The “zero-COVID” policies implemented by the Chinese government and other countries such as Australia, New Zealand and Singapore, mainly consisted of an attempt to completely eliminate outbreaks, establishing strict border controls and extreme containment measures through radical lockdowns. The Australian city of Melbourne endured the longest lockdown in the world: 263 days.

The countries that introduced these radical containment policies experienced resounding success in the early stages of the pandemic. Mortality rates due to COVID-19 across the globe reveal that these countries have fared much better than those whose societies were forced to live with the SARS-CoV-2 virus from the beginning.

Its consequences

Unlike China, the rest of the governments that applied these measures proposed alternatives to tackle the pandemic after the strict lockdown, which was unsustainable in the long-term for many reasons, from social to economic.

The spread of the Omicron variant of the virus — much more transmissible than its predecessors — forced governments to recognize the evidence that the infection could not be contained indefinitely. Thus, the approaches associated with zero-COVID advocated their temporary nature as long as effective and extensive vaccination programs were available to the majority of the population, especially the most vulnerable.

Accordingly, the countries promoting zero-COVID policies gradually relaxed the restrictive measures, as new vaccines became available. But this was not the case in China.

China continued with the same extremely restrictive health policy in an attempt to contain exposure to the virus. Meanwhile, it presented low vaccination rates, especially among the most vulnerable population. Vaccine administration in China was initially limited to adults aged 19 to 60, a mistake the government has not yet managed to remedy. At the present time, only 40% of Chinese citizens over the age of 80 have received a booster dose.

The vaccines that continue to be administered in China are solely those manufactured there, mostly by the companies Sinopharm and Sinovac, with limited efficacy.  After administration of the third dose, their efficacy is between 50% and 60%. In contrast, Pfizer or Moderna vaccines developed with mRNA achieve more than 90% efficacy with two doses.

The health policies of the Chinese government continue to focus on the detection of cases and their isolation, which has overwhelmed its healthcare capacity, specifically in intensive care; China has 3.6 intensive care beds per 100,000 inhabitants, a figure about three times lower than that of Spain, which has 9.9 beds.

The inevitable change: the end of zero-COVID

The Chinese government, led by President Xi Jinping, has suddenly abandoned its zero-Covid policy of restrictions after almost three years in force, according to news reports.

However, this change of course is not accompanied by effective measures to cope with the expected exponential increase in infections. What might the new scenario be?

Collateral damage to the Chinese economy, coupled with social protests at the end of November by a population that no longer supported the government’s strict lockdown policies, have shattered drastic attempts to contain the spread of the virus.

Recent demonstrations in at least 10 cities in the country, including Beijing, Shanghai and Wuhan, have brought about changes, openly criticizing the zero-COVID policies supported by Xi Jinping’s government.

The catalyst for the protests was a fire in an apartment in Urumqi city, in the western Xinjiang region, in which 10 people died and in which the slow response of firefighters was partly attributed to the severe restrictions in force in the area and in much of the country.

Last December, the government declared an end to mandatory PCR testing in mild cases, population testing was reduced, people were allowed to quarantine in their own homes, mass lockdowns were curbed and a scale-up of vaccinations for the elderly was announced.

According to the journal Nature, the expected increase in infections after this change of strategy could generate at least 1.55 million deaths, half of those recorded in the United States, the country that has reported the most deaths due to the pandemic. The peak demand for intensive care units, the report says, would exceed the country’s critical care capacity by more than 15-fold.

This same study, by Fudan University in Shanghai, predicted that the abrupt abandonment of the zero-COVID strategy could lead — in addition to the aforementioned death toll — to more than 112 million symptomatic cases of COVID-19, and about five million hospitalizations.

Feng Zijian, former director of the Chinese Center for Disease Control and Prevention, said that 60% of the population will be infected with COVID after the measures are eased: 840 million people (compared to the 646 million who have been infected so far worldwide) reflect the magnitude of the problem.

According to a model published online by the University of Seattle (U.S.), over the next year 1.6 million people could die in the Asian country, 500,000 until April alone. The report states, however, that widespread maintenance of face masks, some restrictions in movements, the use of new antiviral treatments and a substantial increase in vaccination rates could reduce those numbers to just over half.

Current state of the pandemic in China

According to the BBC, there are reports of an overflow of cases in Chinese hospitals that appear to be filling in the midst of a new wave of infections, according to the World Health Organization (WHO).

Although only seven COVID-related deaths have been officially declared as of December 21 and none in the previous two weeks, it should be clarified that China has limited criteria for confirming COVID-19 deaths, including only those who die directly from respiratory illnesses caused by the coronavirus, and not deaths caused by its side effects.

Therefore, the case registry does not correspond to WHO guidance, resulting in a figure that is well below the death toll in many other countries.

In the week ending December 11, official figures showed a drop in the total number of new infections in China after the previous week’s peak: however, it should be noted that mass testing has stopped and positive cases are only being reported in hospitals and clinics where symptomatic patients are treated.

Despite these reported figures, the WHO warned that the health system in China could be under severe pressure. Dr. Michael Ryan of the WHO said that “in China, what’s been reported is a relatively low number of cases in ICUs [intensive care units], but anecdotally ICUs are filling up”, with videos circulating on social media that appear to show crowded hospitals.

Regardless, the lack of transparency in the information provided from the Asian country makes it very difficult to formulate reliable estimates of the magnitude of the current problem.

Julio Tudela

Bioethics Observatory -Institute of Life Sciences

Catholic University of Valencia



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