A debate of COVID-19 dynamic zero policy in China

DZ is the official COVID-19 policy in China.   Previous blogs on 4/17/22, 7/12/22, 11/1/22, etc have argued against continuing this policy in 2022.  Here is a new one, with clear references to and point-by-point debates of the official justifications for DZ.

There have been many, uniformed, official and media documents supporting DZ, with the same, redundant talking points during the many months in 2022, so suffice to take this editorial as an example: 《“动态清零”可持续而且必须坚持》, by 仲音, published in《人民日报》on Oct 11, 2022.  Its web versions are ubiquitous, e.g., https://baijiahao.baidu.com/s?id=1746473260184521826&wfr=spider&for=pc.

Its arguments for DZ are consistent.  1) 我国是一个有着14亿多人口的大国，加上地区发展不平衡，医疗资源总量不足，放松防控势必令易感人群感染风险加大. Meaning: China is a country with 1.4 billion people. Development is uneven across the country, with insufficient medical resources.  2) 衡量一种病毒是否严重，将传播率和致病率两者相乘，是一个重要指标。奥密克戎的传播力远大于流感和此前的新冠病毒毒株，且部分奥密克戎变异株亚分支的免疫逃逸能力出现明显增强，对老年人和基础病人群仍具较大威胁。Omicron is too infectious and still poses a threat to the elderly and sick.  3) 我国60岁及以上人口达2.67亿，老年人群体数量多，如果选择“躺平”，疫情蔓延开来势必造成人民生命、财产更严重损失，其所带来的公共卫生风险难以估量。There are over 267 million elderly Chinese, too many to relax. 4) 一方面我们不能放松防控，搞“一放了之”；另一方面我们也要警惕过度防疫，坚决防止简单化、“一刀切”和层层加码等现象。We can do better with DZ.

First, a few items must be noted.  This editorial no longer mentions that individuals infected with Omicron face more danger than with previous variants.  It also doesn’t say anything about younger people (majority of the population) at all.  Vaccines fail completely to factor in the conversation.  What it shows is that fearmongering is losing its market in China, and vaccination rates have become so high that they can no longer be used as excuses for DZ.

Now to the actual arguments.  As argued also consistently in previous blogs, while and even if these #1-4 points above are true, they still don’t lead to the conclusion that DZ is necessary.

Against Point #1: Development is uneven across the big country, and not enough medical resources, China was, is, and will always be like that. 20 years ago, China was like that.  Now, China is like that.  20 years later, China will still be the same.  Does it mean DZ for 20 years or forever?  That would be crazy.  Since it is also a subjective argument, the exact same thing can be said about every other big country in the world.  Thus, development is also uneven in the US, medical resources not enough, at least in many parts of the US as well.  That hasn’t stopped almost every country on Earth from opening up in 2022, many or most of which are actually in worse shapes than China in terms of medical infrastructure and readiness. 

Points #2 and 3: Omicron can infect too many people, and the elderly and sick will suffer.  But is DZ the only way to control Omicron?  Can we do away with DZ (its current implementation) and still limit infections, while at the same time have a safe, healthy, and working society?  China never has an open risk-reward assessment and debates, so points 2 and 3 are aimless: who doesn’t want to prevent 疫情蔓延 (pandemic spreading), but why exactly is DZ a must? 

Point 4: We can do better with DZ.  Sure, but how?  The official documents and announcements have been so vague during 2022 that nobody knows for sure.  DZ has been equaled to lockdown, mass testing, code scanning, and restriction of movement everywhere.  Local governments have the liberty to enact their own policies, and different places have different versions of DZ and implementations.  As thousands of officials have been sacked for not controlling COVID in the past 3 years, of course everyone has the incentives to do the harshest DZ possible, which does stop COVID, but also wreck the economy.  Since wrecking the economy is not a cause for dismissal, which way the officials choose is a no brainer.  People have called for the central government to publicize clear and detailed guidelines for what to do and what not to do regarding the current DZ policy, but this is impossible.  For one, impractical.  Development is uneven across China, remember?  Local situations differ, which calls for different solutions locally.  And policy must have flexibility.  Most importantly, DZ is what the central government demands, and lockdown, mass testing, etc, have been endorsed by the central government.  So whatever else the locals can do is at most adding 10 to 100.  Local governments won’t make your life easier unless DZ is relaxed from the top.  Granted, DZ in Nov 2022 is looser than in March 2022, but too many people are still suffering for too long, as the daily national infection number inches toward 10K again. 

Besides these official reasons, a significant number of Chinese do support DZ, and they have the 5^th reason for DZ: China must have DZ unless COVID-19 subsides and/or there is a cure for COVID-19 infection.  This point is based on an unfounded fear of COVID-19 and a misunderstanding of the situation and medicine.  The world (outside China) is not going to control COVID-19, so COVID-19, if it ever goes away, will go away on its own, which nobody knows when.  It could be 5 years, 10 years, or never.  In terms of medicines to treat COVID-19, outside of vaccines, few drugs have ever been developed that cure viral infections.  HCV drugs are essentially the only ones.  Despite decades of efforts no drugs can cure common cold, flu, etc, so banking on a COVID-19 cure is worse than waiting for a miracle.  Thus, point #5 is pure wishful thinking and completely untenable. 

The official debates about DZ in China have a false dichotomy, pitting DZ against “一放了之”, or doing nothing.   However, from DZ to doing nothing there is a large grey area, a huge middle ground.  So in addition to arguing against something (DZ), the blog also argues for something.  It is based on the thesis that DZ is unnecessary and does more harm than good under the present COVID-19 situation.  Further discussions about what to do require a few sets of understandings and facts be established.

Firstly, consider the public fully vaccinated/boosted.  The coverage is China is over 90% now.  Chinese vaccines definitively work, and they have been free and easily accessible for almost two years, and can be boosted if needed.  No country will reach 100%; if you don’t have one now, you will never have one, and societies must move on, not waiting for everybody forever.  

Secondly, return to the pre-COVID era, not to a time when there is no risk from any infection, which doesn’t exist.  Omicron must be compared to and balanced against all other diseases.  We can’t get 100% safety, never did, never will.  

Thirdly and lastly, Omicron infection in the said population poses a very low risk.  Few people (<10%) develop serious outcomes, and vaccines reduces serious outcomes by 90% or more, and Omicron death rate is ~ 0.1% or less. This number has been verified over and over around the world for one full year by now.  Thus, much of the need for DZ rests on the fear of COVID-19 severity and Omicron infectivity, which is demonstratively outdated and false in 2022. 

Here is a helpful comparison.  In the US cold/flu typically kill 40-50K every year.  By the same standard, China loses 200K per year.  If the mortality rate is 0.1%, it means that every year 200 million Chinese get the cold/flu.  Considering the population density in China is much higher than the US, the actual infections and deaths are likely even higher in China.  In other words, hundreds of millions of Chinese got the cold/flu every year before 2019 and nobody said a word.  Then why should China do DZ now for something that is similar?  Can China survive with that many infected with Omicron, or will China ever get even close to that many infections with Omicron? 

Based on the above analyses, a starting point, away from DZ but also not doing nothing, is that China is OK if able to limit COVID-19 to 100 million per year.  This is the middle ground policy, and it is unlikely China will ever have 100 million infections per year anyway.  For 2022, with DZ and maximal efforts and resources, China still has ~ 1 million infections, hence having 10-50 million infections is a reasonable compromise.

How to achieve this middle ground policy, and why is it doable or better?  For one, the policy will keep elements of DZ.  People get tested maybe once a week, more frequently or less depending on the local infection positivity.  Positives will isolate at home and stay away from public places until negative, reinforced by health codes.  Only the seriously sick are admitted to hospitals.  Educate the elderly and sick to avoid crowds.  Lockdown will be in place for only the most extreme cases and limited in scale, place, and time by 50% or more.  Most medical resources now used for the meaningless mass testing and quarantine will return to patient care. 

The ONLY downside of this policy is that COVID-19 deaths will increase. 10 million infections could translate to 10K deaths.  But most of them will overlap with the otherwise 200K cold/flu deaths, so it is a wash.  Unless the Chinese government also declares a new war and DZ against cold/flu, this is actually the old normal.  We have never lived in a no-risk environment, right?  But the upside will be tremendous.  The economy will recover.  People will have freedom.   Patients with severe COVID or diseases other than COVID will be better served.  Overall more lives will be saved, and more will live happily.

A fear among Chinese is that if China abandons DZ and tries the middle way, the middle way won’t hold and will inevitably regress to uncontrollable COVID.  This fear can be easily swayed.   China has established a strong COVID system and standard, supported by high public vaccination rates and knowledgeable medical staff.  The most difficult part, the worst obstacle, however, is to educate the public: why DZ no longer, why the new policy, why no more fear.  If you want your freedom, get tested periodically.  No big deal if you are infected, just stay away from others until you are clear.  It will take hard work and time to pivot from DZ, and China has wasted too much time on this.  But it is much more worthy than continuing down the path of DZ.

PS: It seems that prayers have been answered, as China has just updated its DZ policy on Nov 11, 2022 (https://china.huanqiu.com/article/4AQUNteWR5p).  The changes are major, significant, and all around.  Among the most important ones, no more city-wide mass testing, and lockdown will be restricted to small areas, no more international flight suspension, and shorter isolation time.  They are much different from what are being practiced; while the new strategy is still called DZ, who cares what it is called if the changes are real and meaningful.  It remains to be seen how the local governments follow the instructions.  More importantly, how the Chinese public reacts to the sure increase in COVID-19 cases in the coming months.  The government has so far failed to educate the people the true, low risk of COVID, ensuring that there will be hard resistance to the turnaround among many Chinese.  It is certain that the official media will now change the tune, but altering perception and allaying the 3-year-old fear will take time.