How to pronounce "coughing"

Transcriber: Ivana Korom Reviewer: Joanna Pietrulewicz

Chris Anderson: Welcome to TED Connects.

This is a new series of live conversations,

trying to make sense of this weird moment that we're in:

coronavirus.

Everyone's suddenly changing how they live their lives,

it's so jolting, it's so startling.

We're all trying to make sense of it, and it ain't easy.

That much we know.

We're trying to make sense of this together

in the only way that we know how,

which is by having wise humans coming on,

talking to each other, listening to each other

trying to learn from each other.

We are apart,

but we can use this moment to build community together,

and that's what we're trying to do.

So this is being produced by a virtual TED team

scattered around New York,

currently one of the epicenters of this pandemic.

So it's definitely a scary time for people here.

I'd like to welcome to join me my cohost here,

Whitney Pennington Rodgers.

She's our current affairs curator.

Whitney Pennington Rodgers: We're going to be looking a little bit

at China's response today.

When news surfaced about a strange viral outbreak

in Wuhan, China

at the very last days of 2019,

I think a lot of people were confused about what was going on there,

and in the months that followed,

we learned more about the disease that's now known as COVID-19,

we watched the situation in China quickly worsen

and in the most recent weeks dramatically improve.

And I think as all of us around the world

grapple with how we can contain and control the spread of COVID-19,

there are a lot of lessons we can learn from what China experienced

and how they responded.

So we're really thrilled to be joined today

by the CEO of the "South China Morning Post," Gary Liu,

who's here to share his perspective and insights.

So, welcome Gary.

Gary Liu: Thanks for having me.

WPR: Hey there, Gary, thanks for being with us.

And I think before we dive into things,

I'd love to hear about just how things have been

for you personally,

your loved ones, those close to you,

how have you been experiencing this?

GL: It's complicated.

So we're here in Hong Kong,

I'm working from home, like much of Hong Kong.

I'm actually self-quarantined in our apartment here in Hong Kong,

because there was a confirmed case in our workplace.

So over the course of the last week plus,

and likely for at least another week plus,

the entire organization has been distributed

and working from home.

You know, when Hong Kong got its first confirmed case,

I was actually back in the United States with my wife,

we were taking a small break in the Rockies,

and we came back to Hong Kong pretty soon after that

to make sure we got back into Hong Kong before the airports shut.

And at that point,

it was all of our family in the United States and friends

texting us and worrying about how things were in Hong Kong

as the situation in China started escalating,

and people were sending us, or trying to send us, supplies.

Masks and sanitizer and stuff like that.

And now it's the opposite.

New York City is our home,

so we certainly empathize

with what you guys are dealing with right now

and going through in the city.

And we are seeing our friends and our family

back home in New York and in California

and checking in on them,

trying to send equipment and materials back to them,

so the script has flipped actually pretty fast

over just the last couple of weeks.

WPR: And you know,

I think that's actually a really interesting place to start

and probably a question that a lot of people who aren't in China have,

you know, I think from the outside looking in,

it seems as if what's happened in China

is kind of miraculous.

That to go from, you know,

you have a country with more than a billion people there,

to go from as many as 80,000 cases to nearly zero new cases now,

you know, what can you tell us about how this happened,

to help us understand the current situation

and just really how China ended up there?

GL: Yeah, a lot has happened.

China has been dealing with this for several months now.

Several-month head start, that's not a good thing,

but they have gone through several different phases.

I think, Whitney, before I jump into it,

there are a couple of caveats that are really important to make.

The first one is that we're still parsing what happened in China.

The information system, as everyone knows,

is still relatively closed.

And so a lot of the information that we're using

to piece together what happened in China is still not fully complete.

And so with every passing day, every passing week,

there's more information

that allows us to retroactively make sure that we get the picture

of what happened early on in those early days

at the end of 2019,

get that picture right.

And there's still a lot that's happening today,

even though I think the information sharing

is much more open than it was early on,

there's still a lot of stuff that we need to parse.

And the second important caveat here

is that I think learning sometimes suggests

that everything China did was right and good,

and hopefully, other countries can take it and apply it,

but that's not 100 percent the case.

China, of course, did a lot that was right,

and if we walked through the time line,

I think it would be pretty apparent

the decisions that they made kept the coronavirus

from really exploding across the entire country

and really limited it to one province and mostly one city.

But there were also many, many missteps,

and those are things that I think the world can also learn from,

most importantly, China should learn from,

because most of these --

I think those of us who are professional observers

would call missteps,

are because they are systemic issues with the country,

because of governance, lack of free information flow,

stuff like that.

Those are the initial caveats,

but I think the timing of how China progressed

from first case to now has been fascinating.

WPR: Yeah, and I mean,

so we know now that in Hubei province

they've officially lifted the two-month lockdown.

And are you getting the sense,

do you feel like this is the right decision to make at this moment?

GL: I don't think I'm the right person

to say whether or not it's the right decision.

But certainly, this has been a progression of decisions,

and I think they've been sitting on this decision for quite some time.

Wuhan itself, which was where the pandemic started,

it was the first epicenter and the major epicenter.

Wuhan is opening up on April 8,

that's right now the schedule.

And this is really, what we're in now is the third of three phases

from the first discovery of the virus in Wuhan.

Now, April 8 will be about 11 weeks

after Wuhan the city got completely shut down,

and the Hubei province got shut down.

And so for those who are in a shelter, at home

kind of situations right now in the United States

and wondering how long this is going to take,

in Wuhan, they've been locked down for 11 weeks

and only now has the Chinese government decided

they're ready to start letting people move freely around.

WPR: And to your point earlier

about some of the possible missteps in terms of reporting,

I mean, there are still reports now

that we might not be getting an accurate number of cases

that we're seeing in Wuhan or beyond,

we're hearing some people say there are no new cases,

other people saying that there actually are cases.

So do you feel like there is accurate spread of information

about the current state of the virus in China right now?

GL: Generally, yes,

with the caveat that it is based on the Chinese government's definition.

And this is one of the problems right now

that even the World Health Organization is struggling with,

is that the definition of what is a confirmed case,

what is an infection,

is different from country to country.

As an example, in China,

the folks that have tested positive but are asymptomatic,

we understand now that they are not included,

since February 7,

they have not been included in the official numbers.

Or at the very least, on February 7, they changed that definition,

and they're not included in those official numbers.

And that could be another 50 percent

on top of the numbers that we're seeing today.

So what we've found,

our reporters have gotten their hands on some classified government documents

and government data

that suggests that a third of total actual positive tests are asymptomatic,

and therefore not included in official numbers.

Now, I don't think that this is an example

of the Chinese government trying to hide information.

This is a definitions issue,

which countries have been debating

and people are doing it in different ways.

But like I said,

there really have been three very distinct phases.

We are in the third phase

that I would call recovery and rehabilitation,

rehabilitation being the rehabilitation of China's image.

But the first part was discovery and a lot of denial.

And then there was this two-and-a-half-month period

of response and containment.

And that I think, the response and containment part

is the most interesting to the rest of the world.

WPR: And so maybe we can break some of that down,

you know, thinking about China's response.

What were some of the specific things

that you think China did right,

both as a nation, individuals in the country,

what were some of the things that you saw that worked really well?

GL: OK, so let me walk through the time line,

I want to try and get these dates right, because the dates do matter,

I think again, for context,

how many weeks it took from one step to another.

Let me actually back up into that initial first phase,

that discovery and denial phase.

The first time we heard about the coronavirus,

this mysterious respiratory disease that looks somewhat like SARS,

was on December 30.

That was the day that there was a doctor,

whose name is known all over the world

for the unfortunate reason

he ended up eventually dying,

named Li Wenliang.

And Li Wenliang, Dr. Li,

posted to a private WeChat group on December 30.

These were some of his old classmates from med school.

And he said, "Hey, I'm in Wuhan, I'm at the hospital,

there is a SARS-like illness,"

SARS being the epidemic from 2002 to 2003,

"There's a SARS-like illness

that is spreading through these hospitals in Wuhan."

A private message.

Somebody forwarded it,

and it went viral across the Chinese internet.

The very next --

so that was the first time we actually heard about something

that was going on in Wuhan.

The very next day, December 31,

was the first time that any Chinese officials --

and on that day,

it happened to be the actual provincial and the city officials --

acknowledged that there were 27 people,

at that moment in time,

who had been diagnosed with this mysterious pneumonia,

and they reported the cases to the World Health Organization.

That was also the day that Dr. Li was reprimanded,

officially reprimanded.

So that was really the discovery,

the end of the discovery and denial phase,

because what we know now

is that back to mid-December,

several weeks before Dr. Li wrote his blog post,

the authorities had already been notified

that a SARS-like pneumonia was showing up in Wuhan hospitals.

And action had already started down the chain of authority.

They have now backdated, at least publicly backdated,

the first case to December 1.

But actually, in their confidential and classified government documents

that again, our journalists have seen,

and we've published a story --

Officially, in classified documents,

they've backdated the first COVID-19 case all the way back to November 17,

as the earliest example that they can find

based on symptoms and based on retroactive diagnosis

for a COVID-19 case.

So in effect, there were several weeks

before the acknowledgment to the World Health Organization

that that was going on,

and the first case with symptoms

was actually identified about a month and a half

before that notice to the World Health Organization.

Then the second phase,

which really started, let's say, December 31,

when the acknowledgment happened,

was response and then massive containment.

Now this phase, to be clear, still had some denial

and a good amount of censorship happening within the country.

So on January 1,

the World Health Organization started working with China

on trying to identify the virus and trying to figure out course of action.

It wasn't until several weeks later

that Beijing, the central government, for the first time broke its silence,

and that was on January 18.

And actually, they broke the silence to deny that this was SARS,

and in fact to "defy rumors"

that were spreading around the Chinese internet.

But there was a major date that happened two days afterwards,

which was January 20.

Because for the first time,

a member of the party,

a senior government official who is now one of the central gentlemen

that is actually leading the task force against COVID-19,

his name is Zhong Nanshan, he's an epidemiologist,

he was one of the central figures during SARS 17 years ago.

On January 20, he visited Wuhan.

And he admitted, for the first time,

that human-to-human transmission was possible.

Now this was important,

because prior to that, officials who had spoken up

had said that human-to-human transmission was not likely,

was not possible.

And previous to that,

all of the cases, the majority of the cases

were tied to this seafood and wildlife marketplace

that was in the city of Wuhan.

But now, on January 20,

human-to-human transmission, it's possible, it's happening,

and so of course, the course of action,

not only in China,

but the course of action all over the world,

started to change.

And three days after that, Wuhan was locked down.

It was completely, I mean, it shocked the world

that they could lock down that many people so quickly.

Of course, now India yesterday announced

that 1.3 billion people are being locked down.

So we have another frame of reference now.

And then the end of this middle second phase

I think really came in March, around March 10.

Actually, on March 10 I should say,

because Chinese president, Xi Jinping, visited Wuhan.

And these things, in Chinese politics,

because everything is so well-choreographed,

matters a whole lot.

The fact that Xi Jinping visited Wuhan

signaled that the Chinese government believed the worst was over.

The reality was that probably about 20 days before that,

the curve had already been flattened.

So 20 days before that, probably around February 20,

the infection rate was around 75,000, 76,000,

and it's effectively stayed within a couple of thousand since then.

So on March 10,

Xi Jinping's visit to Wuhan kind of signaled the worst is over,

and then they moved into the recovery and rehabilitation phase.

WPR: OK.

I mean, if I'm hearing correctly -- thank you for sharing all of that,

it sounds like, although there was a slow period

of getting the information out initially,

eventually there was quick reaction from the Chinese government

to respond to this, lock folks down.

And it seems like that had a real impact on flattening the curve

in China, in Wuhan.

GL: A real impact.

WPR: Yeah and I --

GL: Absolutely.

WPR: Yes, please go ahead, Gary.

GL: The date of January 23 was not by coincidence.

Because the Chinese New Year holiday started on January 24,

the very next day.

And the thing is,

with the Chinese New Year holiday,

is that it is, every single year, it's the largest human migration

that happens on Earth.

About 400 million people travel

during about a forty-day period that would have started on January 24.

And that's three billion trips,

it's just people traveling all over the country,

400 million people traveling.

Now, Wuhan is one of the most important cities in China,

although before this,

I don't think a lot of people around the world knew the city of Wuhan,

but it's extremely important.

It is considered the most important city in the center of China

for many different reasons,

but one of the key reasons

is that it is one of the key transportation hubs of the country.

So all of the major train lines,

the high-speed train lines, the normal train lines,

the trade lines,

they all kind of converge on Wuhan.

So you can imagine if 400 million people start moving around

for Chinese New Year on January 24,

a huge number of them were going to go through Wuhan.

And of course, Wuhan itself is an 11-million-person city.

The surrounding cities all added together,

Hubei province has about 60 million people,

and they were also largely going to travel.

And so if January 23 they had not shut it down,

and people had started traveling,

the likelihood would have been

that this would have been really, really hard,

possibly, likely impossible to contain.

And even though they shut down before the Chinese New Year holiday started,

we now also know that at least five million people actually left

the surrounding areas and traveled.

Which is one of the reasons why it did spread a little bit

across the country,

and then eventually spread to other parts of the world.

WPR: And I'd like to come back to that as well,

just thinking about the five million people who left

and sort of where they landed today and how that affected things,

but before we do that,

I'm interested to talk with you a little bit more about --

you mentioned this November date as one of the earliest cases

you discovered that was reported was in November,

and that's something actually that I hadn't heard before,

and I imagine that might be news to a lot of people hearing this,

and so I'm curious,

when you think about the missteps from China's perspective,

in terms of what China did,

you know, there is, as you mentioned,

suppression of information is one thing,

one major criticism of how China handled this.

And hearing that maybe there was knowledge of something as early as November,

if that might have played a role

in how we were able to control and contain this a lot sooner.

GL: I do want to clarify,

from what we understand,

officials were not notified about this until mid-December.

It wasn't --

So it was really a couple of weeks

between officials realizing that there was a SARS-like pneumonia

going around

to when the first case was reported to the World Health Organization.

It wasn't all the way back to November 17.

That was retroactively backdated,

but that has not been made public by the government.

We published it because we've seen the data

that actually backdates the first case.

From a misstep point of view,

again, it's a couple of weeks compared to what happened in SARS,

which was a long time of locking down on information.

This was much shorter,

the period of time that the government wasn't in complete shutdown mode.

But then, after that, of course,

there was still continued censorship on the internet,

especially within the Great Firewall of China,

for communications between Chinese citizens.

And you know, surprisingly to some,

I think for a lot of China watchers not so surprisingly,

is that the government has -- the central government --

over the course of the last several weeks,

actually, I should say probably the last two months,

has started to change their tone

and to some degree admit

that there needed to be better free flow of information.

They've changed the official narrative of a couple of different things,

including this initial whistleblower, Dr. Li,

who unfortunately ended up passing away from the virus,

they actually now refer to him as a national hero,

they have officially removed the reprimand,

the Wuhan police have apologized to Dr. Li's family,

and they have actually been --

a couple of policemen -- have been punished in Wuhan

for the way that they handled the situation.

So there has definitely been an internal shift

and there is a lot more sharing of data and information.

I can tell you,

from Hong Kong's point of view,

without the open sharing of information between the authorities,

between Hong Kong and mainland China,

I think Hong Kong's response would have been much more different

and I think Hong Kong would have suffered because of that.

So that much more open sharing of information

has benefited this city for sure.

WPR: And we have Chris here who has a question,

I think, from the audience.

CA: Hey, Gary.

The online audience, loving what you're saying.

It's so interesting,

you're giving us amazing new insights here.

Just in the current situation

where much of --

you know, there have been these very few reports of new cases.

How much does it feel like life is getting back to normal?

Do people really believe that this problem has been successfully tackled elsewhere?

GL: I think the sentiment in mainland China

is that yes, in China, the problem has been tackled.

And people are looking forward to going back to normal life.

A lot of the other major cities, Shanghai, Beijing,

are starting to get back to work.

Many of the factories have now been reopened.

The last stat that I saw

was that 90 percent of the businesses that had been shut down

are now reopened in China.

So generally speaking, life is getting back to normal.

Wuhan and Hubei are really the last places that are still shut down,

with Wuhan being the city that is shut down until April 8.

Hong Kong is a little bit different.

Hong Kong has actually gone back

into a second wave of social isolation and distancing.

A bunch of different companies, us included,

as well as the Hong Kong government and the civil service

has now gone back to work from home.

And it's because we are starting to see a second wave,

but for us, honestly, is the first time that we've had a spike of infections,

and it's because of imported cases.

It's because a lot of Hong Kong residents

who left Hong Kong prior to,

well, actually when the virus first came into the city,

are now returning, because oddly enough,

the places they escaped to are now more dangerous than Hong Kong.

And as they're coming back,

a lot of them are actually bringing the virus back with them.

And so we're starting to see a spike.

Before this week, the highest infection day that Hong Kong had

during the first two months of this

was 10 infections in one day.

Now the highest that we've seen in the last week was 48.

So this is really the first spike that we're seeing,

and so Hong Kong is returning back to a state of alertness,

to a state of caution,

and more and more people are holed up at home.

CA: Is it possible, in mainland China,

that because of this redefinition that you spoke about,

where if someone tests positive, but they're not showing symptoms,

that is not reported as a case.

That seems significant to me.

Is that part of the explanation

for why new reports have gone nearly to zero?

GL: I don't know if that's the answer to it,

but I do actually think that even with --

and remember, these are folks that are tested,

so the data that we have is that these folks have been tested,

the tests have come back positive,

but have not been added to the official number of infections,

because they're asymptomatic.

But they have still gone through the process

that is part of China's containment strategy,

which has worked extraordinarily well.

Which is, first of all, lots and lots of people have been tested.

And then once --

if there is a positive test return,

regardless of whether or not they're symptomatic or asymptomatic,

regardless of whether or not they're added to official numbers,

what happens next is that they are quarantined,

they're isolated,

and contact tracing happens.

Contact tracing is a key, key, key action.

And so they go and figure out where this person has been moving,

where they've been,

who they've been in contact with,

and all those folks that they've been in close contact with,

they get tested.

And if they come back with a positive test,

then they're also isolated and they go through the process again.

So China has not been testing people,

finding that they're asymptomatic and then just releasing them

and letting them go home.

That's not the case.

WPR: I think to that point too, Gary, what you mentioned

about this trace-testing and being able to figure out

who people have been in contact with

to figure out who may also have been infected,

you know, when you look at what's happening

in other parts of the world,

you hear in the United States, where Chris and I are based right now,

you're hearing that people who are experiencing symptoms,

have symptoms cannot get tested.

You know, how does China's ability to test so many people

affect the way that they can respond to this and control this virus?

GL: It really matters.

Without the significant testing

and without the contact tracing that comes afterwards,

I don't think there's a way that China could have contained it

the way that they did.

The same thing here in Hong Kong.

If we didn't have both of those,

as minimum requirements in a health system,

Hong Kong could not have contained it.

And this is actually the reason why

South Korea is the only other country besides China

that has managed to flatten the curve,

is because they aggressively tested.

I think by far the highest per capita testing

anywhere in the world, as far as we know right now.

And they aggressively did contact tracing.

And because of that, even though South Korea had this huge spike,

and we thought that it was going to get out of hand,

they were able to suppress it, control it,

and now they're in a much, much better place.

WPR: One thing you mentioned earlier that I'd love to talk about, too, is SARS

and the impact of going through that in 2002 and 2003 for China,

other countries in Asia, Hong Kong.

You know, what effect did that have on everyone's preparedness

in that part of the world

for the COVID-19 outbreak?

GL: It was significant.

I think the institutional and social memory of SARS

matters a heck of a lot,

when you look at China, Hong Kong, South Korea,

Singapore, Taiwan, Japan,

a lot of these countries in Asia have dealt with COVID-19.

Let me use Hong Kong as an example,

because it's the one that I know the most intimately.

But a lot of what I'm about to say

actually does apply to those other areas of Asia.

So for context,

SARS, November 2002 to July 2003,

very, very similar coronavirus to COVID-19,

I think there's about an 80 percent similarity to those two viruses.

The global infected number was a little over 8,000,

774 deaths.

So by percentage,

deadlier than COVID-19 is

but far less infectious than COVID-19 is.

Now here's why it impacted Hong Kong so much,

and why the memory is so deep,

and actually it tells you a lot about Hong Kong's reaction to COVID-19.

Of the 8,000 infected,

22 percent were here in the city of 7.5 million,

and 40 percent, actually 39 percent of the deaths,

299 people died in Hong Kong.

Thirty-nine percent of the global deaths happened in Hong Kong.

And SARS did not start in Hong Kong,

it was imported into Hong Kong

from southern China.

And so SARS, again, deep, deep memory,

but it was a massive turning point in the Hong Kong health care system

and also the social practices of the city.

And let me walk through some of that impact,

because you can actually still see it,

even before COVID-19, you see it every day.

The health care system

was able to really, very quickly, ramp up in capacity,

because of preparation post-SARS.

So after SARS,

the Hong Kong health care authorities started preparing for greater capacity,

especially for infectious diseases.

There were new health alert systems,

warnings and treatment protocols put in place.

I can tell you that a lot of folks that were here before SARS

will tell you that in Hong Kong hospitals,

before SARS,

it was actually rare to see

even medical professionals wear face masks.

And now surgical masks are ubiquitous,

not only in hospitals, but across the entire city.

Anytime, anywhere, it seems, especially right now.

New channels of communication and data

and information exchange were opened up with mainland Chinese authorities,

and technology was implemented,

including now a supercomputer that actually does contact tracing

in Hong Kong.

You could trace the existence of the supercomputer

and this contact-tracing ability back to changes that happened post-SARS.

On the social side,

there was also a huge change.

The first thing I have to talk about is, of course, masks.

Now, I know that there is still not consensus everywhere in the world

about whether or not masks actually help in this situation.

I know that the World Health Organization

as well as governments like the US, as well as Singapore,

say that only medical personnel

as well as people who are actually sick and showing symptoms

need to be wearing masks.

In Hong Kong, everyone wears masks.

And the government,

even though they flip-flopped a little bit

during this epidemic,

the general,

the guidance is that everyone should be wearing masks.

That started in SARS.

Ninety percent of Hong Kongers during SARS wore masks,

and that habit actually stayed with Hong Kongers,

and so generally speaking, even outside of the pandemic,

when people are sick and coughing,

you'll see them wear masks out in public.

On top of that,

there was -- it became systemic,

or I should say systematic controls

for hygiene in social and public spaces.

So if you visit Hong Kong,

again, before all of this happened,

you would have noticed that public spaces are constantly being disinfected.

One good example that everyone notices

is that when you go into an elevator in public spaces, in buildings,

they will either have one of two things,

potentially both.

They'll either have a sign that tells you

how often the elevator buttons are disinfected,

or there will be a plastic,

piece of sticky plastic, like a plastic sheet over the buttons

so it effectively becomes a flat surface.

When you eat out,

Hong Kong is obviously famous for its dim sum,

and one of the most famous things about Hong Kong dim sum

are the dim sum carts,

which are also very popular in New York's Chinatown, as an example.

Those dim sum carts,

they pretty much went away after SARS.

And so most dim sum restaurants that you'll go to in Hong Kong now,

the vast majority of them, you have to order off of a menu,

you don't have public carts going around because of hygiene issues.

In most nice Chinese restaurants in Hong Kong now

you will get, when you sit down,

two pairs of chopsticks per person.

And those two pairs of chopsticks are different colored,

because one is used to grab food from the center of the table

to your plate,

and the other one is for you to take the food and put it in your mouth.

And honestly, there are hand sanitizers

and hand-washing notices literally everywhere,

and this is just part of the social behavior after SARS.

Safety protocols in offices,

everyone knows how to shut down an office

and control traffic really well.

Most major offices have temperature-check machines

at the very least available,

and then, of course, social distancing.

People understand social distancing is important,

and so the moment there was fear of what was happening across the border,

naturally, people started social-distancing activities

and self-quarantine became pretty normal.

So those are all the social things

as well as the health system things that kind of changed,

and because of that,

Hong Kong was able to react really, really fast,

not just the government, not just the health authorities

but the people of Hong Kong,

and I think that's the most important part,

is that the entire city, that the community reacted

and went into this mode where you wore masks,

you washed your hands, you carried hand sanitizer,

you stopped going to public places.

WPR: I'm curious then,

I think a lot of people who are listening at home

and figuring out how can we apply some of those things here,

and from where you sit,

and when you see what's going on in other parts of the world,

where maybe people are struggling to make some of these changes.

You know, what are some of the specific things

you think folks can adapt in their own cultures,

in their own countries?

GL: I think communication is a huge deal.

If you talk to local Hong Kongers,

they will likely opine that the communication

from the Hong Kong government has not been top notch.

But thankfully, there have been other authorities

and certainly even just person-to-person communication

has been pretty strong.

A lot of corporates have done an incredible job in Hong Kong

in communicating very transparently

with their employees

and insurance companies have also been making available

all sorts of webinars and materials

and made it actually quite easy

for people to understand how to get tested,

where to get tested, who to get tested.

And so that communication, I think,

has centralized, to some degree, the messaging.

In a city like Hong Kong,

everyone generally believes the same thing,

and what they believe is generally true.

Of course, there's still misinformation issues,

as there are everywhere.

But I think, possibly also because of SARS,

because over the course of the 17 years,

a lot of the misinformation has now been vetted,

everyone knows what is true,

so there is already, sort of, an internal radar

or at least alarm bell for things that seem to be wrong.

So I think communication is really important,

from government, from corporates anywhere in the world.

And I think if there is a recommendation for health systems,

I know getting tests is really difficult.

One of the things that has made testing in China and Hong Kong

certainly so effective, is that there is point-of-care testing,

that still really doesn't exist,

or at least doesn't exist in volume in the US.

And so they have to save these tests

and only a certain number of people can get tested,

the triage system then becomes overflowing.

Whereas here, generally speaking,

everyone can get tested,

and then of course, the contact tracing.

Everyone knows that if somebody that you've been in contact with

tests positive,

you're going to be called in by the hospital authorities

and you're going to be tested,

and then if you're positive,

everyone you've been in contact with for the last two weeks

will also be called in.

And people don't really see it as an annoyance,

it's just what needs to be done.

And I think because of that, again,

the containment has been effective.

WPR: Great. And we have a question from Chris here.

CA: Gary, it actually builds on the point you just made,

people are puzzled online,

how is it that China avoided the explosion of cases

in big cities like Beijing, Shanghai,

where people were coming there from Wuhan.

How on earth did some of those cases not explode?

Was it just down to really diligent contact tracing?

GL: I think it was a combination of things.

First of all, the shutdown of Hubei province certainly helped.

And then, the major cities actually went into isolation

and quarantine as well.

Remember, it was Chinese New Year, so there was no one working that week.

And so everyone just went home.

And generally speaking, in most major cities,

they locked their doors and they didn't leave.

Now, China is very prepared for this,

because the technology stack in China,

including consumer site services,

make it really easy to lock your doors

and get everything delivered to you.

This is infrastructure and this is consumer behavior

that is already ingrained,

especially in major cities across China.

So people just went home.

There was also a stigma issue,

which is unfortunate for people from Hubei,

and especially from Wuhan.

But there are plenty of stories in the other major Chinese cities

where anyone coming from Hubei or with any connection to Wuhan

were ostracized during those early days,

especially after the Wuhan lockdown.

And so folks that might have been, in fact, carrying the virus,

because they were from the epicenter,

they were either self-quarantined,

or they were forcibly quarantined,

because no one was going to spend time with them anyway.

So I think for a lot of those reasons,

some of them social, some of them systemic,

they made it so that there was much less person-to-person contact,

especially after the authorities admitted

that human-to-human transmission was possible.

CA: Hospitals here in New York,

there are warnings that they're about to get overwhelmed.

What can we learn from what happened in Wuhan,

some of the scenes from there were horrifying,

but there were amazing stories as well.

What should we learn from what happened there?

GL: Well, it started off horrifying.

So in the early days, post-lockdown,

all the stories coming out of Wuhan,

we had journalists that were there right before the lockdown,

they got out about three hours before the lockdown happened,

and we had people what ended up having to be quarantined,

because they were stuck in Hubei.

As well as a lot of citizen journalists that were documenting what was going on,

and those images, like you said, Chris, were horrifying.

There were videos showing people literally laying on the ground.

Some were just so sick they couldn't move,

others had already died

and they were just covered with plastic sheets.

There were nurses and doctors that were just crying

in front of the camera, begging for help.

And so, I think it's important to understand

that China's health care system did not just immediately become effective.

And certainly not in Wuhan.

There was not that much information,

people didn't know what they were dealing with.

Certainly, the authorities were trying to help,

I think at that moment,

but again, the information flow was not that free.

And during lockdown,

people were screaming off of their balconies,

because they couldn't get food,

they couldn't even go to the hospital,

because the public transportation systems got locked down.

Remember, this is not,

Wuhan is not a city like New York

where most of New York is walkable.

For people who don't have cars,

and many, many of the Wuhan residents don't have cars,

if the buses are locked down,

then they might have to walk three, four hours, to get to a hospital.

Maybe not that long,

but they have to walk a long way to get to a hospital.

And so a lot of people were just stuck at home,

and they were unable to initially get any diagnosis or any health care.

And so it was a disaster.

But then the capacity actually ramped up.

The triage system became extremely effective.

I think most people have heard now that there were two massive hospitals

with thousands of beds of capacity

that were built within 10 days.

And this is true,

they came out of nowhere,

they were literally just parking lots or flat ground,

and two major hospital units were built up.

To be clear, also, those were the triage units

for those who have very mild symptoms.

But that's really important.

Being able to get people with mild symptoms

out of the major hospital systems,

so that they're not taking up the resources of nurses and doctors,

they are not taking up the diagnostic equipment

for the second confirmation tests,

and also, especially, they are not taking up isolation wards

and ventilators.

And so the moment people started being moved out, the mild symptoms,

the ones that were going to survive

and they just really needed to be separate from family

and have some antiviral medication,

once they were moved out into these new hospitals,

the main hospitals in Wuhan and across Hubei

could deal with the primary patients,

especially those that are critical,

of the overall tested population and do their best and try and save them

and make sure that they're not highly infectious.

At the same time, I think that the health authorities in China,

especially the nurses and the doctors,

did a very good job of also protecting themselves.

So there have been far fewer, by percentage, infections and deaths,

of medical staff than there were during SARS.

CA: I mean, to respond that effectively

took a kind of top-down drive.

Plus a willingness of a lot of people to risk their own well-being

in a way for their perception of what they had to do

for the public good.

You are well aware of the cultural differences between China, Hong Kong

and the West.

Do you -- how do you rate the chances

of, say, the US responding effectively

should things really explode here,

as they seem like they may be about to?

GL: In the health care system side,

I have every confidence that the US health care system

is going to be able to respond well.

I have many, many friends

who are medical professionals in the United States,

and they are raising their hands and volunteering

and going to hospitals to see where they can help.

So I have full trust in the system,

and the people that man those systems.

Our health care capacity in the United States

is also significantly greater, doctors per capita,

than in China.

And because of the fact that also, our health care system

is not just relying on hospitals,

but there are primary care physicians scattered all over the country,

as long as the testing capacity and testing kits are available

across the country,

general practitioners can actually administer those.

And it certainly sounds like more and more med tech start-ups in the US

are now trying to create these home kits,

so that people can start testing at home.

That will help a lot.

My hope is certainly that the citizens of the US,

that people are going to take this very, very seriously

and realize that it doesn't matter that you may not feel sick,

it doesn't matter if you think you are young

and that you are not prone to catching this virus,

or that you're not in --

you may not be fearful of dire consequences and death.

Take it seriously and stay home.

And don't go to public spaces,

and don't be a carrier,

because we now know that asymptomatic folks can be carriers

and there is a possibility that you can be infectious

as an asymptomatic carrier.

So yeah, on the cultural side --

I don't think it's really cultural.

I would say that

it's because of the impact of SARS,

it's because of the social memory of SARS

that has meant people are a little bit more selfless,

and have just said, "OK, I will stay home,

because I might have come in contact."

CA: Yeah, weirdly,

SARS seems to have acted as its own kind of vaccine,

sort of just prepped the system enough for people to be ready.

Yeah, social vaccine, amazing.

Back to you, Whitney.

WPR: OK, great, thanks so much, Chris.

And so I think it's interesting, Gary, to hear you talk

about some of the reactions in Wuhan

and some of the stories that you've heard,

especially running the "South China Morning Post"

and running a news organization during this outbreak.

You know, what are some of the --

First, what is that like, to run a news organization,

to report during this outbreak?

GL: Well, running a news organization in a moment like this,

so close to the initial epicenter where the outbreak started,

is complicated.

We were lucky, very, very lucky

that most of our senior editors,

and certainly the most senior editors,

our editor in chief, our masthead leadership,

they were all journalists and they were reporters during SARS.

So there's a lot of pattern recognition in our newsroom.

Which meant the moment that we got the first,

sort of, the first stories coming out of China,

starting on December 30,

people already raising their hands in the newsroom saying,

"Hey, we've got to report about this

like it's going to be the next SARS.

There's a high likelihood that this is it."

And we did send people to Wuhan early on in January.

Like I said, we also had reporters there right before the lockdown.

After the lockdown, we were lucky enough to pull all of them out of Wuhan.

But we actually did change very quickly

the way that we report.

Partially to make sure we got the story right,

to dig deeper in the places that we knew we had to dig deeper,

but also to protect our journalists and employees.

So one of the things that we did do,

and maybe other news organizations would disagree with our decision,

was I think in late January or early February,

even in Hong Kong,

we said to our journalists,

"You are not to go into hospitals."

So no more in-hospital reporting.

Because they were --

we knew that it was highly infectious,

we were worried that they were going to become

you know, points of spread,

and we just wanted to protect our employees and our company,

so we did that.

We also had a business continuity plan.

Which meant that at the drop of a dime

we could shut down the entire office

and still operate this global news business.

Some of the most interesting stories we've covered

is actually how technology has played a huge role in China

during this epidemic.

Because it frankly has changed the way that diagnostics work,

it changed the way that containment works,

it certainly has changed the way that consumer life works.

And of course,

there's been a lot of instances of really interesting censorship,

but also, more interestingly,

how the Chinese netizens have fought that censorship

and reacted to that censorship.

And I do think that there's quite a lot of lasting impacts

that are likely to happen

because of technology deployment during this time.

WPR: And so I think in talking about some of those lasting impacts,

now that you as a country are sort of emerging from this

and coming on into a different stage with this outbreak,

what are some of the changes you're seeing to daily life,

both as society,

and maybe things that you're hearing that individuals are experiencing

as a result of this?

GL: Yeah, I think probably the two most interesting changes,

actually, I should say three --

The first one is on education.

Now schools have been shut down across China

for quite some time now

and again, this might feel a little bit stereotypical,

or a caricature of China,

but education is extremely important to the country

and extremely important to the citizens.

And we were actually just about to come up to the national exams,

which these students work 18 years for.

And so online education -- very, very quickly moved online.

And part of that move online

was that courses had to be, and classes had to be recorded.

Which means that now, there's this huge repository

of recorded classes.

That means potential democratization of education material,

and significantly lowered costs to get this type of coursework

from the top tiered schools,

whether it's high schools, universities or primary schools,

to the entire country.

Now whether or not China activates on that,

we're still not sure,

but the potential is there.

The second major shift is really on distributed workforce.

The idea of working remotely,

office work remotely, is not much of a concept in China

and across most of Asia.

Certainly far less than in the United States.

And I'm from the US tech industry,

so it was pretty normal,

it's pretty normal in the US tech industry even before this,

in China much less so.

But because of the lockdowns,

not only in Hubei but across China,

this has become much more normal.

And people are kind of falling into a different rhythm of work.

And most importantly,

this has given rise to a whole new set

of teleconferencing companies in China.

Because most of the teleconferencing companies that we know of in the West,

whether it's the Cisco systems, Google Hangouts, Zoom,

that everyone uses,

BlueJeans, Slack video,

they're not available in China.

They don't work in China.

There is this mirror internet in China,

behind the Great Firewall,

and so there's a whole new set of teleconferencing systems

that were used,

but were not really commonplace,

certainly not for distributed workforce,

and now suddenly, over the last few months, they are.

So it will be interesting to see

how those companies and those services develop,

and whether or not the workplace changes in China.

And then finally, the third thing that is really interesting

is that there was a huge internet response

to this censorship issue in China

over the course of the last two months.

It especially exploded after this whistle blower, Dr. Li,

died on February 7.

All over the Chinese internet

hashtags like "we want freedom of speech,"

"national hero Dr. Li,"

things like that just exploded everywhere.

And there have been --

And actually the Chinese government has had to respond,

I think for observers,

a lot of observers believe

that Chinese government's change of narrative about Dr. Li

was largely driven by this reaction from its citizens across the internet.

There have been extremely creative examples

of people getting around censorship.

I think China is quite famous for using emojis

to get around tech censorship.

I think most people also know

that the primary messaging app that the Chinese internet users use,

called WeChat,

it is heavily censored,

it's not just text that's censored,

images are censored really effectively,

individual conversations are censored.

And so when there are specific articles

or specific posts that are about what's happening with the virus

that people want to share,

and the government thinks that it is detrimental to whatever,

they will censor and it will be completely and very effectively removed.

But this time around, Chinese citizens used emojis again.

They translated these posts into ancient Chinese texts

that the censoring machines couldn't pick up yet,

they actually translated one version of this post

into Tolkien's Elvish language,

I don't even know the name of that language,

they translated into that and the AI couldn't pick it up.

And then finally,

I think one of my favorite versions of this

was they used the "Star Wars" intro,

the angled text scrolling,

it became a video,

and they had the entire post about what was going on in Wuhan

in that format,

and that went all over the internet.

So I do think that there is going to be an increased call.

Academics now are speaking up about freedom of speech.

So there's going to be this increased volume of netizens

calling for freedom of speech.

It will be very, very interesting to watch

how the authorities in China deal with that.

WPR: Great. And Chris, you have a question?

CA: Yeah, it sort of picks up on that

about, you know, the stories that could come out of this.

I mean, there are definitely optimistic stories

that people are feeling,

that this could lead to more free speech of a certain kind in China.

Certain things you can't suppress.

Maybe in the US it might lead to the government taking

scientific predictions more seriously,

not clear that's happening yet.

And there's hope that this whole thing,

because it's a common enemy for the world,

will actually bring the world together in some ways.

But I'm curious how you think about this.

President Trump started referring to this as the Chinese virus.

I'm curious how that's being received in China,

and how people are feeling on this issue.

Do you think it's increased sympathy for other countries

or actually dialed up animosity?

GL: Well, it's certainly not being received well across China.

I think one thing that is still really undercovered

is the intensity of rising nationalism

at the grassroots level across China

over the last several years.

And they're very protective of their country,

and their people and their history.

And President Trump's comments

and the fact that so much of the US government

is now referring to this as the Chinese virus

is not received well.

You know, my fear of course, is that even prior to the virus,

the US-China conflict was escalating

beyond anything that I think most of us as observers want to see.

Trade, tech, military, ideology,

and now we can add information conflict

and health conflict, health tech conflict especially,

to the list.

Of course, the hope is that these heightened tensions

will actually dissipate

and that the two countries can actually, at this moment in time,

choose to go down one of two paths.

Either one that further damages the relationship

or one that actually shows what the possibilities are

if the two largest economies in the world,

the two most powerful countries in the world,

actually cooperate.

You know, this week, Thursday is the G20 conversations

that are going to happen remotely.

It will be interesting to see how US and China

actually coordinate, cooperate,

how they communicate during those talks.

CA: I think people want to know

how you think this will play out.

You've got a very special seat there,

you know, looking at all parts of the world in it.

What's your take on how this plays out?

GL: I desperately want to be an optimist, Chris.

But I think that everything we see, especially the data,

shows that it is going to get far worse before it get better.

And I'm very fearful for what's going on in the United States.

It's because of the amount of data we have

across all these different countries,

you can very clearly layer countries

and the way that the pandemic has been spreading,

on top of one another,

and we know that the US is a week and a half,

maybe two weeks, behind Italy,

and we know what happened in Italy and what's going on in Spain.

The US is catching up on that spike

and it's going to come much faster,

and it's going to be much higher

than I think most people originally believed or hoped for.

So it will get worse.

So the hope is that,

again, this is going to be the optimistic side of me,

that the nations will come together,

that those in charge, our governments,

will make the drastic, necessary moves,

and we will be able to come out on the other side faster

than it looks right now.

Remember, when China went to shutdown,

on January 23,

there were only 830 confirmed cases.

And even if those numbers are not exactly accurate,

it's nowhere near the confirmed cases that we have in the US right now,

that we see in the US.

So that is something to be very, very concerned about.

At 830 they shut down.

And even after the shutdown, two weeks later,

the cases had grown to 35,000,

two weeks after that, it was at 75,000.

So at this point, it is late in the US.

But, we, you know --

it can still be fixed.

And I think most ...

experts that we talk to believe that it can be fixed

with fast and decisive action.

CA: Yeah, people struggle with understanding the power

of exponential growth.

And a number can seem smallish today,

but if you believe the science,

yeah, you have to act.

Gary, look, I hope somehow

you will convey to whomever you can convey

that regardless of what some people might say,

in government or elsewhere,

there are millions, there are tens of millions,

there are probably hundreds of millions of people in the US,

on both right and left,

who are amazed by what happened in China.

You know, yes, missteps early on, whatever.

But they're amazed,

you've really --

you know, both the Chinese government, the Hong Kong government,

several Asian governments, Singapore, South Korea,

have shown astonishingly wise and disciplined action

against this thing.

And we're grateful,

we feel there is much we can learn from you

and so --

People, most people want this to be a time of bringing the world together.

I genuinely believe that,

it's maybe the optimistic part of me believing it.

But I believe in it,

it's partly what these conversations are for,

to try and make those kinds of connections.

We want to keep in touch.

You've got an amazing seat there,

and I have loved listening to every word you've said today here.

It's just I've learned so much from you.

So thank you for that.

GL: It was a great conversation.

WPR: Thank you for your insight.

CA: And thank you to our whole online audience,

I mean, this is a journey,

every day we're learning something new.

And just in case anyone out there is feeling a little bit powerless,

and afraid or you know, at the situation,

I mean, the one thing that everyone can do right now, I think,

is we can reach out to the people we know,

we can encourage each of us to be our best selves

in this moment.

I really think it's what the world is going to need,

when people are angry and fearful,

we can turn into nasty people.

But when we're --

When we realize how much we need each other,

and are willing to just reach out and share stories of hope

and share what we're feeling

and share possibilities,

we can really impact each other,

and I see so many incredible instances of that

from around the world,

whether it's Italians singing to each other joyfully

from each other's balconies,

or these sort of tales of heroism

that some of our health workers have been engaged in

all around the world.

There's going to need to be a lot more of that.

And honestly, every single person can play a part in how they are online,

what they share,

how they react.

So I don't want to be overly, embarrassingly Kumbaya,

but I kind of think we need that spirit right now a little bit.

We need each other,

and TED is going to try and play that role a bit.

So if you hate that,

maybe you don't need to be here,

but I hope you don't hate that.

I hope you like that and will be part of it.

Whitney, it's so fun cohosting these,

thanks to the rest of the amazing TED team

who are everyone in our individual homes,

they are sort of racing around,

trying to make this stuff work technically.

We're learning a bit each day, I hope.

Thanks so much for being part of this.

WPR: Thank you, everyone, thank you.

We'll see you all back here tomorrow.