Learning from the Chinese experiences

Xiang Zhao conducts research on health psychology at the University of Klagenfurt. We spoke to him about how China handled COVID-19. Among other things, Zhao recommends more precise instructions to the population.

The interview  was conducted by email on 11th March and was published on 12th March 2020. It is also available in German.

How are you doing during these eventful days?

Pretty good. I experienced the influence of COVID-19 a while ago when I flew back to China in late December 2019. Although my hometown is far from Wuhan, the entire country was controlled to avoid further spreading of the virus. Restaurants, shopping malls were mostly closed or closed early in the afternoon. Each time when people entered any public places, body temperature examination was undertaken by security guards. I think most of these measures are still used in China. Compared to these aggressive approaches, I do not feel many dramatic changes in Klagenfurt. It may take some time to convert meetings and classes to online versions, but I do not see a big problem with these. Shops and restaurants are also running normally. Generally, I would say things are as usual.

Why are you very concerned about the situation in Austria?

I am a researcher in health education and promotion. I spent over 10 years on research and intervention in this field. It is my passion to help people to enjoy a healthy life. I feel it is important to share my knowledge and understanding about COVID-19 with Austrians. Currently, there is an obvious decrease in COVID-19 cases in China. Experts at WHO have praised the assiduous work that China has done. I believe there are many valuable lessons Austria can learn from China. Apart from the medical treatment experience, it is also important to think how to encourage the community members to face the coming public issue positively. Since the outbreak, I have noticed that several people around me have had conversations about COVID-19 with me. I think conversations like this could break the silence and bring out more constructive international and interdisciplinary dialogues.

You work as a scientist in the field of health psychology. How do you assess the global situation from your research perspective?

I have worked with researchers across different countries. I believe health psychology could help us to understand and prevent diseases by altering beliefs and actions. In the face of the global epidemic, health psychologists and other health researchers can do a lot for the public. Because the situation varies in each country, it is difficult to delineate a general picture at a global level. However, there are many health education skills that can be shared by every society. For example, we can help the public to understand the virus, we can provide better guidelines for prevention. China’s intervention work has its ‘hardware’ and ‘software’ sections. The hardware part includes those lab-based investigations, the day-to-day hard work of the doctors and nurses, and the coordination of the government. This part has been mentioned frequently by the media. But people have not mentioned the software part much – the health communication with most people who are NOT infected. China has established good communications with the public. For example, most health education information I saw in Klagenfurt advises people to “frequently wash hand”. To me, this information does not make much sense. When is the appropriate time to wash hands? How long should I wash my hands? If you read instructions in Chinese, you will be surprised with the level of detail they provide. This is not to blame the educators here. I believe the initial version of hand-washing information in China was also unclear. Fortunately, we have 1 billion readers to question things. I also need to say that this health communication is a systematic work. Social media and traditional media (e.g., TV, newspaper) play a key role in shaping people’s knowledge and perception. I truly appreciate those conscientious health researchers who spent their holidays on public health education. I remember there was a rumor in early February. Some smokers said that tobacco smoking is a prevention for COVID-19. Some academic researchers quickly pointed out this rumor with evidence on WeChat (i.e., a widely used social media app in China), along with beautiful illustrations. Cigarette smoking is also a serious health problem in Austria, it is imperative to inform smokers of this high risk. Smokers infected with COVID-19 showed a worse lung condition compared to their non-smoking counterparts.

The coronavirus broke out in China a few weeks ago, now it seems to be getting closer to us here in Austria. Are we reacting quickly enough to the latest developments?

I do understand the difficulty of public health issues. The government has to deal with not only clinical and epidemiological evidence, but also risk management. It is a real test of the government’s overall abilities. There was also a delay in China due to many reasons. The main reason is the novelty of this virus. Nobody knew how to face it—even if you were the President! It is like a burglar who enters your house when you are sleeping. People usually do not have any countermeasures. The WHO has just declared the COVID-19 outbreak to be a pandemic. The Austrian government is taking timely measures. I believe we still have time to fight the virus.

Which psychological factors currently play a role when it comes to complying with restrictions?

My personal experience so far tells me perhaps it is the risk perception. From my conversations with many people in Klagenfurt, I found that most people treat the COVID-19 as a “normal flu”. Most people have the impression that COVID-19 is more likely to infect older people. These beliefs show some inaccuracies. Risk perception is relatively easy to change once accurate information is disseminated. For example, education interventionists may translate the latest version of the COVID-19 Diagnosis and Treatment Plan, informing the public of the transmission route of COVID-19 and other preventive practices. For example, the 7th version carefully mentions the aerosol transmission route of COVID-19, suggesting that cleaners may use stronger protection when they clean toilets. These specific points will guide people how to take care of themselves. A bad situation is when people are panicking, but do not know any actual protective actions. With stricter measures in the community, I also believe people will take it more seriously.

Once the quarantine is implemented (I personally hope this is not going to happen!), people often perceive fear and sense of isolation. When I was in China, where the public transport and shops were closed, I did have a lot of worries even though I had a good social support system there. If the quarantine happens here, universities should quickly think about building online networks to prevent potential mental health issues among people with weak social support (e.g., international students). Brooks et al. (in press) have published a timely review on the psychological impact of quarantine with some useful suggestions for policy makers. It may be helpful to read.

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet. doi:10.1016/S0140-6736(20)30460-8

How quickly do people get used to a state of emergency like this?

This answer really depends on the quality of health communications. Rather than predicting how quickly people would accept it, I think it is more important to consider how to make the control measures better. I think collective commitment and morality are most precious during times of difficulty. Consistent and transparent information should be provided from different levels of the government. Facilitating more e-learning and cyber communications is also important as it can reduce the transmission of the virus and help people concentrate on their work. Provision of living substance such as food can make people feel secure. As Klagenfurt is a very international community, it is also important to use multiple languages. Foreign language plus epidemic is a big terror to anyone! I cannot predict the future development of COVID-19, but let us keep positive and get ready for a protracted struggle. At last, let me end this dialogue with a quote from Chairman Mao: “In times of difficulty, we must not lose sight of our achievements, must see the bright future, and must pluck up our courage.”