances of a relatively younger person dying from\ncoronavirus is much lower than that of a relatively older person. For example,\nJapan\u2019s fatality rate in August was 0.9%. By different age groups, the rate for\npeople who are 69 or younger is only 0.2%, but the figure ghastly spiked to\n8.1% for those who are 70 or older.<\/p>\n\n\n\n In his address to the\nEconomic Club of New York on Oct. 14, the U.S. President Donald Trump said that\n99.98% of the infected under the age of 50 can survive, but the seniors who had\nunderlying conditions have higher risks. Therefore, protecting the high-risk\ngroups through improving the prevention and control system is key to lowering\nthe fatality rate.<\/p>\n\n\n\n (2) A drop in the\nnumber of health care workers<\/strong><\/p>\n\n\n\n A drop in the number of medical staff\ncaused by infections is another feature in this pandemic.<\/p>\n\n\n\n In the early stage of the outbreak,\ncountries lacked knowledge of the coronavirus transmission, and medical staff faced\na huge risk of infection due to the shortage of protective resources such as\nmasks, protective clothing, and negative pressure wards. Those factors made\ntesting, sampling, intubation, and other medical practices that are inherently\nat risk of exposure even more dangerous. As a result, countries have seen a\nsignificant decrease in the number of medical staff caused by infections, which\nalso overstretched the medical system.<\/p>\n\n\n\n Infections not only happen in the\ntreatment process. In this March, the extensive isolation and infection\nresulted from a dinner party attended by trainee doctors from Keio University\nHospital also dealt a major blow to the already scarce medical workforce in\nTokyo[7]<\/a>.<\/p>\n\n\n\n According to the International Council of\nNurses (ICN), data reported by 30 countries showed that at least 90,000 health\ncare workers had been tested positive for COVID-19 as of May 6. By May 5, Spain\nhad 43,956 health care workers infected (accounting for 18% of the country\u2019s\ntotal infections) and Italy had 19,942 medical staff tested positive for\ncoronavirus, among which 150 physicians and 35 nurses died of the disease.<\/p>\n\n\n\n By Sept. 16, ICN said nearly 3 million\nhealth care workers might have infected with the novel coronavirus[8]<\/a>.<\/p>\n\n\n\n From January to June, 48 hospitals in\nTokyo have reported HAIs which caused 889 infections among physicians, nurses\nand patients, and 140 of them had died of the disease. Those infections\naccounted for 14% of the total number of people who had coronavirus in Tokyo at\nthat time, and the number of deaths resulted from such infections accounted for\n43% of the total COVID-19 death toll in the same period. HAIs could not only\nweaken the medical system, but also lead to new infections among those who have\nunderlying conditions, resulting in a higher infection fatality rate.<\/p>\n\n\n\n Even until October, HAIs were still\nfrequently reported in Tokyo. For example, a hospital in Adachi confirmed on\nOct. 15 that 39 patients and 12 staff have infected with coronavirus. A\nhospital in Nerima also reported 58 new infections, in which 23 were patients.<\/p>\n\n\n\n The super-transmissible coronavirus has\nseverely threatened the safety of medical staff and weakened medical\ncapabilities, resulting in the collapse of the medical system. Therefore, it is\ncritical to avoid HAIs during the fight against COVID-19.<\/p>\n\n\n\n (3) A serious\nshortage of hospital beds<\/strong><\/p>\n\n\n\n Since the COVID-19 outbreak, countries\nhave experienced a shortage of medical supplies such as face masks, protective\nclothing, disinfectant, test kits, ventilators, extracorporeal membrane\noxygenation (ECMO) machines, and especially, hospital beds. COVID-19 patients\nare required to be treated under quarantine to curb the spread of the\nsuper-transmissible coronavirus, and severe cases should be treated in\nintensive care units (ICUs), but hospitals have been in serious shortage of\nbeds in general.<\/p>\n\n\n\n There are up to 13.1 hospital beds per\n1,000 people in Japan, the highest in the world. For Tokyo, a city with a total\nof 128,000 hospital beds, the figure is 9.3. Even so, it already saw a severe\nshortage of hospital beds during the first COVID-19 outbreak.<\/p>\n\n\n\n In contrast to Tokyo, for every 1,000\npeople, Italy has a high number of doctors but only 3.1 beds, the U.S. has only\n2.9 beds, and New York has only 2.6, which is even lower than the national\naverage. Obviously, inadequate hospital beds have become a bottleneck that\nrestricts medical institutions from receiving patients and hinders timely\ntreatment.<\/p>\n\n\n\n The figure in China is 4.3, a quarter of\nthat of Japan but higher than that of the U.S. and Italy. Wuhan, in particular,\nhas 95,000 beds, or 8.6 beds per 1,000 people, almost as high as that of Tokyo,\nbut it still suffered from a serious shortage of hospital beds in the early\nstage of the outbreak.<\/p>\n\n\n\n Another problem is that not all hospital\nbeds are qualified for receiving COVID-19 patients for isolation, and the\nscramble for medical resources has made the bed shortage even more prominent.<\/p>\n\n\n\n 3. What are\neffective responses?<\/strong><\/p>\n\n\n\n Wuhan, the first city to suffer a collapse of medical system, finally\nquelled the plague of COVID-19 after 77 days of the lockdown. By mid-June 2020,\nall parts of China had gradually resumed normal production and life.<\/p>\n\n\n\n How did China quickly cope with the situation? It is extremely valuable for\nthe world reeling from the ravages of COVID-19 to check out China’s experience.<\/p>\n\n\n\n (1) Lockdown policy<\/strong><\/p>\n\n\n\n On Jan. 23, 2020, Wuhan in Hubei province suspended public\ntransportation, closed airports, train stations and other routes leaving it,\nand asked people not to go outside the city, beginning the so-called lockdown[9]<\/a>.\nOn Jan. 24, the next day, the whole province activated the first-level response\nmechanism for major public health emergencies according to the Response Plan\nfor Public Health Emergencies in Hubei province[10]<\/a>.\nThe response level specifies the degree of various measures to be taken in the\nidentified infected area, and the first-level response requires to suspend work,\nclasses and traffic to avoid any possible personnel flow and close contact[11]<\/a>.<\/p>\n\n\n\n As the upper-level regulation of the Response Plan for Public Health Emergencies of various provinces, municipalities and autonomous regions, the National Response Plan for Public Health Emergencies was formulated based on the experience of combating SARS, and was announced on February 26, 2006, as one of the nation’s responses to public health emergencies[12]<\/a>.<\/p>\n\n\n\n Subsequently, other provinces, municipalities and autonomous regions\nalso activated the first-level response mechanism. As of Jan. 29, after the\nTibet Autonomous Region\nactivated it,\nall regions in the entire country had implemented the first-level response\nmechanism.<\/p>\n\n\n\n Chart 2: Numbers of daily new COVID-19 confirmed cases and deaths during Wuhan\u2019s lockdown<\/strong> Chart 2 shows the numbers of new confirmed COVID-19 cases and deaths in\nWuhan every day from Jan. 20, days before the lockdown, to Apr. 8, the day when\nthe lockdown was lifted. On Feb. 13, 21 days after the lockdown, Wuhan finally\nbegan to see a decline in its daily number of new cases after overcoming\nvarious difficulties caused by an unknown virus outbreak, such as the collapse\nof medical system. On Mar. 18, 56 days after the lockdown, the figure was\nbrought down to zero for the first time. Although a case was confirmed on Mar. 23,\nthe figure remained to be zero for 16 consecutive days until the lockdown was\nlifted on Apr. 8.<\/p>\n\n\n\n It was undoubtedly a powerful move to lock down the city by cutting off\ntraffic, suspending work, production and classes, and putting in place other\nmeasures strictly restricting personnel flow and close contact. Wuhan finally\nmanaged to fight back the novel coronavirus after 77 days of lockdown.<\/p>\n\n\n\n China saw the effects of its strict restriction measures throughout the country\nsoon, and its\nnew\nconfirmed cases were quickly brought under control. On Feb. 21, Gansu province\ntook the lead in lowering the response level from the first level to the third\nand resuming everyday production and life conditionally. Other regions also\nlowered their response levels from the first to the third since then. On June\n13, as Hubei province lowered the level from the first to the third,\nthe response levels across the country were brought down to the third. China\nhas successfully addressed the first wave of COVID-19 thanks to the strict\nlockdown rules that brought the number of infected cases down to zero.<\/p>\n\n\n\n After that, various parts of China flexibly adjusted their response\nlevels based on local epidemic situations. For example, Beijing raised its\nresponse level from the third to the second on June 16 due to a cluster of\ncases, and strengthened its epidemic prevention and control. As the epidemic\nwas brought under control, Beijing lowered its response level back to the third\non July 20.<\/p>\n\n\n\n (2) Quick dispatch of medics<\/strong><\/p>\n\n\n\n In response to the serious shortage of medical personnel in Wuhan and\ntheir drop in number, the Chinese government quickly mobilized a large number\nof medical staff from all over the country to assist Wuhan. On Jan. 24, 2020,\nthe second day after the lockdown, the Shanghai medical team to assist Wuhan arrived\nin the city first. It was made up of 136 doctors and nurses from the\nrespiratory departments, infectious disease departments, hospital infection management\ndepartments and intensive care medicine departments of 52 hospitals in\nShanghai. Eventually, 346 medical teams involving 42,600 medical workers were\ndispatched to Wuhan and other parts of Hubei province.<\/p>\n\n\n\n The Joint Prevention and Control Mechanism of the State Council introduced\nat a press conference on Mar. 8 that it usually takes no more than two hours\nfrom the time a medical institution receives an order to the time a medical\nteam is set up, and takes no more than 24 hours from the assembly of medical\nteam members to their arrival in Wuhan. The emergency assistance quickly\nalleviated the pressure on Wuhan in medical terms and effectively saved the\ncity’s medical system from collapsing.<\/p>\n\n\n\n It is certain that whether a country can offer its affected area rapid\nand effective assistance or not is one of the keys to winning over the\nepidemic, but not all countries are equipped with such capabilities. Judging\nfrom the situation in New York and Tokyo, even developed countries with\nrelatively abundant medical resources would find it difficult to mobilize a\nsufficient number of medical staff to offer assistance in time.<\/p>\n\n\n\n What is even more worrying are those developing countries with a severe\nshortage of medical resources. Leaving Africa aside, even the neighboring Asian\ndeveloping countries with large populations, like India and Indonesia, have\nonly 0.8 doctors and 0.3 doctors, and 0.5 beds and one bed in medical facilities,\nper thousand people, respectively. In such countries with scarce medical\nresources and insufficient capabilities to offer national assistance, the scramble\nfor medical resources caused by epidemic outbreaks may be extremely severe.\nTherefore, it is extremely urgent to organize global assistance. The problem is\nthat most developed countries are also suffering from the COVID-19 pandemic and\ncan spare no time to take care of others. At this moment, China’s medical\nassistance to other countries is particularly valuable.<\/p>\n\n\n\n (3) Rapid construction\nof makeshift hospitals<\/strong><\/p>\n\n\n\n Wuhan rush-built the Huoshenshan Hospital and the Leishenshan Hospital\nfor severe cases under national support. The two hospitals with high isolation\nlevels are equipped with specialized treatment equipment, and 1,000 beds and\n1,600 beds, respectively. The Huoshenshan Hospital opened on Feb. 3, 12 days\nafter the lockdown, and the Leishenshan Hospital was put into use on Feb. 8.<\/p>\n\n\n\n The city also converted stadiums into 16 makeshift hospitals for\ntreating mild cases, and quickly provided 13,000 beds with antibacterial and\nepidemic prevention levels up to those of first-class hospitals in China. The\nmove channeled mild cases, helping to concentrate high-end medical resources on\nsevere cases, and alleviated the scramble for medical resources.<\/p>\n\n\n\n The experience of Wuhan\u2014building Huoshenshan, Leishenshan and temporary\ntreatment centers to address bed shortage\u2014is worthy of\nreference and learning for the world.<\/p>\n\n\n\n During the first wave of the COVID-19 pandemic, Japan required some\nconfirmed patients to stay at home for quarantine due to insufficient beds,\nwhich was actually an extremely dangerous practice. First, it put the family\nmembers of the patients at risk and might lead to infections in clusters within\nthe families. Second, patients could not get effective and professional\ntreatment, and without timely update on health conditions, they might not be\nable to receive swift referral for treatment when the conditions deteriorated.\nFortunately, the practice was largely halted later, and Japan now has also\ntransformed facilities like hotels into isolation wards for patients with mild\nsymptoms, in an effort to channel mild cases and relieve the pressure on\nhospitals.<\/p>\n\n\n\n A more serious problem in Tokyo is the shortage of ICUs. By 2018, Japan\nhad merely 4.3 ICU beds per 100,000 people, and there was a huge gap compared\nwith the 35 in the U.S., 30 in Germany, 11.6 in France, 12.5 in Italy, and 9.7\nin Spain.<\/p>\n\n\n\n Tokyo, which had the largest number of infected cases in Japan, had only\n764 ICU beds, or only 5.5 per 100,000 people, when the first outbreak took\nplace. Through various efforts, Tokyo addressed the serious shortage of ICU\nbeds and survived the first wave. However, as the second wave arrives in autumn\nand winter, there will be a shortage again. A proper solution to it is a key to\navoiding a potential collapse of its medical system amid an outbreak.<\/p>\n\n\n\n The countries have adopted a variety of measures to address bed shortage\nduring the outbreaks, with the U.S. even sending naval hospital ships to assist[13]<\/a>\nand South Korea taking the emergency importation of a “hospital” as a\nnew option. Faced with a desperate shortage of beds amid the outbreak, South\nKorea imported an entire “Huoshenshan Hospital in slabs” from the\nBroad Group in China. The prefabricated stainless-steel slabs made up negative\npressure isolation wards in South Korea. Equipped with fresh air systems and\nozone technologies, the wards have the highest level of protection against\ncross infection. The project took only two days locally before the wards were\nput into use.<\/p>\n\n\n\n 4. Is there a\ntrade-off between protecting economy and protecting people\u2019s lives?<\/strong><\/p>\n\n\n\n In the responding policies taken by countries around the world to\ncontain the pandemic, the focal point is how to strike a balance between public\nhealth and the economic impact. Through rigorous lockdown measures, China\nsuccessfully contained COVID-19. China is currently trying hard to maintain the\n\u201czero COVID-19 case\u201d situation. China\u2019s COVID-19 response can be called the \u201cZero\nCOVID-19 Case Policy\u201d.<\/p>\n\n\n\n On the contrary, most Western countries reopened economy when there were\nstill infections, although they had placed various restrictions on people\u2019s activities,\nsuch as imposing lockdowns or declaring a state of emergency. The measures\ntaken by those countries can be called the \u201cCoexisting with COVID-19 Policy\u201d.<\/p>\n\n\n\n The second part of the article will compare the \u201cZero COVID-19 Case\nPolicy\u201d and the \u201cCoexisting with COVID-19 Policy\u201d and verify an efficient route\nto fight against the disease. <\/p>\n\n\n\n (1) China:\nPrioritizing COVID-19 response<\/strong><\/p>\n\n\n\n In the aftermath of 2002-2003 SARS, the Chinese government formulated the\nRegulation on the Urgent Handling of Public Health Emergencies, the National\nResponse Plan for Public Emergencies, and the National Response Plan for Public\nHealth Emergencies, on the basis of the Law of the People’s Republic of China\non Prevention and Treatment of Infectious Diseases. In 2007, the Emergency\nResponse Law of the People’s Republic of China was announced, further\nsystemizing the above-mentioned law, regulation and response plans. On Jan. 20,\nbefore Wuhan was put into a lockdown, China\u2019s National Health Commission\nreleased a statement to classify the novel coronavirus pneumonia as a category\nB infectious disease under the law on prevention and control of infectious\ndiseases but take preventive and control measures of category A infectious\ndiseases, meaning that the fight against COVID-19 had been launched.<\/p>\n\n\n\n It is exactly because the law, regulation and response plans mentioned\nabove were put into place after the SARS epidemic that China could swiftly\nimpose lockdowns, activate the top-level public health emergency response and take\nother mandatory measures to curb the novel coronavirus. With a priority placed\non epidemic response, mitigation measures would not be altered willfully,\nregardless of the economic impact. In fact, despite cries for the resumption of\nproduction and schools as soon as possible across China, the Chinese government\nstuck to the requirements for reopening, such as only when there were no new\ncases.<\/p>\n\n\n\n According to Chart 3, China has done whatever it took in economic terms to\nprevent the spread of COVID-19, and then resumed normal economic activities\nsoon. Seen in the longer span of time, lockdowns and level II public health\nemergency response were like strong medicine, but a good therapy to keep the\nsituation under control. It is difficult to keep new case numbers at zero.\nTherefore, once a new infection case was spotted, China would implement strict restrictions\nand large-scale COVID-19 testing in the area to prevent the spread of the\nvirus. <\/p>\n\n\n\n Chart 3 Numbers of daily new COVID-19 confirmed cases and deaths in China (2) Report 9<\/em>\nand Western countries\u2019 t responses<\/strong><\/p>\n\n\n\n On March 16, 53 days after Wuhan\u2019s lockdown, British epidemiologist Neil\nFerguson and other scientists published \u201cReport 9: Impact of non-pharmaceutical\ninterventions (NPIs) to reduce COVID-19 mortality\nand healthcare demand\u201d. The report predicted that the novel coronavirus would\ninfect eight out of 10 people, with 510,000 deaths in the U.K. over the next\nfour months, if measures were not in place. Even with mitigation measures, such\nas isolating infected people, home quarantining, and restricting senior people\nto their homes, there would be still 250,000 deaths in the country. With strict\nlockdown rules, the death toll could be limited to 20,000[14]<\/a>.\nFerguson told the Science and Technology Committee that the move to balance\neconomy and COVID-19 response while tolerating the spread of the virus to some extent\nwas wrong, noting that lockdown was the only option. On March 23, one week\nafter the report was published, the British government announced a nationwide\nlockdown, prohibiting residents from going out if not necessary and closing\nschools and most businesses. <\/p>\n\n\n\n The report projected at most 2.2 million deaths in the U.S. In the light\nof the report, U.S. President Trump extended the federal social distancing\nguidelines, which originally expired on March 30, to April 30[15]<\/a>.<\/p>\n\n\n\n British journal Nature published a report titled \u201cThe effect of\nlarge-scale anti-contagion policies on the COVID-19 pandemic\u201d on June 8. The\nreport analyzed the effect of policies rolled out by six countries\u2014China, South\nKorea, Italy, Iran, France and the U.S. The report estimated that in more than\nthree months from January to April 6, those six countries protected hundreds of\nmillions of people from getting infected, through (1) travel restrictions, (2)\nsocial distancing through the cancellations of events and suspensions of\neducational, commercial and religious activities, (3) quarantines and\nlockdowns, and (4) additional policies such as emergency declarations[16]<\/a>.<\/p>\n\n\n\n Despite obvious effect, lockdown measures have met a lot of resistance\namong many people who thought they limited human activities and wrought damage on\nsocial and economic activities. Many countries began to lift lockdowns\nprematurely, after the spread of COVID-19 slowed.<\/p>\n\n\n\n (3) \u201cZero COVID-19 Case Policy\u201d vs. \u201cCoexisting\nwith COVID-19 Policy\u201d<\/strong><\/p>\n\n\n\n Wuhan\u2019s lockdown was lifted after it met very rigorous requirements. It\nwas only after Wuhan had reported no new cases for the past 16 days that the\nlockdown was lifted. I think that is the radical \u201cZero COVID-19 Case Policy\u201d.<\/p>\n\n\n\n The Chinese government issued risk-grading criteria on Feb. 17, classifying\ncounties, cities and districts that report no cases or no new cases in the past\n14 days as low-risk areas[17]<\/a>.<\/p>\n\n\n\n After successfully containing the first outbreak, China still went all\nout to maintain the \u201czero case\u201d situation across the country. Once a new case\nwas confirmed, strict restrictions and large-scale testing would be implemented\nimmediately to block the spread of COVID-19. For example, after three\nasymptomatic cases were confirmed in Qingdao of Shandong province on Oct. 11,\nthe city tested its entire population and traced people moving out of the city.\nBy Oct. 16, more than 11 million people had been tested. <\/p>\n\n\n\n Contrary to China, European countries and the U.S. lifted lockdown restrictions very soon, because they were eager to reduce the impact of COVID-19 on their economy. A study by the Germany-based IFO Institute for Economic Research and the Helmholtz Centre for Infection Research was released on May 13[18]<\/a>. The study said keeping the Rt (the effective reproduction number, refering to the average number of people who become infected by an infectious person) at 0.75 provides the safest balance between hammering out output and risking a new outburst of infections. In other words, keeping the Rt at 0.75 can minimize the economic costs without jeopardizing the medical objectives. The study is an endorsement of the \u201cCoexisting with COVID-19 Policy\u201d in the academic circle. However, the report failed to come up with effective measures to keep the Rt at 0.75 in response to the highly contagious virus. Therefore, the golden balance put forward in the report is just a hallow theory. The report provides theoretical backing to the \u201cCoexisting with COVID-19 Policy\u201d adopted by European countries and the U.S., which was the scourge of later resurgence in those countries. <\/p>\n\n\n\n In fact, new infected cases in Europe have risen sharply since autumn.\nOn Oct. 14, daily new cases increased to 105,000 in Europe, outnumbering Asia\u2019s\n103,000. On Oct. 15, new cases of infections in Germany soared to 6,638 in the\npast 24 hours, reaching a daily level not seen since the start of the pandemic.<\/p>\n\n\n\n Report 9<\/em> received a chorus of criticism in the U.K., because people worried\nabout the impact of lockdown restrictions on economy. The\nreport predicted the novel coronavirus would kill 510,000 people in the U.K.,\nif mitigation measures were not in place. As a result of\nmeasures like restrictions, deaths in the U.K. had been capped under 43,000 by\nOct. 11. Despite obvious effect, U.K. lockdown rules were lifted when there\nwere still cases for fear of an economic downturn. The \u201cCoexisting with\nCOVID-19 Policy\u201d led to a surge in infections in the U.K. in autumn, prompting London\nto upgrade its COVID alert level from medium to high on Oct. 15. <\/p>\n\n\n\n By May 11, 31,000 deaths had been caused by COVID-19 in Italy. However, the\ncountry lifted the two-month lockdown in early May to reopen its economy. As Chart\n2 shows, in the five months from May 11 to Oct. 11, death rates in Italy\ndropped from 14% to 4%, meaning that Italy had survived from its medical care\nsystem collapse. But the pandemic returned in autumn, after the country adopted\nthe \u201cCoexisting with COVID-19 Policy\u201d. On Oct. 14, the number of daily new\ncases climbed to 7,300, the highest since the start of the outbreak in March.\nIn response, Italy had to once again ban dining together, and order restaurants\nto close before midnight. <\/p>\n\n\n\n On Oct. 25, Spain announced the state of emergency and implemented a curfew\nto rein in the second outbreak. On Oct. 29, Spain\u2019s parliament voted to keep\nthe country\u2019s state of emergency in place until May 2021.<\/p>\n\n\n\n The\noutbreak also resurged in France. On Oct. 14, French President Emmanuel Macron\nannounced the 9 p.m. to 6 a.m. curfew starting Oct. 17 in nine cities including\nParis and Marseille. On Oct .15, French Prime Minister Jean Castex declared a national\nstate of health emergency starting Oct. 17. On the same day, France reported\nthe number of new daily infections jumped above 30,000, setting a one-day record.\nOn Oct. 30, France began its second nationwide lockdown. On Nov. 6, France\nregistered a record 60,000 plus new cases, triggering more stringent\nrestrictions.<\/p>\n\n\n\n U.S. President Donald Trump said long-term nationwide lockdown is not a\nsolution. In late May, the Trump administration decided to restart economy in\nall states, regardless of the spreading virus. As case numbers rose sharply,\nNew York had to announce a partial lockdown starting Oct. 4. From Nov. 4, daily\nnew infection numbers in the U.S. kept above 100,000 for many days in a row,\nrepeatedly setting new highs. On Nov. 7, the tally of confirmed cases surpassed\n10 million in the U.S., and total deaths reached 242,339. <\/p>\n\n\n\n Those European countries, the U.S. and Japan, which adopted the \u201cCoexisting\nwith COVID-19 Policy\u201d, had to resort to lockdown measures to stop the spread of\nthe virus. <\/p>\n\n\n\n Table 3 A projection and comparison of real GDP growth rates among countries and regions.<\/strong> The resurging virus in autumn and winter seasons posed daunting challenges\nto those countries that opted for the \u201cCoexisting with COVID-19 Policy\u201d.\nCompared with them, China benefited from its \u201cZero COVID-19 Case Policy\u201d as all\nlocalities across the country resumed economic activities and normal life based\non their situations. After the postponed National People\u2019s Congress concluded\non May 28, China basically resumed normal economic activities. During the National\nDay holiday, domestic tourists made 640 million trips. China\u2019s real GDP shrank\nby 6.8% in the first quarter from a year ago as the coronavirus outbreak\nseriously impacted its economy. China\u2019s real GDP grew by 3.2% in the second\nquarter, rebounding from the first quarter\u2019s contraction. The IMF projected\nthat China\u2019s real GDP will grow by 1.9% in 2020. <\/p>\n\n\n\n The economy of Japan, European countries and the U.S., which adopted the\n\u201cCoexisting with COVID-19 Policy\u201d, continued to shrink in the second quarter, widening\ntheir falls compared with the first quarter. Some countries even exhibited a negative\ndouble-digit growth. The IMF projected that those countries will all have a negative\neconomic growth in 2020. <\/p>\n\n\n\n South Korea, Singapore, Vietnam, which experienced the test of the SARS\noutbreak like China, deployed the \u201cZero COVID-19 Case Policy\u201d. As shown in Chart\n3, Vietnam and China\u2019s Taiwan have better economic performance. According to an\nIMF forecast, Vietnam\u2019s real GDP will grow by 1.6% in 2020, and the real GDP\ngrowth of Taiwan province of China will stand at zero. South Korea may see a\n1.9% GDP contraction for 2020, which is a smaller drop compared with other\nWestern countries. Singapore\u2019s economy, which is vulnerable to the world\u2019s\neconomic fluctuations due to its heavy reliance on global trade, suffered a\ngreat slump in the second quarter. <\/p>\n\n\n\n According to the analysis above, compared with the \u201cZero COVID-19 Case\nPolicy\u201d, the \u201cCoexisting with COVID-19 Policy\u201d, which was intended to cushion\nthe economic blow from a lockdown, turned out to be a failure that caused a\nlong-term economic gloom. <\/p>\n\n\n\n By Nov. 8, there had been more than 50 million cases of infection\nglobally. The winter outbreak would be worse, with the number of infections\nsoaring. Europe and the U.S. have become the epicenter of the outbreak. I suggest\nthat all countries around the world should take the \u201cZero COVID-19 Case Policy\u201d\nwhen wonder drugs and efficient vaccines are not available, to contain the\nspread of the virus. <\/p>\n\n\n\n (4) Japan: Swinging\nbetween economic growth and COVID-19 response<\/strong><\/p>\n\n\n\n Japan reported the first\nconfirmed COVID-19 case on Jan. 16, 2020. The first flight of the Japanese\ngovernment taking 206 Japanese citizens took off in Wuhan and bound for Japan\non Jan. 29. On Feb. 13, Japan reported the first COVID-19 death. On Feb. 28, Hokkaido\nreleased its announcement of emergency. On March 13, the Diet, or the Japanese\nParliament, passed an amendment of a special law to combat COVID-19, including\nthe virus to the list of infectious diseases suitable for the law. The special\nlaw stipulates that the government is granted enhanced authority to declare a\nstate of emergency in condition that the COVID-19 epidemic may threaten\npeople\u2019s lives and inflict great losses on society, laying a legal basis for\nthe government to declare a state of emergency. <\/p>\n\n\n\n The Japanese government declared\na state of emergency on April 7 with respect to the seven prefectures: Tokyo,\nKanagawa, Saitama, Chiba, Osaka, Hyogo, and Fukuoka. On April 16, the state of\nemergency was expanded to the whole nation. That was a loose requirement aimed\nat reducing person-to-person contact by at least 70% to 80%, rather than a\nlockdown targeting at no new local cases. Even so, as shown in Chart 4, the\ndaily new confirmed COVID-19 cases in Japan plumped immediately, and the\ndeclaration of a state of emergency achieved remarkable results in disease\nprevention and control. As the situation improved, the Japanese government\nlifted its nationwide state of emergency on May 25. Different from China, Japan\nreported 20 new cases on that day. The lifting was accompanied by new confirmed\ncases.<\/p>\n\n\n\n China required that a place\nmust report no new COVID-19 cases for 14 consecutive days before it announced\nitself to be a low-risk area, but Japan lifted the state of emergency with new\ncases, which boded that the epidemic may come once again. It turned out that a\nweek after lifting the state, Tokyo had to declare its state of emergency due\nto the rapid increase of infections, so as to raise the people\u2019s awareness of\ndisease prevention and control amid severe COVID-19 epidemic. <\/p>\n\n\n\n Since July 22, Japan\nstarted to carry out the \u201cGo to Travel\u201d campaign to revive tourism and\nstimulate economy in places except Tokyo. On that day, the new confirmed\nCOVID-19 cases in Japan amounted to 792, 10% more than the peak number in the\nstate of emergency, proving the move to be a temerity regardless of anything. Ten\ndays later, the daily new cases surged to 1,575, a 120% increase over the peak\nnumber during the state of emergency. <\/p>\n\n\n\n On Oct. 1, Tokyo was involved\ninto the \u201cGo to Travel\u201d campaign. The number of Tokyo\u2019s new cases reached 284,\na rising trend again. <\/p>\n\n\n\n As shown in Table 2, by\nthe end of Oct.11, Japan\u2019s death toll from COVID-19 of every 100,000 people is\nonly 1.3, lower than 66.3 of the U.S., 63 of UK, 59.8 of Italy, 50.1 of France\nand 11.6 from Germany. In terms of fatality rate, Japan is the lowest among\ndeveloped countries. It can be said that Japan suffered least of the countries\nadopting the \u201ccoexisting with COVID-19 policy\u201d. However, the winter when\ninfluenza virus may rage is coming soon. The flu virus and the COVID-19 virus\nwould pose more challenges to Japan. Meanwhile, Japan\u2019s economy under the long\nperiod of \u201ccoexisting with COVID-19 policy\u201d has been fettered and sluggish. As\nshown in Table 3, IMF estimated that the real GDP of Japan may decrease 5.3% in\n2020. <\/p>\n\n\n\n Chart 4: Numbers of daily new confirmed COVID-19 cases and deaths in Japan 5. ‘Jared M. Diamond Hypothesis’ VS ‘Zhou Muzhi Hypothesis’<\/strong><\/p>\n\n\n\n There had been 1.5 COVID-19 deaths among every 100,000 Japanese by Nov. 11, 2020. This was a “slight” death rate compared with Spain’s 58.8, the U.S.’ 74.6, the U.K.’s 74, Italy’s 71.1, France’s 65.1, and Germany’s 14.1. The question is raised that how Japan managed to control its COVID deaths at such a low level, while implementing the “Coexisting with COVID-19 Policy” that European countries and the U.S. all deployed.<\/p>\n\n\n\n Among all speculations trying to explain Japan’s low death level, I think “cross-immunity” is the most compelling one. The theory opined that the immunity acquired by the Japanese people has played a role to some extent in preventing COVID-19 or mitigating its symptoms. <\/p>\n\n\n\n The question here is how Japanese people acquired cross-immunity against the novel coronavirus.<\/p>\n\n\n\n U.S. expert Jared M. Diamond hypothesized in his “Guns, Germs, and Steel: The Fates of Human Societies” that during the long time of close contact with poultry, European people became immune to many pathogenic bacteria. On the contrary, as Americas had no domesticated poultry, native people there lacked immunity to bacteria. The European people brought bacteria to Americas in the age of great navigation. The bacteria wreaked havoc on natives who lacked immunity, wiping out population .<\/p>\n\n\n\n I agree with Jared M. Diamond’s hypothesis that Europeans obtained immunity from their long-time close contact with poultry. However, the hypothesis failed to explain why European countries were greatly eclipsed by Japan in terms of the number of COVID-19 deaths, despite of the fact they are all in Eurasia. What’s more, besides Japan, other East Asian countries, including China, all reported smaller numbers of COVID-19 deaths<\/p>\n\n\n\n By Nov. 11, China, South Korea, China’s Taiwan province and Hong Kong Special Administrative Region, Vietnam, and Thailand registered 0.3, 0.9, 0.03, 1.4, 0.04 and 0.09 COVID-19 deaths per 100,000 people, respectively, “very minor” compared with European countries rich in medical resources. Such relatively good performances, though largely due to the “Zero COVID-19 Case Policy,” have also benefited from cross immunity.<\/p>\n\n\n\n I hereby put forward a hypothesis that the lifestyle centering on rice fields in humid regions of East Asia plays a determining role in people’s acquisition of cross immunity against the novel coronavirus. The “Zhou Muzhi Hypothesis” is detailed as follows: The humid rice-growing Satoyama boasts rich ecological diversity, and a new ecology formed upon a moderate intervention of human beings in nature, one with richer diversity than primitive natural ecology. The diversity is also reflected in microorganisms. In Satoyama, human beings, nature, and poultry are in close contact and influence each other, shaping a huge breeding spot for pathogens. This place is richer in microorganism diversity than Europe, though they both belong to Eurasia. Therefore, I infer that people living in rice-growing regions with a variety of pathogens have stronger cross immunity .<\/p>\n\n\n\n Studies on cross immunity against novel coronavirus are still in their infancy. The recent research findings published by Manish Sagar of Boston University confirmed that people who have been infected with seasonal coronaviruses can develop cross immunity against novel coronavirus, thus alleviating severe symptoms . Tatsuhiko Kodama from the Isotope Science Center at the University of Tokyo found through an analysis of the blood of 50 COVID-19 patients in Japan that 75% of the patients have cross immunity against the novel coronavirus .<\/p>\n\n\n\n In fact, seasonal coronaviruses have been frequently around in the humid regions of East Asia. If they can help people develop cross immunity against the novel coronavirus, it should be a grace of living in the rice-growing Satoyama.<\/p>\n\n\n\n From this perspective, it is important and worthwhile to think how to evaluate the life in Satoyama where people and nature influence each other, and how to draw on experience from Satoyama lifestyle in our modern life.<\/p>\n\n\n\n 6. From global failure to global fight<\/strong><\/p>\n\n\n\n Infectious diseases were\nonce the most vicious killer of human. For example, the Black Death broke out\nin 1347 in Sicily caused the death of 25 million people in 20 years. The\nSpanish flu that broke out in 1918 killed 25 to 40 million people worldwide. <\/p>\n\n\n\n In the past century or\nso, with the development and popularization of antibacterial drugs and\nvaccines, most of the infectious diseases once extremely harmful to human\nhealth and life such as smallpox, polio, measles, rubella, mumps, tetanus,\nwhooping cough, and diphtheria, have been extinct or under control. After the 1950s,\nthe death toll in developed countries caused by infectious diseases such as\npneumonia, gastroenteritis, hepatitis, tuberculosis, and influenza,, dropped sharply, while chronic diseases like cancer,\ncardiovascular and cerebrovascular diseases, hypertension, and diabetes have\nbecome the main causes of death. <\/p>\n\n\n\n The achievements made in\nthe prevention and treatment of infectious diseases have increased the average\nlife expectancy of human beings, but the alternation of the main death causes has\nalso shifted the focus of the global medical systems, especially those in\ndeveloped countries, from infectious diseases to chronic diseases. The\nconsequences are that countries now invest little resources in the prevention\nand treatment of infectious diseases, and meanwhile, existing medical resources\nare mainly concentrated on addressing structural problems of chronic diseases.<\/p>\n\n\n\n From the perspective of\nexisting medical resources, neither the professional background of medical workers,\nthe devices, nor the entire medical system can effectively respond to the\noutbreak in a timely and effective manner. Therefore, in the fight against the\nvirus, even metropolises with huge medical resources, such as Wuhan, New York,\nand Tokyo, were caught off guard and paid a heavy price.<\/p>\n\n\n\n As early as in 2015,\nBill Gates warned people that investing too little in viral infectious diseases\nwould lead to a global failure. The scourge of the COVID-19 epidemic\nunfortunately confirmed Bill Gates’ prediction.<\/p>\n\n\n\n 7. Explosive technological progress<\/strong><\/p>\n\n\n\n The current measures of\nvarious countries to combat COVID-19, such as national state of emergency,\nlockdowns of the country and cities, self-discipline when going out, and keeping\nsocial distancing, focus on reducing and cutting off people-to-people\ncommunication to block the spread of the virus. Although the measures have\nachieved certain results, they cannot eradicate the virus from the root. Though\nthe epidemic has been controlled by the strong \u201cZero COVID-19 Case Policy\u201d, the\nachievements are very weak, and any slack or loophole may trigger a resurgence.\n<\/p>\n\n\n\n We must rely on the technological\nprogress to return to a safe and secure world. At present, all countries are stepping\nup the research and development efforts to find wonder drugs and vaccines for\nCOVID-19.<\/p>\n\n\n\n The pandemic has been\ninspiring the breakthroughs in related technologies. Human beings dare not to\nsay that they have controlled and defeated the virus until they master effective\ntesting methods, wonder drugs and vaccines. <\/p>\n\n\n\n Opportunities also lie\nin crises. Every global war and crisis in modern society has brought a major transformation\nand explosive technological progress to mankind. For example, the WWII\nstimulated the development of the aviation industry and initiated the nuclear\nindustry. The Cold War not only promoted the development of aerospace\ntechnology, but also laid the foundation for internet technology. The pandemic not\nonly inspired the breakthroughs of technology but also greatly promoted the\ndigital transformation of human society. <\/p>\n\n\n\n While the tension\nbrought by the pandemic is pushing forward technological progress, it may also\nexplore new technological paths so that those overlooked in the past can stand\nout. For example, traditional Chinese medicine has played an excellent role in\nWuhan\u2019s anti-epidemic process and won global attention. The fight against COVID-19\nmay become an important opportunity for traditional Chinese medicine to go global.<\/p>\n\n\n\n Ozone is also a\ntechnological option that has been neglected due to prejudice. As early as on Feb.\n18, I wrote an article appealing for the attention to the performance of ozone in\nsterilization and advocated the use of ozone in the COVID-19 fight[19]<\/a>.\nExperiments in Japan have proved that the possibility of virus transmission\nthrough droplets in a closed environment is 17.7 times more than that in a\nnon-closed environment. Therefore, an important anti-epidemic measure of the\nJapanese government is to call on people to avoid going to confined spaces,\ndensely populated places, and contacting each other closely. If we can make\nbreakthroughs in the research and development of ozone sensors and control the ozone\nconcentration as cheaply and freely like we did in temperature control, we are\nexpected to solve the indoor virus infection problem in the presence of people\nby using ozone to sterilize and kill the virus, thus freeing people from the\nfear of contact. The globally concerted efforts in combating the pandemic will\nsurely inspire huge technological progress and upgrade a large number of\nindustries. <\/p>\n\n\n\n 8. Globalization will not stop <\/strong><\/p>\n\n\n\n Countries around the world have been cutting off international personnel\nexchanges and locking down cites since the global outbreak of COVID-19.\nGlobalization has been instantly stopped. We are inundated with worries about\nglobalization, and doubts and even opposition about metropolitanization. <\/p>\n\n\n\n Indeed, with the further development of globalization, international\npersonnel exchanges have been expanded. The overseas trips worldwide have\nsurged from 400 million 30 years ago to 1.4 billion in 2018. <\/p>\n\n\n\n Against the backdrop of globalization, metropolitanization is\nthe extension of globalization. From 1980 to 2019, 117 cities around the\nworld saw its population increase by more than 2.5 million people, and the\nincreased population amounted to 630 million in total. Particularly, the number\nof megacities with a population of over 10 million surged to 33 from only five in\n1980. And these megacities are mostly centers of international exchanges, and leaders\nin the world economic and political development. The population of those\nmegacities amounts to over 570 million, accounting for 15.7% of global\npopulation. <\/p>\n\n\n\n The virus has been spread worldwide\nthrough the dense aviation network and a large number of international\npersonnel exchanges, making COVID-19 a pandemic. Many international\nmetropolises with large populations and extensive international exchanges have\nbeen severely stricken by it. <\/p>\n\n\n\n But it must be clear that the real\nreason for global spread of COVID-19 is not the speed and density of international\npersonnel exchanges, but the long existing neglect towards infectious diseases\namong human beings.<\/p>\n\n\n\n Actually, the progress of\nglobalization has been accompanied by the threat of spreading infectious\ndiseases from the very beginning. From the Age of Navigation to today, human\nbeings have been fighting against infectious diseases and paid heavy price many\ntimes during the period. But due to the achievements in suppressing infectious\ndiseases, many countries and international organizations tended to underrate\ntheir threat.<\/p>\n\n\n\n For example, the Global Risks Report\n2020 released at the World Economic Forum listed 10 possible global risks for\nthe future 10 years and infectious diseases were not included. In the list of\nthe ten risks of the greatest global impact, infectious diseases only ranked\nthe last. <\/p>\n\n\n\n Unfortunately, contrary to the\nprediction of the World Economic Forum, the COVID-19 pandemic brought\nunprecedented blows to human society at the beginning of 2020.<\/p>\n\n\n\n Most countries and regions that once\nexperienced SARS, such as China, Singapore, South Korea, and Vietnam, have responded\nwith measures similar to the \u201cZero COVID-19 Case Policy\u201d and achieved good\neffects. That is probably thanks to the impressive experience of combating SARS.\nChina has incorporated the experience of combating SARS\ninto laws, regulations and general emergency response plans, and compiled\nrelated measures into manuals and guidebooks, which determined a quick launch\nof effective measures in time amid the COVID-19 outbreak and suppressed the\nepidemic.[20]<\/a><\/p>\n\n\n\n In this sense, we do not need to be\npessimistic. COVID-19 has drawn global attention and led to global investment\nin viral infectious diseases, which will definitely trigger an explosive\ntechnological revolution and social change. We will eventually overcome the\nthreat from viral infectious diseases and turn the global failure to a global\nvictory. <\/p>\n\n\n\n The pandemic will not stop globalization\nand international metropolitanization, but give birth to a better globalization\nand healthier international metropolises after pains and sufferings.<\/p>\n\n\n\n Kurimoto<\/em> Kenichi, Zhen Xuehua, and Zhao Jian contributed to data compilation and\ngraphic production in the article.Wen Feng contributed to proofreading.<\/em> Endnotes:<\/p>\n\n\n\n [1] Zhou Muzhi, \u201cCOVID-19: Why is the medical system in metropolises so vulnerable?\u201d In China.com.cn<\/em>, Apr. 20, 2020 (http:\/\/www.china.com.cn\/opinion\/think\/2020-04\/17\/content_75944655.htm<\/a>)<\/p>\n\n\n\n [2]<\/a> Zhou Muzhi, \u201cCOVID-19: Why is the medical system in metropolises so vulnerable?\u201d In China.org.cn<\/em>, Apr. 21, 2020 (http:\/\/www.china.org.cn\/opinion\/2020-04\/21\/content_75957964.htm?from=singlemessage&isappinstalled=0<\/a>).<\/p>\n\n\n\n [3]<\/a> Zhou Muzhi, \u201cCOVID-19: Why is the medical system in metropolises so vulnerable?\u201d In Japanese.China.org.cn<\/em>, Apr. 21, 2020 (http:\/\/www.china.org.cn\/opinion\/2020-04\/21\/content_75957964.htm?from=singlemessage&isappinstalled=0<\/a>).<\/p>\n\n\n\n [4]<\/a> For information about China\nIntegrated City Index, please refer to 2018 China Integrated City Index: Development Strategy of megalopolises issued by the People\u2019s\nPublishing House in September 2019.<\/p>\n\n\n\n [5]<\/a> There was\nno COVID-19 death in Wuhan after May 11, 2020.<\/p>\n\n\n\n [6]<\/a> Japan\nsuccessfully avoided overloaded medical system as COVID-19 testing in the\ncountry can only be done after the person has gained a testing approval after\nmedical consultations. However, limited testing has caused delayed quarantine\nof asymptomatic and moderate cases. Moreover, medical consultations and\napproval procedures before the testing also increased the work load of medical\nfacilities.<\/p>\n\n\n\n [7]<\/a> A dinner\nparty attended by 40 trainee doctors from Keio University has caused 18 people\ntested positive for COVID-19 in March even after the Japanese and Tokyo\ngovernments issued guidelines against mass dinner gatherings.<\/p>\n\n\n\n [8]<\/a> According\nto information published by ICN on Sept.16, nearly 3 million health care\nworkers were infected by the novel coronavirus by Aug. 14 from data provided by\n33 nurse organizations of 32 countries. For more information, please visit https:\/\/www.icn.ch\/news\/new-icn-report-shows-governments-are-failing-prioritize-nurses-number-confirmed-covid-19-nurse<\/a>.<\/p>\n\n\n\n [9]<\/a> For details,\nplease refer to the Emergency Notice of the Ministry of Transport on\nEffectively Preventing and Controlling the Epidemic through Traffic Control in\nand out of Wuhan on Jan. 23, 2020.<\/p>\n\n\n\n [10]<\/a> The Response Plan\nfor Public Health Emergencies in Hubei province was deliberated and approved at\nthe 52nd executive meeting of Hubei provincial government on Apr. 22, 2010. It\nis formulated in accordance with the Emergency Response Law of the People’s Republic\nof China, the Law of the People’s Republic of China on Prevention and Treatment\nof Infectious Diseases, the Food Safety Law of the People’s Republic of China,\nthe Law of the People’s Republic of China on the Prevention and Treatment of\nOccupational Diseases, the Frontier Health and Quarantine Law of the People’s\nRepublic of China, the Regulation on the Urgent Handling of Public Health\nEmergencies, the National Response Plan for Public Health Emergencies, and the\nOverall Response Plan for Emergencies in Hubei Province.<\/p>\n\n\n\n [11]<\/a> Responses to major\npublic health emergencies are divided into four levels. The implementation of\nthe first-level response requires to be organized by the State Council or the\nhealth authorities and other relevant departments under it. For details, please\nrefer to the National Response Plan for Public Health Emergencies.<\/p>\n\n\n\n [12]<\/a> The Chinese\ngovernment promulgated the Regulation on the Urgent Handling of Public Health\nEmergencies, on May 7, 2003, and the National Response Plan for Public Health\nEmergencies on Jan. 8, 2006, based on the experience of combating SARS and in\naccordance with the Law of the People’s Republic of China on Prevention and\nTreatment of Infectious Diseases (coming into force as of Sept. 1, 1989). The\nNational Response Plan for Public Emergencies was formulated based on the\naforementioned law, regulation and overall plan. On Aug. 30, 2007, the Standing\nCommittee of the National People’s Congress approved the Emergency Response Law\nof the People’s Republic of China, further systemizing the above-mentioned law,\nregulation and response plans. On Jan. 20, days before the lockdown of Wuhan,\nthe National Health Commission issued its No. 1 announcement of 2020,\ncategorizing the novel coronavirus pneumonia into the Class B infectious\ndiseases stipulated in the Law of the People’s Republic of China on Prevention\nand Treatment of Infectious Diseases, and adopting prevention and control\nmeasures for Class A infectious diseases.<\/p>\n\n\n\n [13]<\/a> U.S. President\nTrump deployed the USNS Mercy and USNS Comfort to Los Angeles and New York\nrespectively in late March 2020. Both hospital ships have 1,000 hospital beds.\nAlthough they are not suitable for patients infected with the novel\ncoronavirus, they can accommodate a large number of patients with common\ndiseases, so that local medical facilities can free up more beds for patients\ninfected with the novel coronavirus.<\/p>\n\n\n\n [14]<\/a> For details, please\nrefer to Ferguson NM, Laydon D, Nedjati-Gilani G, et al., \u201cReport 9: Impact of\nnon-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and\nhealthcare demand\u201d, in Imperial College London HP , March 16, 2020.\uff08http:\/\/hdl.handle.net\/10044\/1\/77482<\/a>\uff09<\/p>\n\n\n\n [15]<\/a> On March 16, the\nWhite House issued the coronavirus guidelines, calling on Americans to practice\nsocial distancing; avoid gatherings of more than 10 people; avoid eating and\ndrinking in bars, restaurants, and public food courts; avoid unnecessary trips,\nshopping or social activities; avoid going to sanatoriums, old people\u2019s homes; encouraging\nschooling from home across the country. On March 29, Trump extended\nthe federal social distancing guidelines, which originally expired on March 30,\nto April 30.<\/p>\n\n\n\n [16]<\/a> For details, please\nrefer to Solomon Hsiang, Daniel Allen, S\u00e9bastien Annan-Phan, Kendon Bell, Ian\nBolliger, Trinetta Chong, Hannah Druckenmiller, Luna Yue Huang, Andrew\nHultgren, Emma Krasovich, Peiley Lau, Jaecheol Lee, Esther Rolf, Jeanette Tseng\n& Tiffany Wu, \u201cThe effect of large-scale anti-contagion policies on the\nCOVID-19 pandemic\u201d, in Nature, June 8, 2020.<\/p>\n\n\n\n [17]<\/a> On Feb. 17, 2020,\nthe Joint Prevention and Control Mechanism of the State Council issued\nguidelines on taking science-based, targeted, region-specific, and multi-level\nmeasures on the epidemic prevention and control. The guidelines ordered\ngovernments at provincial levels to make dynamic adjustments to the list of\nhigh-risk, medium-risk and low-risk areas in their jurisdictions. According to\nthe risk criteria defined in the guidelines, cities, counties and districts\nwith no new confirmed cases in the last 14 days are categorized as\nlow-risk areas. Those with fewer than 50 cases or those with over 50 but without\na concentrated outbreak are classified as medium-risk areas, and those with\nover 50 cases as well as a concentrated outbreak are classified as high-risk\nareas.<\/p>\n\n\n\n [18]<\/a> Wohlrabe Klaus,\nPeichl Andreas, Link Sebastian ,Leiss Felix, Demmelhuber Katrin, \u201cDie Auswirkungen der Coronakrise auf die\ndeutsche Wirtschaft\u201d, in ifo\nSchnelldienst Digital, No.7, May18, 2020.<\/p>\n\n\n\n [19]<\/a> Zhou Muzhi,\n\u201cOzone: a powerful weapon to combat COVID-19 outbreak\u201d In China.org.cn, Feb. 26,\n2020.\uff08http:\/\/www.china.org.cn\/opinion\/2020-02\/26\/content_75747237.htm<\/a>\uff09<\/p>\n\n\n\n [20]<\/a> China has turned\nthe experience in combating SARS into laws, regulations, manuals and guidebooks\nand those are the keys to combating the epidemic. On the contrary, in the U.S.,\nCenters for Disease Control and Prevention prepared a guideline for restarting\nworld economic activities, only to be rejected by the Trump administration in\nthe first 10 days of May for being too detailed.<\/p>\n\n\n\n The article was published on China SCIO Online on Dec 3, 2020, and was republished by foreign media, including China Daily, Guangming Daily, <\/span>as well as today\u2019s headlines and other platforms.<\/p>\n","protected":false},"excerpt":{"rendered":" By Zhou Muzhi, professor of Tokyo Keizai University and president of Cloud River Urban Research Institute Editor\u2019s note:How come the metropolises around the world with concentrated medical resources are so vulnerable to the COVID-19 pandemic? Why China has managed to control the outbreak so quickly? Why Western countries and Japan are seeing a resurgence in the coronavirus outbreak? Professor Zhou Muzhi, president of Cloud River Urban Research Institute, offers his interpretation by comparing the COVID-19 responses adopted by different countries around the world. On Jan. 23, 2020, Wuhan and its surrounding cities like Ezhou and Huanggang announced the suspension of all public transportation such as bus, subway and ferry, temporary … <\/p>\n Continue reading “Global COVID-19 responses: \u2018Zero COVID-19 Case Policy\u2019 vs. \u2018Coexisting with COVID-19 Policy\u2019”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"cybocfi_hide_featured_image":"","footnotes":""},"categories":[4],"tags":[],"class_list":["post-422","post","type-post","status-publish","format-standard","hentry","category-news-event"],"rttpg_featured_image_url":null,"rttpg_author":{"display_name":false,"author_link":"https:\/\/cici-index.com\/en\/author\/wpmaster\/"},"rttpg_comment":0,"rttpg_category":"NEWS & EVENT<\/a>","rttpg_excerpt":"By Zhou Muzhi, professor of Tokyo Keizai University and president of Cloud River Urban Research Institute Editor\u2019s note:How come the metropolises around the world with concentrated medical resources are so vulnerable to the COVID-19 pandemic? Why China has managed to control the outbreak so quickly? Why Western countries and Japan are seeing a resurgence in…","_links":{"self":[{"href":"https:\/\/cici-index.com\/en\/wp-json\/wp\/v2\/posts\/422"}],"collection":[{"href":"https:\/\/cici-index.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cici-index.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cici-index.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cici-index.com\/en\/wp-json\/wp\/v2\/comments?post=422"}],"version-history":[{"count":6,"href":"https:\/\/cici-index.com\/en\/wp-json\/wp\/v2\/posts\/422\/revisions"}],"predecessor-version":[{"id":532,"href":"https:\/\/cici-index.com\/en\/wp-json\/wp\/v2\/posts\/422\/revisions\/532"}],"wp:attachment":[{"href":"https:\/\/cici-index.com\/en\/wp-json\/wp\/v2\/media?parent=422"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cici-index.com\/en\/wp-json\/wp\/v2\/categories?post=422"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cici-index.com\/en\/wp-json\/wp\/v2\/tags?post=422"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
<\/strong>How come the metropolises around the world with concentrated medical resources are so vulnerable to the COVID-19 pandemic? Why China has managed to control the outbreak so quickly? Why Western countries and Japan are seeing a resurgence in the coronavirus outbreak? Professor Zhou Muzhi, president of Cloud River Urban Research Institute, offers his interpretation by comparing the COVID-19 responses adopted by different countries around the world. <\/em><\/p>\n\n\n\n
\n\n\n\n![\"\"](\"https:\/\/i0.wp.com\/cici-index.com\/en\/wp-content\/uploads\/sites\/2\/2020\/12\/Chart-1_List-of-top-30-Chinese-cities-by-health-care-radiation-in-2019.jpg?fit=525%2C744&ssl=1\")
<\/figure><\/div>\n\n\n\n
Source: Cloud River Urban Research Institute<\/em><\/p>\n\n\n\n![\"\"](\"https:\/\/i0.wp.com\/cici-index.com\/en\/wp-content\/uploads\/sites\/2\/2020\/12\/Table-1_A-comparison-of-medical-resources-in-China-European-countries-the-U.S.-and-Japan-in-2019.jpg?fit=525%2C413&ssl=1\")
<\/figure><\/div>\n\n\n\n
Sources: China City Statistical Yearbook by the National Bureau of Statistics, OECD.Stat, Kaiser Family Foundation, Ministry of Health, Labor and Welfare in Japan<\/em><\/p>\n\n\n\n![\"\"](\"https:\/\/i2.wp.com\/cici-index.com\/en\/wp-content\/uploads\/sites\/2\/2020\/12\/Table-2-A-comparison-of-numbers-of-COVID-19-infentions-deaths-and-death-rates-in-China-European-countries-the-U.S.-and-Japan-.jpg?fit=525%2C265&ssl=1\")
<\/figure><\/div>\n\n\n\n
Note: China\u2019s number of COVID-19 infections in this table does not include those are asymptomatic.
Sources: Worldometer, Kaiser Family Foundation, stopcovid19.metro.tokyo.lg.jp, website of the Health Commission of Hubei Province<\/em><\/p>\n\n\n\n![\"\"](\"https:\/\/i2.wp.com\/cici-index.com\/en\/wp-content\/uploads\/sites\/2\/2020\/12\/180f50571123652db2a949c2ef37446a.jpg?fit=525%2C356&ssl=1\")
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Note 1: There is no data for Jan. 23, the day when the city began the lockdown, as well as data for Feb. 11. The number of confirmed cases surged on Feb. 12, presumably because it was added up by the figures of the previous day.
Source: The official website of the Health Commission of Hubei province.<\/em><\/p>\n\n\n\n![\"\"](\"https:\/\/i0.wp.com\/cici-index.com\/en\/wp-content\/uploads\/sites\/2\/2020\/12\/Chart-3_-Numbers-of-daily-new-COVID-19-confirmed-cases-and-deaths-in-China.jpg?fit=525%2C342&ssl=1\")
<\/figure><\/div>\n\n\n\n
<\/strong>Note: The number of infection cases in China marked in the chart does not include numbers of asymptomatic cases and imported cases.
Source: China\u2019s National Health Commission<\/em><\/p>\n\n\n\n![\"\"](\"https:\/\/i2.wp.com\/cici-index.com\/en\/wp-content\/uploads\/sites\/2\/2020\/12\/Table-3-A-projection-and-comparison-of-real-GDP-growth-rates-among-countries-and-regions.jpg?fit=525%2C347&ssl=1\")
<\/figure><\/div>\n\n\n\n
Sources: the National Bureau of Statistics of China, the Cabinet Office of Japan, the Bureau of Economic Analysis of the U.S. Department of Commerce, the British Office for National Statistics, the Italian National Institute of Statistics, the Spanish National Statistics Institute, the Federal Statistics Office of Germany, the French National Institute of Statistics and Economic Studies, the Bank of Korea, the Directorate General of Budget, Accounting and Statistics of China\u2019s Taiwan, the Asian Development Bank and the International Monetary Fund.<\/em><\/p>\n\n\n\n![\"\"](\"https:\/\/i1.wp.com\/cici-index.com\/en\/wp-content\/uploads\/sites\/2\/2020\/12\/Chart-4-Numbers-of-daily-new-confirmed-COVID-19-cases-and-deaths-in-Japan.jpg?fit=525%2C354&ssl=1\")
<\/figure><\/div>\n\n\n\n
<\/strong>Sources: Database of positive cases of the Ministry of Health, Labor and Welfare of Japan, and NHK’s special website for COVID-19 deaths in Japan.<\/em><\/p>\n\n\n\n
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