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For China, moving away from ‘zero-Covid’ is easier said than done

The country is trying to ease strict anti-Covid measures even as case numbers rise, stoking anxiety among a public that has barely been exposed to the virus.
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HONG KONG — China is clamping back down on coronavirus outbreaks, illustrating the difficulties the country faces as it tries to ease “zero-Covid” measures while protecting a population that has barely been exposed to the virus three years into the pandemic.

Only last week, the northern city of Shijiazhuang was being cheered nationally as officials resisted imposing lockdowns and mass testing amid a small outbreak of the highly transmissible omicron variant. 

But as the city of 11 million people recorded almost 700 new cases on Sunday, residents were asked to stay at home for five days and undergo universal testing in some areas. In-person classes were suspended at elementary and middle schools, while university students were confined to campus.

“We took a step forward only to find that it is a stride a little too wide to have made,” Shijiazhuang resident Mike Li told NBC News on Monday. “The resurgence is severe, so we readjusted the policy.”

The Chinese government, whose strict anti-Covid measures make it an outlier among the world’s major economies, insists it is not “opening up” or abandoning what it calls “dynamic zero-Covid,” a policy strongly associated with President Xi Jinping. But as the restrictions take a growing toll on the economy and people’s quality of life, it has acknowledged the need to soften their impact. 

Earlier this month, the National Health Commission announced 20 measures to make Covid prevention and control more “scientific and precise.” They include easing international travel to China, scaling back lockdowns, shortening quarantine times and reducing testing requirements. The idea, as set out in a commentary on Monday in People’s Daily, the mouthpiece of the ruling Chinese Communist Party, is to rectify the “excessive, one-size-fits-all” approach while “avoiding an irresponsible exit.”

The success of this new strategy will depend on how well officials adapt at the local level, said Zeng Guang, former chief epidemiologist at the Chinese Center for Disease Control and Prevention. Local officials have often been fired over outbreaks that grew too large.

“Understanding the measures is not difficult as they are simple and straightforward, but carrying them out properly is challenging, especially in places where Covid-19 cases are surging,” Zeng told the state-backed nationalist tabloid Global Times last week.

Easing Covid measures means accepting a rise in cases that is likely to get worse as winter approaches. On Tuesday, China reported more than 28,000 new cases nationwide, the highest number since April. The capital, Beijing, has reported five Covid deaths since the weekend, the country’s first in six months. (The United States, by comparison, is averaging about 40,000 cases and 300 deaths a day.)

The loosening has also left people with a sense that they’re now on their own against a virus they’ve been taught to fear. The hashtag “What is it like to have the coronavirus?” was a top trending topic last week on the social media platform Weibo.

“They have already got used to all the quarantine measures and control measures, and they still see Covid as a monster, something which is life-threatening,” said Jin Dong-yan, a virologist at the University of Hong Kong.

Large parts of China remain firmly in zero-Covid’s grip. The regions of Xinjiang and Tibet have been on lockdown for more than three months. Shanghai Disneyland has been closed since a visitor tested positive on Oct. 31.

Residents purchase medicine at a pharmacy in Shijiazhuang, Hebei Province of China
Residents buy medications at a pharmacy in Shijiazhuang, China, last week.Ren Quanjun / VCG via Getty Images file

Restrictions are also tightening in cities like Beijing, where officials closed parks, shopping malls and museums on Tuesday as the city reported more than 1,400 new cases. Beijing official Liu Xiaofeng said Monday that the city of 21 million was facing “the most complex and severe prevention and control situation since the start of the pandemic.”

The wild swings in policy direction have been on display in Shijiazhuang, where officials’ earlier laid-back approach was greeted with a mixture of relief and anxiety. Residents fearful of the virus avoided crowded places and stocked up on medications at pharmacies, and some parents pulled their children out of school.

“During lockdown, people want to go out. If we loosen up, people would say they are left to fend for themselves,” resident Li Ye said Monday. “There will always be complaints.”

Though many people in China still support “zero-Covid,” the strict measures have also stoked growing resentment. Videos shared on Twitter last week showed residents in the southern city of Guangzhou, which is partly on lockdown, knocking over barriers and confronting Covid workers in a rare instance of public unrest.

Chinese social media regularly erupts with stories like that of a 3-year-old in Lanzhou, whose father said he died from carbon monoxide poisoning because Covid restrictions delayed treatment. 

The government’s new measures say patients must receive timely medical care. 

Hong Kong on ‘a much larger scale’

There is wide agreement that China’s “zero-Covid” policy made sense as a public health strategy early in the pandemic, allowing daily life to continue relatively normally and minimizing fatalities. While the U.S. has recorded more than 1 million virus deaths, China’s official pandemic death toll is 5,231.

But China has held fast to its zero-tolerance stance even as the arrival of effective vaccines and milder variants led other Asian nations like Singapore, South Korea and Japan to move from suppression strategies to “living with Covid.” China’s measures have been so effective that the virus has hardly spread in the world’s most populous nation. 

China is thus now facing a dual challenge, said Donald Low, a professor at the Hong Kong University of Science and Technology.

“The population hasn’t been exposed to the virus, and the population hasn’t been exposed to the idea that the virus is here to stay,” he said.

Patients held in an area of Princess Margaret hospital in Hong Kong on March 11, 2022 as the city experienced overflowing hospitals and morgues, shortages of medics and ambulances.
A hospital in Hong Kong during a coronavirus outbreak in March.Dale De La Rey / AFP via Getty Images file

Chinese officials have good reason to fear the unchecked spread of Covid, which could overwhelm the fragile health care system. In a country of 1.4 billion people, even a low fatality rate could mean hundreds of thousands of deaths.

Though more than 90% of the Chinese population is fully vaccinated, according to the National Health Commission, that number falls to 66% among people 80 and older, many of whom feared potential side effects and felt little urgency to be inoculated against a disease they saw almost no risk of contracting. China’s vaccines are also considered less effective against the omicron variant than mRNA vaccines like the ones from Pfizer and Moderna, though China is working to develop its own version.

Low said there were parallels in mainland China to the situation in Hong Kong, which experienced a devastating omicron outbreak last spring after years of being virtually Covid-free. 

The Chinese territory of about 7 million people recorded more than 7,500 deaths in less than two months, mostly among unvaccinated older people, as hospitals overflowed with patients. Critics said the Hong Kong government had been too focused on minimizing cases overall rather than treating the most serious ones.

“You’re going to see the Hong Kong story played out on a much larger scale” in mainland China, Low said.

Researchers at the University of Hong Kong estimated that about half of the city’s population was infected between January and mid-March. The intensity of the outbreak came as a shock to a population that had viewed the virus as distant but highly dangerous.

Similarly, Jin said, the challenge for mainland officials is to prepare the population psychologically for infection.

“It is crucially important for them to educate the general public, and to change all the wrong conceptions and all the wrong ideas about Covid,” he said.

Public fear of the virus could be seen in recent weeks as migrant workers fled a Covid outbreak at an iPhone factory in Zhengzhou, some of them returning to their hometowns on foot. The exodus was “completely not rational,” Jin said.

Mike Li, the Shijiazhuang resident, said he was “not very worried” because he was vaccinated.

“I know how to guard against this virus. I will take more care,” he said. “If I really get the virus, I’ll just go for treatment, simple.”