The end of Covid Zero

The world, and India, must prepare for a possible China wave

Following unexpectedly intense, if not widespread, protests against its “Covid Zero” policy, the Chinese leadership has sharply reversed course and begun relaxing pandemic-related restrictions in the country. The importance of this U-turn cannot be overemphasised, since as recently as six weeks ago President Xi Jinping had publicly defended draconian restrictions as being essential for people’s health and safety. While the carefully controlled Chinese media narrative has sought to define the rules of relaxation as some sort of triumph, with one recent editorial in a state newspaper indicating that over the past three years the country has grown stronger while the virus has grown weaker, the truth might lie elsewhere. It seems likely that the protests just underlined what many already suspected — that pandemic restrictions with no end whatsoever in sight were politically unsustainable even for a leader with as complete control of state and polity as Mr Xi.
 

The fact is also that while Omicron is less virulent than Delta, it is still a deadly virus in an unprotected population. After all, 6,000 people died just in Hong Kong earlier this year after Omicron had become dominant once some citywide restrictions had been relaxed. During that wave, Hong Kong, which had access to Western vaccines as well as Chinese ones, saw people die at the rate of almost 38 in every million, which was a high enough rate to overwhelm the health care system. A surge in infections in the mainland after reopening is almost inevitable. This could turn into a surge in deaths if Chinese vaccines prove relatively ineffective against the currently circulating variants, and if health centres become overwhelmed.
 

Contrary to the official narrative, the three years of Covid Zero in China have not been used to build up capacity in preparation for relaxed restrictions. One analysis has suggested that a full reopening might lead to almost six million people requiring intensive care, which means orders of magnitude larger than the available capacity. The People’s Republic still has fewer than four ICU beds per 100,000 people, well below its Asian neighbours to the east. This ratio is much worse in the interior than in the cities along the coast. The most vulnerable Chinese are least prepared for a surge. Only two-thirds of those above 80 have received a full vaccination course, and just 40 per cent were given a booster dose. In addition, the efficacy of these vaccines has come into question.
 

India has learned to live with Covid. Vaccination has reached most of the country, social distancing norms have been suspended, and the borders have been opened. These assumptions are, however, predicated on the fact that Covid-19 is not surging anywhere in the world but has a relatively steady rate of infection. The government will need to re-examine these assumptions in the case of a surge in China after it begins to reopen. Vaccination requirements and testing for arrivals may have to be reintroduced, for example. The government’s Covid policy, including its genome sequencing of variants, must also be re-examined in the case of a China surge. Policy nimbleness and flexibility in response to medical and epidemiological developments have always been central to effective Covid control. It is time to revisit those principles.