Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

In 1974 an article appeared in Science magazine with the dry-sounding title “Judgment Under Uncertainty: Heuristics and Biases” by a pair of psychologists who were not well known outside their discipline of decision theory. In it Amos Tversky and Daniel Kahneman introduced the world to Prospect Theory, which mapped out how humans actually behave when faced with decisions about gains and losses, in contrast to how economists assumed that people behave. Prospect Theory turned Economics on its head by demonstrating through a series of ingenious experiments that people are much more concerned with losses than they are with gains, and that framing a choice from one perspective or the other will result in decisions that are exactly the opposite of each other, even if the outcomes are monetarily the same. Prospect Theory led cognitive psychology in a new direction that began to uncover other human biases in thinking that are probably not learned but are part of our brain’s wiring.

Thinking fast and slow.

Taking Rights Seriously.

Una perspectiva que despierta cada vez mayor interés por parte de administradores públicos, políticos y analistas es el de las llamadas políticas públicas. Se trata de un camino relativamente nuevo, que permite, por una parte, observar y analizar los asuntos públicos desde un ángulo singular vinculado a la transformación de la acción gubernamental y, por otra, idear mecanismos para atender o dar respuesta a lo que se percibe como problemas de orden público. Como es sabido, los problemas públicos son complejos y multideterminados. Su análisis requiere de herramientas que van más allá de lo que comúnmente ofrecen disciplinas como la sociología, la economía, la ciencia política, la administración pública o la psicología por sí solas. De hecho, lo que busca la “ciencia de las políticas”, como la bautizó uno de sus padres fundadores, Harold Laswell (1992: 105), es integrar los conocimientos provenientes de diversas disciplinas bajo un enfoque cuyo objetivo es advertir y “solucionar” problemas. Recientemente, el académico británico Wayne Parsons se ha dado a la tarea de reunir en una sola publicación los aspectos más relevantes del conocimiento que se ha producido alrededor de las políticas públicas. Bajo el título Public Policy: An Introduction to the Theory and Practice of Policy Analysis, Parsons da cuenta de los temas y debates teóricos centrales de este enfoque, además de aportar múltiples referentes bibliográficos y detalles sobre estudios de caso que ilustran la riqueza de las políticas públicas, pues muestran no sólo cómo se aplican sino, sobre todo, qué explicaciones y respuestas pueden brindar. A ello se suma uno de los rasgos más valiosos del libro: poner en claro los dos ángulos de las políticas públicas que, con frecuencia, son ignorados en la bibliografía sobre la materia, a saber: el análisis del proceso de las políticas, por una parte y, por la otra, el análisis en y para el proceso de políticas, o, lo que es lo mismo, el uso del conocimiento y técnicas analíticas para el diseño, implementación y evaluación de las políticas públicas. Aunque ambos están intrínsecamente ligados, su especificidad determina su naturaleza y fin. Mientras el análisis del proceso de las políticas tiene fines

Public Policy: An Introduction to the Theory and Practice of Policy Analysis

The Open and Closed Mind

While China has made great strides in establishing environmental laws and enforcing environmental regulation, problems of non-compliance and weak and slow enforcement remain. This contribution analyses cases of sub-optimum enforcement and the political campaigns that have been undertaken to deal with them. It will argue that enforcement problems are rooted in a lack of local legitimacy caused by conflicting interests of stakeholders. The case of Chinese environmental law enforcement holds lessons beyond its regional scope, about the role of law in balancing interests. Law itself does not exist in a vacuum: on the contrary, it is very much the result of conflicting interests and can be seriously challenged by the need to balance these interests. The use of political campaigns to enhance enforcement in China shows that the flexibility of political short-term policy instruments can offer incremental improvements to enhance the balance between the conflicting interests themselves and their relation with the legal system.

Implementation of Chinese Environmental Law: Regular Enforcement and Political Campaigns

Chinese pollution victims have increasingly started to resort to political and legal action to protect their interests. This paper analyzes such activism by studying how citizens identify the necessity to initiate action against pollution and by investigating the obstacles they meet when attempting to take action. The paper highlights the importance of state and intermediary institutions to aid citizens in understanding the seriousness of pollution and overcoming the obstacles they face. It shows, however, that often such aid is not available, and that state institutions when aligned with industrial interests restrict rather than support citizen action. When this occurs, citizen activism becomes an isolated affair, resulting in adversarial relations with state and industry, sometimes escalating to violence and repression of activists. The paper concludes that isolated activism forces a new look at concepts such as ‘embeddedness’ and ‘rightful resistance’ to capture citizen activism and contentious politic...

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The People vs. Pollution: understanding citizen action against pollution in China

Contents - 8 Acknowledgements - 10 Abbrevations - 14 Introduction - 18 1 Legal Change at Lake Dianchi - 20 Part I: Legislation and Lawmaking - 42 2 Law in the Boks - 44 3 Bargaining on the Land Bill - 69 4 Cleaning Up Pollution Legislation - 87 5 China's Legislative Challenges - 117 Part II: Compliance and Violation - 124 6 Why People Obey the Law - 126 7 Lawful Construction - 149 8 Attempts at Abatement - 169 9 Kunming's Hunger for Land - 190 10 Why Contamination Continues - 210 11 Law and the Complexity of Reality - 229 Part III: Enforcement and Political Campaigns - 244 12 The Enforcement Gap - 246 13 Punishing Violations - 280 14 Movements of Law - 325 15 Ad Hoc Law Enforcement - 371 Conclusion - 380 16 Regulating Land and Pollution - 382 References - 407 Samenvatting - 457

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Regulating land and pollution in China : lawmaking, compliance, and enforcement : theory and cases

Official statistics and independent survey data show that in the last decade China has witnessed a remarkable change in its enforcement of environmental pollution violations, moving toward more formalistic and coercive law enforcement with more enforcement cases as well as higher fines. The data also show that there is considerable regional variation with coastal areas having more and higher punishments than those inland. This article explores these findings, seeking to understand the explanation and meaning of these temporal and regional variation patterns. The study shows how enforcement varies when there is a convergence of governmental, social, and economic institutional forces. The article argues that the basis for such convergence has been fragile, as national pressures have lacked consistency and local community and government support evaporates when dominant sources of income are at stake.

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Fragile Convergence: Understanding Variation in the Enforcement of China's Industrial Pollution Law

Over the last decade, Chinese citizens, judges, and prosecutors have started to take action against industrial pollution, pluralizing a regulatory landscape originally occupied by administrative agencies. Regulatory pluralism here has an authoritarian logic, occurring without the retreat of party-state control. Under such logic, the party-state both needs and fears new actors for their positive and negative roles in controlling risk and maintaining stability. Consequently, the regime’s relation to regulatory pluralism is ambivalent, shifting between support and restriction. This prevents a development of a regulatory society that could bypass the regulatory state. Theoretically, this special edition argues for a subjective definition of regulation in a context of pluralism. Moreover, it finds that regulatory pluralism need not coincide with a decentring of regulation. Finally, it highlights how entry onto the regulatory landscape affects the non-regulatory roles of new actors, creating unintended consequences for regulatory pluralism.

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Benjamin van Rooij

Papers

Implementation of Chinese Environmental Law: Regular Enforcement and Political Campaigns

The People vs. Pollution: understanding citizen action against pollution in China

Regulating land and pollution in China : lawmaking, compliance, and enforcement : theory and cases

Fragile Convergence: Understanding Variation in the Enforcement of China's Industrial Pollution Law

The authoritarian logic of regulatory pluralism: Understanding China's new environmental actors