China is by far the world's biggest COVID powder keg — and it might be on the verge of exploding.
Not since the earliest days of the pandemic has the most populous country on the planet ever reported more than about 200 coronavirus cases per day — dizzying evidence of the blunt, even brutal, effectiveness of Beijing's "zero COVID" strategy, which requires strict mass lockdowns at the first flicker of an outbreak.
For most of the last two years, mainland China has averaged fewer than 50 cases per day. According to official numbers, no one — not one of China's 1.4 billion residents — has died of COVID since May 16, 2020. While the virus ravaged the rest of the globe, China claimed it had basically vanished from its country of origin.
But now, tragically, that appears to be changing.
Over the last few weeks, China's COVID curve has shot straight up, the telltale sign of an Omicron outbreak. Nationwide, new daily cases cleared 5,100 for the first time ever on Monday. Even in February 2020, when the virus first skyrocketed in Wuhan, that number officially peaked at just 3,300 per day, on average.
It's entirely possible, in other words, that Omicron — and its BA.2 subvariant, which is at least 30 percent more transmissible and appears to account for the bulk of new infections — has already triggered China's worst outbreak to date. So far, at least 28 of the country's 31 provinces and regions — including major cities such as Beijing, Shanghai and Shenzhen — have reported new infections.
In response, Beijing has followed its usual playbook. According to CNN, "five cities — collectively home to more than 37 million residents — are now under varying levels of lockdown," with locals forced to remain in their homes or neighborhoods as schools, businesses, factories and public transport close and authorities conduct multiple rounds of compulsory mass testing. Two mayors in northeastern China have been dismissed; even Shanghai has shuttered its school system and shifted to online instruction.
As Lei Zhenglong, deputy head of the National Health Commission's Bureau of Disease Prevention and Control, said in an interview with the official Xinhua news agency published on Wednesday, "Our prevention and control measures" must be "earlier, faster, stricter and more effective ” because of how quickly and easily Omicron spreads.
But the question now is, how long can this go on?
Handled properly, a zero COVID approach can pay off. Until late last year, New Zealand essentially had eradicated the virus by closing its borders, targeting lockdowns and aggressively testing, tracing and isolating every infection it detected. Today, just 156 New Zealanders have died from the disease — total. And the country has lifted almost all restrictions.
Yet there's a reason New Zealand's policy worked: It was just as aggressive about vaccinating its people as eliminating the virus. So far, more than 95% of New Zealanders over 12 have been vaccinated; more importantly, nearly 100% of elderly New Zealanders — by far the most vulnerable group — have received two or more vaccine doses. By the time the country stopped trying to eliminate the virus, after the ever-more-contagious Delta and Omicron variants made it pretty much impossible, nearly every resident at risk of severe illness or death already had the antibodies they needed to ward off the worst outcomes.
Hong Kong, however, has been a different story. The city also went with a zero COVID approach; until Omicron, it never recorded more than a handful of cases each day. Yet when Omicron finally hit, it hit hard, propelling new cases from about 100 per day on Feb. 4 to a high of more than 44,000 one month later.
The problem was that due to hesitancy, misinformation and a lack of official urgency, a staggering 66% of residents over the age of 80 were still unvaccinated at the time — and most of those who were vaccinated had received China's non-mRNA Sinovac vaccine, which is significantly less effective against Omicron infection. As a result, 1 in 4 cases reported in Hong Kong are now resulting in death; more than 4,500 residents have succumbed to the virus in the last month alone. That's by far the worst death rate in the world, an unthinkable toll two years into the pandemic.
The risk for China — where the Sinovac vaccine is standard, where more than 50 million people over 60 are not fully vaccinated and where at least 15 million people over 80 are not vaccinated at all — is that it's about to become the next Hong Kong.
Yet even if that doesn't happen — even if Beijing's more authoritarian "prevention and control measures" do turn out to be "earlier, faster, stricter and more effective" than ever before — major risks remain. For one thing, reporting out of China suggests that people are losing patience with draconian lockdowns. "I really broke down tonight and have never wanted to leave Shenzhen as much as I do tonight. Since I opened my shop on March 1, I haven't made a single penny," a comment made in response to a post on WeChat by the Shenzhen Health Commission read, according to the Washington Post.
The Communist Party government is starting to acknowledge the downside of such restrictions as well, especially as they hinder major auto and tech suppliers and as China's economy slows. On Thursday, President Xi Jinping urged the Politburo Standing Committee, the Chinese Communist Party's top decision-making body, to "strive to achieve the greatest prevention and control effect with the smallest cost, and minimize the impact of the pandemic on economic and social development ,” according to the Xinhua news agency.
Yet China also revised its pandemic guidelines this week to include the use of Paxlovid, the highly effective antiviral pills made by Pfizer — a sign that it may lack confidence in its current immunity levels to prevent mass death from Omicron. Until Chinese residents can receive mRNA boostersit's unlikely that Beijing will follow New Zealand's path out of the pandemic, and the same story — outbreak, lockdown, outbreak, lockdown — will keep playing out over and over again.
And that, in turn, leaves the rest of the world at risk. When China first launched its zero COVID plan, experts thought the virus might peter out someday. Now they predict it will circulate forever, and they warn that whatever versions like after Omicron and BA.2 won't necessarily be "milder." The more people in places like China who remain unvaccinated or undervaccinated, the more chances the virus has to evolve.
"We haven't even seen a new, major variant yet, but there are too many reasons to believe that is likely in the months ahead," Dr. Eric Topol, founder and director of the Scripps Research Translational Institutewrote Wednesday in the Guardian. "Add to all this is what is happening in China, which has fully relied on a zero-Covid policy, resulting in very little natural immunity, and vaccines that have weak efficacy against Omicron. Now this country is facing major outbreaks in two of its most populous cities, Shanghai and Shenzhen, and undoubtedly the whole country will be affected. We learned in 2019 that what happens in China doesn't stay in China.”