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China: Why is the WHO concerned about its zero-Covid strategy? How many Covid cases does China have and what are its rules?
(6 months later)
The World Health Organization (WHO) has said China should rethink its strict Covid strategy aimed at halting the spread of the virus. China has seen its first deaths from Covid-19 in six months, and thousands more people are catching the disease, despite the government's strict lockdown policy.
While many countries are now relying on vaccination and improved treatments, China has stuck to a policy of lockdowns and other restrictions. The World Health Organization (WHO) has said China should rethink its strategy.
The WHO says that with more transmissible Omicron variants spreading, this approach is not "sustainable." Covid rising across China
What is China's current Covid policy? On Sunday 20 November alone, there were 26,824 new cases recorded in China. That is close to the peak back in April 2022.
China requires cities to enter strict lockdowns even if just a handful of cases are reported - one of the toughest policies in the world. Three people in Beijing are reported to have died from Covid-19 over the past few days.
With thousands of new cases reported daily during the latest wave, more than 60 million people have been living under some kind of lockdown. New Covid cases have been reported throughout China. Guangdong, in the south, is the worst affected region.
Mass testing has been rolled out in cities such as Shanghai and Beijing, and roads have been blocked to prevent people from travelling. What are China's lockdown rules?
China is no longer imposing a national lockdown and has relaxed a number of previous measures.
However, the central government is telling local authorities to impose strict lockdowns in their areas when they detect a Covid-19 outbreak - even if only a handful of cases are found.
Mass testing is being carried out in places where cases have been reported. People found to have Covid-19 are isolated at home or placed under quarantine at a government-supervised facility.
Businesses and schools are closed, and so are all shops except for those selling food.
It is one of the toughest anti-Covid regimes in the world and lockdowns last until no new infections are reported.
Tens of millions of people have been living under some kind of lockdown since the latest wave of Covid-19.
Guangzhou, a southern city of nearly 19 million people, recently ordered a five-day lockdown for Baiyun, its most populous district.
Schools have been closed in ShanghaiSchools have been closed in Shanghai
Business and schools have been closed until local authorities announce there are no infections in a city's active population. Some rules, however, have been relaxed.
Although the strategy is now becoming increasingly difficult to sustain, most elements remain in place: Those found with Covid-19 are now kept in isolation for only eight days, rather than 10 - five days at an isolation centre, plus three days of isolation at home.
Travel to and from China is strictly limited, and there are restrictions on internal movement China is also now allowing international arrivals for the first time since March 2022. Inbound travellers need to take a Covid test 48 hours before they arrive.
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 monitoring Why is China still trying to achieve zero Covid?
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) Unlike other countries, which have accepted they will have to live with the disease to a certain extent, China is following a policy it calls "dynamic zero" - taking dynamic action wherever Covid-19 flares up in order to eradicate it.
All non-essential businesses have been shut, apart from food shops and some other essential suppliers China's government argues that this policy saves lives, because uncontrolled outbreaks would put many vulnerable people at risk, such as the elderly.
Schools are closed and public transport is suspended, with almost all vehicle movement banned Strict lockdowns mean China's death toll has stayed low ever since the start of the pandemic - the official figure is now just over 5,200.
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. This reported figure equates to three Covid deaths in every million in China, compared with 3,000 per million in the US and 2,400 per million in the UK.
What are the WHO concerns? What effect have zero-Covid policies had on China's economy?
In recent months, lockdowns have taken place in several cities at the same time.
These include Shenzhen, a city of 17.5 million, which is the centre of China's technology sector, and Shanghai, a city of 26 million which is China's manufacturing, trade and financial hub.
Lockdowns have led to factories and ports being shut for long periods, and they have affected a number of joint ventures with foreign companies.
This means that China's economy has grown by only 3.9% over the past year, compared with China's growth target of 5.5% for 2022.
It is also affecting businesses and consumers in the rest of the world, who have come to rely on China for supplies of goods.
A lockdown at the Foxconn plant in Zhengzhou has affected the production of iPhones, leading to fears of a worldwide shortage of them.
Factory closures have also led to fears of a shortage of toys worldwide in the run-up to Christmas.
China urges veterans to work at iPhone factory
Why does the WHO think a zero-Covid policy is wrong?
China was seen as an example of a country handling the virus relatively successfully at the start of the pandemic.China was seen as an example of a country handling the virus relatively successfully at the start of the pandemic.
But the WHO points out that the current Omicron variant spreading across China transmits more easily than other variants. But the WHO has said it is very hard to contain the current Omicron variant spreading across China because it is more infectious than other variants.
"The virus is evolving, changing its behaviour," said Dr Tedros Adhanom Ghebreyesu of the WHO. "With that... changing your measures will be very important.""The virus is evolving, changing its behaviour," said Dr Tedros Adhanom Ghebreyesu of the WHO. "With that... changing your measures will be very important."
Although Omicron is more contagious, it comes with a slightly lower risk of hospitalisation compared with the Delta variant, dominant since early 2021. Chinese President Xi Jinping says the zero-Covid policy is "scientific and effective", and the government has said the WHO's suggested change of policy would "inevitably lead to the deaths of a large number of elderly people".
How effective has vaccination been in China? Is more vaccination the answer?
The two main vaccines in China, Sinovac and Sinopharm, use inactivated virus to prompt an immune response, but questions remain over their effectiveness. Only about half of people in China aged 80 and above have received their primary vaccinations, with fewer than 20% of them having secured a booster.
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. Fewer than 60% of the 60-69 age group is fully vaccinated. China has been urging the elderly to get vaccinated.
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. People in these older age groups are the most likely to die from Covid-19.
The emergence of Omicron has made all vaccines less effective at stopping infection, although they still protect most people against severe disease. There are also doubts over whether the two main vaccines used in China, Sinovac and Sinopharm, are really effective.
Many countries are now relying on vaccination to mitigate the impact of the virus, rather than on measures to stop infections spreading. Both use inactivated virus to prompt an immune response.
China also has a long way to go in fully vaccinating the elderly, the most vulnerable age group. Studies suggest they provide little protection against infection by the Omicron variant, even after two doses.
Less than 60% of the 60-69 age group is fully vaccinated, with the figures even lower for those aged 70 and older. The US and other Western nations have offered China mRNA vaccines, which might be more effective - but they have not been widely used in mainland China.
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. Additional reporting by Jeremy Howell.
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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