From the outset, mystery has shrouded the COVID-19 pandemic in China. The origin of the virus remains unknown, important Chinese journalists and key scientists have been muted, and case and death totals reported by China’s government have been unbelievably low — the United States and most of Western Europe have reported 500 to 1,000 times as many per capita deaths as China.
There are several theories on the reason for the low numbers coming out of China: poor reporting, deliberate or otherwise; a population with immunity, either natural or acquired through previous coronavirus infections; or the Chinese government’s efforts to reach zero COVID-19 infections through mass testing, lockdowns, quarantine and contact tracing. China is the last major country attempting to eliminate COVID-19; other countries have tried with disappointing, and in some cases disastrous, results.
But now the Chinese zero-COVID-19 policy has been put to the test by the highly infectious omicron variant and subvariant. The focal point is the tight government lockdown in China’s largest city, Shanghai. Reports emanating from Shanghai are harrowing. People are prevented from leaving their homes for any reason — they are dependent on the government to deliver medications, food and water. Parents who test positive are sent to isolation centers, separated from their children. Cats and dogs left homeless when their owners are sent away are being killed by public health authorities. Businesses are closing, and there are reports of people scavenging food and committing suicide.
According to the BBC, centralized “isolation facilities — many using only camp beds, with no showers or other facilities — are bursting with infected people squashed in next to one another. One of China’s few reliable media outlets, Caixin, has reported that close contacts of infected people will be moved to neighbouring provinces. This could potentially involve hundreds of thousands of Shanghai residents.”
Even with these measures, Shanghai is reporting more than 10,000 new cases per day, and things may worsen because China’s vaccine, a non-mRNA one, appears to be less effective than Western vaccines.
While China clings to its zero-COVID-19 approach, other countries have abandoned it in the face of the omicron surge. South Korea, which was praised internationally for its control measures after an initial surge, was overwhelmed by omicron and now ranks eighth in worldwide cases, a higher per capita case rate than the U.S. New Zealand, an island country, that as of February had recorded fewer than 30,000 cases over the first two years of the pandemic, now has seen 800,000 cases total. Hong Kong, with only 200 total deaths during the pandemic at the beginning of the year, had the highest per capita death rate in the world in March.
Why has a zero-COVID-19 policy proved unattainable? Control of COVID-19 poses different problems from previous epidemics. The virus is evolving and mutating at a surprisingly rapid rate, and the current variants present a greater risk of person-to-person transmission. But the real sticking point has been extensive transmission in the community by infected people who are asymptomatic.
This feature of COVID-19 has complicated the pandemic from the beginning. It makes it problematic to know whom to test and whom to isolate.
Contact tracing, a basic public health tool used successfully for previous communicable diseases — especially those sexually transmitted — is basically impossible. Contact tracing works when symptomatic patients seek care, enter the public health surveillance tracking system and identify their contacts. Those exposed to contagious individuals are then located and advised about quarantine, testing and treatment options. But millions of dollars and a lot of personnel have been ineffective in tracing COVID-19 when asymptomatic patients are unaware they should be tested or fail to report a positive if they test at home. The contacts of those infected are often unknown, especially when the virus is spread in crowded indoor locations.
South Korea employed the most extensive contact tracing system in the world but abandoned it recently in the face of the omicron surge. Jang Young-ook, a researcher at the Korea Institute for International Economic Policy studying pandemic response policies around the world, said, “The size of the surge Korea is seeing now renders contact tracing almost pointless. That makes collecting personal information with QR (computerized personal) codes kind of unjustified.”
This is basically an admission that zero COVID-19 is a pipe dream, a lesson the residents of Shanghai are learning the hard way.
When the definitive history is written about the COVID-19 pandemic of the early 2020s, an essential chapter will be the futile quest for zero COVID-19. It will be symbolized by a drone hovering over deserted Shanghai streets, blaring the disheartening epitaph for zero COVID-19 that China has been broadcasting to its people: “Please comply with COVID restrictions. Control your soul’s desire for freedom. Do not open the window or sing.”
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ABOUT THE WRITERS
Dr. Cory Franklin is a retired intensive care physician. Dr. Robert A. Weinstein is an infectious disease specialist at Rush University Medical Center.
