Editor's note: On 10 March, long-time Shanghai resident John Darwin Van Fleet, who was in China through the 2002 –2003 SARS epidemic, wrote this letter to his family in Los Angeles, his third to them in five weeks, updating them about the virus epidemic in Shanghai and around the country. (See the first two letters here and here.) Van Fleet is the director of Corporate Globalization at the Antai College of Economics and Management, Shanghai Jiao Tong University.

Hi all – I'm writing to you just as the COVID-19 situation in the U.S. seems to be heating up further, while here in China we seem to have turned/be turning the corner. Plenty of interesting things continuing to happen over here, some of which may be valuable for you to consider over there now!

"China's CDC prompts you: resume work, report body temperature, open windows, wash hands frequently, wear a mask, eat well, keep a meter's distance. See China's CDC public information site for daily updates."

– All Shanghai residents with mobile phones have been receiving this SMS and variations of it since mid February.

You'll recall that I've mentioned my 'baozi shop indicator,' the length of the queue at the local stuffed bun shop being a sign of the speed with which the city is returning to (something like) normal. The indicator is showing that we're back to normal – the queue length has been long for about two weeks now. One more bit of entertainment there is the paper sign to the right of the customers in this picture:

The sign, which appeared only in the past week, says, "please maintain a one-meter gap in the queue," a message similar to what you see in the SMS message above. You may judge the effect yourself from this next picture:

Not quite a full meter, in fact this also looks like nothing out of the ordinary. But sometimes the concept of keeping space in queues is observed, as I saw in this fast food place:

And in this pharmacy:

When I first visited China, nearly 25 years ago, queues were virtually non-existent. So to see this type of social behavior is notable and laudable.

But sometimes crowds are unavoidable – here's a metro train yesterday:

Something else interesting on the streets here – from weeks ago, we've had temperature checks in public places (banks, metro stations, grocery stores) and most residential complexes. It's mostly a joke – in addition to the fact that infected people go days before having fevers, the majority of the devices being used are for cooking, which means they have nowhere near the sensitivity needed to detect a few vital degrees of difference in human body temperature. No surprise that they tend to produce readings that are humorously off, almost always under (because skin surface temp is lower than relevant body temp). 

I always ask for the reading, and I commonly hear (in Farenheit) 94 degrees or lower, which indicates imminent death by hypothermia, so when I get such a reading I say to the checkers, diwen si!, which means "death by hypothermia." I get a range of reactions – the main security guard at our complex (I had a picture of him in my last letter) has a notable joie de vivre and a robust sense of humor, and we often laugh when such a reading appears.

I look forward to the end of general mask-wearing as well, along with the CDC, WHO and every healthcare authority I've been able to discover, despite the exhortation to do so in the SMS message above. I was entertained to note, ten days ago, that our Surgeon General tweeted a rather aggressive message about general mask-wearing:

Not often that you see a government leader (well, at least not until the past few years) use ALL CAPS to emphasize a point in a communication...

The American Chamber of Commerce in Shanghai continues to publish a deservedly well followed daily update, which has been indicating for a month no new cases in Shanghai (save for a few they caught inbound at the airport, which are now in quarantine), and more recently a collapse in the number of new cases countrywide. 

Some of those rapidly built hospital facilities in Wuhan are closing, and it's become harder to conduct large-scale tests up there, because there aren't enough new patients. But we've all noticed the outbreaks in South Korea, Iran and Italy. Clearly, the crisis points are elsewhere now and, from what I can tell, each of these places failed to learn the first lesson of Wuhan. As in Wuhan, the outbreaks in those other countries stemmed from denial, driven by theological and/or political fealty – Daegu traces to a congregation of believers in divine protection, that tinge hovers over the Tehran theocracy, and northern Italy just didn't take the matter seriously until, well, what we see now.

So I view our own national response with great concern – the Trump administration has exhibited a breathtaking capacity for denial and political fealty – even had he assertedly tried to demonstrate ignorance of the first lesson of Wuhan, rather than just model such ignorance, Trump could hardly have appointed a more unintentionally humorous point person for this outbreak than Mike Pence. And one result of that negligence is breakouts – I'm reminded of that commercial we saw decades ago, where the Mother Nature character is fooled into thinking that margarine is actually butter and says: "It's not nice to fool Mother Nature." Indeed – Richard Feynman (we could REALLY use him now) quipped after the Challenger disaster: "For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled." That's of course true not just for technology, but for epidemic control.

We have, to our advantage, the federal, relatively decentralized structure of the country. Healthcare authorities in Seattle or Boston or wherever can act as they know best, based on evidence and ignoring the spewing nonsense from Washington. But (also as in Wuhan) the lack of resources available for professionals to do the jobs they know how to do should alarm all of us. My favorite epidemiologist says: "If we don't learn the lessons of Wuhan, we will experience excess deaths in waves, which could be overwhelming." She also forwarded this graphic, which is as she says "epidemiology 101."

I don't need to be an expert on what we should do, individually and collectively, because there's plenty of expert opinion we may rely on. WHO's advice, which is nothing new, is that we should be ". . . working across society to identify people who are sick, bringing them to care, following up on contacts, preparing hospitals and clinics to manage a surge in patients, and training health workers."

This poster, from the 1980s, has it right.

"Pay attention to disease prevention."

This past weekend, Shanghai imposed specific controls for those flying in from Iran, Italy, Japan and South Korea. Those people go to a separate area in Pudong airport, are screened and then escorted to their residences, where they then enter a 14-day quarantine period. I suspect we'll be seeing arrivals from the U.S. in that category within a week or two – travel restrictions in reverse – that'd be a bit entertaining.

And we've seen an explosion of alternatives to hand-shaking (let alone cheek kissing) for greetings, including the now-famous Wuhan Shake, the elbow bump, etc. What I don't yet understand is why the most obvious alternative isn't getting much attention – an alternative that East Asia invented a few millennia back – the bow! Look for that practice to come back into vogue.

And for my final prediction, I think it's likely that we'll see an increased level of panic in the West, and a continuing massive sell-off of equities. I've just asked our son/brother to get ready to put a healthy sum into an S&P index fund, as I think we're close to what will be the buying opportunity of the decade. Wise person that he is, he was already preparing to do so.

Be well!

End Note:

By March 12, Beijing's airports had put quarantine restrictions on all international arrivals, and equity markets around the world had lost substantial fractions of valuation.

Video cover: Xujiahui crossing in downtown Shanghai on 24 February – well back to normalcy. /Photo by John D. Van Fleet