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Apr 26: The Chinese city of Wuhan, where the global coronavirus pandemic began, now has no remaining cases in its hospitals, a health official told reporters on Sunday.

"The latest news is that by April 26, the number of new coronavirus patients in Wuhan was at zero, thanks to the joint efforts of Wuhan and medical staff from around the country," National Health Commission spokesman Mi Feng said at a briefing.

The city had reported 46,452 cases, 56% of the national total. It saw 3,869 fatalities, or 84% of China's total.

Wuhan, Feb 9: President Xi Jinping strode onstage before an adoring audience in the Great Hall of the People in Beijing less than three weeks ago, trumpeting his successes in steering China through a tumultuous year and promising "landmark" progress in 2020.

"Every single Chinese person, every member of the Chinese nation, should feel proud to live in this great era," he declared to applause on the day before the Lunar New Year holiday. "Our progress will not be halted by any storms and tempests."

Xi made no mention of a dangerous new coronavirus that had already taken tenacious hold in the country. As he spoke, the government was locking down Wuhan, a city of 11 million people, in a frantic attempt to stop the virus spreading from its epicenter.

The coronavirus epidemic, which has killed more than 800 people in China as of Sunday and sickened tens of thousands, comes as Xi has struggled with a host of other challenges: a slowing economy, huge protests in Hong Kong, an election in Taiwan that rebuffed Beijing and a protracted trade war with the United States.

Now Xi faces an accelerating health crisis that is also a political one: a profound test of the authoritarian system he has built around himself over the past seven years. As the Chinese government struggles to contain the virus amid rising public discontent with its performance, the changes that Xi has ushered in could make it difficult for him to escape blame.

"It’s a big shock to the legitimacy of the ruling party. I think it could be only second to the June 4 incident of 1989. It’s that big," said Rong Jian, a writer about politics in Beijing, referring to the armed crackdown on Tiananmen Square protesters that year.

"There’s no doubt about his control over power," he added, "but the manner of control and its consequences have hurt his legitimacy and reputation."

Xi himself has recognized what is at stake, calling the outbreak "a major test of China’s system and capacity for governance."

Yet as China’s battle with the coronavirus intensified, Xi put the country’s No. 2 leader, Li Keqiang, in charge of a leadership group handling the emergency, effectively turning him into the public face of the government’s response. It was Li Keqiang who traveled to Wuhan to visit doctors.

Xi, by contrast, receded from public view for several days. That was not without precedent, though it stood out in this crisis, after previous Chinese leaders had used times of disaster to try to show a more common touch. State television and newspapers almost always lead with fawning coverage of Xi’s every move.

That retreat from the spotlight, some analysts said, signaled an effort by Xi to insulate himself from a campaign that may falter and draw public ire. Yet Xi has consolidated power, sidelining or eliminating rivals, so there are few people left to blame when something goes wrong.

"Politically, I think he is discovering that having total dictatorial power has a downside, which is that when things go wrong or have a high risk of going wrong, then you also have to bear all the responsibility," said Victor Shih, an associate professor at the University of California San Diego who studies Chinese politics.

Much of the country’s population has been told to stay at home, factories remain closed, and airlines have cut service. Experts warn that the coronavirus could slam the economy if not swiftly contained.

The government is also having trouble controlling the narrative. Xi now faces unusually sharp public discontent that even China’s rigorous censorship apparatus has been unable to stifle entirely.

The death of an ophthalmologist in Wuhan, Dr. Li Wenliang, who was censured for warning his medical school classmates of the spread of a dangerous new disease in December, has unleashed a torrent of pent-up public grief and rage over the government’s handling of the crisis. Chinese academics have launched at least two petitions in the wake of Li’s death, each calling for freedom of speech.

State media still portray Xi as ultimately in control, and there’s no sign that he faces a serious challenge from within the party leadership. The crisis, though, has already tainted China’s image as an emerging superpower — efficient, stable and strong — that could eventually rival the United States.

How much the crisis might erode Xi’s political standing remains to be seen, but it could weaken his position in the long run as he prepares to take a likely third term as Communist Party general secretary in 2022.

In 2018, Xi won approval to remove the constitutional limits on his term as the country’s president, making his plan for another five-year term seem all but certain.

If Xi comes out of this crisis politically insecure, the consequences are unpredictable. He may become more open to compromise within the party elite. Or he may double down on the imperious ways that have made him China’s most powerful leader in generations.

"Xi’s grip on power is not light," said Jude Blanchette, the Freeman Chair in China Studies at the Center for Strategic and International Studies.

"While the ham-fisted response to this crisis undoubtedly adds a further blemish to Xi’s tenure in office," Blanchette added, "the logistics of organizing a leadership challenge against him remain formidable."

In recent days, despite a dearth of public appearances, state media have portrayed Xi as a tireless commander-in-chief. This week they began calling the government’s fight against the virus the "people’s war," a phrase used in the official readout of Xi’s telephone call with President Donald Trump on Friday.

There are increasing signs that the propaganda this time is proving less than persuasive.

The Lunar New Year reception in Beijing where Xi spoke became a source of popular anger, a symbol of a government slow to respond to the suffering in Wuhan. Xi and other leaders appear to have been caught off guard by the ferocity of the epidemic.

Senior officials would almost certainly have been informed of the emerging crisis by the time national health authorities told the World Health Organization on Dec. 31, but neither Xi nor other officials in Beijing informed the public.

Xi’s first acknowledgment of the epidemic came Jan. 20, when brief instructions were issued under his name. His first public appearance after the lockdown of Wuhan on Jan. 23 came two days later, when he presided over a meeting of the Communist Party’s top body, the Politburo Standing Committee, which was shown at length on Chinese television. "We’re sure to be able to win in this battle," he proclaimed.

Back then, the death toll was 106. As it rose, Xi allowed other officials to take on more visible roles. Xi’s only appearances have been meeting foreign visitors in the Great Hall of the People or presiding over Communist Party meetings.

On Jan. 28, Xi met with the executive director of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, and told Tedros that he "personally directed" the government’s response. Later reports in state media omitted the phrase, saying instead that Xi’s government was "collectively directing" the response.

Since nothing about how Xi is portrayed in state media happens by accident, the tweak suggested a deliberate effort to emphasize shared responsibility.

Xi did not appear on official broadcasts again for a week — until a highly scripted meeting Wednesday with the authoritarian leader of Cambodia, Hun Sen.

There is little evidence that Xi has given up power behind the scenes. Li Keqiang, the premier in formal charge of the leadership group for the crisis, and other officials have said that they take their orders from Xi. The group is filled with officials who work closely under Xi, and its directives emphasize his authority.

"The way the epidemic is being handled now from the top just doesn’t fit with the argument that there’s been a clear shift toward more collective, consultative leadership," said Holly Snape, a British Academy Fellow at the University of Glasgow who studies Chinese politics.

The scale of discontent and the potential challenges for Xi could be measured by repeated references online to the nuclear accident at Chernobyl. Many of them came under the guise of viewer reviews of the popular television miniseries of the same name, which is still available for streaming inside China.

"In any era, any country, it’s the same. Cover everything up," one reviewer wrote.

The Soviet Union of 1986, however, was a different country than China in 2020.

The Soviet state was foundering when Chernobyl happened, said Sergey Radchenko, a professor of international relations at Cardiff University in Wales who has written extensively on Soviet and Chinese politics.

"The Chinese authorities, by contrast, are demonstrating an ability to cope, a willingness to take unprecedented measures — logistical feats that may actually increase the regime’s legitimacy," he added.

Radchenko compared Xi’s actions to those of previous leaders in moments of crisis: Mao Zedong after the Cultural Revolution or Deng Xiaoping after the Tiananmen Square crackdown.

"He’s doing what Mao and Deng would have done in similar circumstances: stepping back into the shadows while remaining firmly in charge."

Feb 26: China’s massive travel restrictions, house-to-house checks, huge isolation wards and lockdowns of entire cities bought the world valuable time to prepare for the global spread of the new virus.

But with troubling outbreaks now emerging in Italy, South Korea and Iran, and U.S. health officials warning Tuesday it’s inevitable it will spread more widely in America, the question is: Did the world use that time wisely and is it ready for a potential pandemic?

“It’s not so much a question of if this will happen anymore, but rather more a question of exactly when this will happen — and how many people in this country will have severe illness,” said Dr. Nancy Messonnier of the U.S. Centers for Disease Control and Prevention.

Some countries are putting price caps on face masks to combat price gouging, while others are using loudspeakers on trucks to keep residents informed. In the United States and many other nations, public health officials are turning to guidelines written for pandemic flu and discussing the possibility of school closures, telecommuting and canceling events.

Countries could be doing even more: training hundreds of workers to trace the virus’ spread from person to person and planning to commandeer entire hospital wards or even entire hospitals, said Dr. Bruce Aylward, the World Health Organization’s envoy to China, briefing reporters Tuesday about lessons learned by the recently returned team of international scientists he led.

“Time is everything in this disease,” Aylward said. “Days make a difference with a disease like this.”

The U.S. National Institutes of Health’s infectious disease chief, Dr. Anthony Fauci, said the world is “teetering very, very close” to a pandemic. He credits China’s response for giving other nations some breathing room.

China locked down tens of millions of its citizens and other nations imposed travel restrictions, reducing the number of people who needed health checks or quarantines outside the Asian country.

It “gave us time to really brush off our pandemic preparedness plans and get ready for the kinds of things we have to do,” Fauci said. “And we’ve actually been quite successful because the travel-related cases, we’ve been able to identify, to isolate” and to track down those they came in contact with.

With no vaccine or medicine available yet, preparations are focused on what’s called “social distancing” — limiting opportunities for people to gather and spread the virus.

That played out in Italy this week. With cases climbing, authorities cut short the popular Venice Carnival and closed down Milan’s La Scala opera house. In Japan, Prime Minister Shinzo Abe called on companies to allow employees to work from home, while the Tokyo Marathon has been restricted to elite runners and other public events have been canceled.

Is the rest of the world ready?

In Africa, three-quarters of countries have a flu pandemic plan, but most are outdated, according to authors of a modeling study published last week in The Lancet medical journal. The slightly better news is that the African nations most connected to China by air travel — Egypt, Algeria and South Africa — also have the most prepared health systems on the continent.

Elsewhere, Thailand said it would establish special clinics to examine people with flu-like symptoms to detect infections early. Sri Lanka and Laos imposed price ceilings for face masks, while India restricted the export of personal protective equipment.

India’s health ministry has been framing step-by-step instructions to deal with sustained transmissions that will be circulated to the 250,000 village councils that are the most basic unit of the country’s sprawling administration.

Vietnam is using music videos on social media to reach the public. In Malaysia, loudspeakers on trucks blare information through the streets.

In Europe, portable pods set up at United Kingdom hospitals will be used to assess people suspected of infection while keeping them apart from others. France developed a quick test for the virus and has shared it with poorer nations. German authorities are stressing “sneezing etiquette” and Russia is screening people at airports, railway stations and those riding public transportation.

In the U.S., hospitals and emergency workers for years have practiced for a possible deadly, fast-spreading flu. Those drills helped the first hospitals to treat U.S. patients suffering from COVID-19, the disease caused by the virus.

Other hospitals are paying attention. The CDC has been talking to the American Hospital Association, which in turn communicates coronavirus news daily to its nearly 5,000 member hospitals. Hospitals are reviewing infection control measures, considering using telemedicine to keep potentially infectious patients from making unnecessary trips to the hospital and conserving dwindling supplies of masks and gloves.

What’s more, the CDC has held 17 different calls reaching more than 11,000 companies and organizations, including stadiums, universities, faith leaders, retailers and large corporations. U.S. health authorities are talking to city, county and state health departments about being ready to cancel mass gathering events, close schools and take other steps.

The CDC’s Messonnier said Tuesday she had contacted her children’s school district to ask about plans for using internet-based education should schools need to close temporarily, as some did in 2009 during an outbreak of H1N1 flu. She encouraged American parents to do the same, and to ask their employers whether they’ll be able to work from home.

“We want to make sure the American public is prepared,” Messonnier said.

How prepared are U.S. hospitals?

“It depends on caseload and location. I would suspect most hospitals are prepared to handle one to two cases, but if there is ongoing local transmission with many cases, most are likely not prepared just yet for a surge of patients and the ‘worried well,’” Dr. Jennifer Lighter, a pediatric infectious diseases specialist at NYU Langone in New York, said in an email.

In the U.S., a vaccine candidate is inching closer to first-step safety studies in people, as Moderna Inc. has delivered test doses to Fauci’s NIH institute. Some other companies say they have candidates that could begin testing in a few months. Still, even if those first safety studies show no red flags, specialists believe it would take at least a year to have something ready for widespread use. That’s longer than it took in 2009, during the H1N1 flu pandemic — because that time around, scientists only had to adjust regular flu vaccines, not start from scratch.

The head of the World Health Organization, Tedros Adhanom Ghebreyesus, said the U.N. health agency’s team in China found the fatality rate between 2% and 4% in the hard-hit city of Wuhan, the virus’ epicenter, and 0.7% elsewhere.

The world is “simply not ready,” said the WHO’s Aylward. “It can get ready very fast, but the big shift has to be in the mindset.”

Aylward advised other countries to do “really practical things” now to get ready.

Among them: Do you have hundreds of workers lined up and trained to trace the contacts of infected patients, or will you be training them after a cluster pops up?

Can you take over entire hospital wards, or even entire hospitals, to isolate patients?

Are hospitals buying ventilators and checking oxygen supplies?

Countries must improve testing capacity — and instructions so health workers know which travelers should be tested as the number of affected countries rises, said Johns Hopkins University emergency response specialist Lauren Sauer. She pointed to how Canada diagnosed the first traveler from Iran arriving there with COVID-19, before many other countries even considered adding Iran to the at-risk list.

If the disease does spread globally, everyone is likely to feel it, said Nancy Foster, a vice president of the American Hospital Association. Even those who aren’t ill may need to help friends and family in isolation or have their own health appointments delayed.

“There will be a lot of people affected even if they never become ill themselves,” she said.