Corona virus in China: what next?

How China has boxed itself into an unsustainable strategy to control COVID-19, and the prospects for change are slim. Shun Yuan reports.

More than two years after China ended its unprecedented lockdown in Wuhan as the first COVID-19 outbreak paralyzed the central Chinese city, the Chinese government is still adamant about sticking to its COVID-free strategy, raising serious questions about exactly how China will exit. this epidemic.

As of March this year, Shanghai, China’s largest city, had its worst outbreak, with hundreds of thousands of cases recorded. Subsequent strict lockdowns in the city caused chaos among residents, separated families and strained food and medical resources.

Initially, only certain areas were placed under lockdown, cross-region travel banned, and as case numbers began to rise, the lockdown extended to the entire city: residents were only allowed to leave the house once every few days, depending on the level of danger from the neighborhood, and those who tested positive. If they are infected, they will be taken to quarantine centers or hospitals, at which point their neighbors will also be prohibited from moving.

The goal of this round of lockdown remains the same: to stick to the dynamic zero COVID strategy that basically aims to stamp out the outbreak through mass testing and lockdowns to achieve zero cases, also called defeating the virus, as laid out by the government.

The strategy to eradicate the novel coronavirus has been a pillar of China’s anti-epidemic policies for more than two years. Government officials have long touted China’s success in keeping the virus at bay, in stark contrast to other countries where the virus has killed more than 6 million people. According to official statistics, the virus has so far caused the deaths of about 5,000 people in mainland China, although many questioned the reliability of the figure and attributed it to China’s method of calculating Covid deaths. President Xi Jinping has repeatedly said that “people’s lives are of paramount importance”, to justify closing borders and strict internal control policies. “The dynamic zero-COVID strategy has shielded most of mainland China from the effects of COVID transmission on community health and health system,” said Ben Cowling, chair of the Department of Epidemiology and Biostatistics at the University of Hong Kong. However, during the latest round of lockdown in Shanghai, as the negative effects of the lockdown, including food supply shortages, disruptions to the economy and access to medical care, have become more visible and sometimes even more damaging than COVID-19 itself, they seriously question the efficacy of the lockdown policies being implemented. The country follows suit in limiting the spread of the virus.

A Shanghai resident who spoke to him scalpel Describing his father’s failed attempt to receive dialysis due to a strict hospital policy of not entering without a negative PCR test for COVID-19, another complained that his supplies of necessities, including food, dwindled. Several people in Shanghai have written on social media about the collateral damage to confinement rules, including many patients with chronic and unrelated illnesses associated with COVID-19 losing their access to medical care.

“The government is trying to eliminate all cases of COVID-19, so they have focused all their attention on this virus, but they have not counted other diseases, and they tend to ignore or neglect non-COVID-19 deaths,” Shi Chen said. , an associate professor at the Yale University School of Public Health focusing on health policy and economics.

He spoke with two officials from China’s provincial-level health commissions scalpel On condition of anonymity he also expressed doubt about politics. “COVID-19 has become a highly politicized disease in China, and any voice calling for deviation from the current path of zero COVID will be punished,” said one official. “No one in the senior officials really listens to expert opinions anymore, which is honestly insulting to us medical experts.” Another official expressed similar sentiments, saying that the harm the policy has done has outweighed the benefits it brings. “It’s not cost-effective, and we all know that,” the official said.

Closely related to China’s strict implementation of non-pharmaceutical measures to control COVID-19 is the vaccination campaign, which according to Lian Zhonghuang, a senior fellow at the Council on Foreign Relations, appears to have nothing to do with the intensity of the lockdown measures in place. . After an initially slow vaccination campaign, China ramped up vaccinations with its locally manufactured vaccines, most notably those produced by Sinopharma and Sinovac, but the vulnerable groups were not prioritized. By late February 2021, the vaccination rate in mainland China was just 3.56%, compared to 53% by August last year and 87% now. Based on data from the latest outbreak in Hong Kong, experts at the University of Hong Kong reported that two doses of the Sinovac vaccine were 72% effective against severe or fatal disease in people over 60 in a non-peer-reviewed study. A study looking at infections between December 31, 2021 and March 8, 2022. With a booster dose the effectiveness is up to 98%. However, the vaccination rate in mainland China among the elderly remains low: although more than 87% of the population have received two doses of the vaccine, among those over 80, just over half have received two doses and less. Of the 20% who got a booster dose, according to Zeng Yixin, deputy minister of the National Health Commission.

This lack of protection in groups most at risk of serious disease makes it difficult for China to safely change its policy. “It’s mind-boggling that for the greater part of the past two years, China has had very few cases, but failed to fully vaccinate the elderly, who are more susceptible to infection and severe symptoms of the virus,” Huang said. . “Experience in Singapore shows that a safe exit from zero-COVID is possible if vaccine coverage for the elderly reaches a very high level,” Cowling said.

Huang and Chen said the hesitation about the vaccine was reinforced by the lack of urgency to get the vaccine in China. China’s control of COVID-19 gives citizens fewer reasons to vaccinate, especially when there has been widespread misinformation about vaccine side effects such as frequent heart attacks and severe allergies. Logic says: There is no need for vaccination when there is no virus in the first place.

The government in Beijing remains committed to the strategy to eradicate the emerging corona virus. “It is imperative that we maintain a clear mind and firmly adhere to the public policy of dynamic non-spreading of the coronavirus, and resolutely fight against all words and deeds that distort, doubt and deny our country’s anti-epidemic policies” on May 5, while the lockdown continues in a meeting, President Xi said during a meeting. Shanghai and the number of cases is increasing in Beijing.

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Health experts say several conditions must be met before China can consider changing policy, preventing the possibility that China will lose complete control of the virus, essentially forcing the government to live with the virus – just like what happened in New Zealand.

Chen said increasing vaccination among the elderly while strengthening the healthcare sector is an absolute “prerequisite”. It will also be necessary to inform the public of the variable nature of the infection – lower severity of variant B.1.1.529 (omicron) and lower risk after vaccination. One argument often used by the government and those in favor of the coronavirus eradication strategy is that once the policy is relaxed, the health care system will soon be overburdened and there will be an uncontrollable increase in deaths. To address this problem, experts have proposed solutions that are in line with international practices. Chen said the government should start drafting regulations or guidelines on treating patients with varying degrees of severity, with the goal of not bringing everyone infected with the virus to hospital (as previously required) by ordering home quarantine, leaving hospital and ICU beds. For those who need it most. “If you can prevent millions of people from going out of their homes during the lockdown, there is no point in the argument that you can’t ask people with mild symptoms not to visit hospitals,” Huang said.

Even with updated medical guidelines, the Chinese political landscape will also play a pivotal role. With the party congress approaching when President Xi prepares to secure an unprecedented third term in office, the government will strive to maintain the stability that has been the basis of Xi’s political ambition, Huang says.

With flu season set to begin shortly after the party convention, the timeline for China’s reopening is murky at best. “The earliest possible time for China to abandon the current measures is early next year, and even that has absolutely no guarantee,” Chen said.