A video on daily life in Hong Kong has been circulating for a few days now. It shows that all Hong Kongers wear masks. https://www.youtube.com/watch?v=a9_hP9B84iw
The wearing of masks is said to explain the low death toll. The video therefore shows an apparent correlation between the wearing of the mask and the low number of deaths. However, in the face of a correlation (the reminder is typically given that a correlation is not a causal link, even if it is indeed one indicator of causality, since we must also remember that causality is not directly visible) we wonder if there are other variables, and therefore whether there are any “hidden variables”. A hidden variable, whether in statistics or in a qualitative approach, is a variable that is not immediately visible, and is hidden behind appearances or behind a seemingly obvious correlation.
In any case, as management of the crisis is an approach in terms of a system of action, the explanation is multi-causal and varies according to the development of the situation. Masks do seem to be important in the fight against the development of the epidemic, but not on their own. This is not said in the video – it only shows that all Hong Kongers wear a mask, which is important information in itself.
To explore this question, I will use information that we can gain from the New York Times International (NYT) and especially from an article of March 16, 2020 by Benjamin J. Cowling and Wey Wen Lim with the title « They’ve Contained the Coronavirus. Here’s How. » I follow the information given by the journalists.
They write that the development of the epidemic seems to be accelerating in Europe and the United States. At the same time, in mid-March, in China the epidemic seems to be slowing down, but at the cost of drastic measures.
However, it seems that countries such as Taiwan, Singapore and Hong Kong have achieved the same result with much less draconian methods than China.
1 – The draconian strategy of the Chinese government
At the end of January 2020, the Chinese government introduced highly unusual social distancing and containment measures.
Wuhan was completely locked down. Some transportation was severely restricted. New hospitals were built in a few days. The capacity of the laboratories to test patients was rapidly increased. People who tested positive but with little risk of infection were sent to quarantine in hotels that had been converted to accommodate them.
Initially most of the inhabitants of Wuhan, and of the main towns affected, were to stay at home [as in Italy, and as soon after France]. Schools and businesses were closed well beyond the Spring Festival on January 25, 2020, the beginning of the Year of the Rat.
[For the record, it should be remembered that at the time of the Spring Festival, the Chinese New Year, hundreds of millions of Chinese people move through China. It is a great period of mobility and therefore of risk of the spread of the disease (cf. a dataviz (data visualization) from theNYTof March 22 on the spread of the disease, « How the Virus got out », communicated by Rigas Arvanitis, director of CEPED, on his site http://rigas.ouvaton.org/,
https://www.nytimes.com/interactive/2020/03/22/world/coronavirus-spread.html)].
In the end, nearly 60 million people were locked down in Hubei province, of which Wuhan is the capital, officially until March 20.
[This figure is comparable to the 67 million French people who have been locked down since March 17. A frequent approximation is to compare France and China, or France and the United States, whereas the comparison should be made between Europe, China and the United States. In the same way, if we talk about Europe, it is normal that some countries are more affected than others, as is the case between states in the United States, or between regions in China, as is also the case between regions in France or Italy. Some are affected very little even though the government is the same.
In Wuhan, the end of containment will not be lifted until the beginning of April. Officially the end was set yesterday for April 8, 2020.
Currently in China, at the beginning of April 2020, to go to a doctor or a dentist, you have to scan a code with your mobile operator. It is then possible to see where the person in question has been for the last 15 days. If he or she has not been to Hubei and has no temperature, he or she can go to his or her appointment. A large proportion of Chinese people are therefore geo-tracked.
On March 3, the NYT described what is called in China the « Alipay Health Code », set up in 200 cities and managed by China’s largest e-commerce company Alibaba, the equivalent of Amazon. Before entering a public place, such as a supermarket or subway, a controller scans the QR code. If it is green, the person can enter. If it is yellow, the person must go home. If it’s red, the person must be quarantined. According to the NYT, 98.2% of people have a green QR code, but that means in absolute numbers that one million people are yellow or red. It also means that most people are monitored in transport and at the many checkpoints in public and residential areas. According to the NYT this application is potentially connected to the police. I would add, but without sufficient information at this point, that we would have to investigate whether it is linked to facial recognition, which is as developed in China as it is in the United States (see the NYT of January 21, 2020 on Clearview AI, “the secretive company that might end privacy as we know it”.]
The journalists are of the opinion that the economic and democratic cost of China’s control is enormous, which seems entirely accurate. Is this the price to pay to stop an epidemic? Can democratic countries escape it?
The two journalists believe that “lockdowns and forced quarantines on this scale or the nature of some methods — like the collection of mobile phone location data and facial recognition technology to track people’s movements — cannot readily be replicated in other countries, especially democratic ones with institutional protections for individual rights”.
It seems that one of the implicit objectives of the authors of the article is to take the democratic vs. autocratic variable as an explanatory variable for the effectiveness of methods to contain the spread of the epidemic.
By way of a personal remark, it seems to me that it is possible to compare democratic regimes with authoritarian regimes in terms of individual freedom and freedom of information, to say that authoritarian regimes leave less individual freedom and less freedom of conflicting information, but I am not sure that it is possible to measure the effectiveness of a political regime as such.
Depending on the problems to be solved, it is not certain that China is less effective than the United States or Europe, or vice versa. It is not certain that there is a direct link between the vice or virtue of the actors and their ability to solve problems. The question remains open.
This does not prevent us from preferring democratic regimes where there is more freedom and more flow of contradictory information. It is likely that one of the reasons for the spread of the epidemic around the world from Wuhan is linked to the fact that the information was hidden for several weeks. The first step in the process does not work in favor of authoritarian regimes. However, the rest of the process may be more favorable to them. We need only recall a great constant feature of human societies, which is that freedom has a cost in terms of security and security has a cost in terms of freedom.
In lineage-based society (on the basis of Congolese extended families on which I worked in the 1970s), social control is strong, thanks to a very strict magical-religious symbolic system of control, “sorcery”. On the other hand, the kinship system is supposed to guarantee all peasants’ access to land and thus the nutritional survival of each family.
The health crisis is a vehicle of analysis of power relations and the functioning of political-administrative systems that must constantly decide between security and freedom.]
2 – The “less authoritarian” strategies of the three Asian dragons.
The three “test” countries are Hong Kong, Taiwan and Singapore.
They are directly threatened by the spread of the epidemic since a large part of their population is Chinese and therefore there will be a lot of mobility between China and these three countries during the spring festival. In Singapore there are about 80 percent Chinese. I conducted a survey there on the practices of alcoholic beverages in 2014 with Hu Shen and in Taipei, the capital of Taiwan].
On March 13 “Singapore had 187 cases confirmed and no deaths (for a total population of 5.7 million), Taiwan had 54 confirmed cases including 1 death (for a total population of 23.6 million) and Hong Kong had 131 confirmed cases including 4 deaths (for a total population of 7.5 million).” This represents a very low number of deaths.
Between January 21 in Taiwan and January 23, 2020 in Hong Kong and Singapore the three governments put in place a series of measures: travel restrictions to reduce the number of sick people coming from outside the country who could infect members of the community. Quarantine measures for infected people to limit the transmission of the disease. Measures of self-containment, social distancing and hygiene reinforcement. Each country was to adopt these three basic strategies, but with slight differences.
21 Singapore, at the borderline of privacy.
As soon as the outbreak began, Singapore began by registering all travelers coming from Wuhan with fever and respiratory symptoms so that they could be isolated. At the same time the government banned all flights from Wuhan. Travelers coming from contaminated sites were quarantined. University hostels were turned into isolation areas. They took great care to reconstruct traces of contact between people who were contaminated. When this was not clear, the Department of Health sought further information from transport companies and hotels, including by consulting their video surveillance images.
[As a reminder, Singapore is a hybrid regime between democracy and very strong state control of information. It appears in the case of Singapore that the constraint of « electronic surveillance » played a part in the effectiveness of the control].
Schools and businesses remained open. However, students and teachers were subject to daily health checks, including temperature checks.
A government-led campaign recommended five practices: using a tissue when coughing or sneezing; using food and drink trays to limit contamination in case food falls out of the glass or plate; properly cleaning and drying public toilets; washing hands regularly and using a serving spoon during communal meals.
[The Chinese are used to eating with chopsticks. When they are in a restaurant, everyone helps themselves to the collective dishes with their own chopsticks. In recent years there have been serving chopsticks or serving spoons that avoid people using their own chopsticks, which doesn’t always work, because the habit of using one’s own chopsticks is often too strong.]
The government only recommended the use of masks for people who were already unwell.
[The widespread use of masks is not a practice that is followed by everyone.]
22 Taiwan, blocking the arrival of the virus, tracking its spread and quarantining it.
As an island, Taiwan prioritized the screening of travelers from suspicious areas. At the end of January, Taiwanese medical authorities boarded planes to detect potential sick people. A little later, four companies suspended their flights between Taiwan and Wuhan. In mid-February, a ban was imposed on all flights except for those from Beijing, Shanghai, Xiamen and Chengdu. The quarantine was mostly done at home, but fines for those who did not respect it could go up to 33 200 Taiwanese dollars, or about €1000. All organizers of events were asked to postpone or cancel them. Some religious institutions stopped their gatherings. During the Spring Festival, primary and high schools were closed for four weeks. “The Taiwanese authorities also oversaw the controlled distribution of surgical masks from existing stockpiles through community stores, having also fixed their price. Taiwan’s main health messages — ‘Wear a surgical mask when coughing or sneezing,’ ‘Wash hands thoroughly with soap’ and ‘Avoid crowded places, including hospitals’…” This strategy helped to limit the number of imported cases. On 13 March, 58 percent of those infected were infected through local transmission, which is an indicator that the checkpoints applied against the disease from the borders have been effective.
[However, an article in Les Echos of April 1, 2020 by Yann Rousseau (Tokyo) and Frédéric Shaeffer (Beijing) explains that Taiwan “took advantage of the possibilities offered by technologies and Big Data, in particular by crossing the data of the national health administration with that of customs to strictly control the risk of imported Covid-19 cases.”]
23 Hong Kong, or how to cut off the route of the virus from mainland China
Hong Kong is a special case, since every day 300 000 people cross the border from mainland China to Hong Kong in normal times. In early January, following the first case reported in Wuhan [which, as Wikipedia reminds us, dated from November 17, 2019], Hong Kong set up temperature checkpoints at various entry points into the country. Doctors were asked to report to the authorities any patients with fever and severe respiratory problems. Attempts were made to trace all those who had travelled to Wuhan. In February, the number of travelers from China dropped to 750, and all those coming from outside the country were required to undergo a 14-day quarantine. A special effort was put into traceability throughout the chain of contamination.
Out of 40 000 hospital beds in Hong Kong, 1 000 beds are in rooms with lower air pressure than other rooms, which prevents air from escaping and therefore guarantees insulation (negative-pressure bed). Vacant holiday centers and social housing have been used as quarantine sites.
A large effort has been required in the implementation of « social distancing ». Civil servants have had to work from home. Schools have been closed since the end of January and are expected to reopen on April 20. A lot of courses have therefore been conducted online. The lockdown of children is supported on the grounds that they transmit the virus more easily. School lockdown has been carried out four times in Hong Kong in 12 years, in 2008, 2009, 2018 and 2019. Many families can be helped either by grandparents [which may seem paradoxical given the contagious nature of the children] or by home help.
Practically everyone in Hong Kong wears masks [as confirmed by the video quoted at the beginning of the text]. A month before, the masks of protesters were banned…
[To understand the difficulties of establishing social distancing, it may be useful to read Edward T. Hall’s 1966 book The Hidden Dimension. It deals with « proxemics », i.e. the variation of norms of social distance between individuals according to cultures. In many cultures, touching the other is important, so social distance is low].
It appears that what guided the rapid pandemic strategies of the four countries, China, Hong Kong, Taiwan and Singapore, was the difficult experience of SARS in 2002/2003.
[The difference in the responsiveness of Western countries can be explained by this difference in historical experience. In my surveys of decision-making processes, I have regularly observed « landmark events » that led to decisions that were apparently « irrational », i.e. ineffective or costly in relation to the problem to be solved. For example, following a fusarium attack on wheat leading to high yield losses, some French farmers no longer wanted to hear about a reasoned treatment to limit the more economical use of phytosanitary products, for fear of the return of this disease. This means that part of the decision-making process is explained by the utilization, often implicit, of past experiences, positive or negative.
In the case of France, the mask crisis is partly linked to the massive criticism that was made of Roselyne Bachelot in 2010 when she built up reserves of vaccine that remained unused. Since this « landmark event », no minister of health wishes to be accused of overreaction or worse of being accused of being sold to the pharmaceutical laboratories that produce the vaccines or to the private companies that sell the masks.
A March 18 article in the NYT wondered whether Americans were overreacting by advocating social distancing, either in terms of social inequality, democracy or efficiency, not to mention conservative criticism in terms of a political hoax that was allegedly set up by the Democrats. This is indeed a controversy that is not limited to France.
In an interview published in the IHU Scientific Information Bulletin of February 25, 2020 on the number of deaths in China and the world, some ten or a dozen, the approximate figure at the time outside of China, South Korea, Iran and affected cruise ships Professor Raoult calls for calm and therefore recommends not to overreact.
He explains that the greatest danger is overreacting and therefore that matters must be calmed down. It is panic that creates the damage, he explains, taking a very telling example from the 39-40 war where fear among civilians led to 100 000 deaths, compared with a little more than 50 000 for the French army, something which could have been avoided without panic. This statement, which appears “false” today, is not mentioned to remind us that he was seems to have been wrong, but shows that given the information available at the time it was not possible to predict what would happen next, and that this was the case for all decision-makers. In times of crisis, one of the great difficulties is to accept uncertainty.]
These three countries rapidly developed screening systems for the disease in order to obtain information for better decision-making as the epidemic develops. They utilized a number of constraints such as quarantine in premises that have been refurbished for this purpose. They also had hospital equipment that was well adapted to Coronavirus epidemics.
24 Less dramatic measures of social control are highly intrusive in relation to privacy
The conclusion of the article is that the three countries have managed to block the chain of diffusion of the epidemic with less drastic measures than China.
It is clear from this description that all these elements form a system. First of all, it is necessary to stop the chain of diffusion of the pandemic, by « tracing » the patients either by tests, or by their temperature and possibly by electronic control such as video surveillance cameras or more private health data. Traceability makes it possible to reconstruct the social network of interactions with other people who are potentially ill. Depending on the intensity of the illness, people are either quarantined or sent to hospital. At the individual level, breaking the chain of contagion requires developing practices of social distancing, wearing a mask and washing hands. In a democratic country, the constraint of electronic surveillance to guarantee traceability seems less necessary than in an authoritarian country. And yet, following more complete observations, social control appears to be one of the hidden variables that must be reintroduced in the explanation of the containment of the spread of the disease in the second wave, but also in the first wave.
[Around March 11, 2020, according to Les Echos, written by Yann Rousseau and Yann Verdo (Tokyo), 117 countries are affected by the Coronavirus, identified as Covid-19 by the Chinese. In the event of an epidemic, the classic method is to locate the « patient zero » in order to reconstitute the network of people with whom he/she has been in contact and isolate them. The question arises as to whether mass screening should be carried out or whether it should be done selectively. At the University of Kobe, Japan, Professor Kentaro Iwata, a specialist in infectious diseases, believes that “the solution is probably somewhere in between”. The problem with systematic screening is that it can lead to overcrowding in hospitals, even though it is known that the disease heals itself in 80% of cases. According to the Japanese professor, we must therefore limit ourselves to serious cases. Conversely, the South Koreans carried out large-scale screening on 200 000 people. This enabled them to detect 7513 infected people and, thanks to this screening, to register only 54 deaths by mid-March 2020.
France is ready to enter stage 3, which is the stage where the disease is spreading throughout the country. It is therefore necessary to slow down its progression thanks to « protective measures », such as washing hands and only going out for strictly necessary reasons. The question of testing in France remains open. All we know is that resources are not unlimited, as the two journalists write. All this means that in mid-March, knowledge of the phenomenon was still relatively low. Italy and Spain are in turmoil. The controversy over chloroquine broke out around March 20, at the same time as the controversy over the shortage of masks and their uses. We are between the two rounds of municipal elections, the second round of which will be postponed, but that is another story.
Cf my methodological post on the issue of chloroquine use: https://consommations-et-societes.fr/faut-il-ou-non-generaliser-lusage-de-la-%e2%80%89chloroquine%e2%80%89/
In the meantime, I have read part of Professor Raoult’s e-book, Of ignorance and blindness: for a postmodern science, published on CreateSpace Independent Publishing Platform, Amazon’s self-publishing platform. I understand the importance of transgression in the processes of scientific innovation, and Professor Raoult is a great transgressor. For a layman like me, it is very interesting when he talks about his research on Rickettsia bacteria. At the same time, Professor Raoult’s explanations are often based on shortcuts or allusive statements, and on so-called « arguments by authority ». You have to take his word for it. He finds it difficult to describe in simple and clear terms what he does. In epistemological terms, what he says is neither true nor false, and therefore unfalsifiable, as Karl Popper would say.
The most interesting criticism of the work of Professor Raoult and his team is that of Hervé Seitz, a researcher in molecular biology at the CNRS in Montpellier, who takes up the content of the publications to show that, in his opinion, some of the figures have been manipulated. The demonstration seems convincing https://youtu.be/Bm-GJ4PF9ts
According to the NYT’s March 16 article, Taiwan seems more fragile because it has not developed the testing system as much as Singapore and Hong Kong [or South Korea].
3 – The risks of a new epidemic wave
Over the past three weeks, the situation has changed and the risks of an upswing in the epidemic have greatly increased. With this upswing, the risks of electronic control are becoming clearer, whether the regime is authoritarian or democratic.
On April 2, 2020, 6 days ago, a new article in the New York Times International written by Motoko Rich, 15 days later, writes that the success of the fight against viruses from abroad, especially due to the return of students, is fragile. When the virus developed in Europe and the United States, some of the citizens of these different countries wished to return home where the virus was less devastating. Immediately a rise in the number of cases was observed. That is why Asian governments tightened measures. They imposed strict quarantines. Several of them banned flights from affected countries.
In Singapore, for example, returning citizens are asked to share their location data by phone to prove to authorities that they are in quarantine. In Taiwan, a man who violated the quarantine while travelling was fined about €1,000. In Hong Kong, a 13-year-old girl wearing an electronic bracelet to make sure she was in quarantine was caught in a restaurant. She was filmed. The video was put online to shame her, to make her “lose face”, as it would be called in Chinese.
Most Asian countries are tightening border controls to prevent the arrival of a second wave of Coronavirus. All these measures will remain more or less strongly enforced until a vaccine or treatment is found.
Also between mid-March and early April, in Hong Kong all returning residents were systematically tested on arrival. “During a 14-day quarantine at home, they wear tracking bracelets, and their movements are monitored by a smartphone app. Ms. Lam [the Chief Executive of Hong Kong] said that more than 200,000 people were currently being quarantined at home.”
In China, all returnees are quarantined for 14 days in government-selected hotels. They have to “send their temperatures daily to neighborhood committees on WeChat, a messaging service”.
[This is reminiscent of the 1980s in China, when birth control was introduced, where women had to declare every month to the neighborhood committee of their residence that they had had their period].
In Taiwan, the government has set up a telephone geolocation system. If people turn off their phones, the police come to check that they are in quarantine.
In Singapore, a 53-year-old person who had been in breach of quarantine had his passport taken away.
In Japan, people who do not comply with the containment rules are threatened with more than six months in prison and a fine of €4200. However, at the moment no electronic monitoring is used. They are allowed to go shopping, but with a mask and with the obligation to hurry.
In South Korea, most international flights are banned, especially since South Koreans feel that some people go to Korea for testing and treatment. For some Koreans, apparently from the opposition, « it is time to… practic[e] international social distancing. »
Conclusion
The most important finding to date is that several countries have adopted stricter measures to quarantine and restrict international flights, and to increase the rate of fines and prison sentences incurred. Above all, they have introduced electronic monitoring combined with a bracelet and a mobile phone application, which makes it possible to check that people are properly confined, whether in a democratic, semi-authoritarian or authoritarian system. China used drones very early on to enforce containment.
Several Western countries are now asking themselves whether they should adopt these practices. On page 9 of Les Échos of April 1, the editorial analysis reads: “Confinés ou tracés, faut-il choisir ?” (Locked down or tracked – do we need to choose?”) The protection of personal data is threatened by traceability, which conditions health safety thanks to the monitoring it allows. Technically, everything is already in place, from facial recognition to geo-tracking and electronic bracelets, whether in the United States or China.
This situation is reminiscent of the fable of La Fontaine, the Wolf and the Dog. A gaunt wolf meets a big, fat dog. He asks him what it takes to achieve this bliss. The big, fat dog answers little.
« But faring on, he spies
A galled spot on the mastiff’s neck. / “What ’s that?” he cries. “Oh, nothing but a speck.”
“A speck?”—“Ay, ay: ’t is not enough to pain me: / Perhaps the collar’s mark by which they chain me.”
“Chain! chain you! What! run you not, then, / Just where you please and when?” […]
For me, I’ll shun them while I’ve wit; / So ran Sir Wolf, and runneth yet. »
(E. Wright translation)
Will we also be able to escape the electronic bracelet?
Paris, April 9, 2020