Shanghai lockdown tests limits of China's dynamic zero-COVID policy

A man looks outside from his window during a COVID-19 lockdown in the Jing'an District of Shanghai, April 12. AFP-Yonhap

Soon after midnight on Thursday, a group of 7,500 medical staff boarded buses in Jiangsu Province, on a round trip to Shanghai around 300km away, a total journey time of 12 hours.

They arrived at the stricken metropolis in the early hours, donned protective suits and spent the day swabbing the throats of hundreds of thousands of residents for COVID-19, before starting the long drive home that evening.

Similar journeys were made by more than 30,000 other medical staff from at least 15 provinces to help the city carry out mass testing of its 25 million people, currently enduring the largest effort to control the virus since it was first reported in Wuhan two years ago.

But while the Wuhan lockdown won widespread support from a population eager to contain the outbreak, there has been growing discontent since Shanghai adopted similar measures, March 28.

There have been harrowing reports of people screaming from their homes over the prolonged confinement, as well as food shortages, unmet medical needs and pets bludgeoned to death by zealous pandemic workers.

While Shanghai's outbreak shows no sign of subsiding, there are also concerns for another COVID-19 hotspot, 2,000km away in the northern province of Jilin. Its capital Changchun has been in lockdown since March 11, when 160 local infections were reported.

The city of 8.5 million people has been through two peaks in infections and has yet to achieve "societal clearance" ― the point at which all new cases are found in quarantined areas ― with another 845 cases reported Monday.

While other countries have pivoted to a pragmatic approach of living with the virus, China remains determined to stop outbreaks in their tracks. But the evolving nature of COVID-19 has raised questions over the continuing effectiveness of a strict response.

New variants of the virus are more transmissible, but so far they are also less virulent among the vaccinated population. Shanghai's daily local infections have hovered above the 20,000 mark for more than a week, but most cases are asymptomatic and there have been no deaths from COVID-19.

Someone with the latest Omicron variant can in theory infect nearly 10 people, with a doubling of cases every three days if transmission is left unchecked.

But there are also more powerful tools to control COVID-19, including Pfizer's antiviral pills that can reduce the risk of hospitalization and death by nearly 90 per cent. The Pfizer treatment has been approved for use in China, and there is also a domestically developed antibody treatment that works well against the Omicron variant.

Medical personnel in protective gear wait for people to come for COVID-19 testing in a residential community under lockdown in Shanghai, April 12. EPA-Yonhap

China's vaccination rate is also high, at 87 percent, although the elderly population lags behind. Most have been inoculated with inactivated vaccines, whose effectiveness against Omicron is greatly reduced.

Scientists have been calling for the more effective mRNA vaccines ― developed by BioNTech and distributed in China by Shanghai Fosun Pharma ― to be made available to the public, but approvals have been stuck in administrative review for almost a year.

Shanghai residents expected a swift end to the lockdown 10 days ago for Pudong, east and south of the Huangpu River, under the government's original plan for a staged containment. Communities on the river's west bank were due to reopen a week ago.

Instead, according to the latest government plan, Shanghai residents can now expect to be confined to their homes for another 14 days if there is a positive case in their neighborhood over a seven-day period.

The government has not specified when the new plan will begin, but it will also allow residents of neighborhoods which remain COVID-free for 14 days to walk around their area.

Liang Wannian, who heads the National Health Commission working group's expert panel, said the stealth BA. 2 variant of Omicron was hard to control, with its fast transmission rates and higher levels of patients with few or no symptoms.

"Shanghai has gone from small-scale transmission at an early stage to the gradual emergence of community transmission, and now cases in all 16 districts and counties of the city, indicating it is difficult to fight Omicron in the same way as Delta. More decisive and determined measures are needed," he said.

According to Liang, the aim is to do everything possible to reduce the viral R0 rate to below 1, the epidemiology indicator of an outbreak's peak, when every infection spreads to fewer than one other person.

A resident waits for a food delivery behind a gate blocking an entrance to a residential area under lockdown amid the COVID-19 pandemic in Shanghai, April 13. Reuters-Yonhap

The quick deterioration of the situation in Shanghai left authorities ill-prepared. Horror stories emerged of people sent for isolation to unfinished facilities without access to food, water or treatment.

Reports of young children left unattended and frightened in large open wards after forced separation from their parents prompted appeals to the authorities for families to be allowed to isolate at home.

The arrival of Vice-Premier Sun Chunlan earlier this month to personally oversee the city's response to the outbreak has seen more frequent testing and stricter enforcement of isolation rules for positive cases.

Sun has been leading the country's pandemic response and in Shanghai has overseen a rushed effort to turn some of the city's giant exhibition centers into makeshift hospitals, including two with a combined 65,000-bed capacity.

Facilities are also going up in the neighboring provinces of Jiangsu and Zhejiang, each capable of handling 30,000 COVID-19 patients.

Zhu Huachen, associate professor with the school of public health at the University of Hong Kong, said the strict response in first Jilin and then Shanghai needed to be implemented thoroughly to work well.

Commuters wearing face masks walk across an intersection in the central business district in Beijing, April 12. AP-Yonhap

Essentially, lockdowns and mass testing are intended to minimize infections by restricting the movement of everyone in the city while officials try to identify and isolate positive cases from infection chains.

"In theory if everyone was well-isolated, even without citywide testing, the infection chain could be cut," Zhu said.

"But we are still seeing a high number of infections in Jilin, which suggests some loopholes such as missed testing or improper isolation after identifying positive cases ― [perhaps by] potential contamination through ventilation. In these cases you will see endless infections."

According to Zhu, the strict controls in Shanghai have worked, despite the exponential increase in recorded cases. "Prevention and control has flattened the slope of this line, which [otherwise] would be very steep," he said.

But swabbing the throats of 25 million people is no small task and Shanghai has been through at least three rounds of citywide testing, all while pausing its vital contribution to China's economy, with the exception of key areas like the ports and stock exchange.

A month-long, full-scale lockdown will knock 2.7 percent of Shanghai's aggregated real income but the lingering restrictions are casting a shadow across the entire country's economy.

A paper by researchers from Tsinghua and Zhejiang universities on the mainland, Princeton in the United States, and the Chinese University of Hong Kong found China's strict pandemic response is likely to cost at least $46 billion per month ― 3.1 percent of GDP ― in lost economic output.

Political science professor Dali Yang from the University of Chicago said China was not ready to pivot from the gargantuan lockdowns in Shanghai and other cities, while vaccination rates among the elderly remained low.

Yang said China had not done enough to prepare society for the latest outbreaks and any change in strategy would depend on how the hotspots were managed.

"Thus far, the costs are rising but still, from a national perspective, the Chinese leadership has been adamant about adhering to the zero-COVID strategy. The more this process drags on and affects people's lives and the economy, the more questions will be asked about the sustainability of such an approach," he said.

According to Yang, continued social and economic disruption would erode China's wide acceptance of its "dynamic zero" strategy, which aims to quickly contain sporadic outbreaks as they occur.

Chinese President Xi Jinping and the ruling Communist Party have built political legacies from the drastic means taken to achieve minimum deaths. Xi reiterated last month that China needed to stick to "dynamic zero" while trying to minimize the economic and social impacts.

But the policy has stretched Shanghai's resources to breaking point in its battle to contain the high number of infections.

While there have been no deaths recorded from COVID-19, travel restrictions and limited ambulance services have led to fatalities from delayed or denied treatment for other conditions.

Dozens of the city's outpatient departments have been forced to temporarily close after visits from patients with COVID-19, forcing other seriously ill people ― including those receiving chemotherapy treatment ― to queue for medical attention.

Jeremy Lim, an associate professor at the National University of Singapore's Saw Swee Hock School of Public Health, said China's policymakers had to decide on the "least bad" option ― to minimize loss of life from the virus and other conditions which may be worsened by lockdowns and restricted access to health services.

"The critical issue here is to prevent overwhelming the health system. As we have seen earlier in the COVID-19 pandemic, this can lead to devastating consequences not just for COVID patients but for everyone who needs to access healthcare," he said.