The outbreak has exposed the powerlessness of private charities, civic groups and others who could help the effort but whom the Communist Party considers rivals.
Hospitals in Wuhan and surrounding Hubei province have been making urgent pleas to the Chinese people for three weeks as the new coronavirus ripples through the country: Send more protective gear.
Supplies are close — and yet frustratingly out of reach. Medical supplies donated to the Red Cross Society of China's Wuhan branch sit in warehouses. Individuals who try to organise relief supplies face violating the country's strict charity law.
Beijing has shown the world that it can shut down entire cities, build a hospital in 10 days and keep 1.4 billion people at home for weeks. But it has also shown a glaring weakness that imperils lives and threatens efforts to contain the outbreak: It is unable to work with its own people.
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The coronavirus outbreak has exposed the jarring absence in China of a vibrant civil society — the civic associations like business groups, nonprofit organisations, charities and churches that bring people together without involving the government.
Think of it as the nervous system that helps a society move smoothly and briskly — something Benjamin Franklin recognised over 200 years ago when he organised Philadelphia's first volunteer fire department, first public library and first charity hospital. "It is prodigious the quantity of good that may be done by one man, if he will make a business of it," he wrote in 1783.
"The traditional management mechanism of 'big government' is no longer efficient, and is even failing," Duan Zhanjiang, a management consultant, wrote in an article about managing the epidemic. "The government is very busy but not effective. The social forces aren't being utilised because they can only stand on the sideline, watching anxiously."
Duan suggested that the government restrain its urge to be in charge of everything and focus more on supervision.
The Communist Party has never liked or trusted civil society. It is suspicious of any organisation that could potentially pose a challenge to its rule, including big private enterprises. It has cracked down on nongovernment organisations like rights groups and charities as well as churches and mosques. The party wants nothing to stand between its government and China's 1.4 billion people.
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Big Chinese corporations and wealthy individuals have been donating, many generously. But they also try to keep low profiles for fear of offending a government that is eager to take credit for any success and quick to suspect outside groups of challenging it.
Those gaps are evident on the front lines of the outbreak, where workers have lacked the proper equipment to keep themselves safe. Doctors and nurses wear disposable raincoats instead of protective gowns. They wear ordinary, and inadequate, surgical masks while conducting dangerous throat swab tests. They wear adult diapers because, once they take off their one-piece protective suits, the suits will have to be thrown away. They get only one per day.
Authorities said Monday that more than 3,000 medical workers had been infected, though not all got the virus from work.
Ordinary Chinese people have set up social media groups to help patients find hospital beds, get volunteers to drive them to hospitals and scavenge the world for protective gear. In coordination with the government, they could do much more.
"We're just a small boat with very limited capacity," said Panda Yin, a designer in Beijing who organised a WeChat volunteer group of about 200 people to help find protective supplies for front line medical workers. "People came to us because they know the highway that's supposed to move fast has a big black hole on it."
That "big black hole" is the Red Cross Society of China. Unaffiliated with the Red Cross elsewhere, the Red Cross Society is one of two government-controlled organizations through which Beijing monopolises philanthropy. The Wuhan government has insisted that all donations go through the local chapter.
The Red Cross Society is notorious for corruption and inefficiency. The Chinese news media has reported on many of its scandals, including one nine years ago when a person who reportedly held a senior position there shared pictures of her opulent lifestyle online.
The Red Cross Society has been slow in giving away masks and other supplies, according to analyses by people in China based on incomplete data. Buttressing those claims, the central government Friday told it to speed up donations.
When the society did give out masks, it gave the best and the most directly to local government agencies instead of to front-line hospitals, according to its own data.
On February 11, the Wuhan government's epidemic-fighting central command, which counts top city officials among its members, received nearly 19,000 N95 medical masks, considered among the most effective in filtering particles. Union Hospital, one of Wuhan's biggest public hospitals, received only 450. It was one of only four hospitals that received masks. On Thursday, all N95 masks went to local heath commissions. None went to hospitals.
Three Red Cross officials in Hubei were disciplined this month. The Red Cross in Wuhan said this week that it was only one part of the city's resource supplying team and that city officials were in charge of allocating supplies.
If the Red Cross Society is a bottleneck in distributing medical supplies, the local and central governments can sometimes become obstacles in private efforts to make, buy and distribute these supplies.
The Communist Party does not trust the country's businesses, either.
In Xiantao, a city 70 110km from Wuhan and one of the world's biggest manufacturing centers for protective supplies, the local government shut down all but 10 of its protective-gear factories February 3.
A local official told the official People's Daily newspaper last week that the city had made the decision for quality control reasons. Out of 113 sizable companies in the city, the official said, only two have the certificates to sell medical protective gowns in China because the majority of Xiantao's nonwoven fabric products are for exports only.
Nonsense, said a factory owner in Xiantao who asked to be identified only by his surname, Wang, for fear of retribution. The protective suits he makes for his British and American clients have to meet standards that are equal to, if not higher than, those of China. Many are sold back to China anyway, he said. Xiantao officials did not respond to requests for comment.
The real reason is that Xiantao officials do not want to be held responsible if factory workers become infected or if quality problems emerge, said Wang and two other factory owners who requested anonymity for fear of reprisals, a contention backed by local media reports in China. They agreed that in this extraordinary time the government should set prices and scrutinise quality closely. But it can set rules and supervise them, Wang and others said, instead of shutting them down.
The city allowed 73 more companies back to work by Feb. 9, the local official told the People's Daily, after getting approval from the provincial government, giving it political cover in case anything goes wrong. But most of the factories remain idle, Wang and others said.
Xiantao also cut off private efforts to secure supplies.
Earlier this month, Xiantao city officials blocked volunteers from Jingzhou, a city in Hubei 160km to the west, from getting the supplies it needs. Xiantao authorities tried to confiscate their gear at a checkpoint as they were leaving, according to one volunteer, and they were kicked out of the city. The volunteer asked to be identified by the surname Zhang because he is a government employee and is not authorized to speak to the news media.
Zhang said he and other volunteers had to step in because the Jingzhou health commission was overwhelmed and too bureaucratic to move fast enough to provide supplies to local hospitals.
Photos and videos he shared on social media showed that volunteers had delivered protective clothing, goggles and medical alcohol to hospitals. He almost cried, he told a chat group, when he saw that doctors and nurses at a local fever clinic had nothing for protection except ordinary surgical masks. The head of the clinic was so grateful, he said, that she gave him four watermelons.
Volunteers like Zhang raise money for supplies through social media. One of his chat groups is made up mostly of entrepreneurs like Liu, a tech entrepreneur in his 50s who wanted only his surname used for fear of retribution.
One of the topics the group has debated is whether it can post its fundraising statements on WeChat Moments, a social media feature similar to Facebook's timeline. China has strict rules regulating individuals raising money from the public.
The business owners in Liu's group have experience dealing with the government. Some of them are wary of stepping on the toes of public health authorities, who can go after them for any potential violation of public fundraising rules.
If they have to stay clear of a very murky line, Liu argued, they probably won't be able to do anything.
"Human lives should come above everything else," he said.
Written by: Li Yuan
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