China retains its Covid-19 elimination strategy even as the world reopens

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PM Jacinda Ardern announced that Auckland and some low-vaccinated regions will enter the new Covid-19 Protection Framework at the red setting, with the rest of the country doing so at the orange setting. (First published on November 20, 2021)

As New Zealand accepts that Covid-19 will likely become endemic, one country continues to doggedly pursue a strategy of elimination. National Correspondent Lucy Craymer explains why China is continuing with a zero tolerance policy, even as much of the world accepts they now have to live with it.

In February 2020 governments around the world began to close their borders to visitors from China as the magnitude of the new virus became evident.

The World Health Organisation, and Chinese officials, at the time decried the measures.

But it was for New Zealand, and others, one tool to try to eliminate the virus. Countries also instigated lockdowns, isolated those with the virus and to varying extents mandated masks. But with the more contagious Delta variant now widely spread and vaccination rates climbing it is now increasingly accepted elimination is no longer possible.

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Over the past couple of months, New Zealand’s own strategy has moved from elimination to acceptance with a timetable now in place for the reopening of both domestic and international borders.

But in China, where the virus was first identified, no such shift has occurred. Borders remain closed and outbreaks continue to be met with strict lockdowns, extensive city-wide testing, tracking of people and travel bans.

On Tuesday, November 30, China counted just 39 new cases of Covid-19.

The speed of China’s response in early 2020 was the crucial factor to keeping it under control, says Gregory Poland,​ director of the Vaccine Research Group at the Mayo Clinic, in a Lancet article. “They moved very quickly to stop transmission. Other countries, even though they had much longer to prepare for the arrival of the virus, delayed their response and that meant they lost control.”

China and Covid-19

The virus that would later be named Covid-19 began circulating in the city of Wuhan in December 2019. In the two months that followed, thousands died and even more fell sick. The virus spread through China and across the world.

Yet by March 2020, China was recording only a handful of new cases each day. And even though there have been new outbreaks in the past 18 months, their official new case numbers have never topped 200, according to Our World in Data. The country has regularly recorded no new community cases in their population of 1.4 billion.

In total, China has identified just under 100,000 cases,​compared with around 48 million​ cases in the US, according to Our World in Data.

How has it managed this?

If New Zealand’s response to containing Covid has been strict, China with its authoritarian government has been able to implement even tougher measures.

China uses localised lockdowns, extensive contract tracing, border controls and testing. The population is also very digitally connected making tracking easier. Face masks and hand sanitiser are also widely used.

Rodney Jones, who has provided Covid-19 modelling and advice to the New Zealand Government, says China’s ability to do large scale testing and to use the likes of the military to get this done have allowed it to continue to eliminate new outbreaks of the virus.

”You can’t separate China’s success from it being an authoritarian state,” says Jones, who has worked extensively in an economic advisory role in Asia. “Elimination does work, but it relies on the authoritarian tool box.”

Last month, when three friends from Shanghai tested positive to Covid-19, the local government’s reaction was swift. More than 500 flights from Shanghai’s two major airports were cancelled, six hospitals suspended outpatient services and travel to and from the city was paused.

Local governments have also instigated quick lockdown measures and there is quarantining for travellers moving around the country. Breaking rules can result in criminal detention.

Perhaps just as importantly, China has used widespread testing to root out Covid cases. For example, after a visitor at Shanghai Disneyland was confirmed to have Covid at the start of November, all 30,000 plus visitors were required to get tested for the virus. And in August, China tested all 11 million people in Wuhan after a new outbreak of the virus.

China’s borders, like New Zealand’s, remain closed to most. There are no holidaymakers or foreign students. Instead, it only allows mainland citizens or those on special visas such as diplomatic or resumption of work visas into the country – all must test negative before entry, and then they spend up to 21 days in quarantine. But unlike New Zealand, there are no indications China will soften this approach anytime soon.

Residents wear masks while lining up at a vaccination site on June 21, 2021, in Wuhan, China.
Getty Images
Residents wear masks while lining up at a vaccination site on June 21, 2021, in Wuhan, China.

Why is it continuing to pursue a strategy of elimination?

Around 75 per cent of China’s population is fully vaccinated against the virus -- most of those have received the Chinese-developed Sinovac or Sinopharm vaccines, which have lower efficacy than the vaccines developed by Pfizer or AstraZeneca.

A study from Peking University mathematicians estimated that if China pursued similar opening up strategies to the US, it could see more than 630,000 new Covid-19 cases a day. It adds that if a less restrictive strategy was followed, there is a real possibility of a colossal outbreak, “which would almost certainly induce an unaffordable burden to the medical system.”

And while rising cases and increased deaths are unattractive, they are particularly unattractive right now for the Chinese government. Beijing is due to host the Winter Olympics in February​ and will want these to go smoothly.

More importantly, President Xi Jinping plans in 2022 to break China’s established system of succession and have his party agree he can remain president for life – the successful control of Covid will support this.

Will it ever reopen to the world? Does it have to?

Jones says while China may have been successful with elimination it does not have an exit plan. It seems like borders will be closed for some time.

Like New Zealand before the Delta strain got into the community, many in China are not enthusiastic about opening up and learning to live with the virus because they’ve seen what countries like the US have lived with – school and university closures, overrun hospitals and deaths.

In August, when well-known Chinese infectious disease expert Zhang Wenhong wrote a blog on Weibo that the public might need to prepare to live with the virus, he received a torrent of abuse. He was called a traitor and criticised for following Western ideas. The university where Zhang received his doctorate even received complaints against him.

But there are challenges for China keeping its borders closed forever. Ex-pats living in China (and territory Hong Kong) are leaving because the mandatory quarantine when returning is just too much.

The border challenges also make it more difficult for businesses that have operations in the mainland.

Mark Tanner, managing director of Shanghai-based China Skinny, a marketing and research agency, says that the inability to get into China for both himself and the global brands he works with is really tough because there is no ability to build face-to-face relationships.

“It’s tough even in China. Our team travels quite a bit and with these mini-outbreaks we’ve had to cancel plans or change plans,” he says. “It’s not as easy as it was pre-Covid.”

Life in China is largely back to normal as the country continues to keep Covid-19 out.
Qilai Shen/Bloomberg
Life in China is largely back to normal as the country continues to keep Covid-19 out.

If China could do it, why couldn’t New Zealand?

New Zealand is a democracy with a free media. That means our government is swayed by public opinion, and it is much harder to quieten voices of dissent. It also means that the government has to more actively balance other issues – economic and social – with the health risks of opening the border.

Secondly, New Zealand is a small trading economy. It needs to be connected to the world and relies on selling overseas and bringing goods in. Those connections make it more difficult to be shut off indefinitely.

Michael Baker, an epidemiologist from the University of Otago, Wellington, says there is no question that elimination was the best strategy in the early days, but the Delta strain made it harder to contain the virus and with creation of vaccines, the balance has shifted.

“You’re having to make trade-offs,” he says, adding that he suspects if Delta had not got into the community, New Zealand might have continued with the elimination strategy for longer.