China’s Struggle With Covid Is Just Beginning

China’s leaders are in a dangerous dilemma. Their obsession with eliminating the coronavirus has spared the country the pandemic death rates suffered by other major countries, but at a steep cost: severe social and economic pain that led last weekend to China’s biggest anti-government protests in decades.

The harsh zero-tolerance Covid policy championed by President Xi Jinping is no longer sustainable, and he faces a difficult choice between easing up on Covid restrictions, which could cause mass deaths, or clinging to an unpopular approach that is pushing Chinese society to a breaking point.

The government, apparently spooked by the rare demonstrations that took place in several cities, may be losing its resolve. A few days after the protests, Vice Premier Sun Chunlan, China’s Covid czar, appeared to sound the death knell for the zero-Covid approach, indicating on Wednesday that a new strategy was imminent. As if on cue, some major cities began ditching key pandemic measures. More are expected to follow suit.

But extricating China from this health policy quagmire is fraught with peril.

The government’s uncompromising approach seemed to work at first. Shortly after the virus began emerging from Wuhan in late 2019, China brought it under control with tough lockdowns as it spread globally. Stung by accusations from the likes of President Donald Trump that China had unleashed the pandemic on the world, and eager to prevent the virus from re-emerging, the Chinese Communist Party doubled down. It poured colossal resources into testing, developing a vast high-tech tracing and quarantine infrastructure and locking down entire cities. Small outbreaks were quickly stamped out and infection rates kept extremely low.

But as highly transmissible and difficult-to-contain variants like Delta and Omicron emerged, China had no exit ramp.

The severe strain that the pandemic imposed on the American healthcare system was not lost on leaders in Beijing, who are well aware of the weaknesses of their own underfunded and ill-equipped health care infrastructure and an aging Chinese population.

But walling China’s people off from the virus only increases their vulnerability, inhibiting the immunity that comes with exposure. A vaccination drive was launched in late 2020, but Chinese vaccines have relatively low efficacy, especially against variants like Omicron, and Beijing is yet to allow the import of foreign vaccines. At the same time, low infection numbers create a false sense of security, providing little incentive to get jabbed: Nine out of 10 Chinese have been vaccinated, but less than half of people aged 80 and over have gotten a booster, leaving millions of elderly under-vaccinated.

Chinese policy created a feedback loop: suppression of the virus reduced the impetus for the elderly to get vaccinated, which kept immunity low, further necessitating the no-tolerance approach.

From the outset, Mr. Xi tied himself to zero-Covid’s success, holding it up as proof of the authoritarian Chinese system’s superiority. As recently as October he framed it as an “all-out people’s war.” Questioning an all-powerful leader was politically taboo, especially in the buildup to the Communist Party Congress in October, where Mr. Xi secured a third term. As a result, no serious attempt was made to prepare a road map for transitioning out of zero-Covid.

China simply cannot stamp out variants like Omicron. In the past week, it has reported record daily new case counts numbering in the tens of thousands, and millions of close contacts have been traced or quarantined. Makeshift Covid facilities built to accommodate such cases in Beijing are already 80 percent full. According to the government’s own data, the vast majority of the new cases are asymptomatic. Finding them all will require significantly more resources for testing, tracing and quarantining at a time when local governments are under severe financial pressure from the expense of zero-Covid as well as its role in slowing the economy.

Containing Covid has relied heavily on the Chinese public buying into the official narrative, but as the demonstrations have shown, popular support is quickly dissipating as patience wears thin.

Instead of pouring more money into the zero-Covid strategy, China’s leaders must urgently shift gears. They should rapidly scale up access to more effective — including foreign — vaccines that target the Omicron variant and anti-viral treatments; launch a nationwide vaccination campaign (authorities said last week that a new push is coming); limit hospitalization to the most severe cases to reduce the strain on health care; and ditch the alarmist “people’s war” rhetoric in favor of something reflecting the reality that Covid-19 can be little more than an upper respiratory-tract infection for many healthy, vaccinated people. All of these changes will have to be done delicately given Mr. Xi’s deep political investment in zero-Covid.

But the government’s intentions remain unclear. Only two days before Ms. Sun’s conciliatory comments last week, she instructed authorities managing an outbreak in the huge city of Chongqing to “launch an all-out attack” to “achieve zero-Covid.” On Friday, the Communist Party mouthpiece People’s Daily hinted at a more relaxed policy, but still reiterated war-footing rhetoric such as “winning the battle” against the pandemic.

The next few weeks will be critical. Local authorities on the front lines are under mounting public and financial pressure to relax measures. A lack of clear guidance from Beijing could cause a hasty and messy reopening and more infections. This happened last month when the easing of some restrictions sowed confusion and contributed to the recent surge in cases.

China has officially reported only 5,233 Covid-19 deaths, compared to more than one million in the United States, nearly 690,00 in Brazil, and over 530,000 in India.

But a nationwide outbreak at this point could be dire. If one-quarter of the Chinese population is infected within the first six months of the government letting its guard down — a rate consistent with what the United States and Europe experienced with Omicron — China could end up with an estimated 363 million infections, some 620,000 deaths, 32,000 daily admissions to intensive-care units and a potential social and political crisis. Three punishing years fighting off the coronavirus would have been in vain, leaving China with the worst-case scenario it has struggled so hard to avoid.

Yanzhong Huang (@YanzhongHuang) is a senior fellow for global health at the Council on Foreign Relations and a professor at Seton Hall University’s School of Diplomacy and International Relations. He is the author of “Toxic Politics: China’s Environmental Health Crisis and its Challenge to the Chinese State.”

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