William Miller, MD
When Do Lockdowns Go Too Far? The Case of Shanghai.
On March 28th, I reported on the new Omicron variant, BA.2. In that article, I mentioned that Shanghai, China’s largest city of 25 million was going on complete lockdown. After the original outbreak of COVID-19 in Wuhan, China embarked on an ambitious goal. To have zero cases of COVID within its borders. This would be a challenge for any country, but almost unimaginable for a country so vast. China not only has the largest population with 1.4 billion people, it is also geographically huge at 3.75 million square miles, just slightly smaller than Canada. To its credit, China has been successful at holding COVID at bay. However, at what cost?
If we think back to the images that came out of Wuhan, the epicenter of the pandemic, one might recall stories of apartment buildings having their doors chained shut and windows welded over with steel bars to keep the residents inside. The army patrolled the streets with attack dogs. The city of 11 million people was essentially cut off from the rest of the country. There are reports that food and water were scarce and that some residents died as a result. Since the Chinese government is not sharing details, it is hard to estimate how many people may have died from starvation and lack of water or from COVID and other illnesses due to lack of medical care. These restrictions, which viewed from the West are considered harsh, did undoubtably dampen the spread of COVID to the rest of China. An interesting unanticipated benefit was that air pollution levels dropped dramatically during the lockdown. Wuhan, a major industrial and transportation center, normally has a significant air pollution problem, but with minimal cars and trucks on streets and factories all shut down, the air became much cleaner.
During the pandemic, China has exercised its “Zero COVID” policy and for two years it has kept cases remarkably low. Only 439,000 reported cases between 2020 and 2021 resulting in 4,638 reported deaths in that time according to the World Health Organization (WHO). Of course, there is suspicion that the actual numbers are higher. However, since the beginning of 2022, there has been a surge of COVID cases in China. The total number of cases has literally doubled in just a few months and the number of deaths has more than tripled. Currently, the total cases now number 946,700 with 14,319 deaths. This has caused China to redouble its efforts to crack down, however, this time there has been significant push back from many who feel that the “Zero COVID” policy is worse than the disease it is intended to control.
Turning now to the situation in Shanghai, the current outbreak actually began in Hong Kong. Hong Kong remains a major international hub, despite coming under communist China control in 1997. While China’s “Zero COVID” policy requires all who enter the country to quarantine for 14 days, it is hard when so many shipments of goods are flowing in and out of a port like Hong Kong. The city has a population of 7.4 million and reports 740,000 cases since their outbreak began in December. Prior to that, Hong Kong had gone for two years with relatively few cases. In March, the WHO declared Hong Kong to be the principle hotspot for COVID in the world as hospitals and morgues were overwhelmed. Hong Kong is also a major tech and business hub with ties to Shanghai, China’s most important financial center. It wasn’t long before cases began to pop up there.
On March 30th, the entire city of Shanghai with its population of 25 million was placed in lockdown. The official government statement was that it would only last for 3 days, although few believed that. Right before the lockdown went into effect, there was a massive run on stores for food, medicine, and supplies. Shelves in markets were soon empty.
The lockdown is now heading into its third week. No one is allowed to leave their home, even to buy food or get medicines. A large group of healthcare workers and other support personnel have been sent to the city. Food is supposed to be delivered to each home every two days which is a major logistical challenge. Reports are that deliveries to families may only contain enough food for one person for two days and the next delivery might be 3 or 4 days away.
Every two days, healthcare workers visit every single inhabitant and test them for COVID. If a person tests positive, then they are immediately taken to an isolation center. They are not allowed to return to their homes to make arrangements or get personal belongings. There have been reports of pets being left unattended and even one case of a disabled child who died after his father, his only caretaker, turned positive and was taken away. The report, if true, alleges that no measures for care were provided for the child after the father was put in isolation. There are many reports of children being separated from their parents when the whole family turns positive and all are whisked away to isolation centers.
And Shanghai is not the only major city on lockdown. According to WHO, there are “tens of millions” of other people in other cities outside of Shanghai that are currently in lockdown. The Economist recently reported on the extraordinary expenditure of manpower required to keep all of these people in what essentially amounts to house arrest. The logistical feet of delivering food to all of this people is estimated to require 7.7 million workers. In Shanghai, a battalion of 3,000 healthcare personnel are present to swab all 25 million Shanghainese ever two days. The reports are that some are working close to 24 hours a day with little sleep or food. The article in The Economist goes on to describe one healthcare worker who fainted three times in one day trying to carry out her job.
It remains to be seen if the Chinese government can keep its “Zero COVID” policy in place. Already, there is talk about trying to loosen up some of the parameters to make it a more realistic plan.