Another aspect that may have influenced COVID-19 rapid spread is China's highly centralized, hierarchical and bureaucratic surveillance and health response system. During the SARS-CoV epidemic (over 8300 cases in 26 countries), the government initially withheld information from the public and obstructed infectious diseases experts’ efforts to investigate and report outbreaks, which ultimately delayed the response [4]. Almost two decades after the SARS-CoV epidemic, China's political system and pattern of crisis management may have jeopardized the country's initial response to COVID-19.