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China cancels “Zero COVID” policy – Should we regret or rejoice?
Dear Editor
I read your timely and informative opinion piece (1) on the lessons for China from exiting zero COVID. The question facing the international community is should we rejoice or regret this change in policy. It has been argued (2) that China's "zero-Covid dynamics" policy could have a greater impact on the global economy than the ongoing war in Ukraine. The zero COVID policy involved drastic restrictions on mobility with half of China's highways closed and ports operating inefficiently. It has been pointed (2) out that China’s dynamic zero-Covid policy could ravage the Chinese and world economy. Hence the sudden change in policy is welcome due its potential positive impact on the economy. A recent review (3) highlighted the advantages of the zero COVID policy on the residents including “limited virus infections, hospitalizations, and deaths, reduced presence of other infectious diseases and low incidence of long COVID-19”. There is still significant support for the zero COVID policy with one commentator claiming (4) that the evidence shows zero COVID policy was the best way forward. However results of modelling studies (5) demonstrate that “due to high transmissibility, neither Omicron BA.1 or BA.2 sublineages could be contained by China’s Pre-Omicron non-pharmaceutical intervention strategies” which formed its “Zero-COVID” policy.
There are also concerns and fear in some quarters (6). Key systems and processes that helped many countries to contain the virus and conquer the pandemic including advance preparation of the healthcare system, accurate and shared data collection, and open communication are currently not evident in China. There are worries that a new variant could emerge as China moves away from zero COVID policy and the number of infected grows rapidly. There are estimates (7) that half of Beijing’s 22 million population could be infected with COVID. According to a recent yet to be peer reviewed paper (8) there will be 31,817 deaths in Beijing alone in the first year. The authors urge the government to adopt strategies to flatten the curve through non pharmaceutical interventions to slow down the infection and avoid overwhelming the healthcare system.
The World Health Organisation is concerned about the ongoing COVID situation in China. According to the Director General (9) “WHO is very concerned over the evolving situation in China, with increasing reports of severe disease. In order to make a comprehensive risk assessment of the situation on the ground, WHO needs more detailed information on disease severity, hospital admissions and requirements for ICU support. WHO is supporting China to focus its efforts on vaccinating people at the highest risk across the country, and we continue to offer our support for clinical care and protecting its health system”.
India with its long land border with China has already gone on a COVID alert (10). Countries need to prepare themselves if the effect of the COVID waves in China due to moving away from zero COVID policy has an impact on their COVID situation potentially due to the emergence of a new dangerous variant and its spears across the globe. The interventions that need to be planned for include enhanced communications to the population, rapid testing and tracing of cases, targeted immunisation as required and forcefully bringing back all the no pharmaceutical intervention from the pandemic era. When a country with the largest population is going through what most countries went through in the early stages of the pandemic one cannot say with confidence that, we are in the post pandemic era. Let us hope and wish that the world does not have to fear and hopefully China will learn to leave with virus and its citizens will rejoice with the newfound freedom.
Dr Padmanabhan Badrinath, Retired Consultant in Public Health Medicine
[email protected]
Disclaimer: The views expressed here are the professional views of the author and in no way represent the views of any organisation the author has been associated with in the present or past.
Conflict of interest: The author led the Public Health response to COVID in a local authority in England during the pandemic and beyond.
References:
1 Owens D. Parry J. Covid-19: What can China learn from Hong Kong and Singapore about exiting zero covid. BMJ 2022;379: o3043. Available from: https://www.bmj.com/content/379/bmj.o3043
2 Herrero AG. China’s Covid policy to be year’s largest economic shock. Asia Times [Internet]. [cited 2022 Apr 13]. Available from: https://asiatimes.com/2022/04/chinas-covid-policy-to-be-years-largest-ec...
3 Su Z, Cheshmehzangi A, McDonnell D, Ahmad J, Šegalo S, Xiang YT, da Veiga CP. The Advantages of the Zero-COVID-19 Strategy. Int J Environ Res Public Health. 2022 Jul 19;19(14):8767. doi: 10.3390/ijerph19148767. PMID: 35886618; PMCID: PMC9317662.
4 Marshall M. Zero-covid strategies are being ditched, but they were the best option. New Scientist [Internet] [cited 2022 Mar 30]. Available from https://www.newscientist.com/article/mg25433800-100-zero-covid-strategie...
5 Wang, Y., Sun, K., Feng, Z. et al. Assessing the feasibility of sustaining SARS-CoV-2 local containment in China in the era of highly transmissible variants. BMC Med 20, 442 (2022). https://doi.org/10.1186/s12916-022-02640-6
6 EURACTIV. The world fears a new China COVID wave, ponders how to help Xi. EURACTIV [Internet] [cited 2022 Dec 20]. Available from: https://www.euractiv.com/section/coronavirus/news/the-world-fears-a-new-...
7 The Week. Will China’s three winter waves of Covid have global impact? The Week. [Internet] [cited 2022 Dec 19] Available from https://www.nber.org/system/files/working_papers/w15855/w15855.pdf
8 Shilei Zhao, Tong Sha, Yongbiao Xue, Hua Chen. Flattening the Curve is Imperative: When China Relaxes the Dynamic Zero COVID-19 Policy. medRxiv 2022.12.15.22283335; doi: https://doi.org/10.1101/2022.12.15.22283335
9 World Health Organisation. WHO Director-General's opening remarks at the media briefing – 21 December 2022. WHO [Internet] [cited 2022 Dec 22]. Available from https://www.who.int/news-room/speeches/item/who-director-general-s-openi...
10 BBC News. India steps up Covid surveillance after China surge. BBC [Internet] [cited 2022 Dec 21]. Available from https://www.bbc.co.uk/news/world-asia-india-64048789
I read your timely and informative opinion piece (1) on the lessons for China from exiting zero COVID. The question facing the international community is should we rejoice or regret this change in policy. It has been argued (2) that China's "zero-Covid dynamics" policy could have a greater impact on the global economy than the ongoing war in Ukraine. The zero COVID policy involved drastic restrictions on mobility with half of China's highways closed and ports operating inefficiently. It has been pointed (2) out that China’s dynamic zero-Covid policy could ravage the Chinese and world economy. Hence the sudden change in policy is welcome due its potential positive impact on the economy. A recent review (3) highlighted the advantages of the zero COVID policy on the residents including “limited virus infections, hospitalizations, and deaths, reduced presence of other infectious diseases and low incidence of long COVID-19”. There is still significant support for the zero COVID policy with one commentator claiming (4) that the evidence shows zero COVID policy was the best way forward. However results of modelling studies (5) demonstrate that “due to high transmissibility, neither Omicron BA.1 or BA.2 sublineages could be contained by China’s Pre-Omicron non-pharmaceutical intervention strategies” which formed its “Zero-COVID” policy.
There are also concerns and fear in some quarters (6). Key systems and processes that helped many countries to contain the virus and conquer the pandemic including advance preparation of the healthcare system, accurate and shared data collection, and open communication are currently not evident in China. There are worries that a new variant could emerge as China moves away from zero COVID policy and the number of infected grows rapidly. There are estimates (7) that half of Beijing’s 22 million population could be infected with COVID. According to a recent yet to be peer reviewed paper (8) there will be 31,817 deaths in Beijing alone in the first year. The authors urge the government to adopt strategies to flatten the curve through non pharmaceutical interventions to slow down the infection and avoid overwhelming the healthcare system.
The World Health Organisation is concerned about the ongoing COVID situation in China. According to the Director General (9) “WHO is very concerned over the evolving situation in China, with increasing reports of severe disease. In order to make a comprehensive risk assessment of the situation on the ground, WHO needs more detailed information on disease severity, hospital admissions and requirements for ICU support. WHO is supporting China to focus its efforts on vaccinating people at the highest risk across the country, and we continue to offer our support for clinical care and protecting its health system”.
India with its long land border with China has already gone on a COVID alert (10). Countries need to prepare themselves if the effect of the COVID waves in China due to moving away from zero COVID policy has an impact on their COVID situation potentially due to the emergence of a new dangerous variant and its spears across the globe. The interventions that need to be planned for include enhanced communications to the population, rapid testing and tracing of cases, targeted immunisation as required and forcefully bringing back all the no pharmaceutical intervention from the pandemic era. When a country with the largest population is going through what most countries went through in the early stages of the pandemic one cannot say with confidence that, we are in the post pandemic era. Let us hope and wish that the world does not have to fear and hopefully China will learn to leave with virus and its citizens will rejoice with the newfound freedom.
Dr Padmanabhan Badrinath, Retired Consultant in Public Health Medicine
[email protected]
Disclaimer: The views expressed here are the professional views of the author and in no way represent the views of any organisation the author has been associated with in the present or past.
Conflict of interest: The author led the Public Health response to COVID in a local authority in England during the pandemic and beyond.
References:
1 Owens D. Parry J. Covid-19: What can China learn from Hong Kong and Singapore about exiting zero covid. BMJ 2022;379: o3043. Available from: https://www.bmj.com/content/379/bmj.o3043
2 Herrero AG. China’s Covid policy to be year’s largest economic shock. Asia Times [Internet]. [cited 2022 Apr 13]. Available from: https://asiatimes.com/2022/04/chinas-covid-policy-to-be-years-largest-ec...
3 Su Z, Cheshmehzangi A, McDonnell D, Ahmad J, Šegalo S, Xiang YT, da Veiga CP. The Advantages of the Zero-COVID-19 Strategy. Int J Environ Res Public Health. 2022 Jul 19;19(14):8767. doi: 10.3390/ijerph19148767. PMID: 35886618; PMCID: PMC9317662.
4 Marshall M. Zero-covid strategies are being ditched, but they were the best option. New Scientist [Internet] [cited 2022 Mar 30]. Available from https://www.newscientist.com/article/mg25433800-100-zero-covid-strategie...
5 Wang, Y., Sun, K., Feng, Z. et al. Assessing the feasibility of sustaining SARS-CoV-2 local containment in China in the era of highly transmissible variants. BMC Med 20, 442 (2022). https://doi.org/10.1186/s12916-022-02640-6
6 EURACTIV. The world fears a new China COVID wave, ponders how to help Xi. EURACTIV [Internet] [cited 2022 Dec 20]. Available from: https://www.euractiv.com/section/coronavirus/news/the-world-fears-a-new-...
7 The Week. Will China’s three winter waves of Covid have global impact? The Week. [Internet] [cited 2022 Dec 19] Available from https://www.nber.org/system/files/working_papers/w15855/w15855.pdf
8 Shilei Zhao, Tong Sha, Yongbiao Xue, Hua Chen. Flattening the Curve is Imperative: When China Relaxes the Dynamic Zero COVID-19 Policy. medRxiv 2022.12.15.22283335; doi: https://doi.org/10.1101/2022.12.15.22283335
9 World Health Organisation. WHO Director-General's opening remarks at the media briefing – 21 December 2022. WHO [Internet] [cited 2022 Dec 22]. Available from https://www.who.int/news-room/speeches/item/who-director-general-s-openi...
10 BBC News. India steps up Covid surveillance after China surge. BBC [Internet] [cited 2022 Dec 21]. Available from https://www.bbc.co.uk/news/world-asia-india-64048789
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