What’s next for China’s zero COVID policy
Since the beginning of the pandemic, China has been pursuing a policy called “zero COVID”. The country aims to eliminate the disease from its borders as soon as possible. However, even though other countries have dropped their zero-COVID goals in the past year and despite an unusual statement from the World Health Organization calling policy unsustainable, China’s government has remained true to its plan.
Setting zero COVID goals and implementing policies to achieve that goal are two different things. Australia and New Zealand also pursued zero COVID, but their efforts were thwarted by the Omicron surge. China has not changed its policy and has increased its response to Omicron despite significant costs. It is important to understand how China has done this in order to determine if the country can continue its course for Omicron.
Benjamin Cowling, chair of epidemiology at Hong Kong University who helped draft the WHO’s 2019 pandemic influenza guidelines, talked Popular Science through China’s strategy.
He claims that the policy was not one China had prepared for the pandemic. It grew out the initial response to the Wuhan epidemic.
” “There was no playbook for this before COVID,” he said. “It’s an entirely new idea.” Cowling states that there was no playbook before COVID for this.
Step one: suppression
A national zero COVID strategy consists of two parts. First, stop existing outbreaks and let them die. Stop new outbreaks from coming in, Cowling says it this way: “One is to get to zero .”
, and the second is to stay at zero.”
This first step, suppression, has taken place in Shanghai this spring. While the US’s brief and loose stay-at-home policies in the spring of 2020 were intended to bring transmission down to low levels, China’s lockdown has much tighter controls designed to entirely end transmission.
” They’re very, very adept at total lockdown,” Cowling said. “This then buys time to do another thing that they’re very skilled at, which is testing everyone in a city.” You can see the strategy in Shanghai: Everybody stays at home, they test everybody repeatedly, and anyone who has a case they isolate outside the home, while any contact identified from contact tracing is quarantined.”
Joan Kaufman, a lecturer in global health and social medicine at Harvard University’s School of Medicine, noted that China has a precedent for wielding its infrastructure apparatus to contain a virus: during the 2003 SARS outbreak. She says, “They built these quarantine hospital and took a very aggressive approach in containing and eliminating SARS virus.” “I believe that was the foundation of this approach .”
CoVID lockdowns require more than just medical personnel to run millions of PCR tests. It also requires civil servants to trace contacts and physical buildings to house thousands in government-overseen quarantine.
When cases are identified, Chinese authorities have locked down apartment buildings, neighborhoods, cities, or even entire regions, as in Hubei province in early 2020. Depending on the circumstances, this could mean different things. Sometimes people are restricted to a particular block or neighborhood. Others allow households to make a limited number trips.
This can lead to human suffering. In Shanghai, residents have gone hungry, or slipped into desperation after months without work. And international outlets have reported growing unrest in the city at news of callous or even brutal quarantine policies–like the separation of parents and children, or police who broke down a door to bring a woman into quarantine.
While a lockdown is in place, China can mobilize a massive contact tracing apparatus to identify possible contacts of people who test positive–in November, the South China Morning Post reported that the police in the city of Chengdu had traced 82,000 close contacts of COVID cases. Cowling says that there are people looking at location data from mobile phones and scanning CCTV videos.
Most people who are positive for the disease or are identified as contacts must be quarantined outside their home. Cities have built quarantine and isolation facilities that can hold thousands of people, and the country has a bank of mobile quarantine buildings that can be trucked to the site of new outbreaks. Cowling states that they have them in central warehouses and that if there is an outbreak in a city, the trucks will drive there with these facilities and connect to electricity and water .
Lockdowns can last for several weeks due to the speed of this response. Cowling contrasts this to Australia, which also pursued zero COVID but had to lock down Melbourne for nearly nine months in the face of a simmering outbreak. He points out that China’s longer exceptions, such as Shanghai and Wuhan, were situations in which an outbreak was already well underway before a lockdown.
The downside, Cowland states, is that a large net will inevitably result in quarantining people who don’t have any symptoms. And quarantine facilities in hard-hit cities have ended up crowded, or without enough food or showers. During most of the pandemic, however, life continued as normal across the country. This meant that there were no deaths and no emotional trauma from school closures or other isolation precautions.
And stay out
Then, there’s the option of staying at zero. Travel restrictions are the key to this.
Although it’s possible to enter and exit China, international flights can only land in a handful of cities. Passengers need to take a series of COVID tests–for anyone coming from the US, that means one PCR test seven days from departure, another two days from departure, and a final antigen test before leaving on a direct flight for China.
Anyone flying in is required to quarantine for 14 days and test as often as every day. According to the US State Department, people who test positive are moved to either a hospital or an isolation facility. Kaufman states that after a week of soft quarantine, people who test positive are allowed to move around the city, but cannot go elsewhere for a certain time.
This is not dissimilar to the strategies used by Singapore and Korea during the pandemic. And, until fall 2021, New Zealand and Australia allowed virtually no international travel.
But China is not an island. Tight controls have had serious consequences for the border with Laos, Myanmar, and Vietnam. While most of the country has been spared the disruption of the pandemic, border cities have experienced waves of lockdowns, prompting local recessions and outmigration.
These closures seem to have been an acceptable compromise. Cowling states that most Chinese people do not travel internationally so the government may view it as an economic disadvantage, but not a dealbreaker.
These tactics seemed quite sustainable until Omicron. That variant, which is so easily transmissible, has changed the equation. This is because suppression measures must go further and last longer to be effective. This means that the actions are more disruptive to daily life.
Although news has been centered on outbreaks in Beijing, Shanghai, and other areas of the country, there are still outbreaks. On May 5, CNBC reported that an estimated 40 cities were affected by lockdowns this spring.
” I think the fear in China right now would be that Omicron enters Beijing or Guangzhou, causing disruptions like the one in Shanghai. It’s likely that the virus will infect you .”
[Related: The 5 phases of COVID’s endgame]
A major difference between China’s zero COVID plan and other countries’ is that Australia and New Zealand had envisioned ramps. China’s president, Xi Jinping, has said that the country can maintain zero COVID for the foreseeable future–though the policy has been rebranded “dynamic zero COVID” to acknowledge that COVID cases will still occur.
This has sparked a heated debate between domestic and foreign epidemiologists about the country’s strategy. A letter published in Nature Medicine argued that China now has the medical infrastructure to successfully treat COVID outbreaks without resorting to lockdowns. But another recent paper in the same journal estimated that if the country were to end its current lockdown-and-isolate strategy, and instead rely on a patchwork of school and workplace closures, Omicron would kill between 800,000 and 1.6 million people, depending on the effectiveness of those strategies.
The challenge, Cowling says, is that 14 percent of China’s citizens over 60 and 50 percent of those over 80 aren’t fully vaccinated, in part because the populace hasn’t felt personally threatened by COVID. He says, “If you don’t expect cases in your community, then that’s a sign you probably don’t need to get vaccinated.” The suppression policies can be ended, but only after people have started dying. Similar to what happened in Hong Kong where Omicron overpowered a lockdown, this is similar to what happened there. China must find a way for more vaccines to be available in arms to avoid another similar situation.