From Sars to the Covid-19 pandemic. An interview with writer and journalist Ilaria Maria Sala, who has lived in Hong Kong for years, to understand what we can — and cannot — learn from China.
"To fight a pandemic, you need the strictest and most stringent measures. It's an extraordinary situation." From Hong Kong, writer, journalist and scholar Ilaria Maria Sala says she is deeply troubled: "On 23 March it was not certain that everything in Wuhan was under control, according to the public broadcaster. The whole world should pay attention."
Listen to "07. Coronavirus, quando una pandemia apre il decennio più importante per il clima" on Spreaker.
The new coronavirus that has brought Covid-19 infection to every continent originated in the capital of the Chinese province of Hubei. In Italy, at the time of writing, 74,386 people have been infected and 7,503 have died. In Hong Kong the number of infected stands at 411, with the most recent cases being individuals who have returned from abroad. With Ilaria Maria Sala, who has lived in China since 1988 and permanently in the former British colony of Hong Kong since 1997, we look back over the past 17 years, from the outbreak of the Sars epidemic in 2003 to the new coronavirus of recent months.
Epidemics have always existed and they do not all originate in Asia. Reading back through history and the scientific literature, it becomes clear that entrepreneur and philanthropist Bill Gates prophesied nothing when he warned of the risk of a new pandemic. He simply looked where others turned away. There is much to learn for those who underestimated first the epidemic and then the pandemic: governments, institutions, international organisations, media outlets and even some experts.
In Hong Kong, citizens have learned to put themselves on alert on their own. In Taiwan and Singapore, people have equipped themselves to deal with a risk that is ever more possible on a globalised planet. South Korea, too, has implemented safety measures for the fastest possible containment.
Ilaria Maria Sala, who is also vice-president of the freedom of expression organisation PEN Hong Kong, explains: "You can't negotiate with an epidemic. The military is intervening — not only in China, but also in Asia's most vibrant democracies. Fear of mapping infected people is nonsense, especially in a democracy. The state has a priority duty to protect public health; everything else comes after."
This planetary tragedy has laid bare the limitations of our Western world — and beyond — in our approach to disease and in our understanding of different habits. Here is one of the examples Sala gives in the interview that follows: "In Asia, even before Sars, wearing a mask was a form of respect for the community in which you live, before it was about protecting yourself."
From the Sars epidemic of 2003 to the Covid-19 pandemic. Based on your own experience, can you help us understand what is happening to us?
Sars today looks like a dress rehearsal for what is happening with the new coronavirus, even though it had a far smaller impact and reach. For Hong Kong, Taiwan and Singapore, Sars served as a testing ground. The people, in the case of Hong Kong, and the governments too, in the case of Taiwan and Singapore, became much more capable of dealing with this kind of emergency. We must not forget that in Hong Kong the epidemic crisis began after nine months of anti-government protests. At the first signs of an infectious disease coming from China, the population did not trust the Hong Kong government. People feared it would not apply a reasonable virus containment strategy so as not to offend Beijing. So people immediately changed their lifestyle on their own initiative. Overnight they started going out less. Everyone put on a mask, most public premises took the temperature of anyone coming in, and in almost every shop or post office hand sanitiser dispensers were placed for people to clean their hands.
All of this before the government announced any measures.
Yes, there was also a hospital strike to pressure the government into closing the borders with China. The Hong Kong government did not want to do so, but after almost two weeks of strikes it imposed an almost total shutdown. Now the airport and one land crossing remain open. A bottom-up reaction, driven by the experience of Sars. After the Chinese government tried for a long time to cover up what was happening in Guangdong, where the virus originated, Hong Kong found itself managing the crisis alone, paying a very high price: 299 deaths. It is clear that today that number seems tragically small, but at the time it appeared as the heartbreaking loss of 299 people who might perhaps have been saved.
Can learning from mistakes save our lives?
The people of Hong Kong have learned to keep themselves safe. The governments of Taiwan and Singapore used those 17 years to build hospitals and equip themselves with more intensive care units. That first alarm of 2003 was taken as a very important lesson.
Beijing, however, appears to have been slow to announce the spread of the new coronavirus — why?
The Chinese government has a pyramidal structure in which people lower down know that their future depends on the information they pass up to those above. Not in the sense that they are rewarded for giving accurate information. Those at the top do not want problems. If there are worrying issues of social instability or infectious disease, responsibility is attributed to regional party cadres or individual citizens — to people of lower rank. This has created a system in which no one wants to deliver bad news. But with a virus this infectious and spreading this rapidly, even a few weeks of silence led to the very fast expansion of a disease that is now causing deaths all over the world. Beijing is not responsible for the nature and the virulence of the coronavirus — it did not create it — but it is responsible for suppressing bad news. If even in China, as early as November with the first cases of atypical pneumonia, people had put themselves on alert as Hong Kong, Singapore and Taiwan did, we would not have reached this point.
On the state of contagion in Italy and the rest of Europe. From the first confirmed case in Codogno, there have been delays in implementing safety measures, confused communications, and underestimations. For instance, it was said that masks were not useful.
I'm speaking on the basis of the opinion of doctors here, which is completely different. That is to say, masks are essential. During the first fourteen days we saw that a person can have no symptoms yet still be contagious. Logically, therefore, they are not only needed by those who are infected. Wearing a mask is a way of protecting others, before protecting yourself. It is a habit that predates Sars in various Asian countries, including China, South Korea, Taiwan and Japan. It is considered good manners to wear a mask if you have a cold, so as to avoid infecting others. From a socioeconomic point of view, it also depends on the fact that in this region obtaining sick days is more complicated. There is also a much more pronounced tendency to feel guilty if you infect someone else. If you sneeze, it is common for someone to offer you a mask. Almost everyone wears them during ordinary flu seasons. And now that Hong Kong is not locked down like many Italian cities, the people without masks can be counted on the fingers of one hand. Another thing that Hong Kong doctors have said is to behave as though you are infected. To protect others, you avoid physical contact. A person at low risk of contagion, who is healthy, willingly accepts washing their hands frequently, working from home as much as possible, limiting social interactions and wearing a mask.
In Italy, the opposite. To date, masks and swabs for diagnostic testing are lacking even for healthcare workers.
Here we struggle to understand why so much time was wasted in Europe when the infection was already spreading rapidly in China, Japan and on cruise ships. Every government in the countries where contagion arrived later lost precious time. They should have stockpiled masks, disinfectants, everything that was needed, and prepared the hospitals. Perhaps out of a kind of arrogance, Western governments believed it was purely an Asian issue. It is hard to understand.
What can be said to those in Italy who oppose contact tracing, fear the loss of privacy or even worry about soldiers permanently on the streets?
It is nonsense. Contact tracing has also been carried out in democratic countries such as Taiwan and South Korea. In the face of an emergency of this nature, there can be no fear of what will come afterwards. What is happening is obviously extraordinary. In the long term, Italians cannot want soldiers on the streets. They are there now to deal with a crisis. Tracking where people go and the contacts they have is a matter of public health protection that must be part of a democracy. It is not democratic to allow people to die of a disease that can be contained. To think it is a conspiracy to spy on citizens means that perhaps we need to elect people we trust more.
And yet, various journalists and politicians have spread these fears, complete with likes on social media.
It seems like the syndrome of expressing an opinion before having thought it through. This is typical in our media system: first of all I express an opinion, then perhaps I think about the consequences. If we look at the two most dynamic and vital democracies in Asia, South Korea and Taiwan, nobody is making these arguments. And in both countries, since peace treaties have not been signed and the risk of military return exists, someone might be gripped by this paranoia. Instead, people know that soldiers are acting to contain the contagion and that when the epidemic is eradicated they will leave the streets. In South Korea the army intervened to prevent a religious sect from gathering without protections. The members said their god would do the selecting. To claim that such a blockade is undemocratic is madness.
In Italy there was a delay in closing all non-essential services, factories and offices.
There are no half-measures. With an epidemic you don't reason, you can't sit down and negotiate. You can't tell it that you need to protect the economy. Without doubt, an epidemic hits the economy hard. The state, the European Union, the powers that govern us have a duty to address the economic crisis resulting from the epidemic, protecting the segments of the population that are harmed by it. If a worker falls ill and dies of Covid-19, they have paid a far higher price. In Hong Kong, during this emergency, one thousand euros have been given as an initial palliative to all adult citizens. With the absurdity that this sum has been allocated to the unemployed and to millionaires alike. I am not saying that Hong Kong has done everything right. Nevertheless, there is an aid package that has been provided to businesses and workers.
According to a report broadcast on 23 March by Hong Kong's public radio and television, it is not certain that infections have ended in Wuhan — where the pandemic began. Some people showing symptoms are said to have been turned away without being examined. Should we be worried?
Yes, the entire world must watch very carefully the news that China is putting out, because if it lies we are all in trouble.