Viral outbreaks of emerging infectious diseases are not unique to China — the MERS coronavirus came out of the Middle East, and Ebola emerged in West Africa. But unique factors facilitate the mixing of animal and human viruses in China, and that leaves China more prone than other countries to incubating infections such as avian and swine flus, along with two of the three novel coronaviruses that can infect humans: SARS and the new Wuhan virus.

Though China’s authoritarian system can make effective identification and isolation easier, it may also be inhibiting the broader public response. Here’s what you need to know.

1. China’s response is in line with international best practices

Chinese health officials report more than 4,600 confirmed cases and 106 reported deaths. Outside China, more than 60 cases have been confirmed. Many of the cases are still directly tied to Hubei province and its capital, Wuhan — and to a specific live-animal market. The jump in identified cases reflects increased testing, and includes mild as well as serious illnesses.

But human-to-human transmission is now spreading the virus to others in Hubei and elsewhere. Disease-modeling experts predict that the number of cases will continue to increase despite the travel restrictions.

After notifying the World Health Organization on Dec. 31 about the unusual pneumonia cluster in Wuhan, Chinese officials have been working with the WHO on the response: to investigate the cluster, identify the infectious agent and alert the public and the global community in line with international recommendations. On Jan. 23, WHO officials held off on declaring a public emergency, at least for now.

2. But Hubei’s lockdown will be only partially effective

The immediate challenge of controlling the spread of the virus during the Lunar New Year holiday prompted a travel ban in Wuhan and other nearby cities. Chinese authorities also canceled crowded public events. This isn’t a popular move — but it is in line with global recommendations on social distancing, which stops short of quarantine but reduces person-to-person contact and exposure.

But authorities imposed the ban after 5 million people had left Wuhan, so its effect will be less than intended, given the two-week incubation period. Therefore, the outbreak will probably continue spreading for a while.

Restricting travel is a slippery slope — canceling public transportation and asking Wuhan residents to stay put is not the same as actually quarantining them. The quarantine of people during the 2003 SARS outbreak, a more restrictive approach, backfired. Anyone who had even 30 minutes contact with a SARS patient could be quarantined for up to two weeks. Millions of migrant workers, fearing detention in Beijing and other cities, fled to their home villages in 2003.

3. China’s authoritarian tools may help the response

Even with the SARS misstep, China’s authoritarian system accomplished what other countries would find difficult: the isolation of any infections in those migrants once they were back in their home villages. In late 2003, after the SARS epidemic died down, I visited one of my research sites in rural Guizhou province and learned how they handled the SARS threat.

Local doctors promptly visited returned migrants in their rural homes and asked migrants with no fever to stay home during the incubation period, moving those with fever to a local, quickly constructed infectious disease hospital. Authorities built these hospitals all over China to isolate, observe, test and, if necessary, treat suspected SARS patients.

Health authorities have now mirrored this approach in Wuhan, and plan to rapidly build a 1,000-bed hospital to isolate suspected coronavirus cases and relieve overburdened city hospitals.

4. But the authoritarian system can also slow the response

China’s health authorities appear to be taking the right steps, but there are cracks in other parts of the response. Media controls, which have tightened under President Xi Jinping, initially impeded the flow of information to the public.

China has a long history of underreporting bad news for fear of economic losses, or criticism from Communist Party leaders. Authorities closed the Wuhan live market Jan. 1, but the local paper kept the outbreak off the front pages for several more weeks — probably to avoid any panic during a Jan. 7-17 annual meeting in Wuhan for top municipal and provincial officials. Wuhan’s mayor offered to resign over his own delay informing the public, but noted that he needed to “seek permission” before releasing sensitive information.

A similar dynamic kept the SARS outbreak hidden in Guangdong province in winter 2003, while the virus gathered steam and spread internationally. China’s leadership has reversed course and said anyone hiding coronavirus cases will be” forever nailed to history’s pillar of shame” but the problem is endemic to China’s governance system. Officials at all levels often hesitate to deviate from the current Communist Party line — though the government’s hesitation to publicize the coronavirus threat earlier has prompted widespread outrage on social media.

5. China’s animal practices contribute to cross-species infection dangers

Like SARS and other bird and swine flus, the new virus most likely emerged because of the proximity of people and animals in densely populated areas and the ubiquity of crowded live-animal markets. These markets sell both domesticated and wild animals — and scientists believe viruses can easily jump between species or, in some cases, to humans.

Scientists traced SARS to wild civets, a delicacy in southern China. The source of the current virus remains unclear, but on Jan. 26, the Chinese government announced a ban on the sale of all wild animals. China’s livestock industry, increasingly industrialized, still has many small-scale farmers engaged in backyard production. Bird flu, for instance, emerged when the virus passed from wild birds to backyard flocks and then to humans.

What would help prevent another coronavirus outbreak?

SARS and the new virus both emerged in China in part because local authorities continue to allow the sale of wild animals. Avian flu emerged because of the proximity of people and their animals in small backyard farms. The One Health integrated system to coordinate animal and human health, promoted by the U.S. Centers for Disease Control and Prevention and other global agencies, would boost joint cross-species disease surveillance and control efforts in public health. This type of surveillance, and making reporting of disease outbreaks in animals as important as that in humans, could lessen the chance of new emerging infectious diseases from China.

Joan Kaufman, ScD, Harvard Medical School, is a global health policy expert who has worked in China for 40 years and has published widely on global health topics including HIV, avian influenza and SARS.

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