During the COVID-19 pandemic, China conducted a massive experiment to see if it were possible to contain transmission of this virus within the country and keep it from getting into the country by travellers from abroad. As events unfolded, the approach became known as the “zero COVID strategy”. Did it work? The answer is sort of but it had to be abandoned due to consequences that could not be predicted when the strategy was started.

But first, let’s look at the specific measures that made up the “zero COVID strategy”. For that, we have to go way back to January 2020 when China realized that they had to report the occurrence of 40 unusual cases of severe pneumonia in the city of Wuhan. They were the first officially reported cases of the COVID-19 pandemic, and very shortly, the disease was carried by travellers to other countries. A new and novel coronavirus was identified rather rapidly as the cause, but little was known about how this virus would affect the population. Clearly, it was transmitted from person-to-person, but what measures could be taken to stop it from spreading?

Realizing that international travellers were spreading the disease from county to country, individual countries instituted measures to stop or limit people from entering their countries. Measures such as banning entry, or requiring COVID testing before boarding aeroplanes, or establishing mandatory quarantine for entering travellers were established in nearly all countries.

Meanwhile, once a test for the virus was available, countries initiated measures to stop internal transmission, e.g., mandating social distancing, closing public establishments, mandating mask-wearing, self-isolation if ill, and urging people to get tested.

The introduction of effective vaccines and new treatments that dramatically reduced complications such as hospitalization, intensive care and death changed things. The pandemic became more manageable and the need for dramatic measures to restrict travellers from entering and for stopping local transmission was reduced.

By mid-2022, with large segments of the population immunized through vaccination, a certain level of tolerance for low levels of transmission of the virus, hospitalization and death allowed for the discontinuance of almost all the early control measures.

So how did China fare in all of this?

Early on, steps were taken to nearly eliminate international air travel as well as domestic travel by any means of transportation. The public health measures such as social distancing, limitations on population movement, quarantine and extensive COVID testing were implemented with an intensity not seen in other countries. The stated goal was to stop all transmission of the virus everywhere. A “lockdown” concept was often applied to entire communities or even cities, such that all movement and interactions were stopped. When testing became available, entire cities were submitted to COVID testing and subsequent quarantine.

If people tested positive, there was a risk that they would be quarantined for weeks in a hospital room. If you went to a store or restaurant that had been visited by a COVID-positive person, you could be required to stay at a quarantine centre with sparse accommodations for a long time. Or you might be locked up in your own home without permission to leave, even to secure food. The same result could happen if you just passed an infected person on the street.

If you had been locked up in quarantine, you were often subjected to discrimination after your release.

Testing became ubiquitous. In large cities such as Beijing, Shanghai or Shenzhen with populations of tens of millions of people, people were required to be tested every two or three days at sidewalk booths. Compliance was tracked through health codes on your cell phone.

Chinese-produced COVID vaccines were introduced and more than 3 billion doses were administered. However, studies showed that the most commonly used vaccines were 51% effective (CoronaVac) and 79% effective (Sinopharm) which is considerably lower than the commonly used Moderna and Pfizer vaccines in many other countries.

Back to the original question: did all these harsh measures work?

The answer is that there were no significant outbreaks or “waves” of infection throughout 2020 and 2021. Check out this table:

Overall, China reported approximately 10.5 million cases and 32,700 deaths through 5 January 2023.  In the same time period, the USA recorded 101 million cases and 1.1 million deaths.

Although the reliability and accuracy of Chinese data are often questioned, differences between the two countries and the results of their different strategies are considerably different.

But is China’s zero strategy sustainable? It just broke. Several weeks ago, in the city of Xinjiang, a fire in a locked quarantined apartment building killed 10 people. Accumulated frustration in the population with the restrictive control measures boiled over. There were public demonstrations in many cities questioning the need for ongoing lockdowns and extensive testing and quarantine. The population demanded the end to the government’s zero COVID strategy. The economic costs of severe restrictions (e.g., closed businesses, unemployment, etc.) also have become unbearable.

In early December 2021, China reversed its zero COVID strategy with dramatic repercussions. Nearly all of the measures in the zero strategy were suspended almost overnight. As a result, China is experiencing an unprecedented surge in cases. Although the data are questionable, there are reports of almost a 50% increase, from 15,161 new hospitalizations for mainland China during the week ending December 25 to 22,416 for the week ending January 1. The official death count is underreported but crematoria report that they are inundated with bodies.

Why did this happen? We can speculate that a combination of factors contributed to this explosion of COVID. On one hand, the sudden lifting of very restrictive measures led to an immediate mixing of infected and uninfected people, e.g., the reunification of families, travel to other cities, public gatherings, etc. – all of which increased the risk of transmission of the virus. In addition, large portions of the population were not protected due to vaccines with low levels of effectiveness.

Finally, what does the current China situation mean for all the other countries? On one hand, a huge wave of new COVID-19 cases will spread any new virus variants as the Chinese population travels internationally. In addition, large numbers of virus transmission provide the virus with opportunities to develop new variants. But right now, the World Health Organization and health and government officials worldwide are trying to assess the risk(s) created by China’s COVID-19 problem.

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