China’s zero-COVID strategy aims at not allowing a single infection to happen in the country, aiming at an infection-free population over a prolonged period, achieved through two actions. First, all infected persons, regardless of their health status, are placed in strict isolation in demanding circumstances. Two, all the members in the community are segregated at home or work where even a single case has emerged until no new infections have occurred in the isolated group, usually for a period of two to three weeks.
At the same time, millions of people are continuously tested, and strict contact control is implemented. Also, most travel to and from the country is restricted, with infrequent visitors having to undergo a seven-day quarantine and several tests.
Is it unsustainable?
Proponents of the zero-COVID strategy believed that SARS-CoV-2 virus is amenable to eradication, a term reserved for the disappearance of the virus. Far from extinction, the virus has thrived and morphed into more infectious variant forms. The zero-COVID strategy postponed the inevitable outbreaks to a later point in the timeline, with the virus waiting to find a vast susceptible pool of persons.
The strategy offers a glowing short-term euphoric goal of minimal cases, only to see a rebound in increased cases and deaths, often resulting in excessive pressure on the healthcare system later and derangements in society’s normal order. Consequently, people’s suffering is prolonged. A country’s economy can only sustain the zero-COVID strategy for a short time since any country largely depends on international trade. This strategy would have been theoretically successful if the virus diminished in its capacity to infect or if the population was protected with both primary and booster vaccine doses. Neither of these were realistically achieved in China while the virus was continuously evolving.
While the virus is ubiquitous, it is unwise, disproportionate, costly, and useless to drive all resources toward detecting every case. Many countries including Singapore, Vietnam, Taiwan, South Korea, Hong Kong, Australia, and New Zealand realised that the zero-COVID strategy was a blunder as a destination and pursuit, and abandoned it after initial trials. Continuing with the strategy for a longer time has only exposed the stupefying silence of forceful extreme measures on the individual’s mental health and human rights.
Still most vulnerable
Most countries have had more than three or four waves of infection, resulting in high natural infection levels. Coupled with immunity induced by effective vaccines, the rest of the world is witnessing endemic levels of COVID-19. In contrast, mainland China is extremely vulnerable, with poor vaccination coverage, especially among the elderly. With only one wave earlier, the current upsurge is yet to take off due to the zero-COVID strategy, making China a fertile ground for large-scale spread of the virus. Compounding the problem is that the two locally-made vaccines have shown poor efficacy and offer protection only for a shorter duration.
The virus will not spare any susceptible population pools; impositions of relentless lockdowns and restrictions cannot keep the virus at bay for long. I had emphasised earlier that any lockdown should be an opportunity to ramp up the infrastructure and responses.
Instead of scaling up the manufacturing of effective vaccines and expanding the vaccination coverage in the population, China has frivolously prolonged the zero-COVID strategy. Persistently isolated from the virus coercively and armoured with ineffective vaccine immunity, most Chinese people are sitting ducks for COVID-19.
Abandoning the zero-COVID strategy without a proper exit plan will undeniably lead to several massive waves of infection with multiple SARS-CoV-2 variants in China. China must relax restrictions, combined with expanding primary vaccination and booster coverage with effective vaccines, especially among the elderly and other vulnerable. The Chinese and world leaders need to ensure that China follows a balanced approach that tailors restrictions to subgroups at greater risk of severe disease and death while paying attention to equity.
It is essential to have a long-term strategy that prioritises population health and health equity. Taking a cue from the success of other public health programmes, China can ensure high vaccination coverage, especially among the elderly and other vulnerable people. If this is done before relaxing the strategy phase-wise, it might be a unique example of disease control in the modern world.
What happens in China will have an impact everywhere in the world. The WHO can offer technical support for revamping the strategy, effective vaccines, and escalating care provisions for the severely sick during the inevitable impending waves. Finally, it is time for WHO to revise the case definition to include only severe cases and those with long-COVID, which can help countries plan for the next stage of the pandemic.
- China’s zero-COVID strategy aims at not allowing a single infection to happen in the country, aiming at an infection-free population over a prolonged period, achieved through two actions.
- Continuing with the strategy for a longer time has only exposed the stupefying silence of forceful extreme measures on the individual’s mental health and human rights.
- Abandoning the zero-COVID strategy without a proper exit plan will undeniably lead to several massive waves of infection with multiple SARS-CoV-2 variants in China.
( Giridhara R. Babu is a Professor of Epidemiology at the Public Health Foundation of India, Bengaluru)