When the deadly virus known as coronavirus erupted in China three years ago, everyone worried it would kill Uighurs, Kazakhstanis, Pashtuns and a score of other ethnic groups whose roots are in the Eurasian deserts.

So far, however, the worst sufferers have been for the most part Chinese. On Tuesday the health ministry announced that eight people had died of the virus, all of them in eastern Shandong province — just south of Hubei province, where the first cases were reported in 2014. More than 30 people have been sickened in China. Thirty in Hong Kong. Forty-two in Singapore.

It is the latest twist in a fight that has consisted of battles in two distinct locations. Between early 2014 and July 2016, 15 people died in Malaysia and 481 were infected. In Indonesia and Singapore, most of the cases were linked to flight crews who had traveled from Kuala Lumpur to Jakarta and later on to Singapore. Malaysia and Singapore, though, had decent progress against the virus, so why was China the exception?

The answer lies in how the country’s disease transmission control strategy was developed.

Poverty, rough communities and political conflicts prevented hospitals and clinics from speaking to each other. Dr. Sunil Gupta, a former Chinese medical official who helped set up programs for the World Health Organization in China, told researchers with the Guardian’s global health program that communication between departments could have prevented the virus’ spread.

Malaysia’s Guangdong province, in contrast, was an international hub for its people, its medical equipment and its resources. This allowed it to slow the spread of the virus more effectively, according to research by Wenwen Xu, a professor at Australia’s National University. Many factors made China’s environment conducive to the coronavirus. Poor infrastructure, he said, made airports a poor tool for helping control disease.

But instead of promoting collaboration between health workers, the government instead imposed strict rules on who could travel to Southeast Asia, meaning they needed to rely more on those connected with Chinese embassies. That meant being told by border guards whether it was safe to travel and by local authorities whether the virus was more serious or less. It also meant one thing: no one has been able to infect anyone else in China.

Officials sometimes employed similar notions of what was safe or risky on the Ebola virus during the 2014 outbreak. Top officials quickly decided against evacuating foreigners infected with Ebola, but expanded the flights that travelers could take in case anyone else caught it.

The gulf between one extreme and the other did nothing to stem the virus’ spread. Ebola wreaked havoc on those Africans who did leave the region. Their close contacts were prevented from visiting and grew the virus. By contrast, in China, personal contacts were not strongly suspected as controllers of the disease, and the dominant model was teamwork to prevent infection. That made the virus vulnerable to slipping between people during travel.


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