China had been applauded by the World Health Organization for its success in beating COVID-19 when China ended the largest cordon sanitaire in Wuhan in the history of humanity.
We published our manuscript titled “The end of cordon sanitaire in Wuhan: a wake-up call for the world” in 2020 in the official journal of the Royal Society for Public Health of the United Kingdom, and concluded that “The effectiveness of the non-pharmaceutical interventions implemented in Wuhan could serve as a good reference for leaders and policymakers around the world in formulating their strategies and policies in fighting against coronavirus before effective vaccination and/or drug treatments are available.”
Since the inception of the novel coronavirus, various variants have emerged. Omicron is now the dominant variant worldwide. Although less fatal, it is much more contagious than the original coronavirus or its mutated variants. China’s insistence on the zero-COVID strategy during the omicron wave is leaving it increasingly isolated as other countries with far higher outbreaks and death counts try to return to the pre-pandemic life by co-existing with the coronavirus. The extended outbreak in the financial capital of Shanghai has prompted a more defensive tone from the World Health Organization director-general, who said on May 10 that the zero-COVID strategy is not “sustainable”.
China’s zero-tolerance approach deploys multilayer non-pharmaceutical interventions to contain sporadic COVID-19 outbreaks, which include large-scale viral nucleic acid and antigen screenings; quarantining of infected cases and close contacts in hospitals and hotels; and ultimately, lockdowns, which have protected the majority of its population from COVID-19 over the past two years. Prior to the emergence of omicron, China had remarkable success in containing the pandemic: In the United States, over 1 million people have died after contracting COVID-19, whereas China had reported just over 4,600 deaths prior to the current omicron outbreak. The highly infectious omicron variants have made it more difficult for China, which has not seen a day with no new local cases since October 2021. These strict measures have recently sparked a public outcry as the lockdowns become more stringent and frequent amid the fast spread of omicron. As omicron is more contagious than the delta variant, it has resulted in more hardcore lockdowns, requiring most citizens to stay home. Some of these, such as in Shanghai, have dragged on for over two months.
The WHO’s criticisms came as modeling projections by researchers at Shanghai’s Fudan University forecast that a surge of the omicron variant could result in 112 million symptomatic cases (79.58 per 1,000 individuals), 5.1 million hospital admissions (3.60 per 1,000 individuals) and 1.6 million deaths (1.10 per 1,000 individuals) in the absence of these non-pharmaceutical interventions, with a significant wave occurring in May and June 2022.
The study, published in the journal Nature Medicine, estimates that an uncontrolled omicron outbreak would collapse China’s national healthcare system, with a peak demand of 1 million ICU beds, corresponding to 15.6 times the number of existing ICU beds in China. The researcher found that the level of immunity in March 2022 would have been “insufficient” to prevent the omicron surge from overwhelming the hospital system. Still, China’s firm persistence in the zero-tolerance mitigation policies was able to reduce the death toll. This “dynamic clearing” strategy acknowledges that infections will occur but aims to stop onward transmission.
While the vaccination rate has now exceeded over 90 percent of the Chinese population and a growing number have received boosters, the vaccination coverage has remained low for the elderly: 62 percent of 5.8 million over 60 years are vaccinated, and only 38 percent have had a booster. A similar low vaccination uptake is also observed in Hong Kong among the elderly. The elderly 65 and older accounted for more than 90 percent of the more than 9,000 COVID-19-related deaths in Hong Kong this year through April.
None of the individual mitigation strategies can reduce the death toll to a level comparable to the influenza season or prevent the collapse of ICU capacities. Should the omicron variant be allowed to spread uncontrolled, the researchers estimated that about 77 percent of the deaths would occur in unvaccinated individuals. In the absence of substantially increasing the vaccination uptake to “97 percent and 50 percent or more of symptomatic infections are treated with antiviral”, the researchers stated that “the most optimal strategy to prevent overwhelming the healthcare system appears to be the reliance of strict non-pharmaceutical interventions”.
Besides the available vaccines and different vaccination approaches, new vaccines targeting the omicron variant, including mRNA, inactivated, and recombinant spike protein subunit vaccines, have been approved for clinical trials in China and could soon be available for emergency use to enhance the mitigation measures.
China’s “dynamic zero” strategy has provided a precious time window to enhance vaccine coverage among the elderly and increase access to antiviral drugs. The researchers said that these are the most important policies for China to consider to reduce death tolls and hospitalizations when transitioning away from zero-COVID. Maintaining the implantation of various non-pharmaceutical interventions such as mask-wearing, enhanced testing, social distancing, reducing mass gathering, and ultimately lockdowns should be emphasized and tailored to different regions to account for the heterogeneity in vaccination rates across China.
Shanghai reopened some public transportation routes on Sunday, and aims for a return to normal life within June. For countries to be able to adopt China’s success with the zero-tolerance policy, they need to have the 1) capacity to perform daily rapid antigen and/or nucleic testing, 2) mandates to wear highly protective surgical masks such as N95, KN95 and KF94, 3) close-loop operation of essential services and 4) rapid and large-scale quarantine of close contacts and districts. The same omicron variant from Hong Kong had spread to her nearby cities of Shenzhen and Guangzhou. The populations in Shenzhen and Guangzhou are both well over 15 million. While it took a seven-day lockdown in Shenzhen to achieve zero-COVID, there was no lockdown in Guangzhou. The Chinese government has put the life and health of its citizens above all. Despite dampening the country’s economic growth from the frequent, albeit temporary lockdowns across major ports, commercial and industrial cities, China has proved to the world that its “dynamic zero” strategy is doable, achievable and sustainable.
Dennis Lam is a deputy to the National People’s Congress and a member of the Hong Kong Legislative Council. Kelvin Wan is managing editor of COVID-19 FAQs, Asia-Pacific Journal of Ophthalmology.
The views do not necessarily reflect those of China Daily.