Political Realities of the Pandemic, Part 2

When a new virus broke out in April 2009 in the US, the H1N1 (swine flu), American and Chinese health authorities immediately worked together. The first human infection was detected April 15 in California with the second detected 130 miles away with no known connection. It was reported to the World Health Organization (WHO) April 18. The Centers for Disease Control (CDC) publicly announced the two known cases on April 21. Two additional cases were detected in Texas on April 23, making it a multistate outbreak.

The CDC uploaded complete gene sequences on April 24 of new H1N1 2009 virus to a publicly-accessible international influenza database. The WHO declared a public health emergency of international concern on April 25 (10 days later from original case) and raised the level of influenza pandemic alert from phase 3 to 4 based on data showing person-to-person spread and the ability of the virus to cause community-level outbreaks. The WHO Director-General raised the alert from 4 to phase 5, signaling that a pandemic was imminent, and requested all countries to immediately activate their pandemic preparedness plans and to be on high alert for unusual influenza outbreaks and severe pneumonia.

It wasn’t until June 11 when the WHO declared a pandemic (37 days after global emergency declaration) and raised the worldwide pandemic alert level to 6 which means that the virus was spreading to other parts of the world. By June 25, CDC estimated at least one million cases of 2009 H1N1 influenza had occurred in the United States.

China had its first case on May 10, 2009 (less than a month from the first case in the U.S.) and instituted quarantine measures immediately. Such actions limited their number of deaths while over 60 million in the US alone were infected with 12,469 deaths. Worldwide, the death toll was anywhere from 300,000 to 500,000 (lots of underreporting). No worldwide xenophobia, no blaming of the US, no accusations of bioengineered virus.

Let’s pause for a minute and look at the timelines. From the first case being detected in California to the day the WHO declared a public health emergency took 10 days. It took nearly two months before a pandemic was declared.

The coronavirus outbreak in Wuhan, China was reported on December 31 when Chinese officials in Wuhan confirmed dozens of cases of pneumonia from an unknown cause. It was identified as a new coronavirus outbreak on January 7. The WHO confirmed the first confirmed case outside China in Thailand, Japan and South Korea. The U.S. reported its first confirmed case on January 21.

The WHO declared the outbreak a global emergency on January 30 as more than 9,000 cases were reported worldwide (99% of cases from China), thirteen days after it was confirmed and a week later after Wuhan ordered citywide lockdowns. Pandemic was declared March 11, forty-one days after a global public health emergency was declared by WHO.

The United States took nine days from first case notification to complete gene sequencing of H1N1 and made available to the world while China took 7 days. The significance of gene sequencing in public health is immense as it allows the world to simultaneously begin research on treatment, vaccine development, data analysis among others. By comparison, the SARS coronavirus pandemic in 2002 took three months to complete the genome sequencing.

From a public health standpoint, the COVID-19 reporting timelines followed a methodical approach and are soundly justified. What is apparent is that the speed of reporting and declaration of a global public health emergency and subsequently a pandemic, are not necessarily directly proportional to how a country responds. It is also apparent that speed of reporting does not prevent the global spread of the virus as seen from the H1N1 pandemic. The reason for this is really simple: Nobody shuts down global travel based on a few reported cases albeit not even fully identified. Another is that every country’s leader reacts differently.

The United States had plenty of early notification not only from China, the WHO and other countries reporting confirmed cases. During the SARS, MERS, and H1N1 pandemics, the U.S. and China had a free-flowing information sharing and cooperation with having American experts working in China. President Trump dismantled such information sharing and recalled CDC personnel from China. This situation was further aggravated by Trump’s trade war with China.

Thus, when COVID-19 hit, the U.S. no longer had presence in the Chinese CDC and the relationship was frayed because of the trade war. The trade war had unintended consequences that is literally crippling U.S. response to the COVID-19 pandemic. Trumps billion dollar tariffs on Chinese medical products contributed to shortages and higher costs of vital equipment at a time of national crisis.

In the last two years, Trump’s trade policy of 15-25% tariffs on $360 billion of what Americans buy from China has forced China to divert sales of critical products such as protective gear for nurses and doctors and high-tech equipment such as ventilators, CT scanners, patient monitors, dialysis machines and oximeters; from the United States to other foreign markets.

Remember that Trump was adamant about calling it the “Chinese Virus” earlier? Well, you don’t hear him or Sec. Mike Pompeo say that now because when Trump realized his folly, he quietly announced on March 10 and March 12, that he would temporarily reduce tariffs imposed on Chinese products to treat the coronavirus pandemic. Aside from his tariff folly, his haste to declare a victory back in December 2019 that he was able to make China agree to buy $250 billion worth of American agricultural products over 5 years ($40 billion/year) was a monumental blunder. Trump was reeling at the time from stinging criticisms that his trade war with China was actually hurting American famers.

But the real folly is not catching the significance of a phrase that China President Xi wanted inserted in the trade agreement – a phrase that could pointedly alter this agreement. Xi had the phrase included that allowed for an out in case of “a natural disaster or other unforeseeable event” (i.e., like an outbreak). It seemed innocuous at the time when a virus outbreak was taking place in Wuhan but nobody from the American side questioned it and went ahead with the signing. The fraying (if not yet frayed) trade relationship between the two countries could make China just invoke that “out” provision.

China was not the only one slapped with tariffs – allies and trading partners too such as France, Germany, Canada, Mexico, and etcetera were also included. Because the U.S. was buying less from China and more on foreign trade partners, the cost to Americans for Chinese products sold through other countries increased tremendously. In the midst of the pandemic and lacking global leadership, these partners started competing with the U.S. for medical supplies and helping restrict the flow of medical equipment outside of their borders forcing Trump to hijack U.S. made products from leaving as well. It doesn’t stop there.