A resident of the city of Qingdao wears a mask in February2020, in the early stages of the epidemic. Image by Gauthier Delecroix, available at Flickr.com under CC license.

08:53 am | August 19, 2020

Currents in Context

The Lingering Effects of Lockdown

For Wuhan, the period of full closure and containment has passed. But the actions taken to respond to the epidemic, including the mobilizing of new technologies and mass monitoring of the population, will have a lasting impact on people’s lives.

By Liu Cong

The outbreak of the COVID-19 epidemic in the city of Wuhan in January 2020 coincided with the Chinese New Year, also known as Spring Festival. For Chinese, Spring Festival is the most important holiday of the year. This is true not only because it is a time of celebration during which family and friends come together, but also because it brings the world’s largest migration of people, what Chinese refer to as the “Spring Festival travel rush,” or chunyun (春运). Within just a few weeks, hundreds of millions of people flow across China.

On January 20, as health experts in China notified the public that COVID-19, then known only as a “new coronavirus,” was capable of human-to-human transmission, and that 14 healthcare workers had been infected in Wuhan, other provinces and cities in China began reporting their own confirmed cases. Almost all of the cases reported in these areas, which included Beijing, Zhejiang, Guangdong, and Shanghai, originated in Wuhan. All at once this became a national epidemic, and Wuhan, the largest transportation hub in China's interior, was regarded as the "eye of the storm."

Key Points:

* There were no warning signs before the complete lock down of Wuhan in January, which included a ban on public transport and motor vehicles. Using social media platforms, Wuhan residents showed a strong spirit of volunteerism, building driver networks and offering hotel facilities to support medical staff.

* As a “close off and manage” policy was put into effect for Wuhan, and eventually the rest of the country, China relied on an existing social control system, so-called "grid management," which divides each local jurisdiction into discrete "grids" that can be monitored by millions of low-level officials nationwide.

* Wuhan residents were the first in the country to experience an early invention to deal with COVID-19 – the smartphone-based “health code.” The "health code" system has been pursued in China without any public discussion, and could have long-term implications for data privacy in China.

Three days later, in the early hours of January 23, the Wuhan government announced that from 10AM the same day it would prevent all departures from the city, including from train stations, airports, highways, and ferries, and that it would shut down public transportation such as buses and subways. On January 26, motor vehicles were banned from the streets of Wuhan. Authorities had hit the pause button on a city of over 10 million people.

The news of the lockdown of the city came as a surprise to everyone. By the evening of January 22, Hubei Province had announced 444 confirmed cases of COVID-19, most of which were in Wuhan. Nearly all of the confirmed cases in other cities across the country were identified as having been imported from Wuhan.

But was this enough to justify the wholesale shutdown of a city with a population of 10 million? So far no news has indicated where the closure order came from, but there is no doubt that such a major decision must ultimately have gone through the highest-level of decision-making in China, the Chinese Communist Party’s Central Committee.

The lockdown of the city of Wuhan, and eventually of the entire country, was like a potent injection of painkillers. This rapid response also left behind serious residual effects. For the people of Wuhan, the weeks spent in isolation were not just one of the most difficult and unforgettable periods of their lives, but they have also, in the “new normal” that has followed and in the midst of what is now a global pandemic, had a lasting impact on the lives of everyone.

The City Shuts Down

There were strong winds in Wuhan on January 26, 2020, and that morning the temperature in the city dropped to below zero. Mr. Lin, a hospital employee in this 50s, rushed off to work on a bicycle he rented through a bicycle-sharing service. Previously, it had taken him usually just half an hour by subway or bus to reach the hospital. Now, with public transportation suspended and private cars also ordered off the roads, the journey took him three hours. Hospital personnel like Mr. Lin were among those most keenly affected by the transportation ban.

Fortunately for Lin, his daughter was able to put him in contact with a volunteer driver she located through a group on the popular Chinese social platform WeChat. Many such volunteer drivers emerged in Wuhan after the quarantine order came down, and all were ordinary Wuhan citizens who formed ad hoc chat groups that brought together drivers and medical personnel. Under this improvised system, medical personnel would post their transport requests within the chat group, where drivers would then accept them. These groups were never registered with the Ministry of Civil Affairs, the usual practice for volunteer activities, but were given special treatment considering the circumstances, including entry-exit permits for residential areas. Once Mr. Lin’s shift was finished, the driver, as agreed, picked up him at the hospital entrance.

The city of Wuhan, origin of the COVID-19 epidemic, is a central transportation hub in China, increasing the risks of nationwide infection, particularly during the busy Spring Festival transport rush.

One such volunteer driver under the Wuhan quarantine was Mr. Zhang, a Wuhan native who works in the education industry. Zhang began picking up medical staff on January 23, the very same day the quarantine took effect. In his WeChat group, there are hundreds of volunteer drivers, all ordinary Wuhan citizens. From late January up through the final end of the quarantine in March, when public transportation was resumed, they delivered not just medical personnel but also key supplies to hospitals, including protective equipment and disinfectants.

As working in hospitals put them in close contact with infectious patients may be in close contact with infected patients, many medical staff dared not return home after work for fear of infecting family members. To address this challenge, the “Hotel Medical Support Alliance” (酒店医护支援联盟) was organized among various hotel operators in Wuhan in order to provide free accommodation for medical staff. According to numbers provided by the alliance, it provided accommodation for more than 40,000 overnight stays within just the first week of quarantine.

For both volunteer drivers and hotels, these were risky acts of altruism. In the midst of the epidemic, the hospital was a dangerous place, and all medical staff were high-risk due to their regular contact with infected patients. Many volunteer drivers, in order to prevent the circulation of air in the cramped space, put up plastic film between the front and rear of their vehicles. Medical staff were asked to sit in the back, and the seats and door handles were disinfected with alcohol after each journey.

Image from the back seat of a volunteer driver’s vehicle. Photo courtesy of the author.

These efforts from the local hotel industry came at a time when the industry itself was under tremendous pressure. The closure of the city naturally meant the closure of all businesses and related travel, which meant hotels were largely vacant. But even as they hosted medical staff free of charge, these hotels continued to take on operational costs, including employee wages. Eventually, as more and more medical assistance teams arrived from other cities and provinces, the government offered remuneration to hotels, even requisitioning some facilities outright to help in the anti-epidemic effort.

But the spirit of volunteerism encouraged the earliest efforts of drivers, hotel operators and other Wuhan citizens. "It’s my city, and I will save it," was a quote circulating widely among the volunteers.

There were no warning signs at all before the complete closure of Wuhan. News of the decision was announced by the government in the middle of the night. By that time it was too late to prepare plans to deal with such problems as how to transport medical staff to and from hospitals. It was for this reason that popular initiatives and volunteerism came to play such an important role. The sudden closure of Wuhan also caused many people from outside the city to become trapped there. According to official Wuhan data, there were about 9 million people actually living in the city through the quarantine.

"It’s my city, and I will save it," was a quote circulating widely among the volunteers.

The lockdown of the city not only meant Wuhan was isolated from the outside world. Within the city, too, between communities and between residential buildings, strict containment policies were in place. From February 10 onward, a policy of “close off and manage” was implemented for all residential compounds in Wuhan.

Most of the residential compounds in the city were built in the process of rapid urban development and construction spanning the past two decades. A so-called “compound” consists generally of anywhere from just a few to scores of high-rise apartment buildings, often separated by just a few meters, on a centralized grid surrounded by a wall or fence. This enclosed design makes such compounds relatively easy to manage. The entrances and exits of the compounds can be sealed off with barriers or gates, leaving just one point of entry. Older streets or lanes can, if necessary, also be sealed off with barriers of shared bicycles, making it difficult for residents to leave.

Almost overnight in Wuhan, plastic barriers were visible everywhere on roads and lanes, and blocking entrances to residential compounds. Additionally, the Chinese government also had sufficient personnel at their disposal to dispatch “imbedded cadres” to residential districts who could implement “close off and manage” policies. In Wuhan, a pair of “imbedded cadres” was sent to each residential compound. These were made up of civil servants from various government agencies and government units, and others working in various capacities within the party-state system.

Every day, these “imbedded cadres” held their posts at tents set up at the entrance of compounds, questioning everyone entering or exiting, and prohibiting unauthorized movement. In this way, most residents were completely contained to their compounds. Generally, each family was allowed one person who could go outside and purchase food and supplies every two or three days. All outsiders, those not actually living in the compound, were strictly prohibited from entering.

A makeshift barrier outside a residential compound, watched over by an “imbedded cadre.” Photo courtesy of the author.

Despite this seemingly airtight system, accidents were bound to happen. On March 17, while reporting from Wuhan, I met a couple on the streets of the city after 11PM. They were out searching for the wife’s elderly mother, who was suffering from Alzheimer’s. She had somehow managed to slip out of their residential compound. The old woman had been lost before, they said. But this time was different. The special circumstances of the quarantine left the couple doubly concerned. Their residential community had been sealed off by a barrier for several weeks, leaving only one exit guarded by a pair of “imbedded cadres” stationed at a blue disaster relief tent.

The couple had no idea how the old woman had managed to exit the compound. All incoming and outgoing residents were routinely subjected to temperature checks and asked to present their digital “health codes” under a system instituted nationally in January. "It's clear that everyone has to scan the [health] code to get out of the community,” the woman’s daughter told me. “My mother doesn't even have a mobile. Why did they let her out?" The woman was understandably distraught at the thought of her mother alone on the streets of a city under quarantine. It was only after some explanation to the “imbedded cadres” stationed at the gate, who were strangers to the community, allowed the couple to go out and conduct a search. But of course it was impossible to mobilize family and friends to help in the search, as they ordinarily would have done, because everyone was quarantined at home. They had no choice but to search on their own, on foot. The streets were completely empty, with only the tall street lights to elongate their shadows.

During the early stages of the outbreak in Wuhan, there were serious pressures on medical services and resources in the city as a large numbers of patients flooded to local hospitals seeking care. As hospitals filled up, they were unable to treat critical patients, and the mortality rate was high. This was what healthcare experts and many others called Wuhan’s “darkest hour.” It is possible, in fact, that this was part of the government’s thinking in shutting down transportation and instituting the “close off and manage” policy for residential compounds – in addition to reducing flows of people and slowing transmission, it might keep patients at home and reduce the burden on hospitals. Quite early on in the epidemic, the Wuhan government issued a home quarantine policy, instructing those who showed symptoms of illness to remain at home. But this ultimately proved a failed policy. China's cities are densely populated, generally with three to four people living together in a single household, and the effect of home quarantine was often to encourage greater spread of the virus within families.

The government's overbearing yet nonetheless porous “stay at home” policy led to problems of many different kinds, as in the case of the couple who lost a parent and could not muster the community in their search. And for elderly who urgently need to seek routine medical treatment, these problems could often be cruelly unethical. For example, patients with kidney problems often require dialysis two to three times a week, but transportation shutdowns and other problems meant this was now difficult. I knew one case of a patient in Wuhan who for almost ten days was unable to go for dialysis.

Chinese media also reported the case of an elderly man in Wuhan who was seen pushing his elderly wife through the streets in a wheelchair after she was released from the hospital. Without any means of transport, this old couple had no choice but to walk the long journey home. The “stay at home” policy also prevented COVID-19 patients from receiving timely treatment, as no one was willing to help them to the hospital once they developed symptoms of infection. The sick often avoided treatment until their illness grew severe. In some cases, patients committed suicide out of the fear that they might infect family members by staying at home.

Screenshot from a video taken by a Chinese journalist in Wuhan, of an elderly couple walking home after being released from the hospital.

Some people questioned Wuhan's policy of shutting the city off altogether, and suggested it might have been possible to transport infected people to facilities in other provinces and cities for treatment. In more developed cities such as Beijing, Shanghai, and Guangzhou, there is greater availability of healthcare resources. But in the central government’s view, the best solution was to reduce cross-regional mobility in order to limit the spread of disease – which might also enable local authorities within a given area to get a more accurate grasp of health data and key indicators. Once China’s response to the outbreak was in full force, most provincial borders were closed, and even arterial roads entering cities and villages were blocked off, preventing the movement of people. Even inside Wuhan, the authorities mandated that citizens must go only to hospitals located within their immediate administrative area. In principle, they were not even allowed to cross over into neighboring city districts.

But the true reason the government was in favor of shutting down the city was because it wished to wipe out the epidemic within the area of lockdown, even if this meant mobilizing medical professionals from around the country to support Wuhan. For China’s system, which is vested with a high capacity for mobilization, such a response – closing the gates and launching a full-fledged, coordinated assault from the center – is seen as far preferable to facing a nationwide epidemic in which each area must do battle on its own.

Once the epidemic became the number one priority, mobilization happened quickly. Beijing, Shanghai and other major cities dispatched medical assistance teams to Wuhan within 48 hours of the announcement of the lockdown. Ultimately, more than 30,000 medical personnel from across the country were sent to support Wuhan. In addition to medical personnel, protective materials, ambulances, and even funeral home staff were dispatched as part of the mobilization.

At the end of March, the subway, bus and other public transportation systems in Wuhan gradually resumed operation. At midnight on April 8, Wuhan was finally unsealed. Railways and air traffic were at last restored. Outsiders, many of whom had merely been stuck in transit as they journeyed home for the Spring Festival holiday, were finally able to leave the city, after an agonizing 76 days. Gradually, supermarkets, restaurants and parks were re-opened. The city of Wuhan slowly came back to life.

But even as life had in many ways returned to normal, the system created under the “close off and manage” policy remained in place.

A Secretary for Every Neighborhood

In China's society, where stability is placed before all else, there exists behind the layer of people’s ordinary lives a complex but largely invisible system of command and control built on a six-tier administrative architecture. At the top is the central government, moving down to the provinces (and municipalities), cities, districts, sub-districts and finally neighborhoods, or residential communities. Situated at the bottom of the administrative architecture, neighborhoods are the most basic unit of management for the urban resident, equivalent to the village in the case of the Chinese countryside. Generally, the neighborhood comprises several residential compounds.

At the neighborhood level, the management organization is known as the “neighborhood committee,” or shequ juweihui (社区居委会). Generally, the neighborhood’s Chinese Communist Party secretary serves as the director of the neighborhood committee. The administration at this level also includes anywhere from a few to more than 10 “neighborhood work personnel” (社区工作人员). In China’s cities, this is the most grassroots of all political organizational units.

In China's society, where stability is placed before all else, there exists behind the layer of people’s ordinary lives a complex but largely invisible system of command and control built on a six-tier administrative architecture.

Residential cadres are responsible for carrying out the many commands issued from above. Generally, they are responsible for the daily work of “stability maintenance,” fire safety, civil affairs, the managing of public opinion, and all other necessary party-state work in the area under their jurisdiction, which can be various and fragmented. At the residential level, special importance is given to what is termed “grid management,” or wanggehua guanli (网格化管理), a system of grid or sector-based social management that is already well-developed in China’s cities right across the country. The system was first piloted in Beijing’s Dongcheng District back in 2004, and was formally implemented as a nationwide program at the Third Plenary Session of the 18th Central Committee in 2013.

Under the “grid management” system, each neighborhood is divided into a number of basic grid units (单元网格) The idea is that by strengthening inspection within the unit grid, the neighborhood is able to proactively identify problems and address them in a timely manner. It was from this system that the role of the “grid manager,” or wanggeyuan (网格员), was created. In Wuhan, there are an estimated 12,000 so-called “grid mangers” at work, meaning one “grid manager” for every 300 to 500 households. China has an estimated 4.5 million “grid managers,” both full-time and part-time, in cities nationwide. They are responsible for collecting specific information about each household within their grid unit, and for ferreting out any hidden dangers to social order, ensuring harmonious relationships within the neighborhood. Excessive noise within a household, or an argument between neighbors, can fall under the purview of the “grid manager.” This tight network allows the tentacles of social management to reach into every single building, and into every single family.

In crisis situations, as with the COVID-19 epidemic, the work load of grassroots-level cadres increases substantially. Generally speaking, local medical clinics at the community level in China lack sufficient capacity, so people often choose to go instead to a larger hospital when they become sick. In order to alleviate the pressure on hospitals at the start of the epidemic, Wuhan began implementing a classification and treatment system for COVID-19 patients from January 24. Neighborhood committees across the city were required to investigate cases of fever, and to screen and classify them. The basic idea was to involve community-level clinics, diverting patients from crowded hospitals for as long as possible and avoiding a sudden wave of admissions. Wuhan's 1,337 neighborhood committees and 1,814 village committees – there are also administrative village units located within the wider city limits – thus became another front in the fight against the virus.

One person I interviewed in Wuhan is Zhao Junxia, a neighborhood secretary with many years of administrative experience at the grassroots level. There are nearly ten thousand people in her local neighborhood community, and she has only just over 10 neighborhood personnel working under her. In the initial days of the epidemic response, they went out into the field without any preparation – without thermometers or even protective masks. The first thing they were able to do was community outreach, letting residents know through WeChat platforms, local broadcast announcements and posted notices that they should take measures to protect themselves, avoiding contact with outsiders, regularly washing their hands, ensuring proper ventilation, and so on.

Given the responsibilities of screening and identifying patients, the pressures facing Zhao Junxia’s neighborhood management team increased dramatically. Zhao identified three main problems facing residents at this early stage. First, there was a lack of vehicles, making transport difficult. Second, there was a shortage of sickbeds. Finally, there were problems with the accuracy of nucleic acid tests used to detect virus exposure. Of these problems, Zhao said the lack of vehicles to transport patients was the most difficult to solve.

According to the medical consultation process implemented by the Wuhan government, patients with fever or other suspect symptoms first had to fill out referral forms with the local neighborhood health service center, after which transport to a treatment facility would be arranged. But while this was workable in principle things generally didn’t happen this way, said Zhao. “This channel was unobstructed but useless,” she said. The way the process actually worked was that the local neighborhood-level health facilities notified the sub-district about the need for transport, and the sub-district notified the district-level prevention and control command center. The idea was that the command center would then authorize transport. But with vehicles in short supply, the process was an empty formality. “There were no vehicles [available] in the neighborhood, so patients could only wait at home,” Zhao said.

As it announced the quarantine of the city and vehicle restrictions, the Wuhan government arranged for 6,000 taxis to prove transport services at the neighborhood level, four taxis for each neighborhood. It was clearly stipulated, however, that taxis must not carry people with fever or other symptoms. The taxis were to be used mostly for the elderly and people with limited mobility, taking them to stores or pharmacies for essential food and prescriptions. Meanwhile, the wait for transport to treatment facilities could go on for several days, owing to the process previously described, in which formal applications had to be cleared at each administrative level. Two people in Zhao Junxia’s community died because they could not see doctors in time. Some patients quarreled with community officials over the long wait for transport.

Zhao said she wept bitterly, overcome by a sense of helplessness. The situation finally improved after February 14, when the city government announced that patients with fever could visit doctors at designated “fever clinics” within the neighborhood, and would no longer be required to undergo initial diagnosis through the neighborhood health center.

In order to motivate local response teams, the Wuhan city government required that every compound strive to become epidemic-free and “advanced.” Compounds could only earn the coveted “epidemic-free community” designation if they went for several successive days without newly-confirmed cases or patients with fever. By late Spring on the streets of Wuhan, you would come across signs that read: “This compound has already been epidemic-free for ____ days." But this status would be immediately withdrawn if the community reported a new confirmed case. Such pressures, which meant management personnel could be held directly responsible, meant neighborhood teams were pressured to apply stricter controls on residents.

At the height of the epidemic, it was common in Wuhan to see plastic bags neatly arranged at the gates of neighborhood communities. These contained essential food items, such as rice, vegetables and fruit.