The EconomistFebruary 1st 2020 International 372 infectious. In South Korea in 2015 a patient
with mersinfected 81 people during a 58-
hour stay at a hospital emergency room.
The threat of a global pandemic will put
to the test the preparedness plans that
countries and big cities have in place.
These feature a worst-case scenario, usual-
ly the arrival from abroad of a hypothetical
strain of influenza that is both very deadly
and highly contagious—a rare combina-
tion of features that set apart the Spanish
flu which swept the world in 1918, killing
20m-50m people.
City authorities and hospitals routinely
carry out drills to test their readiness for
such a scenario. In some cases officials
huddle in a conference room and plan what
they would do. On January 24th New York
City’s top officials held such a drill for the
Wuhan virus. In other exercises, doctors
and health officials don protective gear and
get out on the streets to practise their re-
sponse. To test its system, New York City
routinely uses “mystery patients” who
show up at hospitals pretending to have
symptoms of “notifiable diseases” that
doctors are supposed to report to public-
health departments.
When an outbreak starts to cross bor-
ders, as is now happening with the Wuhan
virus, the knee-jerk reaction is to set up air-
port health-checks for passengers arriving
from outbreak hotspots. But many health
experts think such tests are a waste of time
and money. In Canada, screening for sars
at airports in 2003 detected no instances of
the disease; that year sarskilled 774 peo-
ple, including 44 in Canada.
The theatrics of airport checks suit poli-
ticians, who are anxious to be seen to be re-
sponding to worried citizens. It is more
useful to the public to provide those arriv-
ing at airports with information explaining
what to do if they develop symptoms, says
Agoritsa Baka of the European Centre for
Disease Prevention and Control.
Efforts are better spent boosting infec-
tion-prevention measures at hospitals,
says Ms Baka. Health workers are often
among the first to be infected by a new vi-
rus, which they pick up from patients. They
then pass it on to their families and other
patients. In the global sarsoutbreak in
2002-03 about a third of those infected
were health workers.
The best way to nip an outbreak in the
bud is for disease detectives to locate those
infected. The goal is to prevent them from
passing the virus to others, by isolating
them in hospitals and at home. Most coun-
tries ask people to quarantine themselves
voluntarily. Some will demand court or-
ders to enforce such rules if people rebel.
When an outbreak grows from a few
clusters of cases into an epidemic, cities
may go further in their efforts to keep peo-
ple apart. Japan and some European coun-
tries close schools for short periods if flu
seasons look as though they will be partic-
ularly bad. In 2009 Mexico City shut down
bars, cinemas, churches and football stadi-
ums for 13 days to try to stop the spread of
swine flu.
Locking down large areas, as China is
currently doing with the entire province of
Hubei, with a population of nearly 60m, is
untested in modern times. Such efforts can
backfire. One lesson from the Ebola out-
breaks in west Africa is that if those under
quarantine are not cared for and do not feel
that the suffering they are enduring for the
common good is respected, they will try to
evade the quarantine, says Jeremy Konyn-
dyk of the Centre for Global Development, a
think-tank in Washington. That makes
matters worse because in an outbreak it is
crucial to know who is infected, where they
have been and where they are going. A
heavy-handed attempt to quarantine West
Point, a settlement of 70,000 people in
Monrovia, Liberia’s capital, during the
Ebola outbreak in 2014 was abandoned
after residents responded with riots. By
contrast, a similar but well-organised
quarantine in Sierra Leone, in which tradi-
tional leaders were brought on board first,
did not meet resistance.
If China’s drastic measures help delay
epidemics of the Wuhan virus in othercountries by a few months, that could
make a huge difference, says Dr Farrar.
Hospitals in Europe and America will be
better placed to handle a surge of infec-
tions in late spring, compared with Febru-
ary when they are overwhelmed by the
peak in cases of the seasonal flu. Such a de-
lay could also be crucial for testing a vac-
cine for the Wuhan virus. Several are al-
ready in the works in China, America and
Australia. Dr Farrar reckons a vaccine could
be ready for clinical trials in 6-12 months.
When it is clear that an epidemic cannot
be controlled, authorities go into mitiga-
tion mode. That involves setting up places
to care for patients when hospitals over-
flow, and systems to identify which pa-
tients should be treated first when medical
supplies run short. But few countries put
such measures in place in advance. China
is frantically building extra hospitals in
Wuhan to accommodate the current surge
in numbers of patients.
Sometimes no preparation can suffice.
“It will not be possible to halt the spread of
a new pandemic influenza virus, and it
would be a waste of public-health re-
sources and capacity to attempt to do so,”
admits Britain’s flu pandemic prepared-
ness strategy. At that point, officials are left
hoping for the best. 7T
he yu garden, a 16th-century complex
of pavilions and ponds in the heart of
Shanghai, is all gussied up for the Chinese
new-year holiday. Its walkways are be-
decked with colourful lanterns, its stalls
laden with dumplings, its entrances
flanked by dozens of security guards to
handle crowds. Just one thing is missing:
people. Fearful of coronavirus, they are
staying home. “I’ll be doing well if I make a
few sales today,” says Li Xinming, manager
of a silk-scarf shop. Last year Yu Garden at-
tracted 700,000 visitors during the holiday
week, peak season for it and its merchants.
This year, Mr Li says his losses might wipe
out his earnings for months to come.
The question for China, and for the
many companies and countries around the
world linked to its economy, is whether Mr
Li’s travails are indicative of a much broad-
er problem. The obvious reference point is
China’s battle with sars, another coronavi-
rus, in 2003. Growth slowed sharply at the
height of the epidemic but rebounded
swiftly after it was contained. Other recentepidemics have reinforced the impression
that economists should not be overly wor-
ried, so long as good doctors are on the job.
Neither avian flu in 2006 nor swine flu in
2009 dimmed the global outlook.
Yet even flint-hearted investors are
wondering whether the new epidemic
might be worse. Stocks in Hong Kong haveSHANGHAI
China’s semi-quarantine will hurt growth at home and abroadCoronavirus economicsLocked down
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