As China Struggles to Control Outbreak, Experts Question Zero-COVID Strategy 
COVID-19 testing in Shanghai

China’s COVID-19 situation is getting worse, and strategies to control the spread of the Omicron variant are getting stricter as the country registered 20,472 daily cases on Wednesday – the highest-ever infection rate.

The epicentre of the outbreak is Shanghai, which recorded 17,007 cases on Wednesday and municipal authorities are conducting mass testing in the city populated by 26 million in an attempt to identify infected people and place them under quarantine.

Shanghai authorities have also been separating SARS-COV2 positive young children under the age of seven from their parents. According to reports, and videos on the Chinese microblogging application Weibo, children have been separated from their COVID-19 positive parents in Shanghai’s Jinshan district. 

The incidents of separation of young children from their parents were reported to be from the Shanghai Public Health Clinical Centre. This separation is a part of China’s strict zero-COVID strategy, a policy that has now been questioned for being overly regimented. 

Even as Shanghai health authorities continue to defend the policy of separating COVID-19 positive children from their parents, they clarified on Monday that if parents of COVID-19 positive children also test positive, they can isolate together and will not be separated. 

Wu Qianyu, an official from the Shanghai Municipal Health Commission said that according to the Law on the Prevention and Control of Infectious Diseases and the requirements for prevention and control work, infected people should be isolated from non-infected persons.

“In accordance with the principle of classified treatment, we have made it clear that if the parent of the child is also a positive infected person, they can live in the children’s area to accompany and care for them and receive observation and treatment together.” 

Zero-COVID policy under scrutiny

China is under scrutiny for sticking to its zero-COVID policy which includes strict isolation for those with COVID-19, contact tracing, and long lockdowns with very little movement allowed in cities with perceived outbreaks. If your area has been identified for mass-testing, you  cannot leave the home for any reason. 

Professor Antoine Flahault, Director of the Institute of Global Health at the Univerity of Geneva’s Faculty of Medicine, said that China’s “zero-COVID approach seems to continue to be effective up to date, at least in terms of reported numbers of contaminations and deaths which remain very low in comparison to other countries”.

According to Flahault, China fears a “Hong Kong scenario” since they share the same weakness in their vaccine coverage, with low uptake among the elderly population. Currently, only 50% of the population over the age of 80 is vaccinated in Hong Kong. 

Hong Kong has experienced a huge Omicron wave with one of the highest death tolls in the world that has overwhelmed health care system after the region gave up its zero-COVID strategy. 

“Continental China’s authorities believe they have no other choice today than maintaining their zero COVID strategy to avoid similar health disaster,” said Flahault.

China is one of the few countries where the zero-COVID strategy is still in action. Australia, Singapore, New Zealand also tried this approach but have abandoned it, Dr Flahault said. 

Weaker vaccines

“Hong Kong followed them in the midst of their crisis, but China and to a lesser extent Taiwan decided to keep it [zero-COVID strategy]. China probably hesitated and was expected to switch to suppression strategy after the Olympic Games,” he said. “Even as the strategy to suppress was less stringent than an elimination strategy, the Omicron variant changed the rules of the game.”

One of the disadvantages China faces is that immunity gained from two doses of its vaccines, Sinopharm and Coronavac, is only about 56% on average, while the mRNA vaccines, Pfizer and Moderna, have over 95% protection, said Sayantan Bose, Principal Scientist of Virology at Autonomous Therapeutics in the US.

Bose added that China is extremely capable of carrying out mass vaccinations and the regime could very effectively vaccinate the whole population with a third dose which would boost the immunity to a “large extent.”

“Ultimately, the virus has infiltrated the human population to such an extent that it will not completely disappear ever. We just have to figure out the best way to deal with it.”

According to the state media CCTV, China’s zero-COVID approach has “proved effective and necessary” in curbing the spread of the virus despite the recent flare-ups of the epidemic in multiple places across the country. 

Isolated in Shanghai

Shanghai is turning an exhibition centre into a COVID-19 hospital

Currently in Shanghai, all those who test positive for the disease – irrespective of whether they are symptomatic or asymptomatic – have to be isolated at a facility. This has brought fresh fears to people who will be separated from their young dependent children. Isolation is not limited to adults but also to children who test positive but whose family members do not. 

In its crackdown over the dominant omicron variant of SARS-COV-2 that has taken over the major financial hub, Shanghai has converted multiple hospitals, gymnasiums, apartment blocks and other venues into central quarantine sites. Further, according to media reports, Individuals who refuse to be tested for COVID for no justifiable reason will face administrative or criminal punishment. 

Shanghai’s lockdown was supposed to end this week, but it has been extended and military personnel have been deployed to Shanghai to assist in the mandatory screening. 

The images from the Shanghai health centre showed several young children crammed together in rooms with cribs and beds. The health centre, according to media reports, verified the images and said they were real and did not deny the separation of parents from their children. However, after gaining traction and attention of many shocked citizens, the post showing the reality of the children’s separation in Shanghai was deleted. 

According to a report in Reuters, children as young as three months old are being separated from their breastfeeding mothers. In a video shared by a popular Chinese science writer, children can be seen separated and crying in the health centre:

Booster doses are ‘a must’

Last week, China’s National Health Commission published new guidelines that narrowed down the geographic scope of mass testing and said that local governments must aim to complete testing of each designated area within 24 hours.

Such changes in protocols come after Chinese President Xi Jinping has pledged to achieve “maximum prevention and control” while minimising damage to China’s economic and social development earlier last month. 

According to Flahault, China seems determined to continue its zero-COVID strategy and make it a success, whatever social and economic costs.  

“It was a policy which was waiting for the vaccines, but vaccines never allowed for substantially contributing to elimination. By stubbornly continuing with the elimination strategy, Chinese authorities have no other choices now but to implement very tough measures which may become highly unpopular, and even strongly rejected by the population,” said Flahault.

However, Bose says that “it does seem like the zero-Covid policy is outdated as it is impossible to completely stop the virus from spreading in the population, even if you manage to vaccinate every single person in China”.

He said that, according to recent reports, immunity from these vaccines is waning quickly in China and a third dose is a must. 

“So overall, it appears that at this point in the pandemic, the Zero-Covid policy seems like more of a burden to the suffering population. It is unlikely to yield further success and in the end could just add to the suffering of the people and their lives could be further pushed into poverty,” said Bose.

Complex and difficult path out

Jeremy Farrar, Director of the  Wellcome Trust

Meanwhile, Jeremy Farrar, director of the Wellcome Trust, gave credit to China for having succeeded in controlling its COVID-19 pandemic with “minimal loss to life and impact on their broader health systems”.

“China have managed to control the pandemic to the point that there is no natural immunity.  Effectively they’ve had no real waves of this epidemic,” Farrar told a media briefing called by the International Monetary Fund on Tuesday.

However, he added that the vaccines China was using were “not quite as effective as some of the vaccines available in other parts of the world” and it had struggled to vaccinate “their most vulnerable populations, particularly people over the ages of 70”. 

“China has a very complex and difficult path out of this pandemic. What I hope that they do is to use the current programme of trying to reduce transmission whilst having a very active and inclusive ability to get vaccines out to everybody, particularly those who are most vulnerable. If they can buy time, like New Zealand did like Australia did, to get their vaccine programme out to as many people as possible including booster doses, I think that gives them the best strategy of trying to exit from the pandemic,” said Farrar.

Image Credits: CGTN, Wellcome Trust.

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