Where is the exit from China’s zero tolerance on Covid-19?

As China enters another winter with Covid-19, there is no sign that the coronavirus that causes the disease will go away. There is also no sign that the country is loosening its reliance on strict “zero tolerance” controls and restrictions to contain the spread within its borders.

But as other countries seek ways to live with the pathogen and its mutations, questions have arisen over how long China should maintain its fortress approach.

In the past two years, China has contained more than 30 sporadic coronavirus outbreaks, including those caused by the more contagious Delta variant.

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Its latest epidemic began a month ago and affects more than 1,000 cases in 21 provinces and regions.

In addition to mass vaccination, authorities have largely brought the disease under control with a combination of closed borders, strict lockdowns, long quarantines and repeated testing.

All of this is in addition to what’s called a zero tolerance policy – an extremely popular approach that has allowed life to return largely to normal in cities free from epidemics.

It was also effective, with just two deaths from the disease in the year to November 12.

Professor Liang Wannian, head of an expert group advising the government, said China will continue to stick to a “dynamic” zero tolerance approach, aimed at reducing the continued community spread of Covid-19 and to reduce deaths with early and strong measures.

A premature easing of controls would endanger the country’s hard-won gains, he said.

“The experience of a number of countries is that an early relaxation of control measures will lead to an increase in Covid-19 cases, serious illnesses and deaths,” Liang told the news agency. State. Xinhua.

He said the approach could affect the economy in the short term, but containing epidemics has proven to be beneficial in the longer term.

But even though China is proud to have nearly eliminated the virus within its borders, experts say its approach to containment is not sustainable, and Beijing must start seeking public consensus on the measures. of Covid-19 so that when it eventually has to implement an exit strategy, the policy change will be more widely accepted.

“One of the reasons for continuing the [zero-tolerance] policy is to show that China has done a better job than Western countries in its response to Covid-19 and the superiority of the Chinese model, ”said Yanzhong Huang, public health policy expert at the Council on Foreign Relations in New York .

“But just because China is the winner in [its initial] response to the pandemic which does not mean that it will be the ultimate winner … This is why an exit strategy is relevant.

Huang said sporadic cases have become more frequent, affecting more provinces and more people, and becoming more expensive and difficult to contain these outbreaks.

“That’s why you see local governments doubling down on measures. There might come a time when the cost is so high and the capacity will become unable to effectively contain the outbreak, ”he said.

Zero chance for China’s zero-Covid target now that virus has adapted, Sars expert says

Some Chinese experts have indicated ways in which the country can completely relax its controls.

Respiratory specialist Zhong Nanshan said these pathways included developing effective drug treatments, establishing herd immunity with a high vaccination rate, limiting the death rate of Covid-19 to less than 0, 1% and maintaining the transmission rate of each infected person between 1 and 1.5 more.

None of these targets appear to be within reach anytime soon.

In the meantime, other countries are embarking on the path of coexistence, choosing to “live with” rather than eliminate the virus while ensuring that infections do not explode, that hospitals are not overloaded. and that the elderly do not remain vulnerable.

The approach relies on vaccination to reduce the risk of hospitalization and death, as well as public health interventions.

This is also the direction in which Australia is heading. It has partially opened its borders and plans to open more as vaccination increases.

“Giving up zero-Covid doesn’t mean you don’t do anything,” said Peter Collignon, infectious disease expert and professor at the Australian National University School of Medicine.

Collignon said if the number of cases and hospital admissions increase, some restrictions as well as contact tracing would be needed to ensure that those most at risk of transmitting infections and their close contacts are isolated for at least seven days.

“All of this together decreases the ongoing transmission – not eliminated but kept at lower levels so that the hospital system is not overwhelmed. It’s all about ‘flattening the curve’ and keeping it at relatively low levels, ”he said.

Like China, New Zealand has a zero tolerance policy towards the coronavirus.

The strategy kept the death toll at just 32, but last month the country announced it was moving from elimination to suppression.

Michael Baker, an epidemiologist at the University of Otago and a member of New Zealand’s Covid-19 Technical Advisory Group, said modeling indicated that the move to suppression could mean limited cases and deaths.

“It requires multiple interventions. It must use both high immunization coverage and boosters as well as a mix of public health and social measures, such as border management, use of masks, testing, contact tracing and “lockdowns”. “Potentially brief to keep the number of cases low,” Baker said. .

“We can also learn from the experience of countries like Australia and Singapore going through this transition from elimination of Covid-19 to endemic infection to see the impact of different approaches to manage this change.”

Chinese health officials insist country will stick to zero tolerance approach to Covid-19

Singapore was one of the first in the region to move to elimination, announcing in August that it would seek to keep Covid-19 low instead of eliminating it.

More than 82% of the population is fully vaccinated and travel without quarantine is slowly spreading to a dozen countries.

Amid the change, cases rose from double digits to over 3,000 a day at its peak last month. Deaths have risen from zero to over a dozen in recent days, mostly among those unvaccinated.

“The Singapore experience shows that vaccination alone, even with almost complete coverage of the adult population, is not enough to prevent the spread of the Delta variant,” said Alex Cook, associate dean of research at The Saw Swee Hock School of the National University of Singapore. of Public Health.

“However, with the older age groups so heavily vaccinated here, and now with most people aged 60 and over receiving booster doses, the risk of death has fallen to something much closer to influenza than the 2020 Covid-19. This is one of the main reasons for confidence in being able to face a future in which Covid-19 is endemic. ”

What future for China’s zero Covid strategy, as hopes of collective immunity face the Delta hurdle?

One of the big fears in China is that abandoning the elimination approach will push the healthcare system to a breaking point not seen since the disease was first identified in the central city of Wuhan.

Around 50,000 cases of Covid-19 have been identified in Wuhan and more than 3,800 of them died of the disease in the first four months of what has become the pandemic.

An infectious disease expert in Beijing who asked not to be named because he was not authorized to speak to the media said that among doctors there was no consensus on how much the coronavirus that causes Covid -19 would strain the health care system and cause deaths if existing measures were relaxed.

“If it’s like the seasonal flu, we should be able to handle it, but if it’s higher I don’t think health systems are ready, especially with imbalanced medical resources between developed cities like Beijing. , Shanghai and Guangzhou and other less developed areas. ,” he said.

China has about 4.47 intensive care beds per 100,000 population, compared to 34.7 beds per 100,000 in the United States and 29.2 in Germany.

Covid-19 patients should still be treated in designated hospitals or wards, and more beds would be needed to make coexistence more possible, the expert said.

Collignon said overloading the health care system was “a problem”, but vaccination was key for hospitals to cope.

“We need to get the elderly vaccinated as much as possible, including the booster,” he said. “If you want to live with the virus, even at a low level, you have to have high levels of immunization, especially among vulnerable people, that is, anyone over the age of 60, because it is where most illnesses and problems arise. “

He estimated that a 95 percent vaccination rate would be needed among the elderly and those with immune problems, who are at higher risk of complications.

Another option was to postpone elective surgeries to free up more beds, he added.

Zero Covid still cheaper than living with it, according to top Chinese expert Zhong Nanshan

Experts recognized that any change in approach after the zero tolerance strategy would take some time to be accepted by the population and that it was important for society to reach consensus on a possible burden.

Baker said the New Zealand public is wary of the change as an increase in cases and deaths is expected under the new strategy.

“Any move away from elimination means tolerating cases of Covid-19 and ultimately deaths among the population,” he said.

“It is important that there is a public debate on such a change, and the trade-offs involved, before this change is made.”

But in China, such a debate is “out of the question”, according to political scientist Chen Daoyin.

In August, Zhang Wenhong, an infectious disease expert in Shanghai, was attacked for publicly suggesting that China must find the wisdom to coexist with the virus for the long term.

“The response of Covid-19 has become a political issue in China and the debate on Zhang Wenhong earlier showed that this issue has been resolved within the Communist Party without any chance for public scrutiny or debate,” said Chen.

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