China, India Handled COVID-19 Differently. Results Differed Too In China, authorities handled the coronavirus pandemic by centralizing control and locking down vast swaths of the country. India didn't. How has that affected health outcomes in the two countries?
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China, India Handled COVID-19 Differently. Results Differed Too

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China, India Handled COVID-19 Differently. Results Differed Too

China, India Handled COVID-19 Differently. Results Differed Too

China, India Handled COVID-19 Differently. Results Differed Too

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In China, authorities handled the coronavirus pandemic by centralizing control and locking down vast swaths of the country. India didn't. How has that affected health outcomes in the two countries?

RACHEL MARTIN, HOST:

India and China are the two most populous countries in the world. So how have they handled the coronavirus pandemic? Both imposed early strict lockdowns. China, of course, had the first outbreak, but the virus there is now largely contained. India, on the other hand, is now among the top three countries in the world for coronavirus cases and deaths, outnumbered only by the U.S. and Brazil. The country continues to set daily records but is pushing ahead with reopening its economy.

NPR's India correspondent Lauren Frayer and China correspondent Emily Feng examine why the two nations have fared so differently.

EMILY FENG, BYLINE: On a bitterly cold and windy day this past April, doctors in Wuhan, the Chinese city first hit by the coronavirus, defended one of the city's most controversial policies - centralized government quarantine.

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WANG XINGHUAN: (Through interpreter) Every last household fully implemented the policy. We rounded up everyone who needed to be rounded up and treated everyone who needed it, exhibiting morality, respect for life and preserving health.

FENG: That's Doctor Wang Xinghuan speaking at a Wuhan hospital built in under two weeks this February to treat more than 2,000 patients. Centralized quarantine relied on extensive surveillance and testing. Community officials went door to door checking families. They then quarantined anyone with symptoms, regardless of their consent. Wuhan credits the practice with helping it end its epidemic. The results show. China now sees only a handful of new cases a day, nearly all from international travelers. Businesses are all open again. Domestic travel is back. And Wuhan, the former epicenter, just hosted an electronic music festival with ravers dancing together in a giant pool.

LAUREN FRAYER, BYLINE: Things are not back to normal in India. It's where the virus is spreading fastest, adding more than 70,000 new infections a day, and scientists say that's nowhere near the peak. But just like China's strict quarantine system, India too took drastic measures very early on.

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PRIME MINISTER NARENDRA MODI: (Speaking Hindi).

FRAYER: "You are not allowed out of your homes, starting at midnight," Prime Minister Narendra Modi told the nation back in March, giving just a few hours' notice of the biggest coronavirus lockdown in the world. One difference is that while the Chinese population was able to absorb the economic impact of lockdown, India's could not. Hundreds of millions of Indians live in poverty. When everything shut down, poor Indian laborers got stranded in cities and industrial zones far from their homes with literally nothing to eat.

Yamini Aiyar is president of the Centre for Policy Research, a think tank in New Delhi.

YAMINI AIYAR: The state said, we're going to shut down, don't leave your home, we will look after you. But the lack of trust in the state's ability to provide to people meant that people said, well, if there is such a scary pandemic where you might die, I would rather be home than be locked away in a city vulnerable and on my own. And if that means I have to walk home, I will walk home.

FRAYER: And that's exactly what millions of Indians did; they walked home, in some cases for hundreds of miles.

UNIDENTIFIED PERSON: (Singing in non-English language).

FRAYER: "Oh, government, please send us laborers home," this man sang as he walked, begging the Indian government to restart trains and buses. It eventually did and also set up emergency shelters and food distribution centers. But it was already too late. Dozens died of starvation. And their exodus, spurred by a lack of trust in their government, helped spread the coronavirus all over the country.

FENG: Chinese citizens are inclined to trust their government, and the pandemic increased that trust as they watched Beijing correct initial mistakes and then watched other countries, including the U.S., flail. China was also able to harness its state resources in a way no other country did. It built that hospital in two weeks, ordered its factories to scale up PPE manufacturing, and the state funded all COVID treatment expenses for those officially diagnosed. Here's Hu Xijin, the nationalistic editor of a state tabloid.

HU XIJIN: (Through interpreter) China's system has a very strong organizational and dynamic ability. The center leadership directs, and the entire country jumps into action.

FRAYER: India has impressive state capacity, too, but the apparatus of the state just moves more slowly. India's the biggest democracy in the world. It holds the biggest elections in the world. But the voting takes weeks. And when it comes to public health, the analyst Aiyar says...

AIYAR: That's where India's performance has traditionally been extremely weak. We invest very little. Our overall public spending as a percentage of GDP is less than 2%, far lower than China, Brazil or any other comparative country.

FRAYER: So the pandemic overwhelmed India where it was already weakest.

(CROSSTALK)

FRAYER: Video recorded inside a Mumbai public hospital back in May showed corpses in body bags laid out alongside live patients on IVs. Three months later, I spoke to a doctor there, Avinash Saknure. He says things are slightly better now. Mumbai's caseload has plateaued in part because of a new effort Doctor Saknure is part of. He's no longer working in the ICU; he's out patrolling streets and testing people at a grassroots level.

AVINASH SAKNURE: From one of the small area, if one patient has tested positive, we should test all of the patients over there.

FRAYER: It's exactly like the door-to-door check and quarantine system China implemented right away. India is doing it many months later.

FENG: China's authoritarian system let it throw the full weight of the state behind containing the virus. But that same system has downsides. During the first few weeks of the epidemic, local officials punished doctors who first raised the alarm about the coronavirus. And despite having built a complex alert system after its SARS epidemic, local health authorities dragged their feet because they were afraid to deliver bad news. Yanzhong Huang is a senior fellow for global health at the Council on Foreign Relations. He explains how that cover-up at the local level...

YANZHONG HUANG: That only undermined the capacity of the central health authorities, you know, in making decisions to respond to the outbreak in a timely manner.

FENG: And that lost China precious weeks to contain its epidemic. Mao Shoulong, a professor of public administration at Beijing's Tsinghua University, explains the pros and cons of China's concentration of power at the top.

MAO SHOULONG: (Through interpreter) With greater centralization comes tighter information control. Within the political system itself, information may flow faster, but there are too many tasks for higher-level officials to deal with in a timely fashion.

FRAYER: China's response is still enviable. It's tempting to blame India's messy outcome on India's messy democracy. But other democracies did better, and in the end, Indians' lack of trust in their government, inability to mobilize state capacity quickly and endemic poverty probably played a bigger role.

FENG: For China, it believes more than ever that its uniquely authoritarian system is what gave it a decisive edge over its epidemic. And regardless of whether they are right, that bodes ill for democracies.

MARTIN: That's Emily Feng and Lauren Frayer, who cover China and India, respectively, for NPR.

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