The Conversation

Coronavirus: Beijing outbreak shows China’s plan for preventing a second wave

On June 11, Beijing reported its first new coronavirus case in nearly two months. Over the next two days, the city government swung into action, sealing off certain neighbourhoods and closing Xinfadi, the vast wholesale market where the outbreak is believed to have begun.

International reports initially suggested that Beijing was adopting “sweeping” lockdown measures. However, we’ve observed that the authorities have tried to avoid the approach adopted in Wuhan.

Instead, the Beijing government has pinpointed places and people thought to be potential risks, and has then applied targeted measures to prevent infections. The authorities have been tracing, testing and isolating people, focusing on the most vulnerable as well as those at risk due to their profession. The government has also managed movement in and out of specific neighbourhoods and has tried to stop the virus spreading beyond the city.

It seems the approach is working. As of June 24, the number of confirmed cases in the outbreak was 269 and the daily infection rate had fallen to below 15. Importantly, there was no reported spread to a secondary infection point. While the risk of further outbreaks remains, Beijing’s response may be the blueprint for containing the virus in China until a vaccine is found.

Mass mobilisation to identify those exposed

Beijing’s initial strategy was a rapid campaign to find citizens who might already have been infected. This meant looking for anyone who had been to, or had contacts who had been to, markets thought to be connected to the outbreak. This knowledge in turn made it possible to use finely targeted neighbourhood lockdowns and strategic testing of the wider population, based on risk.

The campaign didn’t use sophisticated tracing technology. Instead, this was a large-scale operation using Communist Party, state, private sector and non-profit organisations that relied largely on mobilising people.

To ascertain who might have been infected, teams of volunteers, community workers, and Party and state personnel knocked on doors, made phone calls, stopped people entering residential compounds and contacted people on WeChat, the Chinese messaging app. They asked whether people had been to certain markets since May 30 and, if so, sought further details. Clear instructions were given: “If you’ve been to one of these places, contact your local community office immediately.”

Meanwhile, the Beijing government ordered all employers to ask their employees whether they or those they live with had visited the markets. It then began to identify categories of people to be tested. First, all those who had been to Xinfadi and their contacts. Second, all those identified as vulnerable or easily infected, such as elderly people and staff in care homes, taxi drivers, couriers, and people working in markets and catering businesses. A third category covered all residents living in designated “medium and high-risk” areas, as well as medical personnel, frontline epidemic prevention staff, and people working in services such as transport, supermarkets and banking.

A similarly graduated approach has been taken to isolation. All close contacts of confirmed cases are being taken to centralised isolation sites. Beyond this, self-isolation (at home) has been required only in the 40 or so Beijing neighbourhoods (out of more than 7,000) that have been closed.

Places where confirmed cases are found are closed for environmental testing (surfaces as well as seafood and meat are screened) as well as thorough cleaning and disinfecting. The outbreak in Xinfadi has led to a further screening of all other similar agricultural wholesale markets, as well as suppliers of fresh and frozen meat and fish, supermarkets, convenience stores, restaurants, cafes and workplace canteens.

Lockdowns become localised

After the first case was confirmed, control measures were introduced based on proximity. The first patient’s own neighbourhood was put under the strictest controls, with movement being limited. Surrounding neighbourhoods and those in the same sub-district resumed temperature checks on entry.

As new cases emerged and the connection to Xinfadi became clearer, the authorities introduced similarly localised measures to limit movement in and out of other neighbourhoods. Unlike in Wuhan, instead of announcing these before introducing them – and so leaving a window for people to spread the virus – the authorities implemented small-scale targeted lockdowns overnight. Only after an initial 11 neighbourhoods had been put under strict controls – or “closed management” – were the measures announced the following morning.

In strictly managed neighbourhoods such as these, residents are not allowed to leave, no people or vehicles from outside the neighbourhood may enter, and all residents are tested and put under home observation. By June 20, 40 neighbourhoods were under this strictest level of control. But on June 23, seven were removed from the list.

A looser form of “closed management” has been adopted in the other 7,000 or so neighbourhoods in Beijing. These lower-risk areas must set up entry checkpoints, staffed 24 hours a day. Passes are needed to enter, and face or code verification is used to record who enters or exits. Temperature checks are also being conducted. Delivery drivers, housekeepers and other service industry personnel can only enter after registering and showing that their current status is green on the Beijing Health app. The app uses a person’s health status, travel history and contact with confirmed cases to assign them a colour code to indicate their infection risk.

Neither has there been a full city lockdown in the sense of completely cutting off Beijing from the rest of the country. Although chartered tourist buses and taxis were prevented from entering and leaving Beijing early on in the response, other travel restrictions have only targeted individuals more likely to have been exposed to the virus.

Everyone else has been advised to leave Beijing only if absolutely necessary. People wishing to travel need to have had a negative test in the previous seven days and have green status on their health app. Meanwhle, railways and airlines are checking temperatures, apps and test results. Similar checks have been set up on roads out of Beijing, while the authorities have reduced public transport routes out of the city and suspended some altogether.

Holly Snape receives funding from the British Academy.

Hua Wang receives funding from the UK Medical Research Council and National Institute of Health Research.

Jane Duckett receives funding from the UK Medical Research Council and National Institute of Health Research.

Yingru Li receives funding from the UK Medical Research Council and National Institute of Health Research.