key: cord-0833111-msfwi6x2
authors: Yang, Kaifeng
title: Unprecedented Challenges, Familiar Paradoxes: COVID‐19 and Governance in a New Normal State of Risks
date: 2020-05-28
journal: Public Adm Rev
DOI: 10.1111/puar.13248
sha: f19979381f3784be1854c9a33499c3d12b11fb98
doc_id: 833111
cord_uid: msfwi6x2

Through the lens of paradoxes, this essay understands China's COVID‐19 responses, focusing on normal and non‐normal governance, competing values, expertise and politics, centralization and decentralization, public and private, and technology and institution. Preliminary lessons are drawn regarding pandemic governance: embedding resilience into all aspects of governance; developing a public value framework for pandemic governance and improving individuals' ethical capacity; institutionalizing policy capacity on pandemic governance and requiring expertise in relevant positions; balancing centralized coordination and decentralized responses with a stable and ready‐to‐work commanding center; enabling businesses and nonprofits for pandemic governance but regulating them appropriately; and enacting technologies to revolutionize pandemic governance with proper institutional safeguards. This article is protected by copyright. All rights reserved.

. It emphasizes the simultaneous existence of two contradictory but interrelated elements, the tension between which shapes the development of a management phenomenon (Poole and Van de Van 1989) . The contradictory elements can also be viewed as dilemmas or tough trade-offs (Bolman and Deal 2003) , such as unity and diversity (Ospina and Dodge 2005) , exploitation and exploration (March 1991) , plan and emergence (Mintzberg 1994) .

Increasingly, scholars believe they are not "either or" choices, but "both and" configurations on a continuum (March 1991; Smith and Tracey 2016) . From the viewpoint of the dialectical inquiry (Cosier 1981; Seo and Greed 2002) , the solution is to create a synthesis by combining contradictions (or thesis and antithesis).

Adopting a paradox lens helps place a particular country on a continuum where other countries can find their own place. A paradox, such as differentiation and integration, is a basic relationship that all organizations have to address. Focusing on the same paradox as an analytical dimension facilitates dialogue despite cultural and institutional differences among countries. After all, COVID-19 posed similar challenges to countries. 2 Some caveats are in order. Given the time and space limit, I primarily use China as an example, with only occasional reference to the U.S. Comprehensively describing China is beyond the scope of this essay, and the attention is paid to the central government and the epidemic center-the city of Wuhan, Hubei Province. For the same reason, I discuss only six of many organizational paradoxes in a pandemic. This essay is not written as a research-based article and it does not intend to explain China's COVID-19 performance in causal language. More rigorous analysis awaits future studies.

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Frequently normal and non-normal status of affairs are considered sequential: a normal stage followed by a non-normal one (e.g., pandemic) and then a normal one again.

Alternatively, we should consider them a continuum as accidents are "normal" (Perrow 1999) .

Their relationship is similar to that of "present" and "future": they are embedded in each other. Non-emergency organizations (e.g., education agencies) have a role in pandemic preparation and response; emergency organizations (e.g., CDC) have non-emergency functions; and the two types of organizations should maintain a seamless working relationship. Different arrangements should be in place to coordinate all organizations in situations of various levels of uncertainty and scope. Moreover, leaders should balance their normal and non-normal roles, just as they should balance exploration and exploitation (March 1991) .

Since SARS in 2003, China has established an all-phase, all-hazard emergency management (EM) system. It requires all governments to have an EM plan, an emergency legislation system, an emergency institutional system and an emergency regulatory system.

The system did not deliver timely and orderly responses in the beginning of this pandemic.

When initial cases of SARS-like pneumonia surfaced, some hospitals activated EM plans and took preventative measures including ordering and stocking medical devices, but others did not. After Wuhan was locked down, disarray and chaos ensued-medical beds, transportation, food, and even basic supply for frontline health workers all became problems. The necessary capacity in a pandemic comes from not only EM organizations, but also the non-EM organizations (e.g., Transportation). Neither responded well. That EM plans did not work as expected is not surprising. The EM plans in many Chinese cities focused on emergency This article is protected by copyright. All rights reserved. Accepted Article response upon an event, rather than preparedness and recovery. EM exercises were lacking too.

The leaders of Hubei and Wuhan were unprepared and slow to act. The governor of Hebei did not know their production capacity of medical masks during a press conference.

Wuhan CDC (Center for Disease Control and Prevention) was informed of the virus at the end of December, 2019, but the city lockdown did not come until a month later. Despite the imminent risk, the leaders greenlighted the local Chinese Communist Party (CCP) Congress meetings and community gatherings such as "hundred-family banquets."

The virus was too new and the local leaders were capable cadres otherwise-the province and the city (60 million and 10 million permanent residents, respectively) seemed well-managed. Wuhan's GDP is ranked top 10 among Chinese cities. It was selected in 2019 as an exemplary for community governance by CCP's Central Political and Legal Affairs Commission.

The root problem seems to be institutional. Since 2013, President Xi has emphasized "Bottom-Line Thinking" for government leaders, highlighting the importance of risk awareness and risk governance. Why was Hubei leaders' "Bottom-Line Thinking" not triggered? In the current CCP cadre evaluation system, their performance rating depends largely on economic and social indicators in normal situations. Protecting people's health and safety in a pandemic is a basic government function-arguably more essential for government legitimacy than economic development is, but institutionalizing it in daily operations of governance is a challenge to all countries. Wuhan's award-winning community governance was paralyzed in initial stages of the pandemic, but that does not mean the award This article is protected by copyright. All rights reserved.

Accepted Article was wrong. Rather, it suggests community governance must be reexamined and redesigned from the perspective of resilience and pandemic preparedness.

Wuhan is not alone. U.S. intelligence officials warned of the virus several months before a "national emergency" was declared. 3 According to a New York Times report, 4 throughout January 2020, many people inside the Trump administration identified the COVID-19 threat, sounded alarms, and urged for aggressive action, which did not happen weeks later. If the time gap between "normal" and "non-normal" was smaller, more lives could have been saved.

Maybe underestimating the COVID-19 threat is a high chance event. Human brains are prone to the optimism bias: overestimating the probability of positive future events and underestimating the probability of negative ones (Kahneman 2013; Sharot 2011) . The remedy lies not at the individual level, but the organizational level: Institutional and organizational arrangements should be designed to reduce the effects of the bias (Kahneman 2003) . This requires embedding resilience into governance-including all governance aspects such as functions, processes, techniques, leadership, expertise, and resources. More than often, normal and non-normal governance are separated by bureaucratic silos in governance planning. Risk governance is often treated as an add-on to a governing system. In the EM literature, Model R (Routine) and Model C (Crisis) are often treated as mutually exclusive (Leonard and Howitt 2008) . Instead, they should be viewed as being interwoven. This is particularly relevant for pandemics governance. In the past thirty years, the occurrence of pandemics has become more frequently, leading people such as Bill Gates to forewarn the inevitability of a massive pandemic. 5 We may be entering a new historical stage This article is protected by copyright. All rights reserved.

where humans live with vital and highly contagious viruses. We live with normal accidents (Perrow 1999) .

Policymakers must make trade-offs among competing values in a pandemic. For example, they need balance safety/health and economic development, individual freedom and collective interest (e.g. forced-quarantine decisions), transparency and privacy, rights and obligations, efficiency and equity, and free expression and preventing rumors and panic.

Value tradeoffs present in almost any decision, but they are intensified during a pandemic due to uncertainty, high potential loss, and anxiety. The public value literature (Bryson, Crosby, and Bloomberg 2014; Yang 2016) and the administrative ethics literature (Cooper 2012 ) have offered recommendations on how to make the balance.

COVID-19 manifested the pivotal role of public value governance. Balancing human life and economy is an example. In the early stage of the outbreak, concerns with costs, instability, panic, economy, and image were strong. This was changed when President Xi mandated to prioritize people's life. Under this mandate, forced and self-quarantine was enforced quickly and swiftly, effectively curbing the virus. Despite the mounting economic pressure, China decided to resume work and production in a slow and deliberate manner. This does not mean there were no dissenting voices regarding this in China. There were people who expressed doubts about social distancing and people who argued for reopening the economy sooner. China's authoritarian nature made the value balancing seem easier, but the tradeoff was inherent and present. In comparison, this tradeoff has been a hot political issue in the U.S. President Trump delayed shutting down the economy but hastily pushed for This article is protected by copyright. All rights reserved. Accepted Article reopening, while there were warnings and protests from disease control experts, Democrats, and even officials in his own administration.

Another tension occurred around equity issues such as resource allocation between COVID-19 patients and other patients, especially the elderly who had severe or chronic disease, as well as migrants who lived in "urban villages" (usually in city outskirts). In Wuhan and Hubei, the surge capacity of hospitals was soon overwhelmed, and many secondary and tertiary damages were reported. As drug stores were closed and hospitals becoming over-crowded and concentrating on COVID-19, many patients with chronic diseases could not get treatment. The equity issue manifested differently in the U.S. For example, according to an analysis in Mid-April, African Americans account for 14.2% of the population covered by the analysis, but 30% of the COVID-19 patients were black. 6

After the quarantine mandate in China, reports surfaced where local officials took "hard core measures" to quarantine households who were suspected of infection or returned from Hubei. The tactic could be as extreme as installing a steel bar to block the door. In some local areas, roadblocks proliferated to protect local community, making it hard for ambulances and the critically ill to pass through. This occurred despite the central government has long explicitly prohibited it. The unclear boundary of state power in relation to individual liberty is also seen in a notorious case regarding Li Wenliang, a Wuhan doctor who was summoned and admonished by local police for spreading rumors-sharing COVID-19 information in a WeChat group consisting of his medical school classmates before the government formally acknowledged the virus. 7 This article is protected by copyright. All rights reserved.

The value conflicts were deeply rooted in society and citizens. Hubei residents and auto-plates were discriminated in some areas, being refused to enter, pass, or check into a hotel. A salient case involved Fang Fang, a famous writer living in Wuhan, who posted an online diary recording her thoughts and feelings during the lockdown. Some of the contents were about fears, horrors, angers, and disappointments, leading some people to criticize her for "looking only at the dark." When the English version, "Wuhan Diary: Dispatches from a Quarantined City", went on presale on Amazon, intense debates erupted on the social media.

While some liberal intellectuals publicly supported Fang Fang, many people harshly blamed her for lack of patriotism and selling materials that might be used by foreign enemies. In a similar way, xenophobia and anti-Asian racism was fuelled by COVID-19 in the U.S. and worldwide. 8

These events suggest a need for stronger ethical competency. For officials enforcing orders in a pandemic, having a heightened sense of moral agency and avoiding administrative evil seems important (see Adams and Balfour 1998) . There should be an institutional framework that address value conflicts and enables different voices to be heard. Intensified value conflicts or ideological polarization is why public value governance emerged as a new research paradigm (Bryson, Crosby, and Bloomberg 2014). Governments also have a responsibility to strengthen citizenship, enculturating reasoned deliberation among citizens.

In the Fang Fang case, many online comments were simply venting feelings and emotions, or based on moral rules such as narrow patriotism and "don't air dirty linen outside the organization." That is, many people's ethical reflection is at the expressive level or the moral rules level, not the ethical analysis level or the postethical level (see Cooper 2012 ). This article is protected by copyright. All rights reserved.

This paradox relate to the "dichotomy" of politics and administration, or facts and values.

Democratic governance requires both expertise and politics. This is even more so in a pandemic. Expertise is critical in understanding the virus, identifying effective interventions, finding the cure, and making reasoned intuitive decisions when information is incomplete and risk is high; Politics is essential for allocating resources and responding to competing Both the President and the CCP chairwoman of the former were political cadres, while both leaders of the latter were top notch medical doctors. As the literature shows, professional accountability should be weighted more than political and hierarchical accountabilities in expertise-intensive agencies; otherwise crises are inevitable-the Challenger Tragedy is one example (Romzek and Dubnick 1987) . In recent years, China has tried to increase political This article is protected by copyright. All rights reserved.

Accepted Article control of such organizations, but COVID-19 warns that a dedicated balance must be made between political responsiveness and professional autonomy.

The lack of disease prevention and control expertise is a chronic problem in China. The U.S. response has also seen the tension between expertise and politics. Sometimes the President did not seem to make evidence-based decisions. Sometimes infectious disease experts were pushed out or silenced. In 2018, the administration abolished the Directorate for Global Health Security and Biothreats, a White House unit on the National Security Council created by the Obama administration in fighting Ebola. Timothy Ziemer, the director of the unit, was pushed out and the global health security team he led was disbanded. 12 In addition, President Trump has consistently pushed for budget cuts to agencies that battle infectious diseases such as the CDC and the NIH. When asked about the cuts, the President's response illustrates clearly a lack of appreciation for institutionalized expertise:

"We can get money, we can increase staff-we know all the people. This is a question I asked the doctors before. Some of the people we cut, they haven't used for many, This article is protected by copyright. All rights reserved.

Accepted Article many years, and if we have ever need them we can get them very, very quickly. And rather than spending the money-I'm a business person. I don't like having thousands of people around when you don't need them. When we need them, we can get them back very quickly." (Friedersdorf, 2020) There is a dedicated line between expertise and politics. While expertise is critical, it does not mean all health commissioners must be medical experts. We should also be concerned with the other extreme-technocracy, a government ruled not by people but by an elite of technical experts (Habermas 2015) . Generalists (e.g., politicians) and specialists (e.g., infectious disease experts) must productively co-exist. This also means experts should not retreat too much from politics. After the Chinese CDC was criticized for "publishing SSCI papers instead of warning the public," some researchers defended that scientists should only study the "truth" and let politicians worry about policymaking. The accusation was not entirely accurate, but the defense was troublesome. 

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Centralization and decentralization capture the division of decision authority-vertically between the central and local, and horizontally between the center and peripheral (Pollitt 2005) . Both Centralization and decentralization have pros and cons. Policymakers have to make a tradeoff based on an organization's environment, strategy, and technology. Kaufman (1969) sees a pendulum swinging back and forth between centralization and decentralization. Mintzberg (1979) sees a continuum of decision process of which some steps are centralized and others are decentralized. In the New Public Management doctrine, targets are centralized and implementation is decentralized (Pollitt 2005) . In a crisis, a pervasive notion is that decision making should be centralized in order to have timely and coordinated responses (Hart, Rosenthal and Kouzmin 1993) . But the structural contingency theory suggests that decentralization is preferable for a large organization facing an uncertain and turmoil environment in order to ensure fast information gathering and agile local responsiveness (Donaldson 2001 Accepted Article health hazards, surveillance information, and response status. The laws and regulations are not aligned, and no operational guideline was in place to help local government decide.

In most EM areas, China has adopted the principle of "territorial management", giving local governments the primary responsibility. However, responding to a pandemic is beyond any local jurisdiction and requires national intervention. After the central government stepped in to help Hubei, a centralized effort effectively restored order, confidence, and treatment in the epidemic center. About 346 medical teams of more than 42,600 doctors and nurses were assembled quickly nation-wide and dispatched to Hubei. 13 The vertical problem arose in the U.S. too. President Trump clashed with many state governors over issues such as when social distancing should be implemented, whether the federal government should coordinate the states' purchasing of medical devices from abroad, and who has the authority to reopen the economy. Kettl (2020) The lateral coordination in the U.S. suffered from the lack of stability and clarity at the center. As DHS took over from HHS, the role of HHS became opaque-partly due to its failure in developing a reliable coronavirus test on time. The White House seemed to have three centers of authority: the President himself, the taskforce led by Vice President Pence, and the group led by the President's son-in-law, Kushner. If we view federal actors involved in coronavirus response as in a large and complex network, then a strong and stable center node is critical for the network performance (Milward and Provan 2003) .

This paradox refers to the relationship between government and non-government entities.

It could be separated into two relationships: state-market and state-society. For our purpose and given the space limit, this essay uses one concept instead and focuses on Public-Private Partnerships (PPPs), which are essential for pandemic prevention and response (Abou-bakr This article is protected by copyright. All rights reserved. Accepted Article 2013). "Private" does not mean the private or business sector, but mean private agents as opposed to the government. PPPs "combine the resources of government with those of private agents (businesses or not-for-profit bodies) in order to deliver societal goals" (Skelcher 2005, 347) . Any collaboration process should balance the autonomy and mutuality of the partners (Thomson and Perry 2006) . While China's new governance philosophy emphasizes market as the deciding factor in resource allocation, many people believe government should control resource allocation during the pandemic. The government first mobilized non-governmental organizations in the public sector to help. Many state-owned enterprises (SOEs) participated by donating money, making additional shifts to increase production, converting production lines to make emergency materials, and serving people in crises. Two well-known projects in Wuhan, building the new 1000-bed Huoshenshan Hospital within 10 days and the new 1600-bed Leishenshan Hospital within 14 days, were conducted by SOEs. Similarly, public hospitals played the major role in treating coronavirus patients and sending volunteer health workers to Hubei. 14 In contrast, the contribution of private businesses varies. In some areas, such as Hongzhou and Shenzhen, where the market economy is more advanced, companies such as Alibaba helped in many ways. However, in some places there were illegal market behavior such as jacking up prices and making fake products. The State Administration for Market Regulation had to issue a new guiding opinion on investigating and publishing such behaviors during the outbreak. This article is protected by copyright. All rights reserved.

In the health care industry, although many large private hospitals were active in coronavirus response, the public seemed unware. People expressed anger at the seemingly Bureau of Statistics staff. These employees worked day and night, but they had no professional expertise in allocation and distribution, nor did they have a logistics network to work with. Thus, millions of donated funds went unused and piles of donated materials sat in the warehouse while desperate health workers were waiting. 15 The Red Cross, one of five China's state-run charities, has suffered from a series of scandals and reputation loss since a decade before. And the lack of a network of nonprofits with trained volunteers ready for a Pandemic was obvious in Hubei. The CCP's 19 th Congress This article is protected by copyright. All rights reserved. Accepted Article consultation, broad participation and the rule of law. But a well-functioning nonprofit sector seemed missing. As the Red Cross's capacity and management woes backfired and led to criticisms of government, people have called for re-regulating the sector to enhance its transparency, openness, and trustworthiness. In the meantime, the nonprofit sector should be deregulated so that nonprofits can be in a better position to improve capacities. State-run charities should be de-bureaucratized to improve their professionalism.

Weaving market mechanisms and societal organizations into pandemic governance brings challenges. Even in the U.S., where both the private and nonprofit sectors are strong and active in coronavirus response (e.g., Google, Amazon, and the Gates Foundation), there were concerns. For example, in late February, the administration requested $2.5 billion from the Congress, some of which would go to industries developing vaccines. In a Congressional budget hearing, HHS Secretary Alex Azar said "We would want to ensure that we work to make it affordable, but we can't control that price, because we need the private sector to invest." 16 This angered Democrats and the public. For another example, Jared Kushner led a team of government allies and private industry representatives working alongside the official coronavirus task force, which created confusion and led to criticisms. 17

Technology shapes, and is shaped by, institutions. On one side, technology has a liberating potential in overcoming institutional inertia and bringing out revolutionary changes.

On the other side, technology alone does not guarantee benefits; it is always enacted by institutions and actors (Fountain, 2001; Yang 2003) . Alice Stewart discovered in 1956 that This article is protected by copyright. All rights reserved.

Accepted Article fetal x-rays double a child's risk of developing cancer, only to find the medical practice would not end until more than twenty years later. Edward Jenner invented cowpox and Vaccination in 1976 but Smallpox was not announced by WHO as being eradiated until 1980 (Bennett 2020) . In between technology phobia and technology utopia, institutions are fundamental to ensure the appropriate development and use of technology, to ensure the revolutionary potential of technology is under democratic control.

China's coronavirus response shows the impasse of technology determinism given the role of institutions and leadership. After SARS, the China CDC developed an online infectious disease reporting system, which began to operate in 2004. It puts 39 legally-defined infectious diseases and public health emergencies under real-time surveillance. The direct reporting system has been expanded to all disease prevention and control institutes, all medical institutions at and above the county level, and nearly all township clinics. However, the reporting system did not work at the beginning of this pandemic. After doctors in Wuhan began observing a mysterious pneumonia in December, local health officials asked hospitals to withhold information. The National Health Commission first learned of the outbreak not from the reporting system but after un-known whistle-blowers leaked two documents online. Even after the National Health Commission got involved, local officials still set narrow criteria for confirming cases and ordered hospitals to count only patients with a known connection to the alleged sources of the outbreak, the seafood market. 18

On the other hand, technology has played a significant role in response. In Hangzhou, where Alibaba is located, a mobile system called "Health Code" was This article is protected by copyright. All rights reserved.

Accepted Article deployed on February 11 to track in real time every individual's COVID-19 related status.

The QR code can be accessed from Alipay (a third party mobile and online payment platform that is widely used in China), popular social media APPs such as WeChat and DingTalk, or "Hangzhou Resident" APP. People with a green code can travel in and out the city after showing the code to "gatekeepers"; People with a yellow code must quarantine (in a central place or at home) for 7 days and people with a red code must quarantine for 14 days before the code can turn green. This way, the city government monitors everyone's travel record and health status, enabling healthy ones to work and move. Seeing its huge success, on February Despite its benefits, the Health Code system, as well as other solutions based on big data technologies, raised concerns over mass surveillance, privacy, and information security. 19 Health Code draws on government-held data on coronavirus treatment, as well as plane, train and bus bookings. And each time an individual's code is scanned at a health checkpoint, her location is sent to the central server, allowing the government to track her movements over time. Aside from the problem of mass surveillance, the ownership of such data is unclear.

Putting the massive data in the hands of private firms is problematic too. Similar systems in the U.S. created many dissenting voices. 

COVID-19 forces us to rethink governance. It puts all countries at the same starting line:

none is immune and no governance is ready. Countries must learn from this pandemic and from each other. China has learned from SARS, as demonstrated in the fast bioanalysis of virus, the automated reporting system, the operations of CDC, and the standard procedures in some hospitals. However, the learning was insufficient if we look back from now. We have to ensure learning does not stop as attention attenuates after this pandemic.

This essay argues what happened in Hubei and China reflects similar problems faced by all governments and familiar paradoxes that public administrationists have long been trying to resolve. Adopting a paradox lens, I discussed China's coronavirus response from six dimensions. 20 I intentionally use phrases such as "normal and non-normal" instead of "normal vs. non-normal", as I want to emphasize those are not "either or" choices (March 1991; Smith and Tracey 2016) . Some preliminary lessons are drawn. First, we should avoid the thinking that pandemic governance is a separate part of public governance. Recognizing we are entering a new historical stage of risk, an era with a lasting threat of pandemic, we need to embed resilience into all aspects of governance. EM plans must be exercised and public leaders must be on permanent alert. Second, international and domestic efforts should be made to develop actionable guidelines to address the competing values in a pandemic. The guidelines should be based on a sound public value framework. Efforts should also be made to improve the ethical capacity of both public officials and citizens. Third, we should strengthen institutionalized policy capacity in and outside government on pandemic responses. Relevant expertise should be required for positions responsible for infectious disease control. Experts should develop skills working with politicians and politics. Fourth, when a pandemic hits, there should be a balance between centralized coordination and decentralized responses, facilitated by new information technologies. A stable, clear, and ready-to-work commanding center is important and should be institutionalized. Fifth, businesses and nonprofits should be enabled to help with pandemic responses, but an appropriate regulatory framework must be established to ensure the boundaries and autonomies of the partners. Sixth, we should try harder to take advantage of new technologies in creating effective pandemic response tools, while at the same time designing institutional safeguards to guide the technology.

Public administration educators can play a major role in the pursuit of good governance in a new normal state of risks. In April, the Chinese Ministry of Education selected 20 comprehensive universities to offer EM masters' and doctoral degrees under the discipline of Public Administration. Before this, the EM Ministry had already supported 17 colleges, but This article is protected by copyright. All rights reserved.

Accepted Article they focus more on training frontline EM workers for technological expertise. The 20 new programs are expected to integrate governance, management, and technology, and a national "guideline" on program design and curriculum development has been suggested by the Education Ministry. The guideline emphasizes the purpose of the degrees is to improve students' problem-solving capabilities. 21 Dialogue and collaboration between those programs and similar NASPAA programs would be beneficial.

The New York Times, 03/29/2020.

Citizens a Color Code, With Red Flags", The New York Times, 03/01/2020. 20. There are many other relevant paradoxes, such as localism and globalism, modernism and postmodernism, and deliberate and emergent strategies. For example, China's coronavirus response reflected both the deliberate strategy as developed in the EM plans, as well as the emergent strategy from acting upon suggestions from frontline workers and professional experts. In the pandemic, thousands of recommendations were made through official channels to the central government by researchers from universities and think tanks around the country. Many of them were adopted. 21. In 2011, China listed "Safety Science and Engineering" as a first tier discipline, which includes "Safety and Emergency Management". By now, 30 universities are authorized to offer doctoral degrees in Safety Science and Engineering, and more than 40 universities offer Master's degrees. More than 170 universities and colleges offer undergraduate degrees in safety engineering.

familiar paradoxes" in the title of this essay has another meaning. COVID-19 is unprecedented, and the problems it brought may differ from those in the past pandemics

Intelligence report warned of coronavirus crisis as early as November

This reminds of Captain Brett Crozier's being fired due to his emails to Navy leaders detailing the COVID-19 outbreak on the Theodore Roosevelt submarine. See John Ismay

The comparison between the two hospitals was a popular social media post

The above numbers are from the National Health Commission of China. 11. According to Dr. Guang Zeng's speech at the Seminar on Ten-Year Health Care Reform in China, at the China Development Research Center

Data are from the National Health Commission of China. 14. There are cultural differences here. Chinese SOEs participate in market competition and are subject to market mechanisms. Thus, China's PPPs framework includes SOEs. Also, according to data from the National Health Commission of China, China had about 11,900 public hospitals and 23,200 private ones by the end of

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