On one side of the world, citizens peer outside strictly quarantined homes to find closed shops, empty streets, and healthcare workers armed to the teeth in personal protective equipment. On the other hand, it is almost business as usual. The way the United States has experienced and managed the COVID-19 pandemic vastly differs from China. In the U.S. today, vaccination clinics, hybrid classes, and non-mandatory masking have permanently altered the country’s landscape; many people are ready to move onto a new normal [1]. Yet, three years into the COVID pandemic, China’s dynamic zero-COVID policy still remains, defining the daily lives of an estimated 1.5 billion people. Mass public health responses should give more weight to bioethical, human impacts, and it is time to take a critical look at China’s policy from a non-western perspective to do just that.
First, the motivations and implications of China’s dynamic zero-COVID policy must be established to understand its human impact. The policy was first created by the Chinese government to contain the initial outbreak of COVID in Wuhan during March of 2020. The policy decrees that the Chinese government will take “dynamic” action to eliminate cases that arise as necessary [2]. The implication of this statement has been two-pronged: prevention through frequent PCR testing, especially in cities, and lockdowns. Particularly in the latter, tactics can include neighborhoods to whole cities quarantining in their homes or government-controlled facilities, for weeks or even months. Now, Xi Jinping, the president of the People’s Republic of China and the general secretary of the Chinese Communist Party, stakes much of his political reputation on the policy in hopes that its success will carry him through his unprecedented third-term tenure for CCP’s general secretary position [2].
All this begs the question: has the policy truly been successful? From a purely statistical perspective, there is no denying that it has. According to Johns Hopkins University’s COVID mortality analyses, China has 1.12 deaths per 100,000 people [3]. On the other hand, the U.S. has the highest mortality rate in the world, with 326.74 deaths per 100,000 people [3]. Indeed, as The Atlantic science journalist Ed Yong states in his article The Pandemic’s Legacy Is Already Clear, negative responses to U.S. government-issued vaccine and mask mandates have led to less efficacy in containing it, making the country more vulnerable to new variants [4]. In comparison, China reflects its highly collectivist values in going to extreme measures to put the interest of the whole country or the “group” above the individual.
However, from a bioethical perspective, the zero-COVID policy tells a different story. Shanghai’s lockdown this past spring demonstrates the need for public health responses to look beyond cultural values and prioritize bioethical concerns. In early April 2022, a large spike of COVID cases in Shanghai led to the entire city being shut down for two months, making this lockdown one of the most severe across the globe. Hundreds of thousands of Shanghai residents were forced to quarantine in their homes or designated facilities, relying on government-issued delivery services for medical supplies and food. People posted calls for medical help online when they could not get to the hospital they needed. In fact, facilities exacerbated the vulnerability of the elderly in this otherwise highly effective method [5]. In April, COVID spread widely among elderly Shanghai residents at the Donghai Hospital, many of whom were not vaccinated, and yet no extra protections were made for this already at-risk population. To make matters worse, families were not allowed to visit their elderly relatives in the hospital for a long time. Mr. Shen, a 45-year-old businessman, is just one example of the human cost of this policy. His father, who was already immunocompromised, died alone after running out of medication while waiting in a 400-person line [5].
Shanghai is not the only major Chinese city that has been in sudden mass lockdown like this. Beijing, Chengdu, and Shenzhen are just a few examples. Each lockdown equates to millions of changed lives. Even after lockdown, the daily impact of the zero-COVID policy is apparent; there is still mandatory PCR testing to get on public metro transport, and quarantines are still common even in neighborhoods that just have one or two cases. Public resistance towards the policy has been strong — with their lives clearly on the line, citizens posted their outrage, fear, and despair on social media platforms that contrasted with the cheery lockdown response that the government has tried to project in the media [6]. The usual government censorship struggled to contain public opinion that called for policymakers to rethink China’s COVID controls.
In fact, just this past month on November 26th, 2022, protests in Shanghai in the wake of a deadly fire in a Urumqi quarantine facility added extra pressure to the Chinese government. In response, China has rapidly lifted the strictest parts of their zero-COVID policy, allowing citizens with symptoms to isolate at home instead of state-sponsored facilities and opening up free travel within the country without need for proof of negative tests [7] The immense rise in infections and sudden shift in the government’s language around COVID-19 has caused concern that the country’s healthcare system could be overwhelmed. However, from the relieved public’s response, one thing is certain: public health responses are malleable and should adjust based on the needs of a country.
Shanghai’s reality is one that I, living on the other side of the world, could not ever imagine. I remember watching a Chinese New Years skit performed not too long before the lockdown started. In the skit, citizens young and old smiled wistfully and conversed, wearing KN95 masks, over food delivery and across apartment porches. No matter how these stringent policies have been quelling COVID mortalities, no one should have to live like this for months and years. Yet, the U.S. is a painful reminder that individualist policies downplay the truth that pandemics affect the collective, and individuals must do their part to keep everyone safe. No matter how different cultural values may be, the bottom line is that we all are humans, stumbling our way through a changed world with hope. While people across the world from each other may not live these stories, they must listen and learn from them. Inevitably, this will not be the world’s last pandemic; let these stories be what informs and strengthens public health responses to the next one.
References:
1. John Gramlich, “Two Years Into the Pandemic, Americans Inch Closer to a New Normal,” Pew Research Center, March 3, 2022.
2. Reuters, “Factbox: What is China's zero-COVID policy and how does it work?,” Reuters, November 3, 2022.
3. Johns Hopkins University, “Mortality Analyses,” Johns Hopkins Coronavirus Resource Center.
4. Ed Yong, “The Pandemic’s Legacy Is Already Clear.” The Atlantic, September 30, 2022.
5. John Liu, Amy Chang Chien, & Paul Mozur, “Outbreak at Shanghai Hospital Exposes Covid’s Risks to China’s Seniors.” The New York Times, April 1, 2022.
6. Vivian Wang, Paul Mozur, & Isabelle Qian, “China’s Covid Lockdown Outrage Tests Limits of Triumphant Propaganda,” The New York Times, April 27, 2022.
7. Frances Mao, “China abandons key parts of zero-Covid strategy after protests,” British Broadcasting Corporation, December 7, 2022.