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How is China ending its zero-covid policy affecting cases and deaths?

Covid-19 cases are mounting in China after the government announced it would no longer pursue a zero-covid policy
People waiting outside a clinic in Beijing
People waiting outside a clinic in Beijing
Jade Gao/AFP via Getty Images

A potentially devastating wave of covid-19 is threatening China after the government announced it would forgo its zero-covid policy – a shift that could result in over in the country next year.

While it’s hard to pin down the exact scope of the virus due to China discontinuing widespread testing, reports suggest hospitals and morgues are overwhelmed by a surge in infections, says at the RAND Corporation, a non-profit research organisation in Washington DC. “We’re at the beginning of a tsunami,” she says.

Cases have swelled due to a shift in covid-19 strategy. Since the pandemic, China has pursued a zero-covid policy, which contained the virus through mass testing and lockdowns. But, in early December, the government announced a different approach. Instead of catching and isolating infections, China would live with the virus and use vaccines and treatments to blunt the worst effects. “It’s a 180-degree difference,” says Bouey.

The move makes sense after zero-covid failed to prevent highly transmissible omicron subvariants from spreading to more than 200 cities, says Bouey. The issue is the government didn’t prepare for the sudden shift, leaving much of the population vulnerable.

About 80 per cent of China’s population is what epidemiologists call covid naïve, says at the Institute for Health Metrics and Evaluation in Seattle, meaning they either haven’t been infected with the virus or have waning vaccine immunity. More than of people in China are fully vaccinated, but most received their last shot more than a year ago and only have been boosted.

Plus, covid vaccines in China are less effective than those in other countries. Sinopharm and CoronaVac are, respectively, about and effective against symptomatic infections. In comparison, Pfizer/BioNTech and Moderna’s mRNA vaccines are about 95 per cent effective. China’s booster shot also only targets the original SARS-CoV-2 strain unlike boosters in the US and UK, which target newer variants.

Another issue is that vulnerable individuals were initially told to avoid vaccination due to potential side effects. As a result, less than of those aged 60 and older are fully vaccinated and just under 68 per cent are boosted. For people 80 years and older, booster rates are even lower at about 40 per cent. While officials are now encouraging more people to get vaccinated and are even pushing a , vaccine hesitancy lingers, says Bouey.

“You put all of these [factors] together, and that’s a recipe, unfortunately, for a lot of people to be infected in a short period of time,” says Mokdad, whose modelling suggests over a million people in China could die from covid-19 next year. The death toll could climb higher if the healthcare system collapses under the weight of covid, says Bouey.

The virus also has ample opportunity to mutate as it spreads through the world’s largest country, says Bouey. “The good news is we had more than 3 billion omicron infections globally and didn’t see a newer, more dangerous variant emerge,” says Mokdad.

Another concern is the economic and political fallout. As domestic demand for medicine increases, China may stop selling medical supplies abroad, says Mokdad. Since the country has the second largest economy, a high death toll could also further weaken an already fragile global economy.

Topics: covid-19