China’s Covid ‘Exit Wave’: (3) What Other Countries’ Zero-Covid Exits Show
On December 8, 2022, China abruptly abandoned the zero-Covid policy it had followed for the past 3 years.
Officially, nothing happened. Authorities did admit (in leaked internal discussions) that well over a billion Chinese were infected in the wave that followed. But even so, it was apparently a non-event. There were essentially no adverse consequences. “In the first five weeks after the pivot, the government logged only 37 deaths.”
[That is a mortality rate of 0.000027%. For comparison, the lifetime probability of a person being hit by lightning is about 250 times higher.]
This was evidently too much to swallow. A public relations adjustment soon appeared.
- “The initial death counts were so unbelievable that even the party brass seemed to realize they lacked credibility. That led to a mid-January announcement that 60,000 people had perished in the latest wave, and, more recently [February], the official tally of deaths has risen to a touch more than 83,000 .”
[That is 0.005%. Still far below the Covid mortality rates for any other country. 13 times lower than the New Zealand rate, and 30 times lower than the Hong Kong death rate.]
Moreover, the regime asserted that by February 1 China’s mortality rate was actually falling fast – down 98% from its peak.
Beijing in fact claimed to have achieved the lowest Covid mortality rate in the world.
The authorities were ecstatic. The Politburo of the Chinese Communist Party congratulated itself for having been “totally right.”
The zero-Covid “exit” was declared a “miracle of human history.”
Vice-premier Liu He traveled to the Davos conference in Switzerland to announce that things in China were already “returning back to normal.”
Chinese govt scientists also rushed out a study – based on data collected just two weeks after the end of the lockdowns – asserting that no new variants of the virus had emerged.
Overall (according to The Wall Street Journal) –
- “China’s message is that it has weathered the most difficult period since its abrupt [exit from zero-Covid]—in effect for three years—and that its transition to living with the virus has been smooth and orderly.”
Then, a data-blackout descended. China stopped most data-collection and reporting related to new cases. The mass testing program was abandoned, and test facilities shut down. The testers were fired. Zero-Covid had become zero-information.
- “Workers hired to conduct mass testing and enforce quarantines found themselves abruptly unemployed, leaving no system to reliably test and quantify the surge.”
A “deepening opacity” was setting in. Western observers felt a “mounting unease that China is once again suppressing information.” (Financial Times) It was reminiscent of the deletion of crucial data from records of the earliest days of the outbreak in Wuhan in early 2020.
Is the exit from zero-Covid a “miracle” as China claims, with rapidly declining infection and death rates? Will the Chinese economy now sail smoothly back towards normalcy, and “6% or more” GDP growth this year [Liu He’s Davos prediction]? The official Covid statistics from China have always been “useless” [as per The Economist]. Now, they don’t even exist. We are in the dark as to actual developments in China’s battle with the virus.
Understanding the true trajectory of China’s “exit” from zero-Covid is important not just for China. Given China’s weight in the global economy, as both a producer and a consumer, the “exit” will have an impact on many other countries. China’s trading partners, of which the U.S. is the largest, will certainly feel the effects, one way or another.
What is really likely to happen next? What do we know about the likely exit path from a zero-Covid policy?
The Rise & Fall of zero-Covid
Zero-COVID refers to a public health program focused on ‘control and maximum suppression.’ The goal is to completely eliminate the virus from the population.
In authoritarian China, zero-Covid measures were especially severe. They included continuous mass testing (by 2022 China was “testing every citizen several times a week”); stringent contact tracing; location tracking apps and facial recognition to monitor movements of the citizenry; forced quarantine measures, including relocation of infected or exposed individuals to special isolation “camps”; shutdowns of schools and businesses; strict border controls (China built fence-walls to seal off its borders with Vietnam and Myanmar, for example); comprehensive travel bans; often lockdowns of whole cities where residents could not leave their homes for extended periods.
China is not the only country to have pursued a zero-Covid policy. Over 20 countries originally attempted to follow “elimination policies” similar to the Chinese model. (These were contrasted with “mitigation” policies, where public health measures were more liberal and were focused on vaccination and treatment, allowing natural immunity to develop.)
Zero-Covid programs at first seemed to be successful in limiting the spread of the virus. A study published in Lancet in early 2021 found that countries pursuing an elimination policy (zero-Covid) had lower death rates.
However, the shortcomings of zero-Covid soon became apparent. The emergence of highly transmissible variants (especially Omicron) eventually broke through even the strongest public health measures, and the availability of highly effective vaccines (e.g., especially the mRNA-based alternatives) altered the trade-off between the medical consequences and the sometimes severe social and economic consequences of zero-Covid.
By the end of 2021, medical and political opinion were shifting. The authors of the Lancet study reassessed their position:
- “The situation has changed. Effective vaccines are being widely deployed… Increasingly transmissible variants are proliferating, and the risk of new, immunity-escaping variants is largest when populations are only partially vaccinated. It is thus important to reassess the different strategies. Is elimination still preferable, or has the balance shifted towards other strategies, notably mitigation?”
In a brief analysis titled “Elimination of SARS-CoV-2: an impossible coordination task” one of the Lancet authors confronted this reality.
- “Although elimination is preferable…unilaterally opting for elimination does not seem to be fully preferable to a mitigation strategy (let alone feasible).”
By May 2022, Lancet had soured completely on the elimination strategy. An editorial entitled “Zero COVID in China: what next?” painted a bleak picture:
- “China has cornered itself into an unsustainable COVID-19 control strategy raising serious questions of exactly how China is going to exit this pandemic….The damage the policy has caused has outweighed the benefits it brings [but] any voice advocating for the deviation from the current zero-COVID path will be punished.”
The hard truth that renders zero-Covid unsustainable is the simple fact that the modern world is interconnected, and the virus remains active outside the zero-Covid zones. Permanent national quarantine is impossible. Moreover, even the most stringent measures have not been able to contain the highly transmissible and aggressive mutations appearing constantly. Countries pursuing “elimination” began to realize that they had indeed put themselves in a corner. Maintaining zero-Covid comes with escalating social and economic costs. The policy trade-off involved paying a very high price for an illusion of safety that was bound to come apart eventually.
As a result, all zero-Covid countries (except for China) had essentially abandoned the policy by late 2021 or early 2022.
China alone kept up its efforts at total suppression of the virus, fighting an increasingly desperate battle against new variants. But the fallibility of zero-Covid became clear as the Omicron variant broke through the cordon in March 2022.
- “Starting in March, China’s biggest city, Shanghai, has been hit with its worst outbreak, with hundreds of thousands of cases logged. Subsequent strict lockdowns in the city have caused havoc among residents, separating families and straining food and medical resources.”
In China, the lockdowns reached prison-level intensity, and the economic consequences escalated.
- “In its final year, many citizens were forced to stay indoors or risk being quarantined in state-run facilities under the watch of enforcers in hazmat suits, known as dabai or “Big Whites.” With factories, travel and property investment stalled, economic growth slumped to 3%, the second-slowest pace since the 1970s. Much of everyday life was controlled or limited by the government—whether it was access to food, movement or speech.”
In May 2022, the WHO declared zero-Covid unsustainable.
- “‘When we talk about the zero-Covid strategy, we don’t think that it is sustainable, considering the behavior of the virus now and what we anticipate in the future,’ [WHO Chief ] Tedros told a media briefing, citing the increased transmissibility of Omicron.”
(Beijing authorities responded by vilifying WHO in the media and censoring Tedros’ remarks on WeChat and other Internet channels.)
China pushed on with zero-Covid for another 6 months, defending the policy with increasing ferocity. Then on December 8, suddenly and without any warning or fanfare, zero-Covid evaporated in what seems to have been almost a policy accident. There was no plan in place. Decisions were made in a disorganized fashion, at various levels, often by local officials without clear guidance from above.
- “The rushed opening-up did not come from Beijing; it resulted from local governments interpreting central government signals and getting ahead of Beijing regarding policy implementation….They rushed to re-open, fearing they might get left behind…. Facing the sudden opening at the local level, Beijing realized that ‘the horse has already left the barn’; all it could do was accept the reality.” – The Diplomat (“How Beijing Accidentally Ended the Zero COVID Policy”)
- “Citizens were left in the dark, unsure whether they had Covid and then unsure what to do when they fell ill. The government stopped mass testing in early December, leaving people scrambling for hard-to-find rapid antigen tests.” – BusinessWeek (“China’s Faith in All-Powerful Xi Shaken by Chaos of Covid Pivot” – March 3, 2023)
Vivid anecdotal accounts of the zero-Covid exit situation in China are beginning to emerge – one of the best was published in the March 13 issue of Bloomberg BusinessWeek (cited above). But with testing and data collection halted, there is no direct statistical insight at this time into the true situation in China. Accurate infection and mortality figures are simply not available.
There are other approaches to understand what China may now be facing. In particular, it is useful to examine the experience of other countries that pursued, and then abandoned, similar zero-Covid policies.
What Do We Know About the Exit Path from Zero-Covid From The Experience Of Other Countries?
The overarching problem with zero-Covid is that it delays the development of broad natural immunity (through infection and recovery) in the general population. Such natural immunity, combined with broad vaccination programs employing effective vaccines, leads eventually to a feasible state of “co-existence” with the virus, which allows for a return to social and economic normalcy. Of course the price paid for this is much higher mortality in the early stages of the pandemic. But as time passes, mortality rates in “mitigation countries” have tended to ease, they have been able to reopen. The disease becomes manageable within the framework of existing healthcare systems.
In contrast, the countries following “elimination” strategies did not develop broad natural immunity, and when their zero-Covid policies were lifted, they all experienced a huge surge in infection and death rates – reaching levels much higher than the mitigation countries had experienced even in the early and unprotected stages of the pandemic. In some cases the healthcare systems were inundated with Covid patients and broke down, leading to additional illness and death arising from non-Covid illnesses that could not be treated by overburdened medical facilities.
The experience of several zero-Covid countries illustrates this pattern.
Hong Kong’s post zero-Covid experience is the closest parallel to China’s current situation. The city is formally a part of China and is culturally similar to the rest of China. From May 2020, and the promulgation of the National Security law that effectively brought the city under direct control of Beijing, Hong Kong’s anti-Covid program mirrored that of the mainland, more or less.
Hong Kong fought hard to maintain its zero-Covid framework until February 2022, when it was overwhelmed by the Omicron variant. The pandemic was soon out of control.
- “Hong Kong reports the world’s highest death rate as the zero covid strategy fails. Coronavirus infections are surging in Hong Kong as the city has reported the highest number of covid-19 deaths for population size in the world. Previously a global model for covid containment, transmission of SARS-CoV-2 has soared as Hong Kong’s zero covid strategy has failed to contain the more contagious omicron variant. The city’s low vaccine coverage is also aiding transmission and leading to more fatalities, said epidemiologists. – British Medical Journal (March 2022)
In the 12 months following the breakdown of zero-Covid, the cumulative Covid death count in Hong Kong increased by a factor of 63 times – from 213 to 13,370 — that is, over 6000%. (The increase in the U.S. over the same period was 22%.)
The same pattern was seen in other countries exiting from zero-Covid. In each case, the breakdown of zero-Covid was followed by an enormous surge in infections and mortality.
South Korea’s zero-Covid program had been considered a model.
- “South Korea introduced what was considered one of the largest and best-organized epidemic control programs in the world.”
But following the exit from zero-Covid, Korea saw an enormous surge in cases. The accelerated rate of infections has continued, with a 246% increase in Covid deaths over the last 12 months (through March 24).
- “In March 2020, the Australian government declared a biosecurity emergency. Borders were closed to all non-residents and returning residents were required to spend two weeks in supervised quarantine hotels… Individual states and territories also closed their borders [and] started to close ‘non-essential’ services including social gathering venues such as pubs and clubs… Australia was one of few countries to pursue a zero-Covid ‘suppression’ strategy until late 2021…strict controls on international arrivals and aggressively responding to local outbreaks with lockdowns and exhaustive contact tracing…”
The increase in Australian Covid deaths in the 12 months following the end of zero-Covid was over 1300%. The rate of increase has slowed to just over 300% in the last year.
- “In response to the first outbreak in late February 2020, the New Zealand Government closed the country’s borders and imposed lockdown restrictions. A four-tier alert level system was introduced on 21 March 2020 to manage the outbreak within New Zealand.”
New Zealand carried out one of the most comprehensive zero-Covid programs anywhere, including multiple nationwide lockdowns, with extremely aggressive trigger-criteria. For example, in August 2021 the entire population was sent into lockdown – in response to just a single case of Covid. The policy seemed to be successful. The country experienced fewer than 100 deaths over the two years of the zero-Covid program.
But when zero-Covid was abandoned in early 2022, even after vaccination rates had reached 90%, the predictable surge in infections and mortality occurred. Since March 2022, Covid deaths are up almost 6000%.
- “Singapore’s COVID-19 death rate is the world’s lowest….Singapore has managed to mitigate the spread of the virus via early detection using aggressive contact tracing and testing that won praise from the World Health Organization.” – Reuters (Sept 17, 2020)
Same story: 90%+ vaccination rates didn’t prevent a gigantic surge in infections and deaths following the exit from zero-Covid. Since zero-Covid ended Sept 1 2021, Covid deaths in Singapore are up over 3000%.
The Implications for China
Covid’s impact has been severe everywhere. Countries that tried to control it with hard measures (lockdowns, etc.) were eventually unable to contain the virus. They have all experienced huge disease outbreaks following their exit from zero-Covid, regardless of vaccination status.
In countries that followed a mitigation strategy, the rate of infection and mortality has eventually slowed, reflecting the development of natural immunity in the population, with milder cases and fewer deaths. In the last year (to March 24), Covid deaths have increased in Germany by 32%, in the UK by 25%, in Italy by 19%, in France by 17%, and in the United States by 14%.
It appears that the penalty for zero-Covid is a delay in achieving a community resistance sufficient to bring the rate of infection and mortality down to more manageable levels.
To propose an analogy: the spread of Covid is like a forest fire. Mitigation strategies use “forest management practices” that allow for “controlled burns” to reduce the amount of dry tinder that can fuel a larger conflagration. The fire is destructive to some degree, but not catastrophic. The zero-Covid approach, by contrast, is a situation where there is no forest management, no controlled burn. The flammable undergrowth accumulates and when the fire finally breaks out there is a huge amount of fuel, leading to a massive inferno.
The implications for China are dire. The impact of Covid now, following the chaotic abandonment of the world’s strictest zero-Covid program, combined with a functionally unvaccinated population (as described in an earlier column), will be far more severe than the official forecast.
Actually, there is no official forecast from the Chinese government at this point – which is mute but eloquent testimony to the scope of the looming disaster. One must assume that the health authorities there realize what they are facing. They know the numbers being cited here. Applying the infection and death rates experienced by these other countries following their exits from zero-Covid leads to some appalling predictions of the impact on China over the next year. The next two columns will assess the true scale of the Covid pandemic in China going forward.
Source: Fox Business
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