The outlook for China’s zero-Covid strategy

WHO chief slams Beijing’s plan to eliminate virus as experts warn of 1.5m deaths

A health worker cycles through an empty street in Shanghai during the city’s ongoing lockdown
Health worker cycles through an empty street in Shanghai during the city’s ongoing lockdown
(Image credit: Hector Retamal/AFP via Getty Images)

The head of the World Health Organization (WHO) has warned that China will be unable to maintain its zero-Covid strategy, despite predictions that more than 1.5m lives will be at risk without the strict measures.

WHO Director General Dr Tedros Adhanom Ghebreyesus told reporters in Geneva yesterday that he believed Beijing’s plan for controlling infections is not “sustainable considering the behaviour of the virus”. He had “discussed this issue with Chinese experts”, Tedros said, and emphasised that a “shift” in approach by Beijing was “very important”.

The intervention came as a newly published study in Nature on modelling by scientists in China and the US concluded that dropping the zero-Covid policy without any safeguards risked “causing approximately 1.55 million deaths”.

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Splendid isolation

The new research found that while dropping the policy would be devastating for public health, the danger could be mitigated by other government interventions such as increasing Covid-19 vaccination rates.

Experts from Fudan University in China and the US National Institutes of Health forecast that demand on intensive care would be more than 15 times’ capacity if measures were dropped without the introduction of other measures, resulting in hundreds of thousands of deaths.

But they said that the death toll could be much reduced if there was a focus on vaccination, as well as providing antivirals, while maintaining some restrictions. Only about 50% of over-80s in China are vaccinated, the paper said.

Many countries attempted to impose zero-Covid measures as the world grappled with the best method for controlling the spread of Covid-19. Many, however, abandoned this approach as vaccinations made the strategy less necessary.

As it stands, only mainland China and North Korea are still pursuing an approach that relies on maximum suppression of infections. But data from countries that abandoned the zero-Covid strategy earlier in the pandemic will be giving them cause for concern.

New Zealand, which ditched the plan after the arrival of the Delta variant in late 2021, has now recorded one million infections. And worryingly, “it’s taken just three months” for cases to rise from 200,000 to the “grim milestone”, The New Zealand Herald said.

Experts have said the rapid rise in cases “reflects the enormous scale of problems” that the country faces, having tried to suppress the virus for so long, the paper added. A “second surge” could hit the country “as early as late winter or spring”, with questions remaining about the extent to which New Zealanders have “natural immunity”.

Closer to home

China need not look as far afield as New Zealand for a warning about its predicament. When Hong Kong began to drop its zero-Covid approach in March, it went from having one of the lowest infection rates to “the world's highest death rate”, NBC News reported.

An approach of “mass testing, contact tracing, border closures and strict quarantine requirements kept cases and deaths to a minimum for almost two years”. But experts have since warned that “it also bred complacency” about an “inevitable” outbreak.

Zero-Covid measures have been successful in most examples when governments are trying to “stop the virus from getting in”, Ben Cowling, chair professor of epidemiology at the University of Hong Kong School of Public Health, told the broadcaster.

But the restrictions “only postpone” Covid’s spread, he added, warning that the approach meant Hong Kong was totally unable “to stop an outbreak once it gets established”.

A similar spike in infections was seen in Vietnam when it dropped its zero-Covid strategy after a “stark warning from business and a record quarterly drop in gross domestic product”, the Financial Times said. And Taiwan, “once a zero-Covid poster child”, is also learning to “live with the virus”, The Guardian added, increasing tensions with Beijing.

Lone ranger

Tedros Adhanom Ghebreyesus’s criticism of China’s commitment to a zero-Covid approach was a “rare” example of the UN agency commenting directly on “a government’s handling of the pandemic”, The Times reported.

His concern was also echoed by Mike Ryan, the WHO emergencies director, who described how “the impact of China’s rigid Covid policy on human rights also needs to be taken into consideration alongside the effect on a country’s economy”, the paper added.

It is “understandable” that China would seek to protect its low death toll by taking “tough measures to curb coronavirus contagion”, The Guardian said. But outbreaks of the Omicron variant have “underscored the difficulty” of stemming Covid entirely.

As the rest of the world begins to reopen following two years of lockdowns, “scores of Chinese cities – from the financial hub Shanghai to the capital, Beijing – have been under some form of lockdown since earlier this year”.

The situation has been exacerbated by “authorities’ heavy-handed enforcement of the policy”, the paper added, which is triggering “anguish and anger”.

Despite the public criticism, Xi Jinping last week urged Chinese officials to “unswervingly adhere to the general policy of dynamic zero-Covid”, claiming: “We have won the battle to defend Wuhan, and we will certainly be able to win the battle to defend Shanghai”.

But with China now the only major economy in the world pursuing the plan, his commitment to the policy may be more driven by the worrying modelling about what happens if he changes tack than any desire to remain locked down.

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