China’s Zero-Covid Policy Has Kept Deaths Very Low. Can It Continue?

Chinese exceptionalism:

World leaders are increasingly deciding that their countries need to figure out how to live with Covid-19 rather than minimize the number of cases.

Britain, France, Denmark, Turkey and other parts of Europe have loosened restrictions. Australia has dropped mask mandates and reopened its border. South Africa has lifted curfews and required schools to open fully.

China is doing none of this.

As the Beijing Olympics begin, China continues to pursue a “zero Covid” policy. The Olympics will have few fans. As it has for almost two years, China responds to new outbreaks by imposing strict lockdowns. In the northwestern city of Lanzhou last year, officials told roughly four million people to stay home in response to fewer than 50 known cases.

China’s strategy has had both major successes (holding deaths to low levels) and major costs (disrupting daily life even more than in other countries). It makes for a fascinating case study at a time when Americans disagree vehemently — and often along partisan lines — about whether to maintain Covid precautions or return to normal.

China’s strategy would obviously not be possible in a country that emphasizes individual rights as much as the U.S. does. But China’s strategy does show what a society can do when it makes the prevention of Covid its No. 1 priority, almost regardless of the side effects.

A question that experts are asking now is whether China’s strategy is sustainable, given the contagiousness of Omicron. For now, China’s leaders are sticking with it.

The benefits

Data coming out of China can be suspect, and local officials apparently undercounted Covid cases early in the pandemic to hide the scale of the outbreak. But most experts believe the country’s official Covid counts have been at least close to accurate for most of the past two years.

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That’s partly because big outbreaks are hard to cover up, and partly because China’s leadership has threatened to punish officials who hide cases. As Amy Qin, a Times correspondent who covers China, told us, “Local officials have every incentive to find the infections and stop the spread before they get out of hand.”

Even if China’s official numbers are artificially low, its true Covid death toll is almost certainly much lower than that of the U.S., Europe or many other countries. Consider how enormous the official gap is:

Data as of Feb. 2. | Sources: Johns Hopkins University; New York Times database; National Health Commission of the People’s Republic of China

The zero-Covid policy has also allowed some forms of normalcy to return. Masks are required in public, but unless a city is in lockdown, people have been attending parties and eating in restaurants for most of the past two years, Amy notes.

When Covid began spreading in Wuhan, it seemed as if it might have the potential to weaken the Communist Party’s standing. Instead, China’s success at controlling Covid has turned into a public relations triumph for the regime. President Xi Jinping uses China’s management of the virus to bolster his global campaign for influence, arguing that China’s system of government works better than Western democracies do.

The downsides

China’s maximalist approach has had harmful side effects.

Even modest outbreaks can lead local officials to place millions of people under lockdown, sometimes with terrible consequences. As our colleague Li Yuan has written:

In the northwestern city of Xi’an, hospital employees refused to admit a man suffering from chest pains because he lived in a medium-risk district. He died of a heart attack.

They informed a woman who was eight months pregnant and bleeding that her Covid test wasn’t valid. She lost her baby.

Two community security guards told a young man they didn’t care that he’d had nothing to eat after catching him out during the lockdown. They beat him up.

Lockdowns have also hurt Chinese businesses and the global economy. One reason that inflation has risen around the world is that Chinese factories and ports have been quick to shut down when there are nearby cases, disrupting supply chains.

Chinese officials maintain that zero Covid is still viable. If that’s correct, the approach may need to become even more aggressive, given that the Omicron variant is so contagious. China’s two major vaccines appear to provide significant protection against serious illness but little protection against infection.

China also has little natural immunity, unlike countries where the virus has spread widely. “That immunity gap between China and the outside world is only increasing,” Yanzhong Huang, a global health expert at the Council on Foreign Relations, told us. Some other countries that previously had zero-Covid strategies, like Singapore and New Zealand, have recently moved away from them.

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China seems to face a choice “between short-term pain and long-term pain,” Huang said. Maintaining zero Covid would probably require long-lasting social and economic disruptions; giving it up would invite a rapid surge of infections. “But after that you could be in much better shape,” Huang said.

It does seem possible that China will start to shift its approach after the Olympics, perhaps experimenting with fewer restrictions in some cities and regions. Already, some Chinese health officials have subtly altered their message. “They are emphasizing more now the idea of responding rapidly and nimbly to small outbreaks to get as close to zero as possible,” Amy says.

One factor may be a growing fatigue among Chinese people. While the zero-Covid strategy seems still to have widespread support, some Chinese citizens seem to be growing more frustrated with strict lockdowns. “We are definitely seeing more grumbling from people,” Amy said. “There is a growing sense that you could get caught in a lockdown at any time.”

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