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.