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China: How is its zero-Covid strategy changing? China: Why is the WHO concerned about its zero-Covid strategy?
(about 2 months later)
China's zero-Covid policy has been among the strictest approaches to tackling the pandemic anywhere in the world. The World Health Organization (WHO) has said China should rethink its strict Covid strategy aimed at halting the spread of the virus.
But a recent surge in infections is forcing it to reconsider how it deals with the pandemic. While many countries are now relying on vaccination and improved treatments, China has stuck to a policy of lockdowns and other restrictions.
How serious is the current wave? The WHO says that with more transmissible Omicron variants spreading, this approach is not "sustainable."
The latest jump in daily cases, widely spread across the country, has been driven largely by the Omicron variant. What is China's current Covid policy?
Tens of millions of people in China, including the largest city and financial centre Shanghai, have been put under lockdown. China requires cities to enter strict lockdowns even if just a handful of cases are reported - one of the toughest policies in the world.
Mass testing is being carried out, while makeshift hospitals and quarantine centres have been set up across the country. With thousands of new cases reported daily during the latest wave, more than 60 million people have been living under some kind of lockdown.
Shanghai lockdown: Economy shaken by zero-Covid measures Mass testing has been rolled out in cities such as Shanghai and Beijing, and roads have been blocked to prevent people from travelling.
China: Shanghai hospital struggles with Covid infections Schools have been closed in Shanghai
However, compared with the United States and Europe, infection rates remain low. Business and schools have been closed until local authorities announce there are no infections in a city's active population.
In the week prior to 1 April, there were about 54,000 new cases in the whole of mainland China. In the US over a similar period, there were over 180,000 new infections according to official data. Although the strategy is now becoming increasingly difficult to sustain, most elements remain in place:
How is China's policy changing?
As more infections are detected across the country, China's strict zero-Covid strategy is becoming increasingly difficult to sustain.
However, most of its principal elements remain in place:
Travel to and from China is strictly limited, and there are restrictions on internal movementTravel to and from China is strictly limited, and there are restrictions on internal movement
Travellers from abroad with permission to enter China are screened and sent to government-designated hotels for a mandatory quarantine of at least two weeks, followed by a further period of monitoringTravellers from abroad with permission to enter China are screened and sent to government-designated hotels for a mandatory quarantine of at least two weeks, followed by a further period of monitoring
Regular community testing programmes are carried out and if infections are detected, residents can be evicted and sent to quarantine facilities (along with targeted area lockdowns)Regular community testing programmes are carried out and if infections are detected, residents can be evicted and sent to quarantine facilities (along with targeted area lockdowns)
All non-essential businesses have been shut, apart from food shops and some other essential suppliersAll non-essential businesses have been shut, apart from food shops and some other essential suppliers
Schools are closed and public transport is suspended, with almost all vehicle movement bannedSchools are closed and public transport is suspended, with almost all vehicle movement banned
Millions of people are currently under lockdown in China However, some regulations have been relaxed so that people with mild symptoms no longer need to attend designated hospitals, and quarantine-period rules have been reduced.
As China's healthcare system is put under increasing strain, some regulations have been relaxed: What are the WHO concerns?
People with mild symptoms no longer need to attend designated hospitals, but they still need to isolate at centralised facilities China was seen as an example of a country handling the virus relatively successfully at the start of the pandemic.
Quarantine-period rules have been reduced But the WHO points out that the current Omicron variant spreading across China transmits more easily than other variants.
Self-testing kits are being made available in stores across the country and online, but those who test positive will need to take PCR tests "The virus is evolving, changing its behaviour," said Dr Tedros Adhanom Ghebreyesu of the WHO. "With that... changing your measures will be very important."
China has approved antigen (lateral-flow) self-test kits after cases hit a two-year high Although Omicron is more contagious, it comes with a slightly lower risk of hospitalisation compared with the Delta variant, dominant since early 2021.
How successful has China's zero-Covid policy been? How effective has vaccination been in China?
China has had remarkable success containing the pandemic prior to the current outbreak. The two main vaccines in China, Sinovac and Sinopharm, use inactivated virus to prompt an immune response, but questions remain over their effectiveness.
Since the end of 2019, it has reported just over 4,600 deaths (according to Our World in Data). Studies suggest they provide very little protection against infection by Omicron after two doses, although they still seem to provide reasonable protection against severe illness.
In the United States, close to one million people have died having contracted Covid-19. Some research indicates that even with booster doses, the immune response from the Chinese vaccines may be less than other vaccines which use mRNA technology (bits of genetic code) to generate immunity.
That's around three deaths per million people in mainland China, compared with about 3,000 in the US and 2,400 in the UK. The emergence of Omicron has made all vaccines less effective at stopping infection, although they still protect most people against severe disease.
Reported infections in China have also been very low throughout the pandemic. Many countries are now relying on vaccination to mitigate the impact of the virus, rather than on measures to stop infections spreading.
Concerns have been expressed about the accuracy of the official data, but it seems clear that both infection and death rates have been low when compared with other countries. China also has a long way to go in fully vaccinating the elderly, the most vulnerable age group.
About 88% of the population is now fully vaccinated. Despite this, China is almost alone in adhering to strict zero-Covid policies. Less than 60% of the 60-69 age group is fully vaccinated, with the figures even lower for those aged 70 and older.
There has been some reluctance among the elderly to have vaccines, with many worrying about side effects or in rural areas believing that they don't need vaccines as they don't live near crowded cities.
How successful has China's strategy been?
Until the current outbreak, China had managed to maintain a low number of deaths and infections, going by official data.
If you adjust for population size, there's been around three deaths per million people in mainland China, compared with about 3,000 in the US and 2,400 in the UK.
In the current wave, the country saw a rise in daily cases throughout March and into April, so that by 21 April they were at over 30,000 per day. But daily cases have fallen since then.
Chinese President Xi Jinping has given no indication that the zero-Covid policy will change, insisting it is "scientific and effective".
A government statement in response to the comments by the WHO said that "China's huge population means that relaxing prevention and control measures will inevitably lead to the death of a large number of elderly people".
It added that the current policy is "bringing Covid-19 under control at the minimum social cost in the shortest time possible."
Additional reporting by Alison Benjamin, Rob England and Daniele Palumbo
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