The "Daily" NY Times podcast for 3/12/20 described two effective management schemes for handling the epidemic. Briefly:

Chinese: Check everyone's temperature frequently on a massive scale. Track individuals with QR codes. Use a flow chart procedure to confirm or eliminate a COVID hypothesis, and put affected individuals in government quarantine as needed, separating confirmed cases within a family so as to minimize contagion within families.

The flow chart procedure was describe as follows: screen for body temperature and cough. Eliminate bacterial infection and allergy as possible. Cat scan for pneumonia.

Also an NPR report described an online support group led by a social worker that included quarantine graduates who gave descriptions of quarantine living conditions, including food, and gave advice about what to take along to quarantine. These services apparently helped people cope positively with fears of quarantine.

South Korean: Extensive testing and thorough, meticulous exposure tracing.

My question is, would it be possible to implement one or both of these in the United States (or Europe)?

  • Related: politics.stackexchange.com/questions/50942/…
    – Fizz
    Mar 26 '20 at 1:20
  • 4
    Hi from Beijing. In China, we've been on lockdown since January (and prior to it becoming official, Chinese people were already avoiding going out)---this seems to be a rather important point missing from the description. The restrictions are slowly loosening now. Another important point is a 出入证, a kind of permission slip to re-enter your apartment complex. (I made a YouTube video of what it was like here on the 15-th March.) Mar 27 '20 at 12:02

"From the helicopter" there is now a more general claim (e.g. in the following McKinsey slide) that Western countries are trying to emulate China and/or South Korea's response:

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The devil might be in the details, of course. Getting to the details might be too involved/broad in a question like this, not specific to a pair of countries. There's for example a China-US comparison in a recent BI article, too long to quote here in its entirety, of course. But some things that were probably not done in the West was a complete shutdown of travel, e.g.

"These draconian measures seem to have worked to bring down the cases in a very short period of time in China," Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations, told Business Insider. "Although there is a cost to the economy, to society, not to mention also the second-order problems, like access to health care for people without the coronavirus. The question is whether the United States is willing to pay such a high price." [...] Huang says he cannot imagine an America where many of these measures are implemented. [...]

During the height of the outbreak, trains didn't stop at the disease's epicenter, Wuhan. [...] "Cutting off transportation was considered on the top three measures to contain the spread of the virus," Huang told Business Insider. "But it would hard to imagine the complete shutdown of an American city due to government order."

And regarding tracking of people's movement

"It would be a big change right for the US people to get accustomed to," said Huang, "if the government wants to use this high tech means, like using the cell phones to monitor the movement of the people."

Huang added that even though there is little technological barrier to doing this, this kind of behavior is considered a form of digital authoritarianism, that involves uses privacy issues. Huang would be hard-pressed to imagine the US government using this approach to containing the spread of the coronavirus.

China also apparently co-opted every ("private") security guard in the effort to keep people in their homes:

"In America, you have to stay at home, but there's no police," said Huang. "There's no one actively enforcing that rule, but in China, you have what are basically security guards on patrol of every residence to make sure they don't violate the government containment measures. That's a kind of approach I think can't be copied here in the United States."

Likewise for suspending "non-essential" medical access:

In China, elective surgeries and other non-critical doctors visits were delayed, and many medical services were moved online. [...] But the move hasn't been without negative consequences. One man with kidney disease in China jumped to his death, Human Rights Watch reported. He couldn't get dialysis during the outbreak. Another boy with cerebral palsy died after being left alone for six days while his father was quarantined in China.

A similar opinion was voiced in a Time interview:

“No other nation (western or otherwise) can or should seek to replicate China’s actions,” Thomas Bollyky, the director of the Global Health Program at the Washington D.C.-based Council on Foreign Relations, tells TIME via email. “The disregard for civil liberties and human rights that the government has demonstrated in its quarantine and censorship activities are inseparable from the policies and actions of the government that contributed to the outbreak in the first place.”

Other experts quoted earlier in a Science (news) piece were also skeptical that the full extent of China's measures could be copied in the West:

The question now is whether the world can take lessons from China’s apparent success—and whether the massive lockdowns and electronic surveillance measures imposed by an authoritarian government would work in other countries. [...]

“This report poses difficult questions for all countries currently considering their response to COVID-19,” says Steven Riley, an epidemiologist at Imperial College London. “The joint mission was highly productive and gave a unique insight into China’s efforts to stem the virus from spread within mainland China and globally,” adds Lawrence Gostin, a global health law scholar at Georgetown University. But Gostin warns against applying the model elsewhere. “I think there are very good reasons for countries to hesitate using these kinds of extreme measures.”

There’s also uncertainty about what the virus, dubbed SARS-CoV-2, will do in China after the country inevitably lifts some of its strictest control measures and restarts its economy. COVID-19 cases may well increase again.

More recent cases from Hong Kong indicate that that fear of re-emergence may well be have been justified. So Hong Kong is back into lock down after it was largely lifted at the beginning of March.

Similar expert opinion on restrictions timing:

Epidemiologists say China’s mammoth response had one glaring flaw: it started too late. In the initial weeks of the outbreak in December and January, Wuhan authorities were slow to report cases of the mysterious infection, which delayed measures to contain it, says Howard Markel, a public-health researcher at the University of Michigan in Ann Arbor. “The delay of China to act is probably responsible for this world event,” says Markel.

A model simulation by Lai Shengjie and Andrew Tatem, emerging-disease researchers at the University of Southampton, UK, shows that if China had implemented its control measures a week earlier, it could have prevented 67% of all cases there. Implementing the measures 3 weeks earlier, from the beginning of January, would have cut the number of infections to 5% of the total. [...]

But between 16 and 30 January, a period that included the first 7 days of the lockdown, the number of people each infected individual gave the virus to dropped to 1.05, estimates Adam Kucharski, who models infectious-disease spread at the London School of Hygiene and Tropical Medicine. “That was amazing,” he says. [...]

“These extreme limitations on population movement have been quite successful,” says Michael Osterholm, an infectious-disease scientist at the University of Minnesota in Minneapolis. [... However,] China is suppressing the virus, not eradicating it, says Osterholm. The world will need to wait until about eight weeks after China resumes to some form of normality to know what it did or didn’t accomplish with its population-movement limitations, he says.

There is probably a fierce debate going on in China about when to relax the lockdown measures, says Roy Anderson, an epidemiologist at Imperial College London. He suggests there could be a second wave of new infections when they are lifted.

So whether it's possible to (fully) emulate China's response (in the West) depends not only on the political framework, but also to which experts the (Western) governments might be paying [most] attention to.

I realize this is a long answer already, but there was a recent interview with one of China's [own] CDC officials (whom seldom get interviewed in the West). Some interesting points from there:

Q: What mistakes are other countries making?

A: The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks. [...]

Q: People who tested positive in Wuhan but only had mild disease were sent into isolation in large facilities and were not allowed to have visits from family. Is this something other countries should consider?

A: Infected people must be isolated. [...]

Q: Spread in China has dwindled to a crawl, and the new confirmed cases are mainly people entering the country, correct?

A: Yes. At the moment, we don’t have any local transmission, but the problem for China now is the imported cases. So many infected travelers are coming into China.

More recently (April 2) it has been reported by DW that Germany is considering a voluntary phone app similar to the (mandatory?) one[s] used in China:

The most famous health app was developed by the tech giant Alibaba in conjunction with the Chinese authorities. Other companies have also developed similar software, however. It was possible to work swiftly because the Chinese state already has access regarding citizens' movements and programmers did not have to worry about data protection laws. [...]

There are many who hope that Germany will soon be using such an app. The Health Ministry and researchers at the Robert Koch Institute are developing similar software. The idea is to introduce a non-compulsory app that will not be able to detect who met whom and where but will be able to identify if a phone user was in close contact with another infected user.

The app will only really be able to function if 60 percent of the population uses it. In Germany, it won't be as easy as in Asia to reach such a percentage.

Will Germans cooperate?

Half of the respondents to a recent poll said they would not oppose an app to help warn users who had come into contact with someone infected with COVID-19.

They don't link to the poll, but I guess in was a poll in Germany given that this was an article on DW.

There's now a BBC video discussing Chinese-inspired surveillance measures to combat the outbreak. This is of course somewhat subjective, but they only short-listed Singapore, Israel, Iran, Taiwan and Russia as being closest to China-style surveillance measures used to combat the epidemic, like using CCTV cameras and phone tracking.


No, because in the US (and Western democracies in general) patient privacy is very important and the kind of surveillance that the Chinese/South Korean/Singaporean model involves would be politically impossible.

See source:

There is something fascinating about reading Singapore’s government-supplied coronavirus outbreak information. The data is organized as an unfolding, public story tracing relevant details of the known cases of Covid-19 diagnosed there.

The website shares the age, sex and occupation of each person who has tested positive for the virus. It reveals where they travelled recently, and when they sought medical help. It explains when they were hospitalized and when they were discharged. There’s data on their local whereabouts, including whether they attended either of two large church services which appear to tie together two clusters of the disease.


The freedom to get information about the disease in Singapore, of course, comes at the cost of patient privacy. The Singapore patients aren’t named, but there’s enough information their identities might be inferred – something that would be scandalous in the United States. News reports also show that in Singapore and elsewhere in Asia, some governments are coercing citizens to disclose their movements in ways that would be unacceptable in a Western democracy.

  • 3
    It's clearly not impossible. Lockdowns and forced quarantines are not very democratic either, and we're already doing that. Mar 25 '20 at 23:44
  • @dan-klasson the claim's cited to a source. If you disagree, write to the author of that source.
    – Allure
    Mar 26 '20 at 0:31
  • 4
    @dan-klasson It's not just undemocratic, I imagine a plan like this would be specifically illegal under HIPAA laws.
    – divibisan
    Mar 26 '20 at 0:44
  • @divibisan don’t know the details, however trump announced the relaxation of some HIPPA regulations in light of this national emergency
    – BobE
    Mar 26 '20 at 3:49
  • 1
    @divibisan Actually a better example is the NSA illegally spying on Americans. That was justified by fighting terrorism. This by a virus that kills way more people than terrorism. Mar 26 '20 at 7:32

It's an interesting question, and one that I hope we (Canada) will answer in the affirmative. Short term, in an emergency context like this, I think notion of privacy is turned around a bit: a sick person, unless at home, should have no expectation to keep their status private, quite the opposite. And, once recovered, that previously sick person could quite possibly find it advantageous to provably certify that they have been sick, are now immune and can't infect anyone else. With covid, the sheer volume and randomness of infections should also somewhat remove any stigma, once recovered.

Legally, once a state of emergency has been declared, at lot of regular rights enshrined in law can be temporarily suspended (curfews being a good example), so I don't think there are massive legal impediments, as long as a compelling interest can be demonstrated that it is medically efficient and actually possible.

Whether or not this would be politically acceptable, and how many deaths we need to accumulate before it becomes so is another question.

Wise governments would start out by communicating very clearly why they are doing this and would set sunset clauses as to the duration of these measures.

If we want to entertain any notion of restarting our economies by loosening quarantines at some point before herd immunity kicks in from large enough infection rates, it seems to me that some measure of increased surveillance to watch for symptoms, a la China/Singapore, is not going to be avoidable.


I have now been through more than one week of "social distancing" in Toronto. And, Canada has not slowed that you would notice. Still a doubling time of pretty much 4 days. If we are going to slow this thing, we are going to need to be a lot more active about it.

There is one simple thing that might have been done that would have made a difference.

According to this study, N95 masks are "baseline" 50% effective against SARS. In some situations as much as 74% effective.

I have been hunting for other studies. All I have been able to find are Lancet and WHO saying "don't wear masks, if you wear it wrong it will be worse than nothing." Maybe so. Why is there an absolute snow storm of "don't wear masks" reports, determinedly held up for my attention by Google? Where are the actual studies on effectiveness of masks? They must exist. But never mind.

If this study is correct, then N95 face masks might well cut the R0 value by half or more. This would certainly slow the spread. The existing doubling time is round-about four days. With half the R0 value, this would certainly be much longer. This single thing might well be enough to "flatten the curve" enough to give the medical folks time to cope. And it would certainly give more time for developing a vaccine and testing of various drugs that could help.

But! The supply of masks is absolutely not enough. In January, when I bought a box of twenty N95 masks, the box was $16.95. The store I bought from absolutely has no more. And does not plan to get more, since they are a hardware store, and have been closed for the duration. On Amazon, such masks are typically only available through third party sellers, and at a price of round about $40 each.

I will say that, when all of this is over, we are going to need to have some quite serious discussions with The WHO, and various other groups, about masks. And why this fairly simple to make item is not now absolutely blasting out of factories.

  • 1
    You do realize it takes some time for measures to show effect in reducing new cases? Due to the incubation period, those starting to show symptoms today will have been infected a number of days ago. It may even take a bit longer for them to get tested and for those results to come in. So if you start taking measures today, you might see the first results of those measures after a week or so.
    – JJJ
    Mar 29 '20 at 2:35
  • You know, someplace somebody said "more than a week." But my memory is not what it once was.
    – puppetsock
    Mar 29 '20 at 2:38
  • 1
    Yea, the incubation period varies, but the average and median in earlier studies were 5.2 and 3 days. To see changes in reported cases requires enough testing, so I'm not sure if that happens consistently everywhere. If you're going to judge the effects based on death toll, it will of course take longer to notice these effects, but I'm not in a position to put a number on that, it's probably a longer time window.
    – JJJ
    Mar 29 '20 at 2:43
  • Well, part of the masks issue is that there is a real shortage of masks. So, regardless of whether they help or not, it makes sense to prioritize health workers first - they're most at risk and for every sick/dead health worker you have 1 less person to help when you get sick. That said, yes, we do need to get a quite a bit more serious about it, here in Canada, and elsewhere. Everyone loves to focus on tests. While valid, simpler things like taking your temperature can flag if you might be coming down with covid. But no one's talking about that and thermometers are sold out. Mar 29 '20 at 20:07
  • 1
    @puppetsock cattle-owners-that-be stop being so pointlessly divisive. The head cattle-owners-that-be's wife in Canada caught the effin thing. The UK PM caught it as well. Merkel had to go into isolation. We are all in this together and, while some leaders are entirely inadequate, the political class as a whole is quite exposed, and knows it, due to the people-facing nature of their work. Which can be done by the way - any proof of that? Mar 30 '20 at 17:36

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