Coping with the Coronavirus in China

On 31 January, the world looked on with amazement as China announced it was taking massive measures to protect the country from the rapid spread of the newly identified novel coronavirus, now officially classified by the World Health Organization as COVID-19. When the speed of transmission resulted in long lines at medical centers and rising fatality rates, Hong Kong and Macao quickly followed suit. These unprecedented emergency measures were implemented during one of the largest annual mass migrations in China—the Chinese Lunar New Year holiday, which occurs over a 15-day timeframe in January and prompts many Chinese to return home to visit with family. This year, experts predicted the occasion would attract the largest number of travelers ever, with over 440 million railway travelers expected within China and 79 million air travelers, about 7 million of whom were traveling from abroad. [reference] Noting the severity of the virus outbreak that coincided with this migration, the government moved swiftly to enact multiple measures to contain the spread, with so many people traveling back to the major cities. These included instituting a complete lockdown of Wuhan, the epicenter, shuttering all places of work in all major cities, screening every port of entry—via rail, road, and air—and immediate testing of people upon request to see if they carried the virus. All shops and restaurants were temporarily closed or had restricted hours for food delivery and all public gatherings were cancelled. Screening stations were set up at the borders of cities and provinces. As schools were not in session over the holiday, it was later announced that all educational institutions would be closed until further notice and online instruction was put in place. This response protocol had been planned in advance based on lessons learned from previous outbreaks, such as SARS, Swine Flu, Avian Flu, and MERS, which have occurred about every four years. Imagine the shock for those returning from holiday to see once bustling and traffic-filled streets deserted, with public transport reduced to a trickle. Fourteen-day quarantines were put in place for anyone returning from outside the country, as residents were asked to remain in their homes and visitors in hotels. Individuals’ movements were tracked by monitors in each housing area. Although major stores remained open for shortened days, stocks of key goods—such as face masks, toilet paper, and tissues—were completely exhausted for long periods of time. The sheer magnitude of the measures taken is mind boggling. All universities and schools remained closed after the holiday and, as of 13 March, are still not open. Consider the size of this order, where nationwide there are about 514,000 schools, including undergraduate universities, 260 million students, and about 15 million teachers. This year, all schools have been asked to conduct online learning in some fashion. What a massive undertaking! [reference] In addition, the international community—consisting of international business representatives, specialists, and diplomats from over 100 nationalities—is supported by two types of private schools: those designed to serve local students and foreigners and Schools for Children of Foreign Nationals that are not allowed to enroll local students without written permission from the government. The [reference] The latest WHO Situation reports show that containment has been effective in China to date. In China there is great hope that the virus will not transmit well in summer. "Based on the analogy of pandemic flu, we expect that SARS-CoV-2, as a virus new to humans, will face less immunity and thus transmit more readily even outside of the winter season. Changing seasons and school vacation may help, but are unlikely to stop transmission."[a href="https://ccdd.hsph.harvard.edu/will-covid-19-go-away-on-its-own-in-warmer-weather/"> [reference] Conclusions Major measures by government in China and Hong Kong (SAR) have been very effective in reducing transmission. China was prepared for this, as a result of experiencing previous infectious events. Instituting such extensive measures may not be possible in other countries, where the needed skilled healthcare workers and epidemiology expertise is lacking. At this point, during the first pass, children do not appear to be easily infected and may not do much transmitting, but this could change with time. The average person’s immune system is worse in winter. It is possible that transmission may decrease during warmer weather, but the coronavirus can still be spread from cooler climates to warm ones through travel. As this virus is new to humans, it may take 12–18 months for the spread to make the first pass. Seasonality in the northern and southern hemispheres will make little difference as this virus can be carried and transmitted back and forth between seasons. Most affected are the susceptible hosts—the aged, infirm, smokers, and those will other illnesses, particularly those above age 60. This suggests that we must try to protect those people by encouraging them to limit broad social contact until conditions improve, which could take more time than first thought. If the spread is not contained, there is a danger that the medical community will become overloaded and overworked. International schools all over the world should expect to be affected in some way at some point. Be patient, be confident, be strong, be informed, be a good listener, be safe! Tom Ulmet is the Executive Director of the Association of China and Mongolia International Schools (ACAMIS) since 2014. Before taking this role, he was Founding Chair of Shanghai International Schools Association (SISA) (during SARS in 2003) and was a member of the ACAMIS Board for five years. He served as Superintendent of Yew Chung International Schools in China (YCIS) for 12 years and in the YCIS Foundation Headquarters in Hong Kong for two years. References The ACAMIS Model Infectious Disease Preparation Check List for International Schools 2019-2020 US Flu Season: Preliminary Burden Estimates, Center for Disease Control, February 22, 2020 COVID-19: The Distinction Between a Disease and an Epidemic, Updated, OT and P Healthcare, Owens, Feb 28, 2020 Coronavirus Disease 2019 (COVID-19), Situation Report-55, World Health Organization (WHO), March 15, 2020 COVID-19: why do we close schools, OT and P Healthcare; Owen, Jan 28, 2020 Environmental factors on the SARS epidemic: air temperature, passage of time and multiplicative effect of hospital infection Education in China: A Snapshot, 2016 Genomic Characterisation and Epidemiology of 2019 Novel Coronavirus: Implications for Virus Origins and Receptor Bindings"; Lu, Zhao, Li, Niu, Yang, Wu; The Lancet: V 395, Issue 10224, Feb 22, 2020 Seasonality of SARS-CoV-2: Will COVID-19 go away on its own in warmer weather?, Marc Lipstitch, Harvard School of Public Health, Winter 2020 Understanding the Risk of Catching COVID-19, OT& P Healthcare; Owen, Feb 21, 2020 "What is the Latest on the COVID-19", OT and P Healthcare, Owens, Feb 28, 2020 "Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19), 16-24 February 2020"

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