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GUEST ESSAY
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China’s Zero-Covid Policy Is a Pandemic Waiting to Happen
Dr. Emanuel is a physician, vice provost for global initiatives and a professor of medical ethics and health policy at the University of Pennsylvania. Dr. Osterholm is an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
As some 3,000 athletes, their retinues and the media converge on Beijing, the Chinese government has gone to extraordinary lengths to prevent the 24th version of the Winter Olympics, which open Feb. 4, from becoming a Covid superspreading event.
Though athletes and coaches will be required to be vaccinated, they will face severe restrictions. Those who receive a medical exemption from vaccination are being required to quarantine for 21 days after entering the country. Even the vaccinated will have to present two negative tests. Participants must submit to daily Covid tests and will be confined to an Olympic bubble to prevent spread to the local population.
These extreme measures are in line with China’s zero-Covid policy. President Xi Jinping and his government seem to believe that the country can be sealed off until the virus is eradicated around the world.
But that goal is unattainable with the highly transmissible Omicron variant and has set the nation up for disaster. The coronavirus is not going to disappear — the world will have to live with it. Making matters worse, China’s vaccines are much less effective against Omicron. And the Chinese health care system simply is not equipped to care for millions of people sickened by the virus.
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Yes, China has weathered the pandemic well so far. Even with about four times the population of the United States, China has had fewer than 140,000 confirmed Covid cases and fewer than 6,000 deaths since January 2020, according to the World Health Organization. A vast majority of factories continued to operate. Early in the pandemic, China added thousands of hospital beds in days.
All of this seems like an enormous success when compared with the messy and often chaotic response to the virus in the United States, where more than 860,000 people have died and some 2,000 more die each day. Many hospitals are under siege. The economy has been disrupted.
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But this may very well be the future China is facing. Its pursuit of zero Covid will prove to be a huge mistake. The policy has left it wholly unprepared for what will become endemic Covid.
Recent research shows that China’s vaccines offer limited protection against Omicron, even in protecting people from severe Covid complications and death. This means the vaccines are not providing adequate protective immunity to a citizenry that lacks natural immunity through infection.
For those who become infected, China has limited outpatient medical facilities or home care. Many of those who fall ill will not be able to call a primary care physician, go to an urgent care center or get care at home. And if millions need care — even if they don’t need to be hospitalized — the hospitals will rapidly be overwhelmed. Hospitals might even become sites of superspreading events. As recent episodes in the city of Xi’an showed, Chinese hospitals fearful of the virus may deny care to those in need.
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Over the next few years, most people in the world, including China, are likely to be exposed to the coronavirus. With an incubation time potentially as short as three days, and many infected people being asymptomatic, the virus will spread rapidly. By the time an outbreak is identified, it will have moved to another city.
We can begin to see the future in many Chinese cities, most prominently in Xi’an, more than 600 miles from Beijing. Last month, the government locked down Xi’an’s 13 million residents in response to a relatively small outbreak of the Delta variant, which is less transmissible than Omicron. This strict lockdown lasted about three weeks. There also has been spread in Tianjin, a city near Beijing. Alarmingly, epidemiological research on a sizable number of the people infected with Omicron in Tianjin found that about 95 percent of them had been fully vaccinated with the Chinese vaccines. And on Jan. 15, Chinese officials said Beijing’s first case of the Omicron variant had been found, leading to a localized lockdown and mass testing.
This spread is most likely sending shudders through President Xi and the Chinese leadership. Reflexively, they are likely to clamp down harder. But a zero-Covid policy means the Chinese will always be chasing an ever moving target. And they will never win. Inevitably this will have serious economic impacts for China — and for all of us, given the country’s position in the world economy. While China remains the production capital of the world, this is unlikely to be sustainable should lockdowns ensue. Businesses outside of China are likely to become increasingly hesitant to partner with Chinese ventures when they are unable to enter the country to meet partners and inspect factories that face unpredictable closings. Declines in Chinese production would upend supply chains and the availability of goods everywhere, including in the United States.
Other countries can provide a road map that China can put into action. Denmark, Germany and some other European countries, as well as Australia, have achieved strong immunity without suffering the U.S. death rate. They used effective vaccines, made smarter decisions about when and where to impose lockdowns and protected the most vulnerable — older people and those with compromised immune systems. Community spread resulted, but it would have been inevitable, even with longer or more severe lockdowns, and it allowed those countries to build up immunity.
China’s elaborate containment efforts planned for the Olympics may prevent a Covid outbreak — and we certainly hope that is the case. But a zero-Covid policy is a losing long-term strategy.
Ezekiel J. Emanuel (@ZekeEmanuel) is a physician, vice provost for global initiatives and a professor of medical ethics and health policy at the University of Pennsylvania. Michael T. Osterholm (@mtosterholm) is an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
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