Containing coronavirus: Where democracy struggles – and thrives

As Washington state grapples with coronavirus, Americans are getting their first up-close look at life amid an outbreak – and how the country might balance public health safety with personal liberties.

Six people in the state have died, the first coronavirus-linked deaths in the United States; 18 more cases have been confirmed, and the governor has declared a state of emergency. After revelations that the virus may have been spreading undetected in greater Seattle for six weeks, limited quarantines are now in place, with two teams from the Centers for Disease Control assisting. The local government is renting RVs and modular housing units, and buying a motel to isolate people who can’t stay at home; some schools are temporarily closing.       

“This is a complex and unprecedented challenge” Dr. Jeff Duchin, health officer for Seattle and King County, said Monday at a press conference. The current confirmed cases are “the tip of the iceberg,” he said, and testing could expand to as many as thousands a day. But officials gave no indication of a broader quarantine, and instead said they expect eventually to stop tracking individual cases and handle the virus as they do influenza. “We are still trying to contain, but we are pivoting to a community-based approach,” he said.

Meanwhile, Seattle director of public health Dr. Patty Hayes urged residents to “stop the run on masks” needed by “front-line workers.” Still, many people are stocking up on key supplies and preparing to hunker down.   

Hand sanitizer, paper towels, and soap are “flying off the shelves,” says Tom Pharo, a manager at a local grocery chain, rushing to wipe-down check-out counters on Sunday in a store that is short-staffed. “Getting people to come in [to work] is tricky, too,” he says, because of mounting virus worries.

In some ways, it’s a scene that mirrors others around the globe, from Wuhan to Milan, as authorities try to handle the rapidly growing epidemic. But the differences are also stark – shedding light on the unique questions democracies must wrestle with, compared to China and other authoritarian states, as they seek to protect both public health and individual freedoms. 

“Epidemics ... reveal what really matters to a population, what is at stake, and especially whom and what these societies value,” says David Jones, a professor of global public health and the history of medicine at Harvard University.

Unlike China, where the COVID-19 virus originated, officials in Italy, South Korea, and the United States face more hurdles to rapid mobilization. Yet democracies’ relative transparency, openness, and respect for individual liberties is also a major advantage, analysts say, in keeping the public informed about risks and prevention, reducing panic, and maintaining crucial trust in government actions. “We are trying to engage in radical transparency with the American public,” U.S. Health and Human Services Secretary Alex Azar told reporters last week.

“A strength of the democratic system is we should be hearing about cases from health care facilities,” says Amanda Glassman, senior fellow at the Center for Global Development. ”We don’t have any ban on talking about people who have disease or hospitals that are overwhelmed.”

China’s authorities, in contrast, suppressed initial reports of the virus in December for weeks as the contagion went unchecked – silencing whistleblowers, including a Wuhan doctor who later died from the illness.

The cover up caused “an almost unprecedented online rebellion ... [with] average Chinese people being very angry at the government,” says Diana Fu, associate professor of political science at the University of Toronto, who researches civil society in China. The authoritarian government had broken “the basic social contract” to provide people with safety and security, she says.

Once China’s leaders moved to act, however, they orchestrated a rapid, efficient, and huge mobilization of resources in a “people’s war” against the virus. Beijing was credited with swiftly identifying and sharing the genetic sequence of the virus. Meanwhile, it imposed a draconian quarantine of Wuhan’s 11 million people that “may have bought the world time, for which we should all be grateful,” Professor Jones says.

“There’s no question that China’s bold approach to the rapid spread of this new respiratory pathogen has changed the course of what was a rapidly escalating and continues to be a deadly epidemic,” Bruce Aylward, a Canadian doctor who led a WHO delegation to China, said at a press conference last week.

Other governments’ anti-virus campaigns seem at times disjointed and slow, in comparison to China’s top-down approach, with new hospitals constructed overnight and big cities quarantined. Moreover, a slow distribution of testing kits and overly narrow criteria for testing may have missed numerous cases that are only now being detected. On Sunday, the administration announced a “radical expansion” of testing.  

“We’re well behind the ball in figuring out what is going on,” Ms. Glassman says.

“We don’t have a top-down command and control system,” she adds. “Civil liberties and individual beliefs play a huge role in people’s health-care seeking and their willingness to be led by government or to do what government advises.”

A global question

In South Korea, for example, officials have sued a religious group for obstructing the surveillance work of health authorities in the city of Daegu, contributing to a mushrooming of coronavirus cases from dozens to more than 4,300 in only two weeks. Meanwhile, South Korean President Moon Jae-in faces public outrage – including a petition for his impeachment signed by 1.4 million citizens – for his handling of the crisis. Mr. Moon is blamed in particular for only belatedly imposing an entry ban on foreigners arriving from China’s Hubei Province, while allowing other Chinese travelers to enter South Korea.

In Italy, where cases spiked to more than 1,800 as of Monday, towns throughout the northern industrial heartland have been quarantined as officials attempt containment. But the aggressive reaction by authorities has raised concerns over restrictions on freedom of movement and basic human rights.

Raffaele Maresca is an instructor at a free fall wind tunnel in Milan. His job is usually frenetic, with between 200 and 400 clients showing up for indoor skydiving simulation daily. But now all appointments have been postponed. “There’s a lot of paranoia. It feels like it’s being blown out of proportion,” he says, wondering if he’ll still be able to go to movies, or even the gym. “I feel it affects my freedom, and I don’t like it.” 

Countries’ responses must be vigorous, but not at the risk of violating human rights, says Steven Hoffman, director of the Global Strategy Lab at York University in Toronto, which advises countries on law and policy in the face of transnational health threats.

“When it comes to pandemics, following human rights principles actually align with scientific principles,” he says. “If we are trapped in a city that’s being presented as a high risk to the rest of the world, it’s a natural human tendency to try to leave that city ... which then makes it even harder for public health to identify those folks who might get sick and isolate them.”

As cases have increased in Europe, freedom of movement, one of the foundational pillars of the European Union, has become a central issue. Austria temporarily halted trains from Italy, while many far-right politicians have used the coronavirus to renew their calls, begun in the wake of terrorism threats by ISIS and migration across the Mediterranean, to end passport-free travel between Schengen countries.

But some experts caution against the effectiveness of such bans, and say they also fuel fear of people perceived as “foreign,” or “other.” Incidents of racism, from Canada to the U.S. and across Europe, have spiked toward Chinese populations, and the Asian diaspora more generally. 

In Italy, the far-right has gained space to rail against open borders in the wake of the coronavirus outbreak, says Cecilia Emma Sottilotta, a professor of political science at the American University of Rome. “It is clearly perfect for political leaders like [Matteo] Salvini [of Italy] or Marine Le Pen [in France] or the [Alternative for Germany party] who have been arguing about the control of borders and people,” she says. “They are literally jumping on this.”

Rather than cut off connections, democratic communities must work with each other to overcome the virus, says Devi Sridhar, director of the global health governance program at Edinburgh University. “Citizens have to feel the government has their best interest at heart. And if they do come forward and want to report, they will get the best medical care and not forcibly be put into conditions that are against their will.”

Democracies’ free-flow of information is also central to their response, a key lesson that Canada learned in 2003. During the outbreak of SARS, it became one of the worst-hit countries outside of Asia, especially in Toronto, which was slapped with a WHO travel advisory. The country counted 438 suspected cases and 44 deaths.

The government drew up a commission that looked at weaknesses in the response, like a lack of preparedness and of information-sharing between local hospitals, provinces, the federal government, and the rest of the globe. Afterward, Canada created a public health agency that is now leading the coronavirus containment effort.

“Generally, in open societies, I’m more confident in the ability for a virus to be contained,” says Professor Sridhar. “Because it’s transparent, and that’s what you want to have, free information flowing and good governance.”

Correspondent Catarina Fernandes Martins contributed reporting from Naples, Italy.