Should the US Look to China for its COVID-19 Response?

Sunny Light & Kaveh Khoshnood

Abstract

To what extent should national governments expand their presence during a pandemic, and does American aversion to “big government” need reconsideration during one? These are the key questions posed in this paper. Comparing the US’s early COVID-19 policy responses to those of China—overall centralization; social distancing, quarantining, and isolation; testing and contact tracing; infrastructure and equipment—this piece raises an existential question not just about the US but for all nations as the world learns from the coronavirus. It is a comparison but also a call for holistic scrutiny of some of the institutional barriers to effective outbreak responses, as well as that which nations may glean from one another.

One year into the COVID-19 pandemic, the global community can begin to take stock of the effects of countries’ early outbreak responses. Now perceptible is the longevity of these responses, both their efficacy in reducing morbidity and mortality as well as of the measures themselves. Many countries’ early responses to the pandemic were pilot efforts that have expired with effectiveness or societal tolerance, while others have endured until their objectives were reached.

This is particularly salient in the varying degrees of centralization—how unified and coordinated national responses have been, the dichotomy of which has been most palpable in the United States and China.

Outside the coronavirus context, these two countries occupy opposite ends of the centralization spectrum: the former is characterized by its federalist system and individualistic culture, and the latter by its one-party political structure and absence of democratic accountability¹. Within it, the situation is much the same: the US relied on its decentralized governance system in its response, whereas China responded with a strategy of aggressive national coordination.

Considered together, the two countries present juxtaposing case studies of how these distinct systems and political cultures have impacted their approaches, the spread and containment of a communicable disease outbreak and, consequently, the longevity of their infection-control policies.

A modeling study examining cross-city transmissions estimates China’s response from January to February alone to have prevented 1.4 million infections and 56,000 deaths². Today, China’s incidence rate and death tolls are in low double digits, while those of the US continue to break global records³.

A brief comparison of the two nations’ starkest and most consequential differences yields a conclusion not that China’s approach was superior per se (indeed, its initial concealment of the outbreak, among other missteps, posed a serious global setback), but that one of a decisive and nationally unified nature may be critical to saving more lives—a lesson that the world, beyond the US, can learn⁴.

Overall centralization

While both China and the US formed national coronavirus task forces, the reach of the latter’s was comparatively narrower. That public health in America falls under state jurisdiction, the federal government is constitutionally limited in its ability to command action^5,6. The disunity of America’s pandemic response is, in a word, by design.

In stark contrast, China deployed a national execution led by the National Health Commission, which, among other facets, centralized all testing nationwide, coordinated with zoonotic experts, and, perhaps most saliently, has had a centralized epidemic response in place since SARS.

As a result of this capacity for coordination, China has been able to execute a more stringent overall pandemic response than the US⁷.

Social distancing, isolation, quarantining

In the US, the power to mandate quarantines lies largely with state and local governments, and so the degree of lockdown in each has great variation³. Meanwhile, China’s national government placed entire cities and a province under lockdown (with Wuhan’s being the largest in history), halting nearly all transport to, from, and within the Hubei cities, shutting shops, and cancelling large-crowd activities^8,9. Officials had even been mobilized in May to enforce compliance¹⁰.

Testing and contact tracing

Both countries eventually reached the highest level of testing as categorized by one report, but while China had begun testing a matter of weeks after cases began spreading, many articles argue that widespread testing in the US was delayed more than 1.5 months^7,11.

The Chinese government deployed over 1,800 teams of epidemiologists to trace Wuhan residents daily, implement mass screening in public spaces, and establish thousands of health and quarantine stations¹². The national government also developed a smartphone application categorizing users based on health status and travel history¹³.

The early US response, conversely, involved little federal presence in testing, most being conducted by private laboratories and academic centers¹⁴.

The decentralized US public health system has also meant uncoordinated data collection, organization, and reporting; while the Chinese government mandated all confirmed and suspected cases to be reported in a centralized database^8,15.

Infrastructure and equipment

While President Trump invoked the Defense Production Act, a federal law allowing the President to pay and impel companies to manufacture protective equipment, nearly two-thirds of the Cares Act budget earmarked for it was spent by the Defense Department on semiconductors, shipbuilding, and space surveillance^16,17.

Conversely, China’s production of personal protective equipment had increased by 30,000 pieces daily by March, with mask output alone at 12 times its pre-outbreak supply¹⁴. Within a month of the outbreak, the government converted 16 exhibition halls and sports venues into field hospitals providing an additional 60,000 hospital beds in Wuhan⁵.

Even as the newly approved vaccines begin to roll out, the US battles with tens of thousands of new daily cases; yet restrictions in many states are lower than they were when far fewer people were getting sick and dying. And while China’s own vaccination roll-out is far slower than that of the US, total case and death rates confirm the well documented understanding that early responses can be pivotal in minimizing infection and deaths^18,19. This is not to say China’s governance structure is without fault, optimal, or even a model for any country—perhaps even its own; but its chief feature—its central control—may be something to which nations like the US could potentially look as a temporary measure for a pandemic as rampant and deadly as COVID-19 in a time as fragmented, divided, and in many cases science-skeptical as today’s.

About the Authors

Kaveh Khoshnood, Ph.D. is an Associate Professor and Director of Undergraduate Studies at the Yale School of Public Health, executive committee member at Yale Council on Middle East Studies, co-founder of Yale Violence and Health Study Group and a faculty member of the Program on Conflict, Resiliency and Health at the Yale MacMillan Center.

Sunny Light is an MPH Candidate in the Health Policy department, interested in global health governance. She has lived, worked, and studied in the UK, the US, South Africa, China, Cambodia, and the Czech Republic.

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