The New Yorker: Life on Lockdown in China
Forty-five days of avoiding the coronavirus.
On the twenty-seventh day of the coronavirus lockdown in Chengdu, in southwestern China, five masked men appeared in the lobby of my apartment building in order to deliver a hundred-inch TCL Xclusive television. It was late morning, and I was taking my nine-year-old twin daughters, Ariel and Natasha, outside to get some air. The three of us also were wearing surgical masks, and we stopped to watch the deliverymen. I had never seen such an enormous TV; it arrived in an eight-foot-long box that weighed more than three hundred pounds. Two of the deliverymen stood inside an elevator with a tape measure, trying to figure out whether the box would fit. Otherwise, it was going to be a long haul up the stairs to the twenty-eighth floor.
By that point, the country was deep into the most ambitious quarantine in history, with at least seven hundred and sixty million people confined largely to their homes. The legal groundwork had been established on January 20th, when the National Health Commission designated the highest level of treatment and control to fight the new coronavirus, which eventually became known as covid-19. After that, provinces and municipalities issued their own regulations, and the Chengdu government passed its first measures on January 24th. They were tightened seven days later, when it became clear that the epidemic had reached a point of crisis: during that week, the number of reported deaths in China had increased more than sixfold. By the end of January, there were a total of 11,791 confirmed cases, with two hundred and fifty-nine deaths.
My family rents an apartment in a nine-building complex not far from the center of Chengdu, where I teach writing at a local university. We chose the place, last September, primarily for its location: the apartment blocks are situated beside a pleasant, tree-lined stretch of the Fu River, and there’s a subway stop outside one of the side gates. But, after the quarantine began, the subway was deserted and both side entrances were chained shut. Anybody who arrived at the main gate was greeted by an infrared temperature gun to the forehead. The gun was wielded by a government-assigned volunteer in a white hazmat suit, and, behind him, a turnstile led to a thick plastic mat soaked with a bleach solution. A sign read “Shoe Sole Disinfecting Area,” and there was always a trail of wet prints leading away from the mat, like a footbath at a public swimming pool.
Compared with other places, our compound’s restrictions were relatively light. We could leave and return as often as we pleased, provided that we carried passes that had been issued by the neighborhood committee, the most local level of the Communist Party. The majority of my friends in other parts of China were restricted to one individual per household going out every two days, and often that person had to tell the authorities where she was headed. Even at our complex, which has few foreign residents, it was rare for people to go outside. All restaurants, government offices, and most shops had been closed, and, after the Lunar New Year holiday ended, in February, all schools would be suspended indefinitely. One of the new Chengdu measures even banned “every sort of group dinner party.”
Most of my neighbors ordered things on Taobao, one of the world’s biggest e-commerce sites, and they got their food delivered from Fresh Hema, a nationwide grocery chain that has a branch nearby. (Both Taobao and Hema are owned by the Alibaba Group, a Chinese technology company.) All day, motorcycle deliverymen handed off items to the security guards, who trundled through the compound’s grounds with dollies and shopping carts, dropping off boxes and bags. In my lobby, the most packages I counted at any time was a hundred and twenty-five, all of them marked with apartment numbers in black ink. Sometimes it was possible to see what was inside. On the morning that the Xclusive TV was delivered, the contents of other packages reinforced the impression that people had settled in for the long haul: two electric power strips for Apartment 1101, three bottles of Omo laundry detergent for 3003, a huge box of fresh ginger for 3704.
I tried to strike up a conversation with one of the TV deliverymen. He was standing near the elevator door, and he wore his surgical mask in the position that I call “the holster.” This is when a man keeps the straps around his ears but pulls the mask down beneath his chin, usually so that he can spit or smoke a cigarette. Another Chengdu measure demanded that citizens stop spitting, but I still occasionally saw people holstering their masks and hawking loogies. I asked the deliveryman what he would do if the TV wouldn’t fit inside the elevator.
“It’ll fit,” he said. “No problem.”
He pulled the mask back over his face. People were much warier of strangers than usual, and sometimes if I got in the elevator with another resident he turned his back to me. Most people were aware that our compound was, at least by local standards, a hot spot. On the various apps that mapped the government-issued statistics for coronavirus cases, our compound lit up bright red. There had been a positive test for a resident somewhere in the complex—the only one in our neighborhood.
The deliverymen weren’t making fast progress with the TV, and Ariel and Natasha were eager to leave, so we went out the gate. Next to the river, a long row of ride-share bikes had hardly been touched for weeks, and I used my phone to unlock one. The twins liked the challenge of riding the adult-size bikes—they took turns wobbling along the empty riverside path. After that, we visited the zombie subway station. It was still operating, but the place was silent except for a public-service message, played on an endless loop, that warned nonexistent passengers to watch their step. Ariel and Natasha ran up and down all the escalators in the wrong direction, laughing. This was our usual morning routine during the lockdown. They hadn’t seen another child their age for nearly a month.
After we returned to the compound, and had the infrared gun pointed at our foreheads, and crossed the bleach footbath, the deliverymen were returning with the empty box on a dolly. The man wearing the holster explained that once they’d removed the top half of the box and stood the TV on its end they’d been able to fit it in the elevator. He still didn’t seem very eager to talk.
Last September, my wife, Leslie, and I enrolled the girls in the third grade at a local public school, in part so they would learn Chinese. Like the other students, they also took English, and Unit 2 in their textbook was titled “My Body.” All anatomical vocabulary was taught in the context of injuries, illnesses, or mishaps. There were cartoons of children lying in hospital beds, with labels that identified the patient, the age, and the symptom: “Bill—8 years old—foot hurts”; “Ben—10 years old—leg hurts”; “Lily—9 years old—ear hurts.” One lesson read:
For weeks, Ariel and Natasha returned home imitating the class’s taped dialogues, which invariably ended with the phrase “I’m going to the hospital!” It seemed to confirm an unscientific impression that I’ve long held of the Chinese view of health: namely, that people are even more fearful about children’s safety here than they are in other places I’ve lived. My daughters often complained that at recess the simple jungle-gym equipment at their school was strictly limited to sixth graders, because teachers believed that younger children would injure themselves.
After the epidemic began, though, I saw that recurring phrase—“I’m going to the hospital!”—in a new light. The textbook was accurate: if somebody’s ear hurts, often her only option is to go straight to the hospital. In China, there’s no comprehensive primary-care system, which is one reason that the coronavirus spiralled out of control so quickly in Wuhan, the capital of Hubei Province, where the epidemic started. Some of the most awful images from the early days were videos of mob scenes at hospitals, where terrified citizens, many of them sick, clamored to be tested and treated. Contact in these crowds undoubtedly accelerated the rate of infection.
A number of the earliest cases occurred in people who worked at the Huanan Seafood Wholesale Market, which sold live fish and animals. Epidemiologists told me that they still don’t know the nature of the spillover event—the moment when the disease leaped from animals to humans. Scientists believe that the virus began in bats and likely passed through an intermediate host; some speculate that this may have been pangolins, scaly anteaters that are sometimes consumed as a delicacy in China.
By December, the disease had started to spread among people. Some early victims included medical staff who, unaware that they were dealing with a new strain of virus, lacked appropriate protective gear. In Wuhan, a small number of doctors tried to report what they were seeing, but officials suppressed their comments. Li Wenliang, an ophthalmologist, warned his colleagues via WeChat. Li was subsequently summoned by the police, who forced him to sign a confession saying that he had “seriously disturbed the social order.” Li became seen as a martyr after his death from the disease was announced, on February 7th, and local officials eventually issued an apology to his family.
The coverup gave the virus more time to spread unabated. But, in early January, once Chinese health officials grasped the seriousness of the situation, they moved quickly. “Within three days, they had scientists who were able to sequence and characterize the structure of the virus, which is unheard of,” Wafaa El-Sadr, the director of icap, a global-health center at Columbia University, told me. She said that recent advances in technology made the sequencing possible, a crucial step that allowed scientists to develop ways to diagnose the disease and to start to identify methods of treatment.
But for Wuhan it was already too late, because the first wave of infections overburdened hospitals. With many health-care workers falling sick, and with an urgent need for more support, reinforcements were sent from other parts of China. During the quarantine, I sometimes talked on the phone with an I.C.U. physician from Huaxi, a Chengdu hospital that is recognized as the best facility in southwestern China. After volunteering to go to Wuhan, seven hundred miles east of Chengdu, the I.C.U. physician was assigned to the Red Cross hospital, which is less than a mile from the seafood market where the virus first took hold.
“It was like the epicenter,” he told me, during one of our conversations. “There are a little more than four hundred beds, but they were getting two thousand patients a day. They were adding beds, and some sick people just found places to lie down.”
Like other people in Wuhan with whom I communicated, the doctor asked me not to use his name. Since the initial coverup, the Chinese government has seemed determined to report numbers openly, but it still attempts to control the human narrative. “Keep yourself politically disciplined,” an internal notice from Xiangya Hospital, an institution in Hunan Province, informed staff who had gone to Wuhan. “Do not talk to outsiders in private.”
The I.C.U. physician was one of about two hundred Huaxi staff who had been sent to Wuhan, and when I talked to him on February 22nd he said that none of his colleagues had been infected. He seemed confident that they would stay healthy, and he attributed the high death rate in Wuhan to the time it took to recognize a new disease. The difference from the rest of China was striking: on February 29th, when the government issued an analysis of more than fifty-five thousand confirmed cases, 5.8 per cent in Wuhan had resulted in death, compared with 0.7 per cent in other parts of China. The latter number seemed likely to decline significantly over time—in part because treatment was improving, but also because the early testing didn’t include many people who were mildly sick or asymptomatic. (The percentage of infections that are asymptomatic is one of the major unanswered questions about the virus.)
The reaction of medical staff in Wuhan was sometimes angry. I frequently exchanged messages with a Wuhan hospital pharmacist whom I’ll call Zhang, who had seen a dozen colleagues fall sick. One remained in critical care. “We didn’t have enough protective devices and we weren’t cautious enough,” he wrote. When I asked about the root cause of the epidemic, he was blunt:
Zhang was still working long hours, and he had a wife and an eleven-year-old daughter at home. He had considered checking into a hotel to isolate himself from family, but the few places that remained open required special approval; the city had been shut down more completely than anyplace else in China. Fearing a run on necessary goods, the government had stepped in. Like Chengdu, Wuhan is the capital of a populous inland province, but now the two cities seemed to belong to different worlds, different eras. A few days after the hundred-inch TV passed through my lobby, Zhang described how Wuhan’s neighborhood committees had taken charge of all purchasing and delivery arrangements:
On the thirty-ninth day of the lockdown, the packages in my lobby included a box of houseplants for 3703 and some flowers for 2903. It was now March, and sometimes I saw people on their balconies, tending plants. But it still seemed rare for residents to leave the compound. When women went downstairs to pick up packages, it wasn’t unusual for them to be dressed in pajamas, even in the afternoon. In the lobby, management provided a spray bottle of seventy-five-per-cent-alcohol solution, and sometimes I saw a masked, pajama-clad resident standing in a puddle of the stuff, spraying her hands, packages, shopping bags, whatever.
People rarely spoke in these situations. There were no greetings, no jokes, no moments of commiseration. Part of it was the masks, which were an obsession. On my floor, residents wore them even if they were merely dropping off garbage, ten feet from their door. Mask-wearing, after all, was required by the new measures, and people were diligent: I often saw motorcycle deliverymen helmetless and fiddling with their phones at thirty miles an hour, their masks safely in place. When I went running along the river at dawn, the few other people who were out sometimes shouted at me for being bare-faced. Ariel and Natasha despised the things, and I gave them permission to go with the low-rider—this is when you pretend that you are obeying the rules but actually tug the mask down so that your nostrils are uncovered.
Health-care professionals told me that masks have no value in uncrowded outdoor settings, where infection isn’t a risk, and most people wore them improperly even when they weren’t holstering or low-riding. The notion of these things playing a talismanic role isn’t new. In “The Plague,” published in 1947, Albert Camus described two characters in a hospital:
Masks also make it easier for people to ignore one another. If residents passed me in the courtyard, they avoided eye contact; some wore see-through plastic gloves and surgical booties in addition to the masks. These costumes of the quarantine, along with all the other restrictions, helped turn citizens inward, and people directed their energy toward whatever space was left to them. Among the packages in my lobby, I noticed many home furnishings and cleaning implements: a Pincai-brand storage cabinet for 602, a Deema vacuum cleaner for 2304, a giant carpet, wrapped in tape and plastic, for 303. There was home-office equipment (wireless mouse, 4201; file cabinets, 301). By the forty-fourth day, somebody in 3704 had felt the need to buy an electric footbath machine from Kosaka. (“Powerful by Dreams.”)
From what I could tell, the lockdown diet of my neighbors was remarkably healthy. If quarantined Americans were forced to survive on delivery food, health officials would want to track the X curve of body-mass index rising across the drop in coronavirus cases. In Chengdu, though, my neighbors were obviously cooking: lots of fresh vegetables and fruit. I never saw evidence of alcohol going anywhere other than 1901: my apartment. The government had strategically allowed cigarette and alcohol shops to remain open—these were among the very few places of business that never shut down. But, when I talked to store owners in my neighborhood, they said that sales were terrible. There are many types of loneliness in this world, but it’s a unique sensation to feel that you are the only individual in a forty-three-story building who is drinking his way through a quarantine.
I seldom saw children. I knew they were up there: a Mini Table Football game to 2703, a Huanqi toybox to 1804. The compound printed out documents on request, and sometimes the lobby contained homework assignments for kids who were attending school online: for 2102, a chapter on chemistry; for 3802, a handout on poems from the Northern and Southern dynasties. But, in the early weeks of the lockdown, children didn’t even venture into the courtyard, because parents were so frightened of the disease. I had no idea what they were doing for exercise. Even with our trips to the bikes and the subway station, I usually put my daughters on our treadmill every three days or so. In Wuhan, Zhang the pharmacist was also doing the best he could:
It was widely acknowledged that China’s measures had been remarkably effective at halting the advance of the disease. In mid-February, the World Health Organization sent twenty-five Chinese and international experts to visit medical facilities around the country, including in Wuhan and Chengdu. In a subsequent report, the W.H.O. announced, “In the face of a previously unknown virus, China has rolled out perhaps the most ambitious, agile, and aggressive disease containment effort in history.” One member of the delegation, Dale Fisher, a professor of medicine who specializes in infectious disease at the National University of Singapore, told me that China’s actions prevented hundreds of thousands of cases and thousands of deaths. “I can look at the epidemic curve,” he said, citing the government-issued statistics. “I can look at the trajectory it had and the trajectory that appeared after January 23rd, and there’s no doubt.”
But other scientists wondered about the sustainability of the effort. Wafaa El-Sadr, the epidemiologist at Columbia, told me that drastic measures had been necessary in Wuhan, because the health-care system had been so overburdened. But she wasn’t certain that the same approach made sense in a place like Chengdu, which had a population of sixteen million and had seen a hundred and forty-three cases and three deaths by the beginning of March. “You don’t need to have a complete shutdown of a city like Chengdu,” she said. “What you need is very focussed intervention. Identify cases early, and manage them and their contacts appropriately.”
Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security, believed that China’s quarantine would inevitably be a temporary solution. “As soon as schools open, and as soon as people get back to work, and as soon as people start circulating in the world—China is a global country—the virus will be back,” she told me. “I don’t fully understand what the endgame is in terms of these measures.”
Marc Lipsitch, an epidemiologist who directs the Center for Communicable Disease Dynamics, at Harvard University, was more positive about China’s strategy. But he noted that the next step was difficult—he compared it to letting the air out of a balloon slowly. “I think it will bounce back,” he said, of the virus. “But you will have delayed things, and, if you don’t let it bounce back too much before you put the clamps on again, then you may spare the hospitals from getting overwhelmed. But it’s a really painful process, and people are going to get tired of it.”
In the meantime, there were no announcements of how long schools would be closed, or when the lockdown might be lifted. Many measures seemed likely to continue indefinitely. Every day before noon, like many workers across the country, I was required to take my temperature and submit it in a standardized form to my employer. The form also required me to testify that I’d had no personal contact with people from Wuhan or elsewhere in Hubei in the past fourteen days.
That part was easy, because it was rare to have an old-fashioned mask-to-mask conversation with anybody. Apart from home life, my interactions were mostly by e-mail, phone, or WeChat, and often the subject of these exchanges was the isolation itself. A former student of mine wrote, after her husband returned to his factory job, “When it’s time to work, he needs to wear a gas mask that covers the whole head.” She described the scene during lunch break:
I taught all my writing classes online. I had met only one of the students before, and I never saw any of their faces. We interacted over audio and text. I tried to have discussions, but it was time-consuming to switch back and forth between different microphones; the classes were too large to have everybody on at once. Last semester, the students had lived in dormitories in Chengdu, but now they were scattered across the country, in their home towns. The most distant was in Jilin, not far from Siberia. Of my sixty-plus students, nobody personally knew someone who had contracted the virus. A number of them told me that they had not set foot outside their apartments for more than a month.
Quite a few had learned to cook. One boy happily reported that, because his home had a treadmill and some dumbbells, he had lost twenty pounds. Another described a day when he and his father, after a month of being restricted to their building, took turns cutting each other’s hair. Some had been reading books or watching movies and shows that made them think about fear or claustrophobia: “Chernobyl,” “Parasite,” and another South Korean movie, called “Flu.”
For the first week of class, I assigned John Cheever’s “The Enormous Radio.” In the story, a couple acquire a radio that allows them to listen to the conversations in other apartments in their building. After reading it, my students mentioned things that they had noticed around their homes: how people cringed if you happened to cough in the elevator, or how, when there was a report that a family was under observation for the virus, they were shunned by neighbors. There were also moments of brightness: one student described how the rooftop of his apartment block had become a communal space for people to relax and socialize, because they were restricted from leaving the building. Some students reported that the experience of the past month had brought them closer to their parents. Any complaints tended to be leavened with humor. One student began a paper:
At the entrance to my compound, the Communist Party’s neighborhood committee erected a series of information boards. They displayed the new epidemic measures, along with an organizational chart for an entity called the Communist Party Service Team for Home Quarantine. Head shots and cell-phone numbers of seven officials were included. I had never lived anywhere in China where such information was posted in public.
One afternoon, I dialled the number at the top of the chart. The quarantine-team leader picked up immediately, and, after I introduced myself, she promised to arrange an interview; within an hour, I received a call from the neighborhood committee’s Party secretary. He told me to stop by his office the following morning, which was a Saturday.
Our conversation was masked on both sides. He was middle-aged, a serious man in a blue blazer with a safety-pinned armband that said “Party Member Service Team.” He had grown up in the neighborhood, where his father had also worked for the government. The old man had come out of retirement to don a hazmat suit during the epidemic—he was one of the volunteers who checked temperatures in front of apartment buildings.
The office contained a narrow vinyl-covered couch, and the Party secretary told me that he had slept there for the first two weeks of the quarantine, when he was working from 8 a.m. to midnight every day. His home was in a distant northern suburb, and he couldn’t afford the time to commute. In Chengdu, there are 1,685 neighborhood committees, and each had prepared a quarantine team like the one near my home. Most details of our local lockdown—the information boards, the hazmat thermometer workers—had been managed by the team, which consisted of thirty-eight people, mostly volunteers. In a jurisdiction of nearly six thousand residents, there had been exactly one case of coronavirus: the person in my compound.
The Party secretary explained that the resident had travelled to his home town, in Hubei, during the Lunar New Year holiday. In the early days of the epidemic, the government tracked such links so intensively that locals became terrified by the sight of a car with Hubei plates. Many Chengdu hotels turned away guests from Wuhan, so the government finally designated twelve lodgings to accept them. A friend of mine in another part of the city passed along a WeChat conversation that had occurred among people in her compound:
In my neighborhood, the Party team organized periodic door-to-door surveys, which was how they learned of the resident’s Hubei trip. Thus far, people had come to my apartment three times, and they always asked about Hubei and Wuhan. Their policy was to call the community’s Health Service Center if anybody had visited those places.
“They came and checked his temperature—it was 37.1,” the Party secretary told me, using the Celsius figure. (The temperature was normal.) “He didn’t feel sick, but the health officials tested him for the coronavirus, and it was positive.” Later, the man showed mild symptoms, which meant that the team had caught him at a critical time: he’d appeared normal but may have been contagious. He spent ten days under observation in the hospital, and then he was quarantined at home for fourteen days.
I asked the Party secretary when we would be allowed to enter our compound without the passes, and he said, “I think it will be two fourteen-day periods.” He seemed to think in this unit of time, which is the standard span of a stringent quarantine. He estimated that my daughters’ school wouldn’t resume until mid- or late April—three more fourteen-day units. When I asked if there had been much resistance to the new policies, he shook his head. “Ninety per cent of the population agrees,” he said. “We have some people who think it’s not convenient, and they want to go out and play mah-jongg or something. But most people follow the rules.”
From what I had seen, he wasn’t exaggerating. The overwhelming compliance was one of the most impressive features of the lockdown, along with the dedication of grassroots officials. In Wuhan, the government had sent eighteen hundred teams of epidemiologists, each consisting of at least five people, to trace the contacts of infected citizens. The W.H.O. report noted that the containment effort had been possible because of “the deep commitment of the Chinese people to collective action.” At the individual level, though, people occasionally expressed reservations. During one of my exchanges with Zhang, the pharmacist in Wuhan, I mentioned that most people I knew were supportive. He wrote back:
It was common for Chinese leaders to speak in such terms—President Xi Jinping had declared that the country would “defeat the virus.” Eventually, President Trump’s Twitter feed would adopt a similar tone. (“we will win!”) I asked Zhang to explain what he meant.
During the lockdown, the Ministry of Education estimated that more than two hundred and twenty million children and adolescents had been confined to their homes. At our daughters’ school, for the first three weeks of the semester there were no online classes for the younger grades, although they were given some materials, including a school project titled “The Coronavirus and Everybody’s Battle Against the Epidemic.” Then the school started holding short lessons online, but Leslie and I thought that children of that age shouldn’t be engaged in remote learning.
We organized things as best we could, using the school’s assignments and finding other projects. Ariel and Natasha usually worked well in the morning, and then, around ten or eleven o’clock, when we started to hear sounds of roughhousing, I took them out for our morning walk. In the afternoon, we sent them to play in the compound courtyard, where it was common for passersby to lecture them about the dangers of being outdoors or of wearing their masks improperly. The latter criticism probably should have been directed at me, because I had made the mistake of telling the twins about the flapjack, in which you allow the mask to dangle from one ear in order to answer a cell phone on the other side.
In a four-room apartment, with one adult writing a book and another teaching full time, none of this seemed sustainable, but we had made the decision to stay. The girls’ foreign friends had all been evacuated at the beginning of the quarantine, and the families of their Chinese classmates weren’t meeting with anybody. All over the city, children remained isolated.
I suspected that this was particularly hard on middle- and high-school students. Young people in general suffer significant stress in China, where suicide is the leading cause of death among those aged between fifteen and thirty-five. In the nineteen-nineties, I was an instructor at a teachers’ college in Fuling, a small city less than three hundred miles east of Chengdu, and most of my students now teach in middle and high schools. They often live in third- and fourth-tier cities, where the shift to remote education seemed problematic. “As for the classes online, it couldn’t be much worse,” a high-school teacher wrote me. “The students can’t control themselves.” He said that all his students followed lessons on mobile phones, which seems common in smaller cities, where families often don’t believe that a spare laptop or tablet is necessary. And it requires significant discipline to focus on online lessons. My current students seemed to handle the adjustment well, but they are at one of China’s better universities, and all of them have computers.
As March progressed, certain aspects of the lockdown eased, and many people began to return to work. It was similar to the idea that Marc Lipsitch had described: letting the air out of the balloon slowly. But schools weren’t part of this process, which meant that many children remained at home alone after their parents went to work. Willy, a former student who now teaches in Zhejiang Province, estimated that eighty per cent of his ninth-grade pupils were unaccompanied during the day.
Parents often called him to complain. “People say their kids are shenshou,” he said, using a word that means, roughly, “mystical beasts.” “They say, ‘We want the mystical beast to go back to the cage.’ The cages are the school.” He described the family situation of one of his colleagues: “His son had been good, and he was hardworking. But in the past forty or fifty days he has been doing online courses, and he spends so much time online. His father said he’s very likely to lose his temper. He goes crazy. He shouts. It’s because of using the mobile phone too much.” Willy’s own two children also had classes on phones, and he had noticed a rapid deterioration in his teen-age daughter’s behavior. “We don’t know exactly when she is having class and when she is using the mobile phone to chat or play games,” he said. “She is right now out of control.”
One of the most striking characteristics of the new coronavirus is the vastly different susceptibilities of different age groups. Over all, more than eighty per cent of known cases show only mild to moderate symptoms; older people are much more likely to develop serious cases, especially if they suffer from other health problems. According to the W.H.O., by February 20th, children under the age of nineteen represented only 2.4 per cent of the reported cases in China. Of the few children who get sick, the cases tend to be mild. Last week, Pediatrics released a study showing that, in a set of seven hundred and thirty-one confirmed cases of coronavirus among children, ninety-seven per cent were asymptomatic, or had mild or moderate symptoms. Thus far, in all of China, there has been only one death in this age group, a fourteen-year-old boy.
Fisher, the infectious-disease specialist from Singapore who accompanied the W.H.O. mission, told me that he opposes school closings. From the early case studies, Fisher predicts that children get infected at the same rate as adults yet tend to show mild symptoms or be asymptomatic. And although there is evidence of asymptomatic transmission, such events seem unusual and, in the analysis of the W.H.O., have not played a major role in the spread of the disease.
But a more difficult issue is presymptomatic transmission. There seems to be a brief window—perhaps two or three days—when people are infectious but not yet showing symptoms. Gabriel Leung, the dean of medicine at the University of Hong Kong, told me that he believes between twenty and forty per cent of infections come from people who don’t yet seem sick. “They could be spreading it through droplets, say during eating or speaking,” he said. “These droplets could contaminate surfaces, and this is how it spreads.”
The role that children play in this process remains unclear. Fisher pointed out that there’s no evidence that they have helped spread the disease in China or elsewhere. The W.H.O. report noted that, during the mission’s nine-day trip, none of the Chinese medical personnel who were interviewed could recall a case in which transmission occurred from a child to an adult.
“My view on schools is that children aren’t at risk of severe disease,” Fisher said. “They don’t amplify the spread, they don’t amplify the transmission. They are kind of bystanders while it goes on. There’s no good reason to keep them out of school, unless the society is in total lockdown. I’d rather see just a modification of school activities.”
But Leung cautioned that nothing is definitive at this point. He was currently analyzing how the disease spreads within households, which could reveal information about which ages are most infectious, but he wouldn’t finish until later this month. He thought that an ongoing Chinese analysis of serology, or antibody patterns, could provide some clearer answers to the question of children’s role in the epidemic. But this research would probably take at least a few more weeks.
Leung noted that, in the absence of clear science, political pressures have a large influence on school closures. Hong Kong closed schools, but Singapore did not, relying instead on measures that more carefully limited and screened arrivals, used targeted testing, isolated known cases, and protected high-risk groups. Taiwan followed a similar strategy, allowing schools to reopen after a two-week extension of the Lunar New Year holiday. All three places seem to have managed the situation effectively. The Centers for Disease Control in the United States has noted that countries that closed schools at an early stage have not necessarily handled the epidemic better than those which didn’t, and such closures likely have to be longer than four weeks to have any benefit.
In the short term, China’s all-out lockdown wasn’t surprising after the country caught a glimpse of the abyss in Wuhan. But, as time passed, there didn’t seem to be much evolution in strategy. “We have to fully have a conversation about the cost,” Nuzzo, the epidemiologist at Johns Hopkins, told me. In her opinion, the extremely positive W.H.O. report had missed an opportunity to point out some negative impacts of the Chinese strategy.
She noted that the virus can always return, and that it will probably take one or two years to develop a vaccine. In her opinion, instead of relying on overwhelming measures, the Chinese should develop strategies that might be more flexible and sustainable. The effects of enforced seclusion, stressed children, and distrust of neighbors can’t be quantified as easily and as quickly as cases of infection and death. Even many things that can be counted are simply not prioritized at such a time. I had a feeling that people would be shocked if they knew how many Chinese schoolchildren—many tens of millions, undoubtedly—are currently being educated entirely through mobile phones.
Some critical numbers remain unknown for other reasons. During the fourth week of online classes, a friend in Fuling reported that a teen-ager in the northern part of the city had jumped out of his fifth-floor apartment. Apparently, the middle-school student had been fighting with his father, who was trying to get him to focus on his online lessons. My friend sent me a cell-phone video taken by somebody who lived nearby.
In the video, two people crouch over a motionless form at the base of a building. Police cars have arrived, along with an ambulance; three men in masks approach with a stretcher. Bystanders engage in a terse dialogue:
This single incident in one small city equalled the nationwide death total from the coronavirus in children under the age of nineteen. Earlier this month, there was at least one other suicide, when an elementary-school student in Hebei Province, having been scolded for using his phone to watch videos instead of for remote classes, jumped from a building. If such things were happening elsewhere, they were probably kept quiet. There was no report in the Fuling press, and, if anything was posted on social media, it was quickly taken down. “The online classes are like a campaign that we have to win, just like we must defeat the virus,” my friend explained. “So this kind of thing should not drag it down. This is why I can’t find the information about the incident online, I think.”
In the neighborhood, a few people told me the building and apartment number of the confirmed case in my compound. Such details had a way of getting out, and I observed people behaving in ways that seemed unusually vigilant around the building in question. Once, a woman wearing a mask, plastic gloves, surgical booties, and pajamas walked past me holding a package, a bottle of disinfectant, and a cotton swab. I saw her enter the building and gingerly use the swab to call the elevator, so that even her gloved hand didn’t touch the button.
One afternoon, I went up to the apartment, where I heard voices behind the numbered door. A rack of shoes outside: at least one child lived here. I knocked, and a man called out in a gruff voice, “Who is it?”
I explained that I was a neighbor, and the man opened the door. He was middle-aged, with the kind of paunch that in China is often associated with business careers. He was wearing clear plastic gloves and smoking a cigarette. I introduced myself and said that I had been told a resident had had the virus.
“Nobody here has had it,” the man said.
I tried to put him at ease, explaining that I understood that the case had been mild, and that I just wanted to learn about the recovery process.
“Of course,” he said. “If I were a neighbor, and if somebody had been sick, I’d want to know, too. But nobody here has had it.”
“So you’ve never heard of anybody in this building getting infected?”
“No,” he said. His face was unmasked, but I couldn’t read anything in his expression. He politely said goodbye and closed the door. On the way down, the elevator reeked of seventy-five-per-cent-alcohol disinfectant.
On the forty-fifth day of the lockdown, our family went out to dinner for the first time. Businesses had slowly started to open, according to the logic of the Party. Barbershops were among the first, probably because there was no online alternative. Banks came later, and then a barbecue place across the river opened its doors. My daughters still hadn’t interacted with another child their age, and there had been no announcement about school.
At the restaurant, the hostess shot Ariel and Natasha with an infrared gun, and then Leslie and I took our turn. The hostess carried a clipboard on which we wrote our names, cell-phone numbers, and temperatures: Ariel, 36.5; Natasha, 36.2; Leslie, 36.2; me, 36.0. We sat down and unmasked. This place had always been popular, but tonight it was half full. Across China, there had been more than eighty thousand confirmed cases and 3,119 deaths, but the rate of increase in both figures had slowed dramatically. Chengdu’s last death—its third, total—had happened more than three weeks before. The three victims had been aged sixty-four, seventy-three, and eighty, and all had suffered multiple chronic health problems before becoming infected.
The restaurant was trying hard. After we ordered, a manager called me over with what I believe to have been a conspiratorial smile, although only his eyes were visible. He handed me a silver tray with a sprig of flowers, a bowl of glutinous rice, and a red Valentine’s-style card.
“It’s March 8th!” he said.
I had forgotten—International Women’s Day.
He pointed at the rice and the card. “It’s free,” he said. “Write a message to your wife!”
I stared at the red paper. Then I wrote something to the effect that this was the most romantic period we had shared since the 2013 coup in Cairo. I walked back to the table carrying the silver tray while the masked manager took pictures with his cell phone. A waitress brought the bottle of beer we had ordered, and I filled Leslie’s and my glasses. Soon, the waitress reappeared with another Tsingtao. “It’s free,” she said. “Because of the epidemic!” She opened the bottle and we shared that one, too. ♦
