(CNN) — For nearly two years, the number of daily coronavirus cases in China rarely reached triple digits, with weeks often going by without a single case, in part due to the “zero covid-19” policy.
Even as the rest of the world struggled to contain the most transmissible new variants, China remained an island: its borders were closed and its population unaffected by the virus.
That all changed this month, as multiple outbreaks across the country led to the biggest rise in local infections in China since the coronavirus was brought under control. initial outbreak in Wuhan in early 2020.
In the last three days alone, some 12,000 new cases have been registered, according to health authorities, who have warned that the country’s defenses are facing the highly transmissible omicron BA.2 subvariant for the first time.
These numbers may seem small in a population of 1.4 billion and compared to the rest of the world. But for the ruling Communist Party — which has sought to promote its ability to control the virus as proof of its superior model of governance — the outbreak represents a major political challenge.
To respond, China has launched its well-known disease control methods: put tens of millions of residents under some form of lockdown, closing factories in the tech hub of Shenzhen, building makeshift hospitals to isolate cases in hard-hit Jilin province, and rounding up “close contacts” of the cases to monitor or quarantine them.
But this approach, widely known as “covid-19 zero,” is showing signs of strain.
Authorities have already revised their hospitalization rule for all patients, in a sign they are concerned their own strict measures could quickly overwhelm the health system. And there are also signs that the patience of the general public, which has widely supported the measures, is starting to wear thin.
For now, however, Chinese leaders have few options. Authorities have spent two years focused andn keep covid-19 outside its borders and contain its spread. But now, as more questions about the sustainability of “zero covid-19” are raised, experts say the country remains unprepared for the alternative of “living with the virus.”
Shanghai physician Zhang Wenhong – often compared to leading American epidemiologist Dr. Anthony Fauci for his candor and expertise – alluded to this dilemma last week, writing in business magazine Caixin: “We have not prepared anything we need prepare. How could we dare to ‘lay down’ (and allow the virus to spread)?”
Unprepared in China, despite “zero covid-19”
There is no doubt that China has gone to great lengths to protect its population from the virus, carrying out what has been called the largest vaccination campaign in history: develop vaccines at record speed and distribute 2.8 billion doses in the country in 2021 alone.
But despite this, there are critical gaps in Beijing’s vaccination effort, and—although the vaccines are believed to remain effective against severe illness and death from omicrons—there are unanswered questions about how well they can protect, especially vulnerable groups. This is of great concern for any transition away from Covid-19 in a country that has grown accustomed to not seeing deaths from Covid-19.
Although the vast majority of China’s cases have been mild or asymptomatic, the government on Saturday reported the first Covid-19 deaths in more than a year. The health authorities indicated that the deceased – two elderly patients with covid-19 in the northeastern province of Jilin, one vaccinated and the other not – had mild cases and succumbed to their underlying diseases.
But experts say the risks of a more serious situation have been made abundantly clear to Beijing by events across the border in Hong Kong, where a rampant outbreak has overwhelmed hospitals and morgues, killing more than 5,500 people. so far this year, largely due to low vaccination rates among the elderly.
Although one is a city of fewer than 8 million and the other a nation of 1.4 billion, experts say the parallels have set off alarm bells in recent weeks.
“Both have followed a ‘zero covid-19’ strategy, both have a large unvaccinated elderly population, and furthermore (both) have not invested in public health capacity building before the wave of omicron,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations (CFR).
“And in China, there is a large percentage of the general population that has not been exposed to the virus, due to “zero covid-19″, or that is vaccinated with vaccines that (according to studies) are not effective in preventing infection” .
While China’s overall vaccination rate exceeds 87%, immunization among the elderly, and especially the most vulnerable over 80s, lags behind that of countries such as the United States or Britain, as initially these groups were not prioritized in China’s vaccination campaigns.
An estimated 40 million Chinese over the age of 60 have yet to receive a vaccine, according to data from China’s National Health Commission. While about 80% of China’s 264 million elderly are fully vaccinated, that percentage drops to only about half for the group most vulnerable to Covid-19, those over 80.
“We have sounded the alarm again and again on this matter: it is a difficult lesson to learn not only for Hong Kong, but also for China,” said Jin Dongyan, a professor at the School of Biomedical Sciences at the University of Hong Kong. .
China’s potential problem is further aggravated by its reluctance to approve a foreign mRNA vaccine, which could be used as a booster dose, despite having secured an option to purchase 100 million doses of a widely used vaccine developed by Germany’s BioNTech at the end of 2020.
“(Not approving the BioNTech vaccine) was also a missed opportunity for Chinese policy to overcome the evolution of the virus,” said health security expert Nicholas Thomas, an associate professor at the City University of Hong Kong, who called the decision as a “clear example of nationalism” in favor of China’s national vaccines.
“If (they had approved the BioNTech vaccine last year), considering the impressive resources that China deployed with its previous vaccination program, it is unlikely that they would now face the same threat from the omicron outbreak,” he said.
Although several domestically manufactured mRNA vaccines are in development — with at least one in late-stage clinical trials — it remains unclear when or if those doses will ultimately be approved, or if they will measure up to existing vaccines in the US. everyone.
Adding to these risks is the fact that many of China’s elderly live in the countryside, where health care is far less advanced than in cities. China’s ability to deal with a flood of serious cases could also be hampered by its ICU capacity, which falls far short of that of many Western countries.
There are signs that China is trying to find solutions. In recent days, the health authorities have reported on the efforts made, for example, for mobile clinics to vaccinate the elderly and underline the importance of their reinforcement. They have also included Pfizer’s covid-19 antiviral pill, a new addition to the Chinese medicine cabinet, in the latest guidelines and have said that specific vaccines for omicron are in the works.
The end of the game?
The problems China faces are not necessarily unique: Countries around the world have battled Covid-19 with low vaccination rates in the elderly and weakened health systems.
In China, because heavy-handed tactics have so far spared the population the worst effects of the virus, experts say relaxing those measures could come as a shock.
“The pressure to maintain ‘covid-19 zero’ is not only from the central government, but also from the general public,” said Xi Chen, a professor at the Yale School of Public Health, noting public support for the government’s measures. in the last two years.
Although there are signs that people and experts in China are beginning to look more towards the rest of the world’s policies to “live with the virus”, this may also require a significant change to official messages that have focused on severity. of health crises outside China’s borders, even after mass vaccination campaigns reduced deaths in developed countries.
“The problem is that if the danger of the disease continues to be highlighted and other countries’ pandemic response efforts are demonized, it means that fear in the public will not go away, and that makes it difficult to move away from a strategy of ‘zero covid-19,'” the CFR’s Huang said.
And even if this outbreak is brought under control, these issues will continue to come to the fore in China, as containing omicron is a “Sisyphean effort” for Chinese leaders and its people, he said.
“They’re not going to eradicate every case of omicron in China… they’re just waiting for the next round.”
With information from CNN’s Beijing bureau.
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