Lost Opportunities to Contain COVID-19 in China

Three years after the SARS-COV-2 virus emerged in Wuhan, China is now facing a tsunami of COVID-19 infections. The unprecedented spread of the disease appears to have been fueled by an ill-timed sudden change in COVID-19 policy and the lack of vaccination and boosting. A rethinking of national strategy could still help.

From Beijing to Shanghai to Shengzhen, the megacities in China have had empty streets, vacant buses, and empty pharmacy shelves for several weeks as COVID-19 swept the country after an abrupt reversal of the Zero-COVID policy. Three weeks into this outbreak, most of the country's hospital beds were occupied by severe COVID cases, and bodies were piling up at morgues. The country lost its reliable case counting system after the vice premier hastily announced the change to the Zero-COVID policy on December 1. News from a few cities recently suggested that between 40 percent and 80 percent of people were infected in just two weeks.

In Beijing alone, 18 million people were estimated to be symptomatic by New Year's Eve. These estimates confirmed the findings of an outbreak model by Chinese scientists published in July 2022 that predicted there could be over 100 million cases, 5 million hospitalizations, and 1.6 million deaths within six months of the stop of the Zero-COVID policy. In response to this crisis, many countries announced a new requirement for SARS-COV-2 tests for passengers from China and the IMF lowered the 2023 GDP perspective for China.

The Perfect Storm Caused the Fast and Violent Outbreak in China

Epidemic patterns are determined by three factors: the agent (virus), the host (people's vulnerability), and the environment. The Omicron virus is one of the most infectious that has ever been recorded with a reproductive R number estimated to be up to 16. The dense and highly mobile population in China created a suitable environment for the highly contagious virus to spread quickly.

At the same time, the population's immunity to COVID-19 in China is lower than that of people in the rest of the world due to two factors: the fact that elderly people in China were least likely to be vaccinated and the low booster rate in the last six months before the end of the Zero-COVID policy. More than 85 million Chinese people 60 and over failed to get vaccinated because of the low-infection environment, a lack of confidence in the vaccines' efficacy, and misguided concerns about possible complications. At the same time, over the last six months only 0.5 percent of people in China received the booster, which has been shown to be the best strategy to boost immunity.

The Lack of Political Will to Prepare for the Reopening

Naturally, there will be questions as to why China didn't build a road map to reopening. China had plenty of warning about the threat posed by Omicron, given the outbreaks in the United States, Hong Kong, and Shanghai last year. The United States reported a reproductive number of 11 for the Omicron variant; Hong Kong recorded one of the worst mortality rates in the world during its winter outbreak; and Shanghai's spring cases grew astronomical even with the Zero-COVID policy.

Instead of scaling up hospital capacity and strengthening health care professional training, the focus of the government over the last six months was on building temporary clinics for quarantine of asymptomatic cases like the Fang Cang clinics. Between July and December of 2022, China's vaccine rollout rate was the lowest since the vaccine became available (Figure 1), missing out on the optimal time for boosters before the opening. There was also no stockpiling on Paxlovid, the antiviral medicine that can reduce COVID-19 hospitalization by 90 percent, even though Zhe-Jiang Hua-Hai Pharmaceuticals obtained a license from Pfizer to produce the drug locally in April.

Date	Total Vaccinations
12/15/20	1500000
12/31/20	4500000
1/9/21	9000000
1/13/21	10000000
1/20/21	15000000
1/26/21	22767000
1/31/21	24000000
2/3/21	31236000
2/9/21	40520000
2/28/21	52520000
3/14/21	64980000
3/20/21	74956000
3/22/21	80463000
3/23/21	82846000
3/24/21	85859700
3/25/21	91346000
3/26/21	97470000
3/27/21	102417000
3/28/21	106613000
3/29/21	110962000
3/30/21	114690000
3/31/21	119821000
4/1/21	126616000
4/2/21	133801000
4/3/21	136677000
4/4/21	139970000
4/5/21	142802000
4/6/21	145392000
4/7/21	149071000
4/8/21	155150000
4/9/21	161121000
4/10/21	164471000
4/11/21	167343000
4/12/21	171928000
4/13/21	175623000
4/14/21	179216000
4/15/21	183536000
4/16/21	187368000
4/17/21	189809000
4/18/21	192127000
4/19/21	195022000
4/20/21	198965000
4/21/21	204191000
4/22/21	211223000
4/23/21	216084000
4/24/21	220309000
4/25/21	224901000
4/26/21	229489000
4/27/21	235976000
4/28/21	243905000
4/29/21	253463000
4/30/21	265064000
5/1/21	270406000
5/2/21	275338000
5/3/21	279905000
5/4/21	284595000
5/5/21	289627000
5/6/21	297734000
5/7/21	308226000
5/8/21	317586000
5/9/21	324307000
5/10/21	332964000
5/11/21	342697000
5/12/21	354272000
5/13/21	366910000
5/14/21	380633000
5/15/21	392987000
5/16/21	406938000
5/17/21	421991000
5/18/21	435689000
5/19/21	449511000
5/20/21	466698000
5/21/21	483343000
5/22/21	497272000
5/23/21	510858000
5/24/21	527253000
5/25/21	546714000
5/26/21	566723000
5/27/21	584360000
5/28/21	602991000
5/29/21	620974000
5/30/21	639172000
5/31/21	661468000
6/1/21	681908000
6/2/21	704826000
6/3/21	723486000
6/4/21	744483000
6/5/21	763065000
6/6/21	777879000
6/7/21	794134000
6/8/21	808962000
6/9/21	824856000
6/10/21	845299000
6/11/21	863513000
6/12/21	878523000
6/13/21	892770000
6/14/21	904134000
6/15/21	923910000
6/16/21	945150000
6/17/21	966652000
6/18/21	990257000
6/19/21	1010489000
6/20/21	1029223000
6/21/21	1049744000
6/22/21	1071783000
6/23/21	1095902000
6/24/21	1120643000
6/25/21	1143805000
6/26/21	1165230000
6/27/21	1185787000
6/28/21	1206714000
6/29/21	1225734000
6/30/21	1244675000
7/1/21	1264149000
7/2/21	1283175000
7/3/21	1296037000
7/4/21	1305499000
7/5/21	1318417000
7/6/21	1331669000
7/7/21	1342381000
7/8/21	1354226000
7/9/21	1365463000
7/10/21	1374162000
7/11/21	1382482000
7/12/21	1391432000
7/13/21	1402019000
7/14/21	1414609000
7/15/21	1426347000
7/16/21	1437623000
7/17/21	1447427000
7/18/21	1456557000
7/19/21	1467316000
7/20/21	1478484000
7/21/21	1491605000
7/22/21	1507605000
7/23/21	1524897000
7/24/21	1538707000
7/25/21	1550268000
7/26/21	1565872000
7/27/21	1583361000
7/28/21	1601249000
7/29/21	1619218000
7/30/21	1637395000
7/31/21	1652819000
8/1/21	1669527000
8/2/21	1688683000
8/3/21	1708356000
8/4/21	1726223000
8/5/21	1741812000
8/6/21	1757780000
8/7/21	1770304000
8/8/21	1782525000
8/9/21	1795049000
8/10/21	1808092000
8/11/21	1820238000
8/12/21	1832450000
8/13/21	1844382000
8/14/21	1853839000
8/15/21	1862928000
8/16/21	1875371000
8/17/21	1887273000
8/18/21	1900127000
8/19/21	1912419000
8/20/21	1924390000
8/21/21	1935869000
8/22/21	1946954000
8/23/21	1961893000
8/24/21	1975738000
8/25/21	1988433000
8/26/21	2003914000
8/27/21	2019549000
8/28/21	2032934000
8/29/21	2044625000
8/30/21	2055966000
8/31/21	2067589000
9/1/21	2076428000
9/2/21	2084650000
9/3/21	2092174000
9/4/21	2100387000
9/5/21	2107445000
9/6/21	2113083000
9/7/21	2119025000
9/8/21	2124582000
9/9/21	2129833000
9/10/21	2135240000
9/11/21	2142580000
9/12/21	2148120000
9/13/21	2152520000
9/14/21	2156938000
9/15/21	2161428000
9/16/21	2165679000
9/17/21	2170017000
9/18/21	2174043000
9/19/21	2177638000
9/20/21	2180986000
9/21/21	2182604000
9/22/21	2186583000
9/23/21	2190792000
9/24/21	2194467000
9/25/21	2197689000
9/26/21	2200202000
9/27/21	2203185000
9/28/21	2206054000
9/29/21	2208921000
9/30/21	2211452000
10/1/21	2212206000
10/2/21	2212961000
10/3/21	2213691000
10/4/21	2214564000
10/5/21	2215428000
10/6/21	2216382000
10/7/21	2217563000
10/8/21	2218826000
10/9/21	2220128000
10/10/21	2221245000
10/11/21	2222666000
10/12/21	2224081000
10/13/21	2225504000
10/14/21	2227334000
10/15/21	2229212000
10/16/21	2230567000
10/17/21	2232088000
10/18/21	2234096000
10/19/21	2236226000
10/20/21	2238325000
10/21/21	2240550000
10/22/21	2243018000
10/23/21	2244727000
10/24/21	2246217000
10/25/21	2248688000
10/26/21	2251339000
10/27/21	2254252000
10/28/21	2257584000
10/29/21	2262226000
10/30/21	2268362000
10/31/21	2274072000
11/1/21	2279422000
11/2/21	2285954000
11/3/21	2293820000
11/4/21	2302679000
11/5/21	2311626000
11/6/21	2322102000
11/7/21	2330726000
11/8/21	2338493000
11/9/21	2346831000
11/10/21	2355525000
11/11/21	2364032000
11/12/21	2372713000
11/13/21	2382133000
11/14/21	2389568000
11/15/21	2396045000
11/16/21	2402897000
11/17/21	2409784000
11/18/21	2416179000
11/19/21	2422908000
11/20/21	2430743000
11/21/21	2437252000
11/22/21	2442786000
11/23/21	2449427000
11/24/21	2456617000
11/25/21	2464330000
11/26/21	2472847000
11/27/21	2482895000
11/28/21	2492041000
11/29/21	2499813000
11/30/21	2507975000
12/1/21	2516380000
12/2/21	2524363000
12/3/21	2532799000
12/4/21	2543424000
12/5/21	2553028000
12/6/21	2560117000
12/7/21	2567552000
12/8/21	2574931000
12/9/21	2582740000
12/10/21	2591879000
12/11/21	2602703000
12/12/21	2612218000
12/13/21	2621190000
12/14/21	2630204000
12/15/21	2640059000
12/16/21	2650561000
12/17/21	2661838000
12/18/21	2673688000
12/19/21	2684290000
12/20/21	2695181000
12/21/21	2706676000
12/22/21	2719459000
12/23/21	2732749000
12/24/21	2745877000
12/25/21	2758094000
12/26/21	2769530000
12/27/21	2781869000
12/28/21	2795716000
12/29/21	2810118000
12/30/21	2823418000
12/31/21	2835332000
1/1/22	2841269000
1/2/22	2847898000
1/3/22	2855225000
1/4/22	2863561000
1/5/22	2872017000
1/6/22	2879993000
1/7/22	2887772000
1/8/22	2894178000
1/9/22	2899557000
1/10/22	2905638000
1/11/22	2912178000
1/12/22	2918249000
1/13/22	2923698000
1/14/22	2928981000
1/15/22	2933485000
1/16/22	2937632000
1/17/22	2942111000
1/18/22	2947136000
1/19/22	2951846000
1/20/22	2956218000
1/21/22	2960675000
1/22/22	2964370000
1/23/22	2968121000
1/24/22	2973459000
1/25/22	2978646000
1/26/22	2984055000
1/27/22	2989480000
1/28/22	2994162000
1/29/22	2997884000
1/30/22	3000198000
1/31/22	3000532000
2/1/22	3000603000
2/2/22	3000893000
2/3/22	3001624000
2/4/22	3002896000
2/5/22	3004681000
2/6/22	3006862000
2/7/22	3010669000
2/8/22	3016150000
2/9/22	3022646000
2/10/22	3029588000
2/11/22	3036707000
2/12/22	3042376000
2/13/22	3046687000
2/14/22	3052435000
2/15/22	3056997000
2/16/22	3063391000
2/17/22	3069619000
2/18/22	3075752000
2/19/22	3080788000
2/20/22	3084712000
2/21/22	3090309000
2/22/22	3095767000
2/23/22	3101760000
2/24/22	3108286000
2/25/22	3114622000
2/26/22	3119664000
2/27/22	3124118000
2/28/22	3129845000
3/1/22	3135598000
3/2/22	3141473000
3/3/22	3147007000
3/4/22	3152419000
3/5/22	3156899000
3/6/22	3160685000
3/7/22	3165486000
3/8/22	3169916000
3/9/22	3174984000
3/10/22	3180060000
3/11/22	3185239000
3/12/22	3189426000
3/13/22	3193236000
3/14/22	3198272000
3/15/22	3203688000
3/16/22	3209041000
3/17/22	3213773000
3/18/22	3218716000
3/19/22	3222868000
3/20/22	3226334000
3/21/22	3230367000
3/22/22	3234601000
3/23/22	3239170000
3/24/22	3243599000
3/25/22	3247624000
3/26/22	3251412000
3/27/22	3254984000
3/28/22	3259042000
3/29/22	3263129000
3/30/22	3267140000
3/31/22	3270874000
4/1/22	3274120000
4/2/22	3276886000
4/3/22	3279249000
4/4/22	3281604000
4/5/22	3283586000
4/6/22	3286373000
4/7/22	3289463000
4/8/22	3292643000
4/9/22	3295208000
4/10/22	3297551000
4/11/22	3300328000
4/12/22	3303126000
4/13/22	3305884000
4/14/22	3308616000
4/15/22	3311245000
4/16/22	3313338000
4/17/22	3315186000
4/18/22	3317463000
4/19/22	3319950000
4/20/22	3322488000
4/21/22	3325049000
4/22/22	3327616000
4/23/22	3329766000
4/24/22	3331771000
4/25/22	3334018000
4/26/22	3336285000
4/27/22	3338555000
4/28/22	3340711000
4/29/22	3343008000
4/30/22	3344528000
5/1/22	3345524000
5/2/22	3346607000
5/3/22	3347640000
5/4/22	3348588000
5/5/22	3349702000
5/6/22	3350934000
5/7/22	3352053000
5/8/22	3353022000
5/9/22	3354196000
5/10/22	3355535000
5/11/22	3357120000
5/12/22	3358576000
5/13/22	3360050000
5/14/22	3361333000
5/15/22	3362389000
5/16/22	3363651000
5/17/22	3364987000
5/18/22	3366402000
5/19/22	3367720000
5/20/22	3369057000
5/21/22	3370162000
5/22/22	3371096000
5/23/22	3372243000
5/24/22	3373460000
5/25/22	3374726000
5/26/22	3375898000
5/27/22	3377153000
5/28/22	3378211000
5/29/22	3379075000
5/30/22	3380191000
5/31/22	3381314000
6/1/22	3382178000
6/2/22	3382998000
6/3/22	3383416000
6/4/22	3383918000
6/5/22	3384372000
6/6/22	3385080000
6/7/22	3385853000
6/8/22	3386647000
6/9/22	3387446000
6/10/22	3388256000
6/11/22	3388904000
6/12/22	3389454000
6/13/22	3390194000
6/14/22	3391088000
6/15/22	3391955000
6/16/22	3393119000
6/17/22	3393907000
6/18/22	3394504000
6/19/22	3395026000
6/20/22	3395704000
6/21/22	3396446000
6/22/22	3397224000
6/23/22	3397993000
6/24/22	3398762000
6/25/22	3399317000
6/26/22	3399803000
6/27/22	3400401000
6/28/22	3401112000
6/29/22	3401857000
6/30/22	3402622000
7/1/22	3403201000
7/2/22	3403643000
7/3/22	3403989000
7/4/22	3404537000
7/5/22	3405158000
7/6/22	3405812000
7/7/22	3406557000
7/8/22	3407361000
7/9/22	3407945000
7/10/22	3408404000
7/11/22	3409032000
7/12/22	3409697000
7/13/22	3410413000
7/14/22	3411136000
7/15/22	3411903000
7/16/22	3412457000
7/17/22	3412950000
7/18/22	3413628000
7/19/22	3414388000
7/20/22	3415146000
7/21/22	3415934000
7/22/22	3416727000
7/23/22	3417357000
7/24/22	3417900000
7/25/22	3418638000
7/26/22	3419441000
7/27/22	3420260000
7/28/22	3421121000
7/29/22	3422060000
7/30/22	3422910000
7/31/22	3423669000
8/1/22	3424070000
8/2/22	3424465000
8/3/22	3424838000
8/4/22	3425218000
8/5/22	3425593000
8/6/22	3425843000
8/7/22	3426023000
8/8/22	3426316000
8/9/22	3426619000
8/10/22	3426938000
8/11/22	3427246000
8/12/22	3427564000
8/13/22	3427788000
8/14/22	3427965000
8/15/22	3428258000
8/16/22	3428587000
8/17/22	3428933000
8/18/22	3429254000
8/19/22	3429579000
8/20/22	3429804000
8/21/22	3429988000
8/22/22	3430297000
8/23/22	3430624000
8/24/22	3430949000
8/25/22	3431247000
8/26/22	3431560000
8/27/22	3431791000
8/28/22	3431965000
8/29/22	3432235000
8/30/22	3432506000
8/31/22	3432778000
9/1/22	3432984000
9/2/22	3433182000
9/3/22	3433328000
9/4/22	3433450000
9/5/22	3433615000
9/6/22	3433788000
9/7/22	3433960000
9/8/22	3434119000
9/9/22	3434270000
9/10/22	3434317000
9/11/22	3434390000
9/12/22	3434487000
9/13/22	3434621000
9/14/22	3434774000
9/15/22	3434906000
9/16/22	3435066000
9/17/22	3435207000
9/18/22	3435302000
9/19/22	3435442000
9/20/22	3435577000
9/21/22	3435719000
9/22/22	3435855000
9/23/22	3436001000
9/24/22	3436132000
9/25/22	3436227000
9/26/22	3436355000
9/27/22	3436494000
9/28/22	3436630000
9/29/22	3436773000
9/30/22	3436911000
10/1/22	3436966000
10/2/22	3437018000
10/3/22	3437085000
10/4/22	3437161000
10/5/22	3437218000
10/6/22	3437286000
10/7/22	3437347000
10/8/22	3437442000
10/9/22	3437516000
10/10/22	3437619000
10/11/22	3437728000
10/12/22	3437851000
10/13/22	3437961000
10/14/22	3438086000
10/15/22	3438202000
10/16/22	3438277000
10/17/22	3438378000
10/18/22	3438482000
10/19/22	3438588000
10/20/22	3438697000
10/21/22	3438817000
10/22/22	3438920000
10/23/22	3438993000
10/24/22	3439087000
10/25/22	3439201000
10/26/22	3439299000
10/27/22	3439408000
10/28/22	3439525000
10/29/22	3439620000
10/30/22	3439698000
10/31/22	3439802000
11/1/22	3439907000
11/2/22	3440016000
11/3/22	3440119000
11/4/22	3440231000
11/5/22	3440346000
11/6/22	3440421000
11/7/22	3440524000
11/8/22	3440638000
11/9/22	3440760000
11/10/22	3440879000
11/11/22	3441007000
11/12/22	3441126000
11/13/22	3441205000
11/14/22	3441334000
11/15/22	3441497000
11/16/22	3441680000
11/17/22	3441859000
11/18/22	3442080000
11/19/22	3442253000
11/20/22	3442376000
11/21/22	3442539000
11/22/22	3442683000
11/23/22	3442840000
11/24/22	3442976000
11/25/22	3443114000
11/26/22	3443240000
11/27/22	3443327000
11/28/22	3443451000
11/29/22	3443554000
11/30/22	3443749000
12/1/22	3443887000
12/2/22	3444010000
12/3/22	3444166000
12/4/22	3444295000
12/5/22	3444548000
12/6/22	3444906000
12/7/22	3445402000
12/8/22	3446141000
12/9/22	3447152000
12/10/22	3448175000
12/11/22	3448992000
12/12/22	3450244000
12/13/22	3451677000
12/14/22	3453156000
12/15/22	3454559000
12/16/22	3455859000
12/17/22	3456803000
12/18/22	3457491000
12/19/22	3458412000
12/20/22	3461498000
12/21/22	3465123000
12/22/22	3467395000
12/23/22	3469670000
12/24/22	3470946000
12/25/22	3471819000
12/26/22	3473153000
12/27/22	3474309000
12/28/22	3475387000
12/29/22	3476443000
12/30/22	3477453000
12/31/22	3478094000
1/1/23	3478488000
1/2/23	3478946000
1/3/23	3479607000
1/4/23	3480354000
1/5/23	3481101000

Source: Official data collated by Our World in Data

What Can Be Done, and What Are the Implications for the World?

The rapid spread of the virus, which infected 250 million Chinese people in just two weeks, could mean that the number of new cases in China will exceed the 660 million total cases reported globally over the last three years.

The rest of the world is watching the unprecedented crisis unfolding in China, and many are willing to provide assistance with vaccines while strengthening border screening, and variant monitoring. Public health professionals understand when and how to switch from a strategy focused on nonpharmaceutical interventions to one that relies on vaccines and pharmaceutical treatments. Prodding Chinese leaders, physicians, and communities toward such a policy change could be a worthy next step.

---

Jennifer Bouey is a senior policy researcher, Tang Chair for China Policy Studies, and an epidemiologist at the nonprofit, nonpartisan RAND Corporation.