China signals it could soften its zero-Covid policy, but there are more questions than answers

China signals it could soften its zero-Covid policy, but there are more questions than answers

By Paul Misfud

China has sent the clearest indication yet that it may try to relax its strict zero-Covid policy, which has disrupted daily life, strained the economy, and, most recently, caused a surge of protests across the nation. China's top Covid response official informed health officials on Wednesday that the nation was facing a "new stage and mission" in terms of pandemic control.

According to state media Xinhua, vice premier of China Sun Chunlan stated on Wednesday that "China's pandemic containment faces (a) new stage and mission with the decreasing toxicity of the Omicron variant, the rising vaccination rate, and the accumulating experience of outbreak control and prevention."

The comments come in response to a rise in public annoyance at China's stringent zero-Covid policy and its enormous human cost, which has resulted in unheard-of protests in at least 17 cities since last Friday.

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According to Xinhua, Sun, who has represented the Chinese Communist Party's enforcement of the policy, made no mention of "zero-Covid." Her remarks come a day after a different group of top health officials promised to change some Covid control strategies and urged local governments to promptly "react to and settle the reasonable requests of the populace."

The high-level statements, along with minor rule changes and some recent easing of lockdown procedures in significant Chinese cities, imply that China is reexamining its policy, which has grown more disruptive as it struggles to combat highly transmissible coronavirus variants and record case numbers.

However, the change in tone has not been accompanied by a roadmap for getting there or any mention of abandoning the zero-Covid policy, so it is still unclear how it will affect the situation on the ground or calm growing public angst.

Due to their designation as "high risk" as of Thursday, thousands of buildings and residential areas spread over 32 Chinese cities continue to be subject to lockdown restrictions.

Because the central government has long taken pride in its zero-Covid policy, local officials may be reluctant to let cases proceed for fear of retaliation. According to experts, the US is still falling behind in some critical areas of readiness for a large outbreak.

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Priorities

Chinese health officials and experts have long argued that the costs of the zero-Covid policy are scientifically justified. They have done so by pointing to gaps in medical preparedness, including a lagging elderly vaccination rate and an inadequate intensive care infrastructure - especially in rural areas - as well as uncertainties about how the virus will evolve in the future and its long-term effects.

They have cautioned that these flaws could cause the healthcare system to become overburdened if the virus spreads freely throughout the 1.4 billion-person nation, which could increase the deaths that are anticipated with an opening up.

Nicholas Thomas, a health security expert from City University of Hong Kong, stated that this is still a major problem for the government: "There is still a sizable portion of the populace that is believing in the government's activities in dealing with the virus. Uncontrolled interaction with the virus could undermine that confidence and put at danger vulnerable groups.

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The new remarks about the policy, according to him, "do not indicate that China is prepared to make the transition to living with Covid, but rather a hint that the virus has gotten out of hand and the government is unable to return to a zero-Covid environment."

With over 35,000 new cases reported on Wednesday, case numbers have been at or near record highs for the past week. This presents a significant challenge to efforts to bring case numbers down.

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Observers claim that China has prioritized maintaining zero-Covid, which relies on lockdowns, mass testing, and forced quarantines of both cases and close contacts, rather than making preparations for the virus's widespread spread.

According to Alfred Wu, an associate professor at the Lee Kuan Yew School of Public Strategy at the National University of Singapore, one reason for this has been the government's own narrative about its success and the support of the policy by leader Xi Jinping.

China's border controls and quick way of detecting and suppressing the virus allowed the country to live relatively virus-free after putting its initial outbreak in Wuhan under control in 2020, while hospitals in most of the rest of the world were inundated with sick and dead patients. Only 5,233 Covid-19 fatalities have been reported in China officially since the beginning of 2020, and fewer than 600 were in 2022.

China's policies and the comparatively low number of Covid deaths have been hailed by Xi as achievements of Chinese leadership. The nation maintained that system even as more people learned to live with the virus as a result of widespread immunizations and the spread of the milder but highly contagious Omicron variety. Omicron, however, also increased the disruption and decreased the efficacy of Chinese controls.

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"The number one (reason) is propaganda — they want to claim that China is doing a much better job than the United States," said Wu, who also suggested that maintaining the zero-Covid policy may also be due to a desire to increase state control over the populace given that Xi has made state security a priority.

China "missed so many precious opportunities" to prepare for life with the virus and to prepare the public for a greater number of deaths from Covid-19, he claimed, while pursuing this policy.

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Prepared?

One shortcoming that health officials on Tuesday unveiled a new plan to overcome is the low incidence of booster immunization in the older population most susceptible to Covid-19.

According to official media, on November 11 just 40% of China's over-80 population had received a booster shot, while about two-thirds had received two doses. This is due to both vaccine reluctance and an initial vaccine roll-out that did not give the elderly priority.

In order to assure adequate protection, a World Health Organization advisory group suggested last year that elderly individuals receiving China's inactivated-virus vaccinations have three doses in their initial course. It is well known that vaccine protection against the Omicron form diminishes over time.

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China's immunity, however, is mostly dependent on vaccination because the virus has only infected a very small number of people there. 90% of people have received all recommended vaccinations. Although studies have demonstrated that China's immunizations can guard against deadly diseases, they provide less antibody protection than the widely used mRNA vaccines in other parts of the world. Any mRNA vaccination has not yet received Beijing's approval.

In Hong Kong, where low vaccination rates among that most at-risk group contributed to the Chinese territory's Covid-19 death rates becoming some of the highest in the world last spring, a clear warning of the hazards for the mainland was witnessed.

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According to infectious disease specialist Peter Collignon of the Australian National University Medical School, vaccinations and booster shots are essential for nations transitioning away from policies aimed at "zero-Covid," even though they won't completely prevent an increase in deaths when restrictions loosen.

"The preparation is not just vaccinations; it's surge capacity; it's making sure you have enough hospital staff; it's making sure you have enough beds; and particularly it's making sure the elderly (are protected)," he said.

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What’s next?

China has hinted that it would put more effort into fortifying its anti-virus defenses. An action plan to increase elderly immunization rates was released by officials on Tuesday. This was in line with a goal outlined in a 20-point plan to improve zero-Covid measures that was unveiled last month and which also urged hospitals to stockpile antiviral medications and medical supplies.

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The same notification also loosened some restrictions on testing and quarantine and issued a warning against excessive local policy enforcement — all statements that have recently been reaffirmed by senior health officials.

State media has emphasized a number of localities that have made minimal modifications to their policy in response to that advice and in the wake of the recent protests, most notably regarding testing and quarantine regulations.

On Wednesday, authorities in the southern city of Guangzhou loosened quarantine rules and lifted lockdowns in four districts. Local authorities in Urumqi, Xinjiang, announced on Saturday that they would progressively relax lockdown restrictions in areas deemed to be of "low risk," and they moved to restore crucial enterprises and public transportation the following day.

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At least 10 people perished in a horrific fire on November 24 in Urumqi, which spurred demonstrations across the country. Videos of the tragedy appeared to show that lockdown precautions prevented firefighters from reaching the victims. They were included to a list of fatalities that have been frequently connected in popular discourse to Covid-19 restrictions.

On China's strictly controlled social media, a discussion on Omicron's relative "decreased pathogenicity" was trending on Thursday. This could be an indication that the government is trying to change the public's perception of the virus after years of emphasizing its dangers.

However, several social media users remained dubious, claiming that the modifications to the testing specifications were too slight to lessen the effect of zero-Covid on daily living.

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And at least one city, Jinzhou in northeast China, resisted the changes made by other cities by announcing on Thursday that it would not ease up on its precautions in advance and abandon its efforts to control an ongoing outbreak, arguing that "not having (the virus) is still better than having it" regardless of how virulent the coronavirus was.

According to experts, the actual test of the nation's course will be revealed in the upcoming months.

Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations in New York, stated that China would have "a way ahead for future opening" if the vaccine drive and other suggested measures enhancing medical preparation were "fully implemented." "But the implementation process has not yet given them a higher priority."

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Another issue is the discrepancy between Beijing's rules and how they are carried out by local governments, which are under pressure to reduce the number of cases since doing so could result in their dismissal, a common punishment for officials who have allowed epidemics to expand in the past.

There will be problems if you open up and make a mistake, Huang said. Before any significant improvements can be made, "you have to modify the incentive structure of the local governments," he continued.

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