China careens off the zero-COVID highway

China’s about-face on how to tackle COVID has caused heads to spin at home and abroad. After nearly three years of relentless enforcement of General Secretary Xi Jinping’s signature policy of COVID eradication, the government issued new guidelines easing some of its strict zero-COVID policies in early December 2022. Official propaganda proclaiming that zero-COVID was a superior approach to foreign models, and essential to keep the Chinese people safe, gave way to a new message that, well, the virus wasn’t so threatening after all.

Epidemiologists warned that hundreds of thousands of people would die due to the sudden change in rules. Despite the risk, the Chinese government has forged ahead with a messy reopening that has jettisoned mass testing, quarantines, lockdowns of populated areas, and contact tracing. The National Health Commission has been selective with the details it shares on case counts and COVID-related deaths to avoid embarrassment and criticism of the new course of action. Medical workers have been discouraged from attributing an infected person’s demise to COVID when completing death certificates.

Officials advised that deaths would only be attributed to COVID if the virus directly caused respiratory failure, a narrow definition that would yield a substantially lower number of deaths. The single-digit death total announced nearly two weeks after the new guidelines were introduced was risible. The World Health Organization publicly called upon China to release more data on its COVID situation to improve understanding of transmission dynamics and highlighted the underreporting of COVID-related mortality.

Authorities then began to acknowledge a higher death toll, but even the number offered in mid-January (close to 60,000) grossly understated the true number of fatalities by that time. Evidence from satellite data, self-reported information, online search results, and open-source data revealed an explosion in COVID-related deaths belying official statistics.

The use of COVID-related terms in Baidu, the Chinese language internet search engine, provided a proxy for the fast rise in cases and deaths. Search volumes for “funeral services” already began to surge towards the end of December.

Average citizens have shared stories and photos on apps and social media of queues at funeral parlours and crematories, crates filled with yellow body bags, and overwhelmed medical facilities. Satellite images have provided further evidence of crowds, as well as a stream of funeral vans, assembled at crematories.

People have reported multiple instances of sick people being turned away from health facilities or forced to wait for hours in hospital corridors. Treatable patients have died because of a lack of hospital capacity and adequate equipment and medicines. Grieving relatives have struggled to secure cremation appointments for loved ones who succumbed to the virus.

As of January 23rd, just under one third of people in China reported that they either had COVID symptoms themselves in the past two weeks or had a close friend or family member with symptoms, according to data from the predictive analytics firm RIWI collected throughout January from across all parts of the country. When excluding rural areas, the number is closer to half. About 1 in 5 people from across the country also reported a close friend or family member that had been hospitalised with COVID-19 in the past two weeks.

In contrast to most significant policy changes in China—changes that are typically underpinned by preparation and adequate support—this big one took place with a fraction of the resources and planning needed to prevent truly awful outcomes. In an earlier commentary, we anticipated an inevitable change in China’s approach, and offered thoughts on how it could be managed to mitigate negative impacts.

Yet Beijing decided to let COVID run its course across the land. The enormous budgetary and economic costs of trying to isolate every case of the virus had become too great. This became increasingly clear since a spike in the number of cases of the highly infectious Omicron variant last November. Widespread public fatigue with life under Zero-COVID also contributed to the government’s change of heart.

Among the population, the abrupt way in which Zero-COVID came to an end has stimulated confusion, worry, frustration – and optimism. Consumption has been tepid since early 2020 and youth unemployment had soared. A reopened economy will boost business activity and increase jobs. This is certainly what the government is hoping people will focus on rather than questions like why they had to live under a system of draconian virus control for the better part of three years. 

Ongoing efforts by senior officials to promulgate the narrative that the worst is over and that life in China has already been “restored to normal” are being greeted sceptically. The UK-based health analytics firm Airfinity estimates that COVID is felling over 35,000 people per day in China, and predicts that this shocking figure will rise before it falls.

Although case counts appear to have peaked in several provinces, the virus has spread rapidly to rural areas, aided by the mass internal migration that occurs during the Lunar New Year Holiday Season. COVID’s relative threat is greater in rural areas due to weaker healthcare capacity. For many Chinese families, the joy of reunions postponed by the pandemic will soon be supplanted by great sadness at the loss of elderly family members. The BBC is reporting that coffins are selling out in rural areas.

After resolutely adhering to the Zero-COVID policy, China has conceded that it cannot contain an unyielding opponent. Had authorities invested more in the healthcare system, embraced mRNA vaccines, imported mass quantities of Paxlavoid, and boosted vaccination rates in 2022—rather than enforce nonstop testing and quarantines—the transition out of Zero-COVID would have been far smoother and less tragic.

The great loss of life within a short period, the chaos and stress caused by the policy reversal, and failed attempts to conceal the ensuing damage, have tarnished the government’s performance legitimacy. Chinese citizens, domestic businesses, and foreign investors are now left to wonder if they can trust official data and assertions about the durability of other policies that have great importance to their lives.