Choices of responses to COVID-19 in 2022

There are currently robust debates between the strategies of “dynamic zero” and “living with COVID-19” in Chinese social media.  The traditional, official media decidedly tilt towards “dynamic zero”, but by answering the question of “living with COVID-19” and explaining why “dynamic zero” is better, the government recognizes and publicizes the suspicion and opposition to “dynamic zero” in a large Chinese populace.

For any discussion, the terminology first must be clear and unified, yet much talk conflates the terms and positions.  Both “dynamic zero” and “living with COVID-19” are living with COVID-19, only differ on how: the Chinese government never claims to eradicate COVID-19 (3/16/2022 blog).  For DZ the devil is in the details, and its extremes are a bottomless pit, with city-wide lockdown and continuous RNA testing being the most visible, disruptive, and last resorts to achieve DZ.  Right now, seeing Shanghai as an example, cities everywhere are doing lockdowns (though not as harsh as Shanghai) and population RNA testing at the slightest trigger.  Thus, most public anger is towards the implementation of DZ being too wasteful and unnecessary two years into COVID-19.  As for LWC, no Chinese is advocating the UK or US type of COVID-19 response.  Instead, certain measures, like targeted testing, in door masking, contact tracing or tracking, can stay, even lockdown of limited areas for limited time is OK under the worst conditions.  But city-wide lockdown, closing businesses all around, and endless city-wide testing over and over, must stop.  LWC can be designed as a more nimble, humane, and cost-effective DZ.  So if COVID-19 control on a scale of 0-100, DZ is 0, the US type is 100, then LWC may be 10.  It accepts a low level of COVID-19 circulating and more COVID-19 deaths than in 2021 or even 2020 (there are more ways to reduce infections and deaths now than before), in exchange for reducing the overall deaths and surely helping the economy and the public’s freedom and well being much better than a hard DZ.

LWC in theory is a better strategy, but whether it will work is admittedly unknown, for it has never been adopted in China.  Perhaps HK had attempted it to great effect in 2020 and 2021 until it gets busted in 2022.  Still, caveats abound: Omicron is more contagious, HK is always more lax than the mainland, and mainland Chinese cities had beaten Omicron before.  Shanghai is a special case whose lesson shouldn’t be applied widely.  Which, unfortunately, is happening, as many Chinese cities are upping their DZ measures. 

The way it is used across China right now, therefore, DZ is synonymous to lockdown, and there is no good way to do lockdowns, the bad will always be there and often overwhelm the good.   Shanghai in fact shows why DZ is counterproductive.  Shanghai’s first mistake was not recognizing the problem in Feb and early March.  Then in late March it ordered the city-wide lockdown without enough preparation, leading to shortage of supplies and delivery to people confined to their homes and living quarters.  Meanwhile the city tests everybody again and again, which causes congregation and further transmissions.  They try to round up all infections, but 25K daily infections increase much faster than anyone can ever build shelters, resulting in more tired people and confusion.  In truth, most infected can stay at home and get well all by themselves.  Yet Shanghai wastes so many energies in testing and shelters that services for other illnesses suffer greatly. Business disruption also means that basic medical supplies go down, further straining care inside and outside hospitals.  Since my 4/16/2022 blog, this Omicron wave has claimed its first 10 lives, but probably dozens or even hundreds of people have died due to medical care shortage over China.  Good to see signs that Shanghai is slowly back to work, but deaths both due to COVID-19 and due to DZ but not COVID-19 will rise in the days ahead.      

Despite all the well reported deaths, there is no indication of any above normal rate yet in Shanghai where ~ 560 die every day anyway (4/16/2022 blog), and still no expectation of any significant extra deaths in Shanghai or China.  Lest we forget that many countries still have hundreds of daily COVID-19 deaths.  But death is only one parameter and a rather low bar to cross.  It is never a good, moral idea to, or no one should, restrict the freedom of so many people unless under the most dire situation, where COVID-19 shouldn’t qualify any more in 2022.  And we can’t just consider what happens in March and April.  People’s disgust will last, and a tanked economy will manifest itself and linger for many months and years to come.  The Wuhan lockdown could be justifiable due to an unknown disease and emergency two years ago, but not this Shanghai lockdown and the ones currently in other Chinese cities.  The actual lockdowns may be short term, but DZ is long term, so are its many negative effects.  As it stands now, DZ can no longer be separated from its poor implementation and consequences and is an outdated strategy, for it places one disease over many others and destroys people’s life and livelihood in a wholesale and long-lasting manner.

Then why is DZ still dominating?  The government has provided its rationales, endorsed by a few scientists and doctors.  The most talked about reason is that China has 1.4 billion people, a lower medical service capacity per capita than developed countries, and a low vaccination rate among the seniors.  So even if Omicron is less deadly, with so many people infected at the same time, the medical community will be squeezed, leading to millions of deaths.  It must be stressed that this argument is not analogous to the accusations leveled at China by the Western MSM and politicians about COVID-19, Xinjiang, and other subjects, which are lies, damn lies, and fake statistics.  It is at least based on facts and suitable for scientific debates.  But upon close examination, one can conclude that either they do not support DZ, or, with extra work, a better alternative (LWC?) is feasible.

First the low vaccination rate among seniors.  How low is “low”?  90% adults nationwide have had at least 2 shots, but reportedly 50 million seniors have not been vaccinated.  In Shanghai >60% seniors have been vaccinated, and so far all 10 deaths were unvaccinated.  So is there a solution here?  Simple, just do a more thorough vaccination campaign: it must be much easier and less disruptive than any lockdown!  Then you can’t use a low number as an excuse for DZ or lockdown, but continue DZ even when the number gets higher.  If after some time, a certain number of seniors still refuse vaccination, will DZ be on forever?  A society should care for but not wait for everybody.

Then the constant fear for a rush to hospitals.  But as my 4/16/2022 blog mentioned, whereas Shanghai has among the best medical preparedness in China, many people still die waiting for care: DZ claims needed to prevent the rush, but instead it causes it!  DZ siphons crucial resources for work of little use, thereby endangering everything else.  What is the solution without resorting to DZ?  Well, mandate everybody infected isolated at home, enforced by community services and health codes, and only those with serious underlying conditions or symptoms, e.g., oxygen level below 93, can be checked by ambulance and go to hospitals.  With <1% or fewer such cases in Omicron, any Chinese city can handle the load.  Another thing the government must do is to really drive home the message that COVID-19 is not that dangerous or fearsome, recovered patients are safe and shouldn’t be discriminated against, and don’t panic to the hospitals.  Hospitals around the world save lives in emergencies but if you don’t feel so bad to begin with, hospitals might actually make you sicker due to cross infection and tiredness.  Thus the solution is part new strategy on the ground and part education.  Both the government and public must be more tolerant of COVID-19 just like other diseases.

And the fear that with so many Chinese, even a 0.1% Omicron death rate amounts to 1-2 million lost lives.  But this scenario is wildly improbable or not as bad as it sounds, and the government and scientists should give people the full picture.  India has about 4 million COVID-19 deaths in two years, Africa fewer, but most deaths are due to Delta without vaccines (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02796-3/fulltext).   China has better medical infrastructures, a better COVID-19 containment scheme, and is highly vaccinated.  Even with LWC China will never have a high infection rate, few people will ever need hospitalization, and even fewer deaths.  Not everybody will be exposed at the same time anyway, and people will adjust their behaviors to minimize risks even without DZ.  COVID-19 will drag on for years.  Once you are vaccinated or recover from infection, your survival is almost ensured.  So COVID-19 deaths in China will even out over the years.  In 2021China had ~ 20K domestic infections. Assume a vast, 1000X increase due to Omicron and LWC, we have 20 million infections, which realistically is impossibly high under China’s COVID-19 containment plans even minus the lockdowns.  Assuming 0.2% fatality rate, again a high-end number for Omicron, we have 40K deaths.  Considering 10 million people die every year in China, 40K is a drop in the bucket with or without DZ, but only DZ, particularly lockdowns, will bring about many extra deaths of other causes, economic destruction, and social problems.        

Lastly, how about long COVID, and the kids?  Once more the fears are often overblown, and we need contexts and perspectives.  Kids are the least affected, which we have known since Jan 2020!  And vaccines will protect kids.  Kid’s death is very rare: in the US ~ 1K children have died from COVID-19, but at the same time many more have died from other causes.  Long COVID is real, but we also know most symptoms will lessen or go away over time.  COVID-19 is not unique at all, because other illnesses like flu also have long term effects.  Even tennis elbows take months to heal!  Cures shouldn’t be worse than the disease.  Lockdown will inevitably lead to psychological stress in kids.  Which is worse, mental issues in 100K kids, or one child’s death due to COVID?  Hopefully we don’t have to make a choice, and the way to avoid it is to do away with DZ and adopt a better strategy now.

 

The COVID-19 pandemic anew

COVID-19 has evolved both predictably and unpredictably for 28 months.  Predictably in that we see many parallels in prior pandemics, unpredictably in that there is also uniqueness in the virus and human responses. Despite the fast changing pace of the pandemic, including from not knowing what it was and did to knowing so much about it in just two months, flying blind to care for patients to the discovery and inventions of treatments and especially vaccines, and the emergence of many variants, my positions have remained consistent since Jan 2020, about lockdowns (Jan 26, 2020 blog), disease origin (May 27, 2021 blog), mass testing (May 12, 2020 blog), data reporting (Jun 3, 2020 blog), and vaccines (Aug 11, 2020 blog).

The first Wuhan lockdown was viewed very critically (Jan 26, 2020 blog).  Even though a major, unprecedented move like that was never easy, there must always have been a better way to handle the situation, or at least a better way to conduct the lockdown (May 2, 2020 blog).  But in Jan 2020 we knew next to nothing about COVID-19, so a lockdown, no matter how well or poorly conducted, might be a necessary evil.  This became salient when later many countries thought to be able to handle COVID-19 better than China failed miserably.  So Wuhan was bad, but it could have been much worse for Wuhan or China.

But by the same token, the current lockdowns in Shanghai and a few other places in China are, no better way to put it, an absolute unnecessary evil, idiotic, and suicidal (March 16, 2022 blog).  For things have changed so much since Wuhan.   Despite what many in China and the West are claiming, 1. Omicron is not a big threat like the virus in 2020, 2. Chinese vaccines work, and 3. China is well prepared for Omicron.  Vaccination rates are >90%, and most seniors (>60%) are vaccinated.  There are now a few drugs to reduce COVID-19 severity and death.  China also still maintains a monitoring, masking, and testing scheme better than any other countries.  All these ensure that COVID-19 will never run wild in China like in the West, and the death rate in China will be low, comparable to other causes.   

Data bear it out.  There have been ~ 400K infections this year in mainland China.  Cases that require especial treatments, like oxygen, are only 1 in 1000.  So far officially two people died in Jilin, but it can be sensibly argued that they died with, not from COVID-19.  It is expected that infections will rise further, and real COVID-19 deaths will follow.  Yet already well over 10 people have died while waiting for treatments not rendered due to COVID-19 restrictions, and these are just the known minority.  Because of the high profile lockdowns, many other cities with few COVID-19 and not under lockdowns also apply strict, bothersome, and self-defeating measures.  Consequently, economy is suffering terribly, the whole country, not just those under lockdowns.  China is wasting too much energy doing things that are hurting itself and yielding little in return.

Then why does China do it?  Inertia is likely the primary reason.  Wuhan lockdown worked, right?  So why don’t we do it again everywhere?  This lazy mentality ignores everything humans learn and gain since Jan 2020.  This is why COVID-19 measures have become even stricter now than two years ago in China, which is laughable and indefensible, as if two years’ worth of knowledge, drug discovery, and vaccines never counted. 

A significant percentage of the Chinese public also have a long-running fear, reinforced by COVID-19, that if you get sick, you must be treated by doctors.  This is why Chinese hospitals are overflowed with people with the slightest symptoms.  Also just a human nature, many Chinese do support lockdowns, particularly if other people are the ones under lockdowns.   It is utterly disappointing that even some scientists and doctors who know better are pandering to the sentiment.  Wu Zhunyou, a prominent national figure, had talked about easing COVID-19 measures before, but turns around to rationalize the current lockdowns by saying that millions would die if loosening.  This is used to justify Shanghai lockdown, and many Chinese agree with it, but it is fearmongering.

A major piece of evidence cited to support the “millions” number is the South Korean data.  The death rate in Korean Omicron is 0.1%, so 1-2 million Chinese could die.  But this ignores the fact that Korea opened up prior to the most recent wave, and China didn’t and won’t in the near future.  Another case often cited is HK, but HK deaths are 90% unvaccinated, and HK also more or less opened up prior to Omicron.  None of those conditions exist in mainland China.  The final piece of evidence in support of lockdown is that China has fewer hospitals, so a rush of Omicron patients will overwhelm the medical system and lead to overall more deaths.  This has happened in places under lockdowns like Xi’An, Jilin, and Shanghai, resulting in savable deaths but, ironically, almost no COVID-19 deaths.  This is because most medical resources are summoned for the senseless, continuous, city-wide COVID-19 screening and gathering all the positives for isolation, leaving fewer to treat other patients at the hospitals.  What is more, many parts of the hospitals are closed for fear of admitting COVID-19 positives.  No wonder all those wildly reported and denounced deaths.  In short, lockdown creates the squeeze, not COVID-19 patients!  This is even the more unacceptable because China has had two years’ experience with lockdowns, Shanghai may have the best medical infrastructure in China, but Shanghai still fails.

The failure in Shanghai is well documented by the media, and it feels worse because it is self-inflicted and completely avoidable.  Of course COVID-19 will lower, but other diseases will kill more people, and a bad economy will kill more people in Shanghai and the rest of China.  In China 10 million people die every year, 200K in Shanghai, 560 per day in Shanghai.  How many have died from COVID-19?  Even those well-known deaths related but not due to COVID-19, 10 so far, times 10 assuming underreporting, that number is still negligible compared to the “normal” daily deaths in Shanghai.  Is it really worthy to shut down the whole city and a huge chunk of China’s economy and anger so many people, without manifestly saving any or many lives?   

What should happen instead?  Like it or not, the whole world, including China, have been and will be living with COVID-19 ever since 2020 (Jan 26, 2020 blog).  China can certainly live with COVID-19 in its own way unlike other countries, with monitoring and other requirements, but no constant city-level lockdowns here and there, this month or next month.  The public must be informed that there is no need to fear or discriminate COVID-19 and to seek care with minor cold like symptoms, and medical professionals must do their usual jobs, not prioritizing COVID-19 above other diseases.  The government needs to improve vaccination of the public and elderly, including the third or fourth shots, perhaps with protein and other types of vaccines coupled with the more widely used inactivated virus vaccines.    

Compared to a month ago (3/16/2022 blog), Shenzhen escaped the worst COVID-19 measures after one week, and Jilin has gone over the wave, leaving Shanghai the only major one still battered, with many other places in China unable to loosen because of an eye on Shanghai.  But just to be fair, Shanghai nowadays may be an emotional hell, but no need to over dramatize, because as calculated above, the actual death toll is nothing standing out comparing to prior records, provided that the lockdown doesn’t drag on much longer.  A ray of light emerges with reports that Shanghai may be preparing for returning to work after over two weeks’ lockdown, a welcoming sign. Another good sign is that a few cities, Shanghai included, will shorten isolation time from 14 days to 10 days for oversea travelers.  There is no doubt that lockdown will reduce COVID-19 infections, but the real improvement will come only after we learn the lessons and act more smartly, not blindly using the old toolkit, the next time around.