The Dire Aftermath of China’s Untenable “Zero COVID” Policy

In “How to Lie with Statistics,” a best-selling book from 1954, the journalist (and tobacco apologist) Darrell Huff details common techniques for manipulating people’s understanding of reality, among them truncating the y-axis of a graph. A trend line starts in a chart’s midsection and moseys up and to the right—a gradual rise over time. But if you hack off empty space at the bottom and zoom in on the action, the line takes off like a rocket. The axis transforms the narrative.

Throughout the pandemic, we have truncated not the y-axis but the x-axis: stopping time to pass judgment on a nation’s performance instead of waiting to consider the broad sweep of the COVID-19 years. Cut the graph at the summer of 2020 and the United States is a catastrophic outlier, a beacon of pandemic mismanagement. Let it roll a few more months and European countries botch their reopening, unleashing a wave of deaths. Press play again and India is engulfed in a viral inferno that threatens not only its own citizens but, because it stopped exporting vaccines for half a year, millions of lives around the world. Last month, China, after suppressing the virus for three years through its often draconian “zero COVID” policy—recording just five thousand COVID deaths in a population of 1.4 billion—abruptly abandoned that approach and is now consumed by an enormous viral surge. The country that was home to the first coronavirus outbreak may now experience its worst. The axis transforms the narrative.

In the past month in China, hospitals, pharmacies, and funeral homes have been overwhelmed, but the scale of the misery is anyone’s guess. The country no longer tallies asymptomatic infections or reliably reports COVID deaths—employing not the distortion of statistics but their omission. According to minutes from a meeting of the National Health Commission, however, a quarter of a billion people are thought to have contracted the virus in the first three weeks of December; an estimated thirty-seven million were infected on a single day. Experts expect the initial surge to peak in the cities later this month, but a second, possibly more punishing wave could tear through rural areas in February or March, after millions of people trek home for the Lunar New Year. Projections of the eventual fallout vary, but some models anticipate that one to two million people will die of COVID in the coming months.

An outbreak that touches a sixth of humanity creates countless opportunities for the virus to mutate into more transmissible forms, and to drive repeat infections and fresh surges around the world. In the United States, a new Omicron subvariant, XBB.1.5, is thought to be the most contagious yet—already accounting for three-quarters of new cases in the Northeast—and COVID hospitalizations are on the rise. It’s possible that China’s viral tsunami will generate new Omicron descendants, or, worse, entirely new variants of concern.

The crisis raises fundamental questions about why China persisted with “zero COVID” for so long and why it chose to reverse its policy now. The spread of the hyper-contagious Omicron variant last year forced other countries to accept that the societal costs of purging the virus had grown unsustainable. China pressed on, but deepening economic concerns and social unrest forced President Xi Jinping’s hand. In 2022, the economy grew at the slowest rate in three decades (aside from the pandemic-inflicted slowdown of 2020), and in November the country saw its most widespread protests since Tiananmen Square, triggered by a deadly apartment-building fire and a series of traumatizing lockdowns that limited access to food and medical care, not to mention meaningful human connection.

A more perplexing question is why China failed to prepare for the inevitable. Owing to a confluence of factors, the country found itself in a uniquely perilous position as it looked to reopen. The success of “zero COVID” meant that the population had little exposure to the virus and, consequently, little natural immunity. China, which is one of the fastest-aging countries on earth, has more than two hundred and fifty million people over the age of sixty—the group most at risk of serious illness and death after contracting the virus. Meanwhile, vulnerable populations are dangerously undervaccinated: by mid-December, only forty-two per cent of people over the age of eighty had received two shots and a booster. Those who are immunized have received domestically developed vaccines, which are less effective than the mRNA vaccines, and have not been updated to target Omicron subvariants. (China has refused to authorize Western vaccines, although it recently allowed the Pfizer-BioNTech vaccine to be given to German expatriates.) These challenges are compounded by a fragile health-care system, which has long struggled to meet the needs of China’s immense population and is now further weakened by medical workers falling ill. The demand for I.C.U. care could soon exceed the country’s capacity many times over.

A less deadly transition was possible. The government could have authorized mRNA vaccines and mounted an aggressive immunization campaign focussed on the elderly. It could have procured and distributed much larger quantities of antiviral and anti-fever drugs. It could have bolstered its health system’s capacity and communicated forthrightly about how and where to access resources. Instead, the ruling Communist Party, which prizes control, has been conspicuously quiet. (Failing to prepare is, of course, not unique to China: the U.S. has repeatedly failed to fund needed investments in pandemic readiness, and the government no longer covers the cost of vaccinations or antiviral medications. Meanwhile, few Americans have availed themselves of Omicron-specific boosters.) Xi waited for weeks to address the nation, presumably to distance himself from the turmoil. When he finally spoke, he told the public to “develop good personal-hygiene habits,” and in an address on December 31st—as factories shuttered, hospitals reeled, and crematoriums filled—he said that the Party had “put life first all along.”

China’s emergency serves as a lesson that, in an interconnected world, isolation can buy time, but it can’t eliminate threats. New COVID-testing requirements imposed by the U.S. and other countries on travellers from China are unlikely to accomplish much beyond scoring a few political points and providing a false sense of security. In the meantime, the virus threatens the health and the well-being of hundreds of millions of people, many of whom lack the basic protections that we now take for granted. Beijing has at its disposal many tools to shape the narrative, statistical and otherwise, but it can’t change that reality. ♦