The race to curb the spread of the new strain of coronavirus that has killed more than 130 people worldwide has triggered a massive public health experiment in China that is being closely watched by health experts around the globe.
Chinese authorities have indefinitely barred 50 million people from traveling and advised them to stay home to contain the rapidly spreading virus, known as 2019-nCoV.
A quarantine of this scope is “absolutely unprecedented,” said Lauren Sauer, an emergency medicine professor at Johns Hopkins University. “I can’t think of anything that comes even remotely close.”
On Tuesday, as case counts rose, Chinese authorities agreed to allow the World Health Organization to send international experts to China to assist with research and containment of the virus. It is unclear whether or how that will affect the standing quarantine orders.
The virus as of Tuesday evening had infected more than 5,570 people on four continents after it was first detected late last year in Wuhan, China. Five cases have been reported in the United States, including two in Southern California.
China’s containment measures could theoretically prevent infected people from introducing the virus elsewhere in the country or world, experts say. The virus is believed to be spreading from person to person through coughing and sneezing, though information evolves daily.
But the lockdown orders were likely put into effect too late and could lead to food and medicine shortages that worsen the outbreak, said Lawrence Gostin, director of the World Health Organization Collaborating Center on National and Global Health Law.
Many experts also worry that the measures, which some consider inhumane, could stoke panic and mistrust in the government and ultimately impede prevention efforts.
“There’s reason to believe that this could backfire,” Gostin said.
In December, cases of a pneumonia-like illness began to mount in Wuhan, a major city in central China. Chinese authorities who sequenced the virus learned it had never been seen before but was genetically similar to severe acute respiratory syndrome, also known as SARS, which killed 800 people worldwide in 2003.
In an attempt to contain the outbreak, Chinese officials last week began sealing off highways and closing bus and subway systems in Wuhan, a city of 11 million people. Lockdown orders have since been expanded and now apply to more than 50 million people across 17 cities.
John McGory, 65, has been mostly confined for the past week to his apartment on a Wuhan university campus where he teaches English.
He can leave the grounds through a single gate, if he is wearing a mask, but most friends are unwilling to meet up because of fears of falling ill, he said. More than 3,500 coronavirus cases have been in Hubei, the province of which Wuhan is the capital.
Streets and stores in the usually bustling city, the seventh-most populous in China, are largely deserted, he said.
“It’s just a ghost town now,” said McGory, an American who has lived in Wuhan for six years.
In public health lingo, “quarantine” typically refers to confining people who have likely been infected with a virus. Measures that limit the movement of large swaths of people, like entire cities, are called “cordon sanitaire,” a French term that has been adopted into English meaning sanitary barrier.
Cordons were widely used to control the Black Plague during the Middle Ages. A cordon was implemented in West Africa in 2014 during an Ebola outbreak, prompting cries that it was inhumane to trap people in an infected area while waiting for a fatal disease to run its course.
Though Ebola is far more deadly than this coronavirus, the people left in Wuhan and other cities are still likely to “feel like they’re kind of being left as guinea pigs,” Gostin said.
And the most important thing in public health is maintaining the public’s trust so they will cooperate with prevention measures, he added.
“It will provoke fear and panic, and people will not come into the hospital, and so you’ll drive the epidemic underground,” said Gostin, a Georgetown University law professor. “You might even amplify the epidemic.”
Little is definitively known about 2019-nCoV. Officials are unsure how likely people who get it are to die, whether it can be transmitted before people show symptoms, where it originated and when exactly it began circulating.
Gostin added that the barrier was implemented too late to keep the disease from spreading beyond the region. When the cordon was announced last week, people in other countries had already been diagnosed with 2019-nCoV. There have also been reports that in the days before the quarantine was enacted, thousands fled their homes.
Some experts hypothesized that China’s response is an overcorrection to its handling of the SARS outbreak in 2003. Chinese authorities were criticized for not acting quickly enough, allowing the deadly virus to infect 8,000 people worldwide.
“People were very angry that they failed to share what was going on rapidly,” said New York University bioethics professor Arthur Caplan. “They definitely may be trying to look transparent or do the best they can.”
And if there’s one country that could pull off these large-scale quarantines, it’s China, he said.
In addition to being ruled by an authoritarian government, Chinese people tend to be more community-oriented and willing to do things for the greater good than Americans, who are more focused on their individual liberties and freedoms, Caplan said.
“Those values have muted some of the protesting and dissent that you might get if you tried to do it elsewhere,” he said. “China can clearly enforce.”
Caplan pointed out that telling people to stay inside the boundaries of a massive city is less restrictive than a traditional quarantine that forces people to stay inside their homes all day. Most people who live in Los Angeles, for example, don’t leave the city on a daily basis.
Still, any restrictions on freedom are touchy in the United States. Here, public health officials often refrain from using the word quarantine as to not stir backlash. When a nurse flying into Newark airport was quarantined because officials feared she had Ebola, she, with the help of the ACLU, later sued then-New Jersey Gov. Chris Christie.
For that reason, U.S. officials opt for a different tack during outbreaks. During a swine flu pandemic in 2009, U.S. officials considered canceling public events, closing schools and recommending that people wash their hands, said Dartmouth College professor Dr. Elizabeth Talbot.
“We would almost certainly not do any quarantine on the scope that China is doing now,” she said. “We have a different cultural acceptance of restriction of our rights, and quarantine always bumps up against that.”
Currently in the United States, the risk of catching the coronavirus is extremely low, experts say.
Anyone worried about falling ill should remember to wash their hands and take other routine prevention measures that will also protect people during flu season, which is ongoing and will run through May.
Before the coronavirus outbreak, McGory had resigned from his job and was planning on moving back to Ohio, where he is from. For now, however, he is stuck in Wuhan.
Authorities have provided no information about when the quarantine orders will be lifted. McGory said the grocery stores were already running low on food and other supplies last week.
As the measures go on longer, he said he anticipates that anxiety will build. At the very least, people will likely begin — if they haven’t already — obsessing about sore throats and other cold symptoms, worried they have caught the coronavirus.
McGory compared what’s happening in Wuhan to shutting down Chicago, as both are major university-filled cities in the middle of the country.
“How long could you shut Chicago down before chaos ensues?” he said. “We’ll see.”