Policy Lessons From Early Reactions to the COVID-19 Virus in China

Yu Liu, MPH; Richard B. Saltman, PhD


Am J Public Health. 2020;110(8):1145-1148. 

In This Article

Abstract and Introduction


The World Health Organization (WHO) declared the COVID-19 virus outbreak to be a Public Health Emergency of International Concern on January 30, 2020. Although the Chinese central government implemented significant measures to control the epidemic from January 20 within China, the crisis had already escalated dramatically.

Between December 1, 2019, and January 20, 2020, a total of 51 days passed before the Chinese central government took full control. Several major factors combined to cause what had been in retrospect a clear break in the governmental information chain between December 1 and January 20. The management of this epidemic also illustrated key organizational limitations of the current Chinese health system, in particular provincial-level senior officials' lack of knowledge and awareness of potential public health risks and insufficient emergency medical material storage and logistics arrangements.

We review the specific disease control actions that the Chinese central government took between January 20 and January 27, the major reasons why the governmental information chain had broken before January 20, and key structural health system limitations highlighted as the epidemic expanded.


The COVID-19 epidemic began in the city of Wuhan in Hubei Province, China. Biomedical researchers immediately sought to establish the disease's origins and potential infectious paths.[1,2] Several factors about this particular infectious agent and its timing are important to understand subsequent control efforts. First, clinically, the COVID-19 virus and its disease progression have unique features that present particular challenges for disease prevention and control. Current biological and epidemiological research suggest that COVID-19 can be infectious among humans without symptoms and through aerosol transmission paths[3] and that the incubation period can be as long as 24 days[3] with a preliminary estimated infectious rate of 1.4 to 2.5 according to the World Health Organization (WHO).[4] However, there remains much that is still clinically unknown about COVID-19.

Second, socially, the rapid expansion of the epidemic occurred just before the Chinese Lunar New Year (January 25, 2020), during which period approximately 3 billion holiday trips normally take place in China.[5] Much like Thanksgiving and Christmas Eve in the United States, the Chinese Lunar New Year is a time for reunions with families and friends. This Lunar New Year celebration break was originally scheduled to be from January 24 to January 30. Wuhan's mayor Zhou Xianwang stated in an interview on January 26, 2020, with China Central Television (CCTV) that some 5 million people had left Wuhan before the city's lockdown.[6]

Third, economically, Wuhan has the nickname of "China's thoroughfare"—it has a population of 11 million and serves as the commercial and transportation center of Central China.[7] It also has a substantial number of manufacturing sites, including western automobile companies.

These 3 structural factors combined highlight why it was difficult for local, regional, and central government to successfully control the COVID-19 virus from spreading to other parts of China as well as internationally, despite many Lunar New Year celebration events being cancelled in Wuhan after the city's lockdown on January 23.

Given this set of early events, scrutiny of China's central government's response and the limitations of the current Chinese health care system as illustrated by the development of the epidemic thus far may be helpful to other countries as they in turn fight the epidemic's ongoing spread.