The development of an epidemic like COVID-19 is tracked by a now-familiar statistic – daily new confirmed cases. Data from the ten countries with the highest caseloads - the US, Italy, and Spain, indicate that across the board, the rate of new cases is decreasing. The decline is attributed to the success of widespread stay-at-home orders issued by these governments in the wake of an initially bungled response.

Google’s Community Mobility Report demonstrated that, despite a lack of draconian enforcement, citizens of these countries have taken advisories to heart and have effectively flattened the curve.

A decrease in new infections confirms that social distancing, the strategy of choice for Western nations, has been an effective method of nipping the spread of the virus in the bud. For these countries, the question of how things return to normal, and what normal looks like, still remain.

 An analysis of the practices in countries that have either stemmed their epidemics or managed to prevent them in the first place is a good way to piece together a more reassuring picture of what the new normal needs to look like.

 China

 China, the origin point of the pandemic, applied the most extreme approaches to stem the virus. After attempting to obscure the new outbreak, the central government instituted an enormous, countrywide lockdown that started from 60 million in Hubei Province, and then expanded to include around 230 million people throughout the entire country in some form or another.

It has been heralded as the largest social control strategy ever been implemented during peacetime, and early on demonstrated the efficacy of strict social distancing for controlling the virus. 

In addition to the largest lockdown ever seen, China began an aggressive campaign of contact tracing with the help of tech and ecommerce giant Alibaba. Alipay, an e-wallet app made by Alibaba that has nearly 1 billion monthly users, quickly added a “health code” to its features. This code evaluates the contagion risk posed by a user, and is being rolled out across the country as a mechanism for quickly and easily controlling spread of the virus.  After signing up for the service, each user is given either a green, yellow, or red status code. Green means the user is free to move about the country, yellow that they need to isolate for seven days, and red that they will need to quarantine for two weeks.

Privacy concerns have surfaced – including a report by the New York Times that indicates the app shares information with local police departments. Despite questions about privacy, the health code has quickly become synonymous with China’s ability to control the epidemic without having to use extant surveillance systems to perform the complex labor of contact tracing.

The app, whose inner workings are mysterious, is likely organized by two factors – the most obvious one being if a user is currently located in a province, district, or township that is under quarantine orders. The second is likely the ability to accurately identify the location of a cell phone, and therefore the people that cell-phone user has come in contact with, due to the widespread rollout of 5G.

Because 5G cell towers are much less powerful than previous generations, there need to be more of them in order to provide sufficient coverage. Cell phones usually connect to more than one tower at a time in order to ensure uninterrupted coverage while the user is moving, which provides a relatively course-grain output using 4G and earlier technology. But with China adding something like 130,000 base stations  for 5G this year, and more on the way, location tracking becomes much more fine grain. This fine grain location tracking has been used in other countries – like Taiwan and South Korea – to passively track the spread of the outbreak once an in infected individual has been identified by healthcare system.

This approach was successful enough that, as of April 8th, the Chinese CDC has reported no new deaths from the virus for two days in a row. There have been some concerns of recovered patients testing positive for the virus, and a new cluster of imported cases triggered a new county-level lockdown in Suifenhe, a city on the Northern border with Russia – but the news, overall, is good.

In short, the Chinese response was, following a brief period of denial, an overwhelming approach that effectively flattened the curve.

South Korea

South Korea, which had kept its overall number of cases quite low, experienced a spike in new cases at the end of February/beginning of March. With nearly a thousand cases a day at the height of the outbreak, the total number of cases stands at 10,643. Despite the late-in-the-game surge, South Korea has managed to control their COVID-19 epidemic without throwing the emergency break.

One key aspect of the response that prevented the rampant expansion of cases seen elsewhere, was an early focus on testing. Drive through test sites, made possible by intellectual property sharing between private industry and the government, were established early in the epidemic.

If you look at the chart above, dynamically linked here, you’ll see that South Korea started testing well before anyone else. By March 1st, they had administered 96,985 tests, or about 1.8 tests per person in the country. Per capita testing can be seen in this chart here:

Italy, with it’s devastating outbreak, did not overtake South Korea in number of tests administered until March 26th, and did not match their per-capita testing until March 29th, by which point both countries had administered roughly 7 COVID-19 tests per person.

 Following testing, all who tested who tested positive for the virus were placed into quarantine, their movements monitored using Bluetooth technology – a less invasive alternative to the kind of fine-grain location monitoring seen through 5G networks in the Chinese epicenters.

In some cases, the government did need to resort to the sort of widespread contact tracing that’s best accomplished through cell phone networks. Public acceptance of the approach in extenuating circumstances helped slow the increase in cases that began at the end of February. The spurt of cases were linked to densely packed religious services. Public health agencies moved quickly - they isolated cases, even the mild ones, and prevented a small outbreak from ballooning into an overwhelming surge. 

Following that surge, South Korean daily new cases have hovered at or around 100, indicative of an epidemic that’s effectively under control.

Taiwan

Taiwan, an island nation about 80 miles off the coast of China, has been an exceptional example of how to deal with a looming public health crisis. First off, they bucked the recommendations released by the World Health Organization who, on January 14th, publicly announced that Chinese officials had informed them that COVID-19 infection could not be transmitted from person to person.

Two weeks before the WHO made this announcement, Taiwanese health officials had visited Wuhan and come to the exact opposite conclusion, based off of the unease they perceived among the Chinese public health officials.

 Instead of deciding to wait and see how the situation developed, the government acted proactively. It accelerated surgical mask production, implemented strategic supplies chains that prevented panic buying, and tested widely – though significantly less widely than South Korea.

Their strong public health system ensured that all infected individuals had access to high quality care. They controlled the spread of the virus through concerted action – testing and isolating the most likely cases rather than absolutely everyone, screening travelers coming from high-risk areas, and instituted early travel controls on those from hard-hit areas.

Proactive response by the government, according to principles set out in a 124-point plan, was grouped into three large categories – travel restrictions, resource allocation, and community action. Early, coordinated action that defied WHO recommendations ensured that the Taiwanese avoided the worst of the epidemic – to date, they have only 379 cases and only 6 deaths.

Emerging from Panic

Globally, it has become clear that there are strategies that simply work. Ample access to testing, widespread contact tracing, and government actions that prevent panic buying of goods like masks and toilet paper, are all effective at controlling the spread of the virus. As more and more countries manage to get their cases under control, it will become less like fighting a fire that continues to erupt on all sides, and more a gradual process of getting things under control.

 There are still some wildcard situations. Japan, which until recently had largely escaped the epidemic, has seen an alarming spike of cases. European and American travellers coming to Hong Kong, Singapore, and Taiwan have carried the virus with them, repeatedly reactivating the detection and quarantine systems that have kept these countries safe from unchecked spread of the virus.

 It’s worth noting that all of the countries, save for China, that managed to stem their outbreaks did so because they had already experienced coronavirus epidemics – MERS and SARS had passed through all of these countries, and had already started the conversation about the kinds of surveillance systems needed to ensure public safety.

 In the West, we have largely avoided widespread exposure to the highly lethal members of the coronaviridae family. But we can hope that, in much the same way that the human immune system must first encounter a threat, we can learn to respond more quickly to public health disasters.

 As humans encroach further on remaining habitats in places like China and the Amazon, it’s highly likely that there is a risk of another, much worse pandemic. In the aftermath of this one, it’s important to put politics aside, and focus on the measures that will protect us in the future without needing to resort to an uneasy surveillance state.

 In a place like the United States, notoriously resistant to government encroachment on privacy, it’s hard to imagine people tolerating a cell-phone and credit-card based surveillance system that can be used by the government for contact tracing in an epidemic.

 Perhaps the model that we choose will be to accept widespread stay at home orders, a high death toll, and a recurrent conversation of what could have been done better. But there’s always room to hope for something better, wiser, and more humane.