Even before President Trump began calling it the “Chinese virus,” the outbreak of sudden acute respiratory coronavirus 2 (SARS-CoV-2) and the disease it causes, coronavirus disease 2019 (COVID-19), set the occasion for a disturbing wave of anti-Chinese racism. I am aware that, merely by writing about superstition and COVID-19, I might be accused of cultural imperialism or of fueling racist views. To the contrary, if I am successful in this article, you will learn that:
- These outbreaks come from all over the world, not just China.
- Yes, superstition may play a role in COVID-19, but it is not as simple as you may think.
- Food superstitions—Chinese or otherwise—are not the only false beliefs that promote disease.
- The loudest voices against the promotion of these superstitions have come from within China.
Like many things, this story is not as simple as it seems.
The Wuhan Outbreak
In late February, as I was just getting up to speed on the novel coronavirus, I came across an article in the New York Times, “Why Did the Coronavirus Start in China: Let’s Talk about the Cultural Causes of this Epidemic.” Among other things, the author pointed to a variety of traditional Chinese beliefs about the healing powers of the meat and other byproducts of wild animals, which he suggested played a role in the epidemic. Although the exact origin is unclear, the current outbreak has been traced to a Wuhan seafood market—a “wet market”—in Hubei province. Wet markets exist all over the world, but in many Chinese markets, fish are gutted and other animals slaughtered on-site to guarantee freshness. They are called “wet markets” because the ground is often wet with melted ice from seafood displays and the blood of various species.
Most new epidemics begin when an animal pathogen is passed to humans for the first time. Due to the emphasis on freshness in Chinese wet markets, live animals are sometimes housed in closely packed open cages where blood and animal droppings can easily intermingle, creating a fertile environment for viruses to pass among species and ultimately to humans. But before going further into the specifics of this outbreak, let’s take a step back and look at the history of epidemics and pandemics.
Where Do Epidemics and Pandemics Come From?
Readers of Jared Diamond’s Pulitzer Prize–winning Guns, Germs, and Steel: The Fates of Human Societies (1997) understand that the European conquest of indigenous peoples in North and South America was less a function of superior military strength than it was a case of stronger immunities. The overwhelming majority of deaths among the native peoples of the Americas were from germs carried by the colonialist. Europeans had a much longer and more extensive history of living among domesticated animals, and as result they’d lived through a long string of epidemics and plagues, developing immunities along the way. When they arrived in the New World, Europeans carried smallpox and measles, and these diseases decimated the unprotected local populations.
Epidemics and pandemics typically begin when a pathogen moves from one species to another. Once they become communicable human diseases, their range depends upon human movements and behavior. Human and nonhuman animals come into contact all over the world, and as a result major epidemics can arise almost anywhere. Table 1 shows the top five epidemics of the twentieth and twenty-first centuries ranked by number of fatalities. It is impossible to know the origin of smallpox because it has been around for at least three thousand years, and although it is assumed to have had some zoonotic (animal) beginning, long ago it became anthroponotic, meaning humans can transmit it to other animals. Smallpox was a devastating disease throughout human history until it was finally eradicated in the twentieth century by mass vaccination (Shchelkunov 2011; Breman et al. 1980).
Encephalitis lethargica, or “sleeping sickness,” was portrayed in Oliver Sacks’s 1973 book, Awakenings, and the 1990 film based on the book starring Robin Williams and Robert De Niro. In the film, catatonic survivors of the 1915–1926 epidemic were given L-DOPA, the metabolic precursor of the neurotransmitter dopamine, and made dramatic recoveries—awakenings—only to discover that the effect was temporary. Because it emerged at the same time as the Spanish flu, one theory suggested the condition was caused by the flu virus, but the evidence does not support this conclusion. The cause of encephalitis lethargica remains unknown (Dale et al. 2004).
The other epidemics on this top five list all have zoonotic origins. There is some debate about how the Spanish flu began, but one popular analysis points to a British World War I base camp in northern France where live ducks, geese, and pigs were kept in close proximity to the troops (Oxford et al. 2005). HIV/AIDS is known to have transferred from monkeys and chimpanzees in west and central Africa. The Asian flu epidemic of 1957–1958 is thought to have resulted from the combination of an H1N1 human flu virus with an H2N2 avian virus—probably in a human host but possibly in another species (e.g., pig)—resulting in a new flu virus combining aspects of both (Belshe 2005).
In addition to these, the 2002 SARS outbreak started in China (Hsieh et al. 2005); the 2009 swine flu outbreak was traced to farms in central Mexico (“2009 Swine Flu” 2016); the 2013 MERS-CoV outbreak began in Saudi Arabia (World Health Organization 2020); and the 2014-2016 Ebola outbreak emerged in Guinea (Centers for Disease Control and Prevention 2019).
So, it is clear that deadly epidemics can and will come from almost anywhere on the globe. In addition, the choice to domesticate animals as a source of food has exposed us to additional zoonotic diseases. If we needed another reason to become vegetarians—or stop eating species that are genetically similar to humans—it might be to reduce our vulnerability to zoonotic diseases.
The Chinese Wild Animal Industry
If there is a cultural component to the outbreak in Wuhan, there are two reasonable hypotheses: (a) the belief, grounded in traditional Chinese medicine (TCM), that certain foods and animal byproducts have unique powers to affect health, produce virility (in men), and fertility (in women) and (b) the promotion of exotic wild animals as luxury food items. The strong appeal of wild animals—grounded in these two cultural trends—may have a connection to the current SARS-CoV-2 outbreak.
Herbal remedies have been used to treat disease from the beginning of human history, and there are many traditional forms of medicine that have evolved in cultures throughout the world, including TCM, Ayurveda in India, and Kampo in Japan. In addition, there are traditional systems in Africa, Russia, and among the Aborigines of Australia (Yuan et al. 2016). Although orthodox forms of early American medicine were drawn from European medical schools, in the nineteenth century, the Thomsonian system of herbal remedies developed by Samuel Thomson (1769–1843) became popular—in part because the standard treatments of the day (e.g. bloodletting and purgatives) were quite brutal (Vyse 2015). Herbal remedies remain popular as alternative medicines, and although most are of unproven value, some of the science-based medicines we use today—typically in synthetic forms—originally came from plants and herbs. Famously, aspirin is a synthetic form of a substance derived from the bark of the willow tree, which was used for medicinal purposes for millennia (Goldberg 2019), and the drug artemisinin—used to treat malaria—comes from a Chinese herbal remedy that has also been used for thousands of years (Yuan et al. 2016). However, the great majority of medicines in TCM lack scientific evidence (The Editors 2007).
Of particular importance to the coronavirus outbreak are the use of substances derived from wild animals in TCM and the popular belief that wild and fresh animals have health benefits. Two of the animal substances that are particularly important to TCM are tiger bone and bear bile, both of which come from endangered species. Although almost every part of the tiger is considered healthful in some way, tiger bone is particularly popular due to claims it restores vital energy and protects against disease (“Traditional Chinese Medicine” n.d.). Tiger bone is often mixed with wine and sold at a high price (Rothman 2015).
Bear bile is thought to have a number of health benefits. The active ingredient in bear bile is ursodeoxycholic acid, which has been shown effective in the treatment of liver disease, but a synthetic form has been available for decades (Paumgartner and Beuers 2002). Nonetheless, in China, bears are farmed for the purpose of producing bile, and in early March of 2020—somewhat bewilderingly—China’s National Health Commission listed bear bile as one of several treatments for COVID-19 (Fobar 2020). Of course, at this early stage, there are no proven treatments for COVID-19.
In China, there is an extensive bear farming industry widely known for its cruel treatment of Asian black bears. Bears farmed for their bile live their lives in individual cages that are often hardly bigger than their bodies, and bile is extracted from their gallbladders through an open hole in their bodies or a surgically implanted catheter (Li 2006). Wildlife activists in China have mounted campaigns to convince pharmacies to advertise their opposition to the sale of bear bile. Although farming bears is illegal in Vietnam, the practice has not disappeared, and bear farming remains legal in China. In addition, despite being protected by law, many other wildlife animals are offered as delicacies in markets and restaurants. They are assumed to have various health benefits, despite a lack of scientific evidence to back these claims.
Superstition and COVID-19
So, did superstition play a role in this novel coronavirus pandemic? Although we don’t know the exact path of the SARS-CoV-2 virus, it is clear that unfounded beliefs about the benefits of different kinds of animal meats and byproducts, combined with the view of some people that freshly slaughtered meats are safer and more tasty than frozen, encourage traders to sell these products in the wet markets of Asia. This created an environment ripe for the transfer of pathogens among different species and ultimately to humans. To the extent that these beliefs—many of which are drawn from TCM—contribute to demand for these products, they are a public health hazard (Still 2003). However, the persistence of these unfounded ideas is encouraged by a number of larger forces that may be more powerful than mere cultural tradition.
Peter Li, professor of East Asian Politics at the University of Houston-Downtown, points out that the Chinese government considers wildlife a resource, and wildlife breeding is a powerful and lucrative industry. Furthermore, the wildlife industry has presented itself as a pro-conservation effort, justifying the breeding of bears, tigers, and rhinoceros as a means to replenish endangered species. However, farming has not prevented the illegal hunting of wild species, many of which continue to decline in numbers (Li 2020). Following the 2003 SARS outbreak, which emerged from a live animal market in Guangdong providence, the Chinese government cracked down on wildlife trade for the exotic markets, but the restrictions were later relaxed.
On February 23, 2020, in response to the Wuhan outbreak, the Chinese government implemented a ban on all trade and consumption of wildlife (Li 2020), but given the government’s track record and the sheer size of the industry, it is unclear whether the ban will last or ultimately be effective. Overcoming popular ideas will be difficult. A 2011 survey of Beijing residents showed that some were concerned about wildlife preservation and were willing to choose TCM remedies made from alternative substances, but a large percentage of respondents preferred medicines derived from wild animals because they believed them to be more potent and safe (Lui et al. 2016).
The Chinese government could have a positive influence by openly criticizing the unscientific ideas of TCM, but because TCM is so closely tied to the national identity, Beijing has not done so. As Prof. Li wrote in an email, “superstition and nationalism are mixed together to reinforce each other.” Westerners who criticize TCM are likely to be labeled cultural imperialists, but many commentators, scholars, and scientists within China have long criticized the unfounded ideas of TCM. Unfortunately, political and economic forces exert a substantial influence. As I suggested in a previous column, it seems unlikely that the many references to superstition in the Chinese commercial market (e.g., red-colored products, lucky cats, the number eight, and feng shui) will ever disappear because they are sustained by the profit motive. Similarly, profit provides a strong incentive to promote Chinese live and wild animal markets using false claims of health benefits.
As to the question of superstition’s role in the current SARS-CoV-2 outbreak, the water is further muddied by a number of more recent epidemiological studies (e.g., Huang et al. 2020; Li et al. 2020) identifying cases as early as mid-November of 2019 in people who had not visited the Wuhan seafood market. The 2003 SARS outbreak was traced to bats, which may have transferred the virus to civet cats that were sold at a wet market (McKie 2017), and it is a reasonable hypothesis that the current outbreak also stems from bats who either passed SARS-CoV-2 directly to humans or through an intermediate host animal. Bats, like us, are mammals, and they are sometimes eaten or found in close contact with humans and other animals. But at the moment, we don’t know exactly where the SARS-Cov-2 virus came from or how it was transferred to humans. What we can say, however, is that the unfounded beliefs of TCM and the practice of breeding wild animals—often mixed with wild-caught but sick and injured animals—creates dangerously unsanitary conditions in China’s wet markets. Where they exist, these markets are fertile incubators for new zoonotic diseases, epidemics, and pandemics, and every link in this pathogenic chain is supported by powerful economic and political forces.
Final Words about China
Although this particular outbreak began in China, we are all in this biological war together. After a slow initial response, Beijing made a quick reversal. Chinese scientists have done vital work on the genetics of the virus and the epidemiology of the Wuhan outbreak and have promptly shared their findings with the rest of the global community (see the list of references below). Furthermore, China was not alone in its initial instinct to downplay the story. As the virus silently spread across the globe, leaders in the United States and several other countries made efforts to minimized the implications of the epidemic.
It is easy to be critical of the Chinese fascination with live animals, but ask yourself, when did you last slide an oyster—traditionally considered an aphrodisiac—down your throat, boil a live lobster, or pay someone to boil one for you at a restaurant? The Chinese may lead the world in false beliefs—encouraged and sustained by wildlife traders—about the benefits of certain kinds of animal parts, but they are not alone. I am old enough to remember the pork industry’s “the other white meat” advertising campaign, which suggested that pork offered health benefits over beef (Levere 2005). Marketers all over the world will use any means available to increase profits, and false claims have rarely been a barrier. Caveat emptor.
Finally, the Chinese can be justifiably proud of how they quickly controlled the spread of SARS-CoV-2 in Wuhan. As I write this, deaths in China have dropped to single digits, and restrictions on movement in Wuhan are being relaxed. Some early observers of this remarkable success pointed to the tools of control available to China’s authoritarian government, but similar results are now playing out in South Korea, Taiwan, Japan, and Singapore, all of which are democracies. If there is a secret to these successes, I would hypothesize that culture plays an important role. Asian collectivist philosophy is well-suited to the challenges of an epidemic. In many of these countries, wearing face masks in public is a cultural norm, and family traditions instill a deep respect for elders—a valuable trait when a disease targets older people.
On March 13, 2020, the New York Times published tandem profiles of twenty-nine-year-old women, Wuhan healthcare workers, who came down with COVID-19 disease. For reasons that are unclear, one of the women died and the other survived. As she recovered, Deng Danjing vowed to return to service in the hospital. “It was the nation that saved me,” she said. “And I think I can pay it back to the nation.” This sentiment is not common in the West. We are individualists, and we make up our own minds. But if we hope to minimize the carnage of this pandemic, the collectivism of Asian culture has much to recommend it. As the virus encircles the globe, infecting people without respect to ethnicity, race, class, gender, politics, or religion, it reminds us that we are all connected, and there are times when we all need each other. This is one of those times.
I am grateful to Peter Li for his comments on an earlier version of this article.
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