Ending China’s extreme COVID policy could lead to a health catastrophe

After nearly three years of a pandemic that has killed more than 6.6 million people worldwide, the official death toll in mainland China stands at 5,233, a startlingly low number for the world’s most populous country.

While most countries long ago stopped trying to eradicate the coronavirus and instead chose to live with it, China has taken extreme measures to prevent its spread. The government is ruthlessly watching its citizens, ordering constant testing, shutting down workers in factories and locking down entire cities in a plan that has come to be known as “COVID zero”.

Now, with China’s economy in a slump and protesters taking to the streets in a rare show of defiance against an authoritarian government, the country’s leaders are facing enormous pressure to ease those restrictions.

But there is a major problem they will have to face: Zero COVID has turned China into a tinderbox for the coronavirus.

As outbreaks are scrupulously suppressed and vaccination rates lag behind, the population is likely to have weak natural immunity. Experts fear that if rules are loosened too much, the country of 1.4 billion people will experience a massive public health emergency, jeopardizing its ability to care for the sick.

“Without a coordinated and consistent plan, this can simply lead to a rapid increase in cases, and then you will find that the healthcare system is quickly overwhelmed,” he said. Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations and an expert on public health in China. “It would defeat the very purpose of China’s response to the pandemic.”

To get an idea of ​​what this might look like, consider Hong Kong in February. It was then that a highly contagious variant of Omicron broke through the city’s defenses against COVID zero and swept through the densely populated metropolis.

While 72% of residents were vaccinated against COVID-19, vaccination coverage for vulnerable older people was significantly lower. Less than 45% of those aged 70 and over were vaccinated when the outbreak began, and among residents of nursing homes, the rate was below 20%.

Within weeks, the huge convention center was converted into a makeshift hospital to care for elderly patients with COVID-19. The waiting time for an ambulance lasted up to two days. Morgues have run out of coffins as the daily death toll has risen from zero to nearly 300, though this option is often seems less dangerous than his predecessors.

Masked people lie in hospital beds, some under tents, outside the building

Patients in a makeshift treatment room outside the Caritas Medical Center in Hong Kong, February 2022.

(Kin Cheng/Associated Press)

In addition to public anger and frustration, many citizens fear a similar scenario could unfold on the mainland.

“Society is very divided,” he said. Xi Chen, health policy expert at the Yale School of Public Health. “They are worried about lockdown measures being too harsh, but they are also worried that the government will ease things up.”

When the novel coronavirus first emerged in Wuhan in late 2019, Chinese officials were slow to recognize the threat. But once the risk became clear, the country took drastic measures to eradicate transmission of the virus. This meant the cancellation of international flights, the blocking of highways and the imprisonment of the entire urban population in their homes.

Within months, life in China returned to normal as countries like the US, South Africa and Brazil struggled to keep the death toll under control.

President Xi Jinping proclaimed COVID-19 zero as one of his crowning achievements, calling it proof that China’s governance is better than the West’s. For a long time it seemed like he was right, he said Michael Osterholmdirector of the Center for Infectious Disease Research and Policy at the University of Minnesota.

“Then Omicron came along,” Osterholm said. “Early options were like big wildfires: they were difficult, but they could be contained. Omicron is like the wind. They can distract him. But they can’t stop it.”

Chinese officials, of course, tried.

Authorities are requiring daily or near-daily coronavirus tests to detect infections immediately. A single digit number of cases has caused lengthy lockdowns. As new cases hit record levels, as of November, 95 of China’s 100 largest cities by economic output have imposed COVID-19 restrictions. 22, according to Beijing-based research firm Gavekal Dragonomics.

Under the tightest restrictions, citizens have struggled to obtain adequate supplies of food and medicine. These measures also led to a recession in the economy, the closure of enterprises, the destruction of factories and the containment of consumer spending.

The government continues to advertise the country’s low death rate, with the exception of Hong Kong. While the official figures are the subject of controversy, experts agree that China’s COVID-19 death rate remains one of the lowest in the world.

But this success did little to quell the growing resentment. For many, the costs of such uncompromising policies have shown up in events such as a bus accident in southern Guizhou province that killed 27 people who were transported to a quarantine facility with zero COVID. Or that anxious Sichuan residents were banned from leaving their apartment buildings after earthquake which killed at least 93 people. Or the death of a 3-year-old boy in Gansu who died of carbon monoxide poisoning after medical workers providing isolation prevented his father from calling an ambulance.

The last straw was fire in the apartment that claimed the lives of 10 people Last week in Urumqi, the capital of the Xinjiang region, which has been on lockdown for more than three months. Angry citizens believed zero COVID controls prevented residents from fleeing and prevented firefighters from reaching the burning building in a timely manner.

Over the weekend, pickets in memory of the victims of Urumqi turned into massive demonstrations across the country, with many participants complaining about China’s policy to combat COVID-19 and even Communist Party and Chairman Xi.

People holding sheets of paper are illuminated near a car with headlights on

Protesters hold blank sheets of paper and chant slogans during a march in Beijing 27, 2022.

(Ng Han Guang/Associated Press)

Although the government acted quickly crush protestsThere are signs that public dissent has put more pressure on party leaders to come up with a COVID-zero exit plan.

Exactly what this will entail is unclear, but authorities on Tuesday re-emphasized one top priority: boosting vaccination rates for older people. While 90% of Chinese people were fully vaccinated as of mid-November, the National Administration for Disease Prevention and Control reports that only 66% of those aged 80 and over have been fully vaccinated, and only 40% have received a booster, though doses are widely distributed. accessible.

Boosting immunity among the elderly is vital as they are the most vulnerable to serious COVID illnesses. AT Singapore, for example, 99% of pandemic deaths occur in people over 60 years of age. Englandthis age group accounts for 92% of deaths.

Vaccine skepticism has been widespread among older people across China since the first shots were given, he said. Winnie Yipdirector China Health Partnership at the Harvard T. H. Chan School of Public Health. She attributed this to the fact that the first two domestic COVID-19 vaccines were only available to adults under 60.

“The general consensus that the government gave to people was, ‘We are not sure about the vaccine yet, so maybe older people shouldn’t take it,’ Yip said. “Older people generally believe that because they are older they should not be at risk of vaccination.”

Whom can China count on if citizens have strong immunity from past infections. Frequent testing for the coronavirus in the country and the use of mobile health codes that record travel and close contact history are identifying people with asymptomatic infections before they have a chance to spread the virus too widely.

As a result, if severe COVID-19 free restrictions are lifted in China, the healthcare system could be overwhelmed with patients needing hospital beds. According to research estimates and official commentary, there are about 4 intensive care beds per 100,000 people in the country. According to the Kaiser Family Foundation, this compares to 27 ICU beds per 100,000 people in the US.

Even a slight easing in the current conditions can lead to the fact that the situation will quickly get out of control. During outbreak caused by Omicron in Shanghai In the spring, a trial run of looser restrictions flooded hospitals and care facilities for the elderly, forcing a two-month shutdown on the city of 25 million people. Residents in their homes complained about lack of food and medical supplies, while others were forced to spend weeks in quarantine facilities, sometimes resulting in parents being separated from their children.

A view of neat rows of hospital beds in a cavernous warehouse setting.

In April 2022, workers built a 40,000-bed makeshift hospital for COVID-19 patients at the National Exhibition and Convention Center in Shanghai.

(VCG via Getty Images)

“Cities are in a dilemma right now because they want to use a softer hand, but that’s not working,” he said. Ben Cowlingepidemiologist at the University of Hong Kong.

Until China boosts vaccination rates for older people, improves the effectiveness of its vaccines and treatments, and bolsters its medical resources, it cannot afford to loosen its grip on COVID.

“If they had one of those three things, it would change the risk calculation significantly,” said Andy Chen, lead COVID analyst at Beijing-based consultancy Trivium China.

But so far, China lacks all three.

Yang reported from Taipei and Healy reported from Fairfield, Connecticut. David Shen of The Times Taipei bureau contributed to this report.