A red panda is pictured among cherry blossoms at Manor Wildlife Park in St. Florence, Wales, on April 15, 2020. The park is crowdfunding for food to feed its endangered animals as the spread of the coronavirus continues Luna watches from a tulip field on a sunny day in Grevenbroich, Germany, on April 15, 2020 Giulio Giovannini, 12, studies with a tablet, a small camping table, and a chair on top of a hill, where he is able to access the internet to participate in online lessons while schools remain closed in Scansano, Italy, on April 15, 2020. A Palestinian mother entertains her children with makeshift masks made of cabbage as she cooks in Beit Lahia, in the northern Gaza Strip, on April 16, 2020 Cheerleaders wearing face masks are seen at the first professional-baseball-league game of the season, at Taoyuan International Baseball Stadium in Taoyuan City, Taiwan, on April 11, 2020 Cardboard cutouts of fans are seen prior to the Chinese Professional Baseball League season-opening game between the Rakuten Monkeys and the CTBC Brothers at Taoyuan International Baseball Stadium in Taoyuan City, Taiwan, on April 11, 2020. The game was set to be played behind closed doors, without fans, due to the coronavirus pandemic. People observe social-distancing measures as they stand among hospital cubicles, while a giant screen displays an image of British Health Secretary Matt Hancock, speaking via video link during the official opening of the NHS Nightingale Hospital Birmingham on April 16, 2020. The hospital was set up inside the National Exhibition Centre in Birmingham, England, to help Britain's National Health Service cope with an expected influx of patients during the coronavirus pandemic. President Donald Trump departs after speaking about the coronavirus in the Rose Garden of the White House on April 14, 2020. A woman walks through the Square Mile at sunrise in London, England, on April 10, 2020 The Oculus transit hub sits empty of commuters on Easter Sunday, April 12, 2020, in New York City. A view of an empty street in Moscow, Russia, on April 15, 2020. Special digital passes were introduced in Russia for trips on personal and public transport, to work, medical facilities, or the grocery store. The pass is mandatory for travel around the city and can be obtained online or through a call or SMS. A view of Tower Bridge at sunrise in London, England, on April 16, 2020 A girl wears a mask while walking as the sun sets over the Mediterranean Sea coastline in Beirut, Lebanon, on April 14, 2020 A worker cleans a tunnel in the center of Budapest, Hungary, with a high-pressure washer on April 14, 2020 The bishop of Mallorca, Sebastià Taltavull, offers the traditional Easter Sunday Mass in a deserted cathedral in Palma de Mallorca, Spain, during the coronavirus outbreak on April 12, 2020 The sun begins to rise through trees standing among bluebells, also known as wild hyacinth, in the Hallerbos forest in Halle, Belgium, on April 16, 2020. The Italian tenor and opera singer Andrea Bocelli rehearses outside the Duomo cathedral on a deserted Piazza del Duomo in central Milan on April 12, 2020, prior to an evening performance, without a live audience, for a world wounded by the pandemic. Izabela Pitcher, the owner of Prior Attire, and her husband, Lucas, take their daily evening walk around their Buckinghamshire village near Milton Keynes, England, dressed in historical attire on April 13, 2020 Members of the artistic group Cirk La Putyka perform for residents stuck at home in Prague, Czech Republic, on April 14, 2020 People ride motorcycles during a sandstorm in Ouagadougou, Burkina Faso, on April 15, 2020 An aerial view of a boat on Die Hu (Butterfly Lake) in Zhengzhou, Henan province, China, on April 15, 2020 A shepherd leads a flock of sheep across the ancient Palu Bridge over the Murat River, a major source of the Euphrates as nomads make their way to the highlands with warmer temperatures in Elazig, Turkey, on April 13, 2020 A roll of toilet paper is towed by a drone as a stunt on the south bank of the River Thames in London on April 14, 2020 A statue of the Mexican actor and singer Pedro Infante in Mérida, Yucatán state, Mexico, is seen with a face mask on the 63rd anniversary of his death, April 15, 2020 A view of the world-famous Christ the Redeemer statue in Rio de Janeiro, Brazil, on Easter, April 12, 2020, with a doctor's uniform projected on it in honor of all the medical staff fighting the coronavirus worldwide. Health workers gesture as citizens show their support from their balconies and windows in Barcelona, Spain, on April 15, 2020 Residents applaud across France to show their support to health-care employees in Paris on April 14, 2020, the 29th day of a lockdown aimed at curbing the spread of the coronavirus. Emma Pritchett, 78, holds up a broken glass from her kitchen sink in Chatsworth, Georgia, on April 13, 2020, the day after a tornado hit. Severe weather swept across the South, killing multiple people and damaging hundreds of homes from Louisiana into the Appalachian Mountains Construction workers walk at the site of the Grand Egyptian Museum, in front of the Giza pyramids, on the outskirts of Cairo, Egypt, on April 13, 2020, after the museum's opening was postponed this year amid the coronavirus outbreak. Police officers on horses ride on Fifth Avenue near Saint Patrick’s Cathedral on Easter Sunday, April 12, 2020, in New York City. A large number of parked buses sit idle at a depot in the Brazilian city of Curitiba where only half of the fleet is circulating due to the drop in passengers caused by the coronavirus outbreak. People pose for photos in a tulip field as the sun shines in Grevenbroich, Germany, on April 14, 2020 Lauren Dufrat wears gloves as a coronavirus precaution as she puts out Easter eggs for her neighbors' children to find on Easter Sunday, April 12, 2020, in Washington, D.C Catholic priests ride on a truck with a statue of Jesus on the cross, to bless residents quarantined in their homes as part of Good Friday commemorations, amid a government lockdown on April 10, 2020, in Mandaluyong, Manila, Philippines A policeman wearing a coronavirus helmet distributes pamphlets to raise awareness about the virus in a residential area of Chennai, India, on April 12, 2020
On November 8, 2017, Air Force One touched down in Beijing, marking the start of a state visit hosted by China’s president and Communist Party chairman, Xi Jinping. From my first day on the job as President Donald Trump’s national security adviser, China had been a top priority. The country figured prominently in what President Barack Obama had identified for his successor as the biggest immediate problem the new administration would face—what to do about North Korea’s nuclear and missile programs. But many other questions about the nature and future of the relationship between China and the United States had also emerged, reflecting China’s fundamentally different perception of the world.
Since the heady days of Deng Xiaoping, in the late 1970s, the assumptions that had governed the American approach to our relationship with China were these: After being welcomed into the international political and economic order, China would play by the rules, open its markets, and privatize its economy. As the country became more prosperous, the Chinese government would respect the rights of its people and liberalize politically. But those assumptions were proving to be wrong.
China has become a threat because its leaders are promoting a closed, authoritarian model as an alternative to democratic governance and free-market economics. The Chinese Communist Party is not only strengthening an internal system that stifles human freedom and extends its authoritarian control; it is also exporting that model and leading the development of new rules and a new international order that would make the world less free and less safe. China’s effort to extend its influence is obvious in the militarization of man-made islands in the South China Sea and the deployment of military capabilities near Taiwan and in the East China Sea. But the integrated nature of the Chinese Communist Party’s military and economic strategies is what makes it particularly dangerous to the United States and other free and open societies.
John King Fairbank, the Harvard historian and godfather of American sinology, noted in 1948 that to understand the policies and actions of Chinese leaders, historical perspective is “not a luxury, but a necessity.” During our state visit, Xi and his advisers relied heavily on history to convey their intended message. They emphasized certain historical subjects. They avoided others.
The American delegation—which included President Trump and the first lady, Secretary of State Rex Tillerson, and the U.S. ambassador to China, Terry Branstad—received its first history lesson as it toured the Forbidden City, the seat of Chinese emperors for five centuries. We were accompanied by Xi, his wife, and several other senior Chinese leaders. The message—conveyed in private conversations and public statements, as well as in official TV coverage and by the very nature of the tour—was consistent with Xi’s speech three weeks earlier at the 19th National Congress: The Chinese Communist Party was relentlessly pursuing the “great rejuvenation of the Chinese nation.” As Xi described it, “rejuvenation” encompassed prosperity, collective effort, socialism, and national glory—the “China dream.” The Forbidden City was the perfect backdrop for Xi to showcase his determination to “move closer to the center of the world stage and to make a greater contribution to humankind.”
The Forbidden City was built during the Ming dynasty, which ruled China from 1368 to 1644—a period considered to be a golden age in terms of China’s economic might, territorial control, and cultural achievements. It was during this dynasty that Zheng He, an admiral in the Ming fleet, embarked on seven voyages around the Western Pacific and Indian Oceans, more than half a century before Christopher Columbus set sail. His “treasure ships,” among the largest wooden vessels ever built, brought back tribute from all parts of the known world. But despite the success of the seven voyages, the emperor concluded that the world had nothing to offer China. He ordered the treasure ships scuttled and Chinese ports closed. The period that followed—the 19th and 20th centuries in particular—is seen by Xi and others in the leadership as an aberrational period during which European nations and, later, the United States achieved economic and military dominance.
Like the closing show of the 2008 Beijing Olympics, which placed modern technological innovation in the context of 5,000 years of Chinese history, the tour of the Forbidden City was meant, it seemed, as a reminder that Chinese dynasties had long stood at the center of the Earth. The art and architectural style of the buildings reflected the Confucian social creed: that hierarchy and harmony fit together and are interdependent. The emperor held court in the Hall of Supreme Harmony, the largest building in the Forbidden City. The grand throne is surrounded by six golden pillars, engraved with dragons to evoke the power of an emperor whose state ruled over tianxia—over “everything beneath heaven.”
While the images broadcast to China and the rest of the world from the Forbidden City during our visit were meant to project confidence in the Chinese Communist Party, one could also sense a profound insecurity—a lesson of history that went unmentioned. In its very design, the Forbidden City seemed to reflect that contrast between outward confidence and inner apprehension. The three great halls at the city’s center were meant not only to impress, but also to defend from threats that might come from both outside and inside the city’s walls. After the end of the Han dynasty, in a.d. 220, China’s core provinces were ruled only half the time by a strong central authority. And even then, China was subject to foreign invasion and domestic turmoil. The Yongle emperor, Zhu Di, who built the Forbidden City, was more concerned about internal dangers than he was about the possibilities of another Mongol invasion. To identify and eliminate opponents, the emperor set up an elaborate spy network. To preempt opposition from scholars and bureaucrats, he directed the executions of not only those suspected of disloyalty, but also their entire families. The Chinese Communist Party used similar tactics centuries later. Like Xi, the emperors who sat on the elaborate throne in the heart of the Forbidden City practiced a remote and autocratic style of rule vulnerable to corruption and internal threats.
Our guide showed us where the last royal occupant of the Forbidden City, Emperor Puyi, was stripped of power in 1911, at the age of 5, during China’s republican revolution. Puyi abdicated in the midst of the “century of humiliation,” a period of Chinese history that Xi had described to Trump when the two leaders met for dinner at Mar-a-Lago, seven months before our tour. The century of humiliation was the unhappy era during which China experienced internal fragmentation, suffered defeat in wars, made major concessions to foreign powers, and endured brutal occupation. The humiliation began with Great Britain’s defeat of China in the First Opium War, in 1842. It ended with the Allied and Chinese defeat of imperial Japan in 1945 and the Communist victory in the Chinese Civil War in 1949.
Our last meeting of the state visit, in the Great Hall of the People, was with Li Keqiang, the premier of the State Council and the titular head of China’s government. If anyone in the American group had any doubts about China’s view of its relationship with the United States, Li’s monologue would have removed them. He began with the observation that China, having already developed its industrial and technological base, no longer needed the United States. He dismissed U.S. concerns over unfair trade and economic practices, indicating that the U.S. role in the future global economy would merely be to provide China with raw materials, agricultural products, and energy to fuel its production of the world’s cutting-edge industrial and consumer products.
Leaving China, I was even more convinced than I had been before that a dramatic shift in U.S. policy was overdue. The Forbidden City was supposed to convey confidence in China’s national rejuvenation and its return to the world stage as the proud Middle Kingdom. But for me it exposed the fears as well as the ambitions that drive the Chinese Communist Party’s efforts to extend China’s influence along its frontiers and beyond, and to regain the honor lost during the century of humiliation. The fears and ambitions are inseparable. They explain why the Chinese Communist Party is obsessed with control—both internally and externally.
The party’s leaders believe they have a narrow window of strategic opportunity to strengthen their rule and revise the international order in their favor—before China’s economy sours, before the population grows old, before other countries realize that the party is pursuing national rejuvenation at their expense, and before unanticipated events such as the coronavirus pandemic expose the vulnerabilities the party created in the race to surpass the United States and realize the China dream. The party has no intention of playing by the rules associated with international law, trade, or commerce. China’s overall strategy relies on co-option and coercion at home and abroad, as well as on concealing the nature of China’s true intentions. What makes this strategy potent and dangerous is the integrated nature of the party’s efforts across government, industry, academia, and the military.
And, on balance, the Chinese Communist Party’s goals run counter to American ideals and American interests.
II. Three Prongs
As China pursues its strategy of co-option, coercion, and concealment, its authoritarian interventions have become ubiquitous. Inside China, the party’s tolerance for free expression and dissent is minimal, to put it mildly. The repressive and manipulative policies in Tibet, with its Buddhist majority, are well known. The Catholic Church and, in particular, the fast-growing Protestant religions are of deep concern to Xi and the party. Protestant Churches have proved difficult to control, because of their diversity and decentralization, and the party has forcefully removed crosses from the tops of church buildings and even demolished some buildings to set an example. Last year, Beijing’s effort to tighten its grip on Hong Kong sparked sustained protests that continued into 2020—protests that Chinese leaders blamed on foreigners, as they typically do. In Xinjiang, in northwestern China, where ethnic Uighurs mainly practice Islam, the party has forced at least 1 million people into concentration camps. (The government denies this, but last year The New York Times uncovered a cache of incriminating documents, including accounts of closed-door speeches by Xi directing officials to show “absolutely no mercy.”)
Party leaders have accelerated the construction of an unprecedented surveillance state. For the 1.4 billion Chinese people, government propaganda on television and elsewhere is a seamless part of everyday life. Universities have cracked down on teaching that explains “Western liberal” concepts of individual rights, freedom of expression, representative government, and the rule of law. Students in universities and high schools must take lessons in “Xi Jinping Thought on Socialism With Chinese Characteristics for a New Era.” The chairman’s 14-point philosophy is the subject of the most popular app in China, which requires users to sign in with their cellphone number and real name before they can earn study points by reading articles, writing comments, and taking multiple-choice tests. A system of personal “social credit scores” is based on tracking people’s online and other activity to determine their friendliness to Chinese government priorities. Peoples’ scores determine eligibility for loans, government employment, housing, transportation benefits, and more.
The party’s efforts to exert control inside China are far better known than its parallel efforts beyond China’s borders. Here again, insecurity and ambition are mutually reinforcing. Chinese leaders aim to put in place a modern-day version of the tributary system that Chinese emperors used to establish authority over vassal states. Under that system, kingdoms could trade and enjoy peace with the Chinese empire in return for submission. Chinese leaders are not shy about asserting this ambition. In 2010, China’s foreign minister matter-of-factly told his counterparts at a meeting of the Association of Southeast Asian Nations: “China is a big country, and you are small countries.” China intends to establish a new tributary system through a massive effort organized under three overlapping policies, carrying the names “Made in China 2025,” “Belt and Road Initiative,” and “Military-Civil Fusion.”
“Made in China 2025” is designed to help China become a largely independent scientific and technological power. To achieve that goal, the party is creating high-tech monopolies inside China and stripping foreign companies of their intellectual property by means of theft and forced technology transfer. In some cases, foreign companies are forced to enter into joint ventures with Chinese companies before they are permitted to sell their products in China. These Chinese companies mostly have close ties to the party, making routine the transfer of intellectual property and manufacturing techniques to the Chinese government.
The “Belt and Road Initiative” calls for more than $1 trillion in new infrastructure investments across the Indo-Pacific region, Eurasia, and beyond. Its true purpose is to place China at the hub of trade routes and communications networks. While the initiative at first received an enthusiastic reception from nations that saw opportunities for economic growth, many of those nations soon realized that Chinese investment came with strings attached.
The Belt and Road Initiative has created a common pattern of economic clientelism. Beijing first offers countries loans from Chinese banks for large-scale infrastructure projects. Once the countries are in debt, the party forces their leaders to align with China’s foreign-policy agenda and the goal of displacing the influence of the United States and its key partners. Although Chinese leaders often depict these deals as win-win, most of them have just one real winner.
For developing countries with fragile economies, Belt and Road sets a ruthless debt trap. When some countries are unable to service their loans, China trades debt for equity to gain control of their ports, airports, dams, power plants, and communications networks. As of 2018, the risk of debt distress was growing in 23 countries with Belt and Road financing. Eight poor countries with Belt and Road financing—Pakistan, Djibouti, the Maldives, Laos, Mongolia, Montenegro, Tajikistan, and Kyrgyzstan—already have unsustainable levels of debt.
China’s tactics vary based on the relative strength or weakness of the target states. When undertaking large-scale investment projects, many countries with weak political institutions succumb to corruption, making them even more vulnerable to Chinese tactics.
In Sri Lanka, the longtime president and current prime minister, Mahinda Rajapaksa, incurred debts far beyond what his nation could bear. He agreed to a series of high-interest loans to finance Chinese construction of a port, though there was no apparent need for one. Despite earlier assurances that the port would not be used for military purposes, a Chinese submarine docked there the same day as Japanese Prime Minister Shinzo Abe’s visit to Sri Lanka in 2014. In 2017, following the commercial failure of the port, Sri Lanka was forced to sign a 99-year lease to a Chinese state-owned enterprise in a debt-for-equity swap.
The new vanguard of the Chinese Communist Party is a delegation of bankers and party officials with duffel bags full of cash. Corruption enables a new form of colonial-like control that extends far beyond strategic shipping routes in the Indian Ocean and South China Sea, and elsewhere.
The Military-Civil Fusion policy is the most totalitarian of the three prongs. In 2014 and then again in 2017, the party declared that all Chinese companies must collaborate in gathering intelligence. “Any organization or citizen,” reads Article 7 of China’s National Intelligence Law, “shall support, assist with, and collaborate with the state intelligence work in accordance with the law, and keep the secrets of the national intelligence work known to the public.” Chinese companies work alongside universities and research arms of the People’s Liberation Army. Military-Civil Fusion encourages state-owned and private enterprises to acquire companies with advanced technologies, or a strong minority stake in those companies, so that the technologies can be applied for not only economic but also military and intelligence advantage. It fast-tracks stolen technologies to the army in such areas as space, cyberspace, biology, artificial intelligence, and energy. In addition to espionage and cybertheft by the Ministry of State Security, the party tasks some Chinese students and scholars in the U.S. and at other foreign universities and research labs with extracting technology.
Sometimes U.S. defense funding supports China’s technology transfers. One of many examples is the Kuang-Chi Group, described in the Chinese media as “a military-civilian enterprise.” The Kuang-Chi Group was founded largely on the basis of U.S. Air Force–funded research into meta-materials at Duke University.
Chinese cybertheft is responsible for what General Keith Alexander, the former director of the National Security Agency, described as the “greatest transfer of wealth in history.” The Chinese Ministry of State Security used a hacking squad known as APT10 to target U.S. companies in the finance, telecommunications, consumer-electronics, and medical industries as well as NASA and Department of Defense research laboratories, extracting intellectual property and sensitive data. For example, the hackers obtained personal information, including Social Security numbers, for more than 100,000 U.S. naval personnel.
China’s military has used stolen technologies to pursue advanced military capabilities of many kinds and drive U.S. defense companies out of the market. The Chinese drone manufacturer Dà-Jiāng Innovations (DJI) controlled more than 70 percent of the global market in 2017, thanks to its unmatched low prices. Its unmanned systems even became the most frequently flown commercial drones by the U.S. Army until they were banned for security reasons.
Chinese espionage is successful in part because the party is able to induce cooperation, wittingly or unwittingly, from individuals, companies, and political leaders. Companies in the United States and other free-market economies often do not report theft of their technology, because they are afraid of losing access to the Chinese market, harming relationships with customers, or prompting federal investigations.
Co-option crosses over to coercion when the Chinese demand that companies adhere to the Communist Party’s worldview and forgo criticism of its repressive and aggressive policies. When a Marriott employee using a company social-media account “liked” a pro-Tibet tweet in 2018, the hotel company’s website and app were blocked in China for a week, and the employee was fired under pressure from the Chinese government. Last October, when Daryl Morey, the general manager of the Houston Rockets basketball team, tweeted his support of the Hong Kong protesters, Chinese state-run television canceled the broadcast of Rockets games.
The Chinese Communist Party has also pursued a broad range of influence efforts in order to manipulate political processes in target nations. Sophisticated Chinese efforts have been uncovered in Australia and New Zealand to buy influence within universities, bribe politicians, and harass the Chinese diaspora community into becoming advocates for Beijing.
III. Strategic Empathy
Americans, as Hans Morgenthau noted long ago, tend to view the world only in relation to the United States, and to assume that the future course of events depends primarily on U.S. decisions or plans, or on the acceptance by others of our way of thinking. The term for this tendency is strategic narcissism, and it underlies the long-held assumptions I mentioned earlier: about how greater integration of China into the international order would have a liberalizing effect on the country and alter its behavior in the world.
But there’s another way of thinking about how countries behave: strategic empathy. According to the historian Zachary Shore, strategic empathy involves trying to understand how the world looks to others, and how those perceptions, as well as emotions and aspirations, influence their policies and actions. An outlook of strategic empathy, taking into account history and experience, leads to a very different set of assumptions about China—one that is borne out by the facts.
The Chinese Communist Party is not going to liberalize its economy or its form of government. It is not going to play by commonly accepted international rules—rather, it will attempt to undermine and eventually replace them with rules more sympathetic to China’s interests. China will continue to combine its form of economic aggression, including unfair trade practices, with a sustained campaign of industrial espionage. In terms of projecting power, China will continue to seek control of strategic geographic locations and establish exclusionary areas of primacy.
Any strategy to reduce the threat of China’s aggressive policies must be based on a realistic appraisal of how much leverage the United States and other outside powers have on the internal evolution of China. The influence of those outside powers has structural limits, because the party will not abandon practices it deems crucial to maintaining control. But we do have important tools, quite apart from military power and trade policy.
For one thing, those “Western liberal” qualities that the Chinese see as weaknesses are actually strengths. The free exchange of information and ideas is an extraordinary competitive advantage, a great engine of innovation and prosperity. (One reason Taiwan is seen as such a threat to the People’s Republic is because it provides a small-scale yet powerful example of a successful political and economic system that is free and open rather than autocratic and closed.) Freedom of the press and freedom of expression, combined with robust application of the rule of law, have exposed China’s predatory business tactics in country after country—and shown China to be an untrustworthy partner. Diversity and tolerance in free and open societies can be unruly, but they reflect our most basic human aspirations—and they make practical sense too. Many Chinese Americans who remained in the United States after the Tiananmen Square massacre were at the forefront of innovation in Silicon Valley.
Beyond a focus on strengths that the Chinese Communist Party regards as our weaknesses, there are explicit protective steps we must take. They include the following:
Many universities, research labs, and companies in countries that value the rule of law and individual rights are witting or unwitting accomplices in China’s use of technology to repress its people and improve the Chinese military’s capabilities. For dual-use technologies, the private sector should seek new partnerships with those who share commitments to free-market economies, representative government, and the rule of law, not with those acting against these principles. Many companies are engaged in joint ventures or partnerships that help China develop technologies suited for internal security, such as surveillance, artificial intelligence, and biogenetics. In one of many examples, a Massachusetts-based company sold DNA-sampling equipment that has helped the Chinese government track Uighurs in Xinjiang. (The company has ended such sales.) Companies that knowingly collaborate with China’s efforts to repress its own people or build threatening military capabilities should be penalized.
Many Chinese companies directly or indirectly involved in domestic human-rights abuses and violation of international treaties are listed on American stock exchanges. Those companies benefit from U.S. and other Western investors. Tougher screening of U.S., European, and Japanese capital markets would help restrict corporate and investor complicity in China’s authoritarian agenda. Free-market economies like ours control the majority of the world’s capital, and we have far more leverage than we are employing.
China’s use of major telecommunications companies to control communications networks and the internet overseas must be countered. There should no longer be any dispute concerning the need to defend against the multinational technology company Huawei and its role in China’s security apparatus. In 2019, a series of investigations revealed incontrovertible evidence of the grave national-security danger associated with a wide array of Huawei’s telecommunications equipment. Many Huawei workers are simultaneously employed by China’s Ministry of State Security and the intelligence arm of the People’s Liberation Army. Huawei technicians have used intercepted cell data to help autocratic leaders in Africa spy on, locate, and silence political opponents. A priority area for multinational cooperation among free societies should be the development of infrastructure, particularly 5G communications, to form trusted networks that protect sensitive and proprietary data.
We must defend against Chinese agencies that coordinate influence operations abroad—such as the Ministry of State Security, the United Front Work Department, and the Chinese Students and Scholars Association. At the same time, we should try to maximize positive interactions and experiences with the Chinese people. The United States and other free and open societies should consider issuing more visas and providing paths to citizenship for more Chinese—with proper safeguards in place. Chinese who engage with citizens of free countries are the ones who are most likely to question their government’s policies—whether from abroad or when they return home.
The U.S. and other free nations should view expatriate communities as a strength. Chinese abroad—if protected from the meddling and espionage of their government—can provide a significant counter to Beijing’s propaganda and disinformation. Investigations and expulsions of Ministry of State Security and other agents should be oriented not only toward protecting the targeted country but also toward protecting the Chinese expatriates within it.
Without effective pushback from the United States and like-minded nations, China will become even more aggressive in promoting its statist economy and authoritarian political model. For me, the state visit to Beijing—and exposure to China’s powerful combination of insecurity and ambition—reinforced my belief that the United States and other nations must no longer adhere to a view of China based mainly on Western aspirations. If we compete aggressively, we have reason for confidence. China’s behavior is galvanizing opposition among countries that do not want to be vassal states. Internally, the tightening of control is also eliciting opposition. The bravado of Li Keqiang and other officials may be intended to evoke the idea of China as sovereign of “everything beneath heaven,” but many beneath heaven do not, and must not, agree.
The ordinary laws no longer govern. Every day, new rules are being written to deal with the crisis. Freedoms are curtailed. Enforcement is heavy-handed. Usual civil-liberties protections, such as rights of appeal, are suspended. By act, if not by word, a state of emergency has been declared. This is not a description of the United States, or even Hungary. It’s the internet during the coronavirus pandemic. We are living under an emergency constitution invoked by Facebook, Google, and other major tech platforms. In normal times, these companies are loath to pass judgment about what’s true and what’s false. But lately they have been taking unusually bold steps to keep misinformation about COVID-19 from circulating.
As a matter of public health, these moves are entirely prudent. But as a matter of free speech, the platforms’ unconstrained power to change the rules virtually overnight is deeply disconcerting.
As this crisis unfolds, Facebook says it is “limiting misinformation and harmful content” at an unprecedented level. In March alone, it displayed fact-checking warnings on 40 million posts related to the pandemic and took down hundreds of thousands of posts that it said could lead to physical harm. On Thursday, the company went so far as to announce that it will individually alert users who have commented upon, liked, or otherwise reacted to debunked myths about COVID-19. Meanwhile, Twitter’s blog post about how it is “broadening [its] definition of harm” contains a long and growing list of types of tweets that the platform is removing. Google says it has “taken down thousands of videos” to protect people from misinformation. These are all important steps, so why not just applaud and move on?
Mark Zuckerberg has justified Facebook’s newly hands-on approach on the basis that “you can’t yell fire in a crowded theatre.” But what constitutes shouting “fire”—and how far platforms should go in their willingness to intervene—is a matter of significant controversy.
The urgent need for platforms to do something should not stop us from asking questions about the powers these and other titans of the online world have assumed under a state of emergency. The platforms, which operate across national borders, are private companies that generally have the right to pick and choose what they allow on their services. But the awesome nature of this power—the ability to decide what is hate speech, permissible political campaigning, or too much bare skin—has led to calls for more accountability in the way platforms exercise it. Time and again, Facebook and other platforms have disavowed any role as “arbiters of truth,” and they have laid out ostensibly neutral rules for deciding what to take down, tried to set processes for enforcing them nonarbitrarily, and offered limited right of appeal to users who have been found to violate them. These efforts were evolving into a silent constitution that bound users and the platforms themselves. But now it’s been rewritten.
In constitutional-law scholarship, an emergency constitution describes an exceptional state of governance that operates during a crisis and enhances the powers of those in charge. About 90 percent of countries have explicit provisions for how to deal with states of emergency. Their form varies a lot, but typically certain rights and liberties are curtailed, and checks and balances removed, to allow for a more decisive and forceful response to whatever disaster threatens the constitutional order. The ongoing pandemic has, unsurprisingly, triggered the invocation of many emergency constitutions around the world, so governments can take exceptional measures to deal with the unfolding public-health crisis. People’s privacy, freedom of movement, and freedom of speech are being restricted in ways that would not be accepted in ordinary times.
Major tech companies, too, have responded to the pandemic in ways that expose just how much power they can exercise when they decide to do so.
First, many platforms—not just Facebook, Twitter, and Google—have adopted new rules specifically addressing coronavirus-related content. Amazon has quietly removed dozens of books containing conspiracy theories or medical misinformation. Medium is aggressively taking down viral posts under a new policy on COVID-19 content, despite the site’s mission to be a platform for “whatever you have to say.” Reddit has added warning messages on two subreddits for boosting misinformation. Pinterest is limiting all search results about the coronavirus to those from “internationally-recognized health organizations.” Internet companies, in short, are trying to impose guardrails.
Second, enforcement during the state of emergency is swift and blunt. With most human content moderators at home and unable to work remotely for logistical reasons, the major platforms have to rely on their automated tools more than normal. Facebook, Twitter, and YouTube all acknowledged that they would make more mistakes as a result. In other words, they would remove speech that should stay up. This speech becomes collateral damage in the mobilization around the pandemic, and a concession to the exigencies of the moment. With misinformation a potential matter of life and death, and simply no way of having humans review every post, the choice between blunt tools and no moderation at all is simple.
Even the usually sacred principle that platforms will not interfere with the speech of political figures has been abandoned. After Twitter removed tweets from the Brazilian President Jair Bolsonaro for violating its policies by tweeting false or misleading information about COVID-19 cures, Facebook and YouTube quickly followed. For a tech platform to suppress statements by a democratically elected leader is a truly remarkable step—and potentially one that makes it harder for voters to hold their representatives accountable in the future.
Third, even with these sweeping new rules and blunter enforcement, platforms have been suspending their usual due-process protections. Being muted by an algorithm on Facebook or YouTube may have no legal consequence—unlike, say, being silenced by police in the public square. Still, the former is a much greater hindrance than the latter is on a person’s ability to connect with an audience, especially at a moment of social distancing. Nevertheless, without as many human content moderators on deck, the major platforms have all scaled back their appeals processes for people who feel their posts were taken down incorrectly.
The platforms are revealing their far-reaching power in other ways. For some time before the pandemic, members of Congress and regulators around the world had been attacking major internet companies over their data-collection and data-sharing practices. Yet in recent weeks, Facebook and Google have presented their troves of hyper-detailed data as a boon to disease researchers and have unveiled new products that employ user information to help document the pandemic’s spread and organize response efforts. As the tech journalist Casey Newton wrote recently, “Big tech companies, which have spent the past three years on the defensive over their data collection practices, are now promoting them.”
If ever an emergency justified a clampdown on misinformation and other extraordinary measures, the coronavirus pandemic is surely it. The tech companies’ swift action in the current crisis has beenwidelypraised, and so it should be. But this still leaves very real questions. Unlike most countries’ emergency constitutions, those of major platforms have no checks or constraints. Are these emergency powers temporary? Will there be any oversight to ensure these powers are being exercised proportionately and even-handedly? Are data being collected to assess the effectiveness of these measures or their cost to society, and will those data be available to independent researchers? The question is alreadybeingasked whether things should ever go back to “normal”—or whether this more iron-fisted rule is what the internet needed all along. The favorable news coverage that platforms are receiving will no doubt make similar heavy-handedness more tempting in the future—and in circumstances far less dire than a global pandemic. Users have no way of forcing platforms to answer any of these concerns. Indeed, the state of emergency throws into sharp relief what is always true about the majority of regulation of online speech: the powers of rule making, enforcement, and review are all concentrated in the same hands. What’s happening during the pandemic is just an accentuated version of the norm. It has shown that even the most seemingly entrenched rules can be instantly overthrown. Right now, this may be helpful. But what about once the worst of this crisis subsides?
I trained for this moment. All emergency-medicine physicians did. Residency training—the notorious gantlet that turns medical students into attending physicians—prepared me to manage an onslaught of patients entirely on my own. I may be ready, but that doesn’t mean the situation I’m in is right.
At Bellevue Hospital, where I trained, New York’s most disenfranchised patients come through the doors at every hour of the day. While my attendings taught me to diagnose appendicitis, ectopic pregnancy, and multiple sclerosis, they also watched me fail. They watched me struggle to keep up with the pace of the department, to remain calm when patients would mock my race or sexual orientation, to cope with my own emotional reaction to the destitution, hunger, and loneliness that so many patients take as a given. The directive throughout was that I needed to pull myself up by my bootstraps. No one would do it for me or teach me how.
So why should I or any physician have expected more than a meaningless cacophony of messaging at this exceptional time of need? President Donald Trump has promised Americans access to testing. And yet, before the state of emergency, the New York City Department of Health mandated testing only for admitted patients. As a physician, I was stuck in the middle, left to absorb the ire of patients who accused me of being uncaring. They did not want to hear from me that they had been lied to, that the system did not have capacity, and that they needed to come back when they were even sicker for treatment.
Health-care systems in America do not support physicians and do not support the most vulnerable patients. Physicians are seen as upwardly mobile and willing to pay the price of unacceptably low residency pay and backbreaking work in order to do what they love. Patients without access to care are seen as unambiguous—they lack insurance because they do not work. Hopefully this crisis opens the eyes of Americans to the plight of both groups.
The White House, the Centers for Disease Control and Prevention, the Department of Health, the National Institutes of Health—they all failed to deliver on sufficient testing, on guidelines, on coherent messaging. Hospitals across New York City failed to report health-care-worker fatality rates or to produce ventilation-eligibility criteria, leaving me to guess at my own risk and to decide who lives and dies. There has been an abdication of leadership at the highest levels of this crisis that has trickled down to me, a physician in an ER with inadequate personal protections telling oxygen-starved patients to come back when they cannot speak a full sentence or are coughing up more than one tablespoon of blood. These institutions, just like my attendings, are teaching me a lesson through absence: how to manage a pandemic alone. And I am ready because I have been left alone before.
“Sink or swim” seems to be the mantra of medical training. The second year of my residency was physically taxing, with eight or nine 12-hour overnight shifts in a row. I frequently had to flip my sleep schedule to wake up at 6 a.m. or 5 p.m., depending on the day. The physical rigor of residency left me moody, weary, stretched thin. And yet that was only the beginning of the process. On top of the physical exhaustion, residency pushes new physicians to extreme autonomy.
My attendings could have easily lightened my patient load, but they did not, so that I could learn self-sufficiency. They could have acknowledged the particular challenges I faced later as a black physician at NYU Medical Center, treating upper-class white patients who sometimes doubted that I was even a doctor. But they did not, so I could learn resilience. They could have counseled me on how to process the immense human suffering of Bellevue. Instead they mostly did not, leaving me to internalize my agony, and see the next patient. Their effective absence—only there as a malpractice safety net—taught me how to work efficiently, to manage an entire team of caregivers in the emergency department, and eventually to manage the ugliest parts of myself and others.
This approach was not without its costs. The isolation at work was made worse by isolation at home. A resident work schedule spares no nights or weekends; I craved moments of release or nourishment with friends and family and found them few and far between. The social isolation compounded by intense personal tragedies—the loss of my mother while I was in medical school and my father during my residency—had me at wits’ end, and eventually forced me into therapy and a two-week elective period that I used as a wellness leave. But residency had made me competent in my field and able to practice in a vacuum. Costs be damned.
Now, at Columbia University Irving Medical Center, I again find myself socially isolated from friends and family, navigating experiences my loved ones will never truly understand. During the surge of patients sick with COVID-19, personal protective equipment was promised to me, but only a month ago I had to intubate patients with a used sheet protector and industrial paper clips as protection. This is not why I became a physician, but I did not resist, because I have ceased to expect appropriate support from administrators, institutions, and the government itself.
The volume of patients has plateaued, so I have more time to prepare myself for the difficult decisions ahead that I am certain I will again face alone. Contemporary analyses already demonstrate that the burden of this pandemic is falling most heavily on our country’s most disenfranchised groups. I fear that postmortem analyses will show the death count to be orders of magnitude greater in hot spots like Elmhurst, Queens.
The wealthiest Americans stay home and practice social distancing while essential workers continue to expose themselves and their relatives in dense, multigenerational family housing. And although the world should look to its legislators to provide basic income and housing to vulnerable groups, instead it looks to hospitals, to doctors, to save as many as possible. And we will do our best to sort the living from the dead, because we cannot say no. Because we work in a system that mandates we say yes. Yes to extra shifts, yes to unsafe working conditions, yes to deciding who lives and who dies. This can-do attitude will be the undoing of many of us.
In the meantime, doctors are left alone to sort through our own mental anguish. Which end-of-life conversation will keep me awake at night in a decade? Which face will flash into my consciousness when I’m commuting to work? Essential to sink or swim is acting now and thinking later.
Those that live through this crisis must not let its lessons go unlearned. People must elect leadership that will not lie to us. We must seek transparency from our institutions. We must reform a culture of medicine that tells trainees they must endure alone. Otherwise, how will we survive the next crisis?
Even as Donald Trump has delineated his plan to relax social distancing, the United States remains very much in the dark about who has the coronavirus and who does not. We have a shortage of COVID-19 tests, and we simultaneously have the highest number of confirmed cases in the world. Consequently, not every American who wants a test can get one. Not every health-care worker can get one. Not even every patient entering a hospital can get one. Because of the shortages, we are rationing tests, and medical facilities and public-health officials are prioritizing the sickest patients for them.
If the goal is to restart the American economy, the United States isn’t performing anywhere near enough tests. Worse still, we are testing the wrong people. To safely reopen closed businesses and revive American social life, we need to perform many more tests—and focus them on the people most likely to spread COVID-19, not sick patients.
COVID-19 testing has been an unmitigated failure in this country. This month, according to the COVID Tracking Project, a data initiative launched by The Atlantic in March, the number of tests performed in the United States has plateaued at about 130,000 to 160,000 a day. Rather than growing rapidly—as all experts think is absolutely necessary—the daily number of tests administered in some jurisdictions has even decreased. In New York, for instance, 10,241 tests were performed on April 6, but supply limits forced a huge drop a few days later to 25 total tests. Quest Diagnostics, one of the two biggest firms that run tests, just furloughed 9 percent of its workforce. In addition, news reports suggest that, as of last week, 90 percent of the 15-minute tests developed by Abbott Laboratories are idle due to a lack of necessary reagents and qualified personnel. Testing bottlenecks such as these are major obstacles to getting Americans out of their homes and back on the job.
How many tests do we need in order to safely relax social-distancing measures, reopen nonessential businesses and schools, and allow large gatherings? According to the Morgan Stanley analyst Matthew Harrison and the Harvard professor Ashish Jha, we should be conducting a minimum of 500,000 tests a day. One of the authors of this article, Paul Romer, has called for the capacity to run 20 million to 30 million tests a day. Even this has been criticized as insufficient for the task of identifying enough of the asymptomatic spreaders to keep the pandemic in check.
Current guidelines from the Centers for Disease Control and Prevention give priority first to hospitalized patients and symptomatic health-care workers, then to high-risk patients, specifically those over 65 and those suffering from other serious health conditions, with COVID-19 symptoms. Under this system, asymptomatic individuals are not tested, even if they had contact with people who tested positive.
This is an enormous mistake. If we want to control the spread of COVID-19, the United States must adopt a new testing policy that prioritizes people who, although asymptomatic, may have the virus and infect many others.
We should target four groups. First, all health-care workers and other first responders who directly interact with many people. Second, workers who maintain our supply chains and crucial infrastructure, including grocery-store workers, police officers, public-transit workers, and sanitation personnel. The next group would be potential “super-spreaders”—asymptomatic individuals who could come into contact with many people. This third group would include people in large families and those who must interact with many vulnerable people, such as employees of long-term-care facilities. The fourth group would include all those who are planning to return to the workplace. These are precisely the individuals without symptoms whom the CDC recommends against testing.
Not testing suspected COVID-19 patients will not harm those patients. Because we do not have any treatment targeted for the new coronavirus, confirming an infection generally does not change the way a patient’s symptoms are treated. Patients suspected of having COVID-19 should be presumed to be infected and receive care accordingly. Symptomatic patients should be tested only in the rare case where a positive test would meaningfully change what type of care is delivered.
To shift the focus of testing away from the sickest patients and toward the people most likely to spread the coronavirus, we will have to conduct millions of tests a day. Millions of health-care workers in the United States are in positions that may expose them to infection: physicians, nurses, respiratory therapists, midwives, pharmacists, phlebotomists, hospital cleaners, and others. By one estimate, 3 million people work in grocery stores. To screen everyone in these two groups once a week will require about 1 million tests a day. We currently lack the infrastructure for that. And that is before we add the approximately 800,000 police officers, 290,000 bus drivers, and 60,000 sanitation workers—and patients without any symptoms in the health-care system. We will need millions more kits to test asymptomatic potential super-spreaders and people planning to return to work. Taking a sample from seemingly well people just once isn’t enough; effective surveillance over time requires repeated testing.
How can we close this gap between our needs and current capacity? We need a national strategy over the next 10 weeks, one that draws on the many strengths of our research system. It should leverage the thousands of research laboratories at U.S. universities, medical schools, and health-care systems that have the capacity to perform polymerase-chain-reaction tests for COVID-19—the only type of test that catches infections in the crucial early days. We also need to encourage rapid adoption of the saliva test that now has an emergency approval from the FDA and expedite the approval of tests that require fewer reagents and staff.
Another promising pathway is to pool many tests and run them together. If a pooled sample tests negative, everyone in the pool is negative. If it is positive, the members of the pool can be tested individually. A more sophisticated version of this approach uses genetic “bar codes” that make it possible to trace back which of the many samples in a pool was the one that had RNA from the virus, without any retesting.
How can we get this testing capacity up and running? One idea is for Congress to award in the next stimulus bill, say, $150 million in unrestricted research funds to the first five universities that can process 10 million tests in a week or less. That will unleash a huge amount of latent testing capacity. Another catalyst could be to subsidize businesses that agree to test all their employees as they return to work. This testing should not be in competition with tests for health-care workers and the other groups. To encourage early and widespread adoption, the amount of money a state gets per test decreases with time from the announcement.
A plan for using these approaches to scale up testing will only be a first step toward sustainably containing the coronavirus. When someone tests positive, officials should identify close contacts, find them, and test them. To do the tracing, we may need to hire 100,000 to 200,000 additional public-health workers. Those workers would need to have technology that makes it easy for them to speak with those contacts and direct them to a test site.
This type of voluntary contact tracing is labor-intensive and requires some training, but it does not require highly specialized skills. Technology can speed it up without risking a permanent erosion of privacy or the further intrusion of for-profit firms into our personal lives. These health workers must offer two vital assurances to the American public: Data will never be commercialized, and all data will be destroyed within 45 days, when they no longer serve a public-health purpose.
If we adopt and follow a coherent plan, we can have a testing regime that keeps us safe without compromising our freedoms. But what Americans must not do is assume that the current rate of testing is sufficient to bring our society back to life. Until the United States can successfully perform a lot more tests—and starts testing the right people—the public will have little reason to believe that the virus is in check.
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