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  • Writer's pictureWilliam Miller, MD

China quickly backs down on Zero-COVID.

Since the start of the pandemic, China has attempted to control COVID through widespread testing leading to strict lockdowns whenever the virus is detected in a community. People that test positive are taken to regional quarantine centers. During lockdown, no one is allowed to leave their homes except for the most urgent medical emergencies, not even to get food or medications. The government’s stated goal is to have literally zero COVID cases in the country. This approach has been largely successful if the only measure of success is the number of cases and deaths.

For a country of 1.5 billion people, China has had remarkably small numbers of both COVID cases and deaths. The official Chinese total number of cases has been 345,000 with a death count of only 5,200 on the mainland since the start of the pandemic. This is likely an under reporting and the World Health Organization (WHO) puts the estimated number higher at about 30,600. It isn’t an apples-to-apples comparison as the WHO number includes Taiwan. Even at the higher number, that is only 20 deaths per million population. This is a fraction of what we have had in the US where we have experienced 100 million cases, a third of our population, and 1.1 million COVID related deaths which comes in at 3,300 deaths per million.

The Chinese people, however, seem to have reached their limit on what they are willing to accept in terms of lockdowns and enforced quarantines. Recently, there have been widespread demonstrations across the country railing against not only the Zero-COVID policy, but now against the Chinese Communist Party leadership and its policies of censorship. The symbol of resistance has become holding up blank sheets of paper as protest signs. The signs are blank symbolizing the repression of free speech in the country and the government’s censorship.

This puts the Chinese government in a very awkward position. As an authoritarian government that has historically cracked down on any open dissent, for example Tiananmen Square and more recently in Hong Kong, it is difficult to be seen as making policy changes in response to protests. None the less, in the past couple of weeks there has been a quiet relaxing of some of their harsher COVID policies. People who test positive are now only required to stay in a regional quarantine center for 7 days and then can finish a 10-day isolation at home. People are also not being required to show a negative test result within the previous 48 hours when they try to ride a public bus or go into a public building.

As China relaxes its policies, many health experts fear that China will see an explosion of new cases. There are two reasons for this. First, the unintended consequence of the Zero-COVID lockdowns may be an absence of so-called herd immunity. The experience of Omicron in the US has been a much less virulent disease in part due to this herd immunity. The other important factor is the relatively low vaccination rate amongst the Chinese elderly coupled with reduced effectiveness of the Chinese vaccine. The Sinovac vaccine is the most used one in China and has only about a 70% effectiveness in preventing serious illness and death compared with Western vaccines such as Pfizer and Moderna, which consistently show greater than 90% effectiveness. A second Chinese vaccine, Sinopharm, performs slightly better at 79%.

Until recently, only 20% of Chinese over the age of 80 were fully vaccinated with two initial shots plus a booster. Part of the reason given for this is that while in Western countries vaccination programs have targeted the elderly because they are most vulnerable, in China young people of working age were the primary target. This is quickly changing and now China has rolled out a broad campaign to bring vaccination rates in the elderly up to levels that will hopefully provide protection if cases continue to climb.

The rate of new infections had started to dramatically rise in China even before recent events. A month ago, there were about 5,000 new cases per day. The WHO now puts the daily rate at almost 20,000 new cases daily as of this writing and the number is increasing. Interestingly, China’s healthcare system may not be prepared to handle a massive surge in hospitalizations if that occurs. According to a recent article in the Wall Street Journal, China initially put resources into building new hospitals and healthcare infrastructure at the start of the pandemic three years ago. However, the article goes on to say that when China’s president, Xi Jinping, announced his Zero-COVID approach, almost all of those resources were diverted to the costly lockdowns which required literally battalions of workers to test the population every three days and supply all those in lockdown with food and other necessities.

Of course, it is easy to sit 6,000 miles away and criticize the decisions that others have made. None of this is easy and hopefully we are all learning from the experience. We shall continue to watch China to see how this all plays out.

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