John Henry Smith,the foreign teacher who has been working in Shaanxi Polytechnic Institute since August 2009 and has received several awards from Shaanxi Provincial Government in respect of his contribution as a foreign expert. He has qualifications in both Public Health and Health Service Management, law, economics and business management and a Diploma in Teaching English as a Foreign Language from Cambridge, which supplies him a wider perspective on life. Besides, he has always taken an interest in health and has worked closely with some professionals at the local hospital, providing a western perspective on health care.
The following is an interview from Science and Technology Daily with John Henry Smith, in which John shares his personal view of the 2019-nCOV.
Part I
John Smith’s view of the coronavirus epidemic
1. Background to the Coronavirus Outbreak
It would seem that everyone was shocked and surprised when details emerged about the outbreak of this new form of virus. There has been much speculation regarding not only how this virus originated but also when it was first discovered.There are many unknowns but what is certain is that the virus (most likely) jumped from an unconfirmed source to an intermediate host possibly pangolins which were being sold as food at a market in Wuhan. The infected people unknowingly spread it to others, setting off the outbreak’s deadly journey. It has been estimated that it takes between 5 and 14 days for someone to show symptoms after being infected.
2. The Ongoing Problem
The ongoing problem, not so much in other provinces in China, but continuing in Hubei and the rest of the world, is the further spread of the virus through so called“super-spreaders”and invisible carriers. We now know that some of the tests undertaken in hospitals have returned false negatives results prompting more rigorous testing (which takes longer). There have been reports about individuals who are considered‘super-spreaders’. It was first thought that an infected individual would be capable of spreading the virus to 1-2.5 others. However, it has now been confirmed, at least in the UK that one individual has infected 11 other people including a young child. That being so, there are also the invisible carriers. The outbreak is still evolving, and authorities are yet to see the totality of those infected. Do the health authorities have enough testing kits? Are those who present with symptoms being tested and are the results correct? There are of course those individuals who are mildly infected with minor symptoms or no symptoms, yet do we know if these individuals are infected?
3. The Way Ahead
The Chinese public health authorities are under enormous pressure to make difficult decisions with an incomplete and rapidly changing, understanding of the epidemic. They have to strike the right balance of containing the spread of the virus against the long-term effect of a continued shutdown on not only the general population but also on the economy as well.Having a better understanding of how the coronavirus is passed between people; understanding the basic reproductive number of the virus and how many individuals can be infected by another person should go somewhere into controlling the virus. Knowing the number of people likely to die or who will get seriously sick or have zero symptoms will help health authorities determine the strength of the response required. They can then better estimate the number of isolation beds, medicines, specialist equipment amongst other things.
Part II
Q&A between Science and Technology Daily and John Smith
“I should like to preface the answers by saying that Foreign Experts are not special people but should be treated as any other individual who works in China. They are no different from the teachers, engineer, managers, doctors etc., who work alongside them. They have no special skills other than what they bring with them and should not be placed on a pedestal.”
1. As a foreign expert who has been living in China for a long time, do you know about this notice from the Ministry of Science and Technology?
“No, I don’t believe that I have seen this notice or been made aware of it. I could of course be wrong. In your opinion, what should a foreign citizen prepare to ensure his or her own safety face the New Coronavirus Epidemic? The Foreign expert should do what other citizens currently do. If they are living in the heart of the epidemic, Wuhan or perhaps Hubei, and they thought that they were at risk, then perhaps they should consider leaving China in the interim period or if they had family here, then they should decide if they should stay. For those individuals remaining in China, either in Hubei or other provinces, they should be aware of the requirements that are placed on Chinese citizens and take the necessary actions to prevent infection of the Coronavirus and conform with what is required of them.”
2. Do you have any suggestions on how the Chinese government can better serve foreign experts in China and prevent the outbreak?
“The Chinese government should inform foreign experts of the necessary requirements in English and perhaps set up a website specifically directed at foreign experts and perhaps other foreigners working in China, where information can be obtained about such events such as matters of national significance and importance.”
3. Do you agree with the measures taken by the Chinese government in the fight against the epidemic? Do you have any suggestions for improvement?
“There are two schools of thought with regards to the application of Public Health in an emergency. There is one that the Chinese government is applying (The Cordon Sanitaire) which is isolation and lockdown of communities, preventing individuals from either entering or leaving areas unless under strict supervision such as buying supplies and necessities and the other one is the is conducting symptomatic surveillance and isolating confirmed cases rather than closing off whole cities. I think the Chinese government missed an opportunity of doing the latter and as a result of missing that window of opportunity had to resort to the wholescale isolation of cities and communities. We are dealing with a huge population and it is difficult to know which is best. Perhaps after the event when everything is settled down, modelling can be undertaken to see how the two schools of thought would have dealt with this problem.”
4. What do you think the international community will react to the new coronavirus epidemic? Will China and foreign countries cooperate in a related field to help humanity together overcome this very“war”?
“I believe that China did a disservice to the doctors and general public by missing the window of opportunity–the time between the first notification of the virus and the eventual action by the central government to kick start the response to the coronavirus outbreak. This put it on the back foot and some international conspiracy theorists were given an opportunity to put their theories onto the internet. This did not help matters. Luckily, an international consortium of health professionals was able to quickly work on different areas of this epidemic and are working on identifying how the virus works, how it infects people etc and the development of a vaccine. Again, missed opportunities don’t help in a fight against a disease such as this.”
5. Do you have some real impressive people and events during this fight against the epidemic, more details the better?
“I think a real champion of the fight against this virus must be Dr. Li Wenliang who sadly lost his life after catching the virus from one of his patients. He was resolute in his determination to let people know, even though he was dying. Also, we must thank from the bottom of our hearts the doctors and nurses who are at the front line in fighting this contagion. They work tirelessly in what is a dangerous situation. It is not the leaders who are doing this but the doctors, nurses, health care professionals, and those who help to make the society a safer place to live in.”
6. How can we ensure that something like this doesn’t happen again?
“First and foremost, this is a Public Health matter. We should listen to those in this area who have the necessary knowledge and expertise. They are at the front line of any health care emergency and they need to be listened to and appreciated. If they say that there is a problem with a particular area of health that will affect the general population, then that needs to be acknowledged and the necessary steps taken. I am afraid that Managers and Leaders are not necessarily experienced in areas of health and public health in particular and they need to trust the health care professionals if they say that something is not right. People should not be afraid of giving bad news and people need to learn from mistakes made. The person who says that they never make a mistake is a person who never learns. When I was studying for my post-graduate in Public Health, an area which was very important was“Root Cause Analysis”. In science and engineering, root cause analysis (RCA) is a method of problem solving used for identifying the root causes of faults or problems. It is widely used in IT operations, telecommunications, industrial process control, accident analysis (e.g., in aviation, rail transport, or nuclear plants), medicine (for medical diagnosis), healthcare industry e.g. epidemiology, etc. This should be used to see what went wrong, why it went wrong, what lessons could be learnt from this major problem, what needs to be changed to prevent it happening again, what training needs to be structured for personnel involved in the area of public health and management. Only in this way will a better, sharper and quicker response to a possible epidemic be achieved.”
John Henry Smith
