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China’s Let-It-Rip Covid Reopening

China’s Let-It-Rip Covid Reopening

Xi Jinping compounds his zero-Covid mistake with a 180-degree reversal that endangers everyone.

By Ezekiel J. Emanuel, WSJ

Dec. 22, 2022 1:27 pm ET

China put the world in peril with its coverup and slow response to the emergence of SARS-CoV-2 three years ago. The country’s current approach to Covid-19 is creating new risks—in China and beyond.

Xi Jinping has made an abrupt about-face—swinging from total Covid suppression to population-wide immunity through viral spread. Chinese experts predict a Covid explosion, with hundreds of millions of cases. China will also become a petri dish for new variants, which will inevitably spread globally.

Early in the pandemic, China appeared to contain the virus. It distributed masks and tests domestically and world-wide and developed a vaccine it shared with other countries. These achievements allowed Beijing to portray itself as a global public-health leader, especially compared with the bumbling early response by many Western countries.

But global health is a long game, and China has fallen far behind by making three crucial mistakes.

First, the zero-Covid strategy. China used ubiquitous electronic tracking systems, mandatory testing and severe lockdowns of neighborhoods, cities and even entire regions whenever a Covid case was detected. If these extreme measures limited Covid deaths in China, they came at a huge cost. Economic growth, which averaged nearly 8% in the decade before the pandemic, is projected to be only about 3% for 2022. Youth unemployment is above 20%. The wealthy are trying to flee, and foreign companies are searching for alternative manufacturing centers because of China’s unreliability. The lockdowns have sown deep and unprecedented public hostility toward the government.

Second, China’s vaccine fiasco. China adopted a conservative approach, pursuing traditional inactivated-virus vaccines rather than novel ones like the Pfizer and Moderna mRNA shots. Early on, Chinese scientists ridiculed the American mRNA effort. China made its homegrown vaccines available to nearly 70 countries to bolster its image as a global-health leader. But even Chinese officials quickly acknowledged that these vaccines offered significantly less protection than the mRNA shots.

Yet Mr. Xi has repeatedly refused to procure Pfizer or Moderna vaccines despite multiple offers. (Moderna refused China’s demand that it hand over its intellectual property as a precondition for purchase.) Instead, Chinese researchers have tried to develop their own mRNA vaccine, with no evident success. National pride has superseded public health, endangering millions of Chinese people.

Third, letting Covid rip. In the past few days, Mr. Xi has turned 180 degrees and eased almost all restrictions. Zero Covid was always untenable and had to be ended. But it could have been done responsibly.

Among other things, that would involve buying Pfizer and Moderna bivalent vaccines and administering them to the elderly and other high-risk people, and purchasing Paxlovid and molnupiravir to treat those who test positive. Supplies of these products are ample. Authorities could continue mask mandates to reduce transmission. And China could institute a rigorous wastewater testing program to identify potential SARS-CoV-2 variants as soon as possible—and commit to sharing the data with the world.

Instead, China ended zero Covid in the most dangerous way possible—precipitously. Covid is spreading like wildfire in a population that has little immunity. Epidemiologists measure contagion with a variable called R—the average number of people to whom one infected patient spreads a pathogen. Early on, the R for SARS-CoV-2 was 2 to 3. During the omicron surge last winter, it jumped to 10 in the U.S. Today Chinese health officials report an R of 16.

With no time to prepare, these factors will produce a perfect Covid conflagration. NPR reports that the Chinese Centers for Disease Control and Prevention estimates 800 million people in China—roughly 10% of the world’s population—could get Covid in the next 90 days. That will overwhelm hospitals and could cause a million deaths.

It will also enable the development of new Covid variants and subvariants. Whether any particular variant proves dangerous—with the ability to spread rapidly, evade immunity and cause more severe disease or higher rates of long Covid—is impossible to predict. But the more opportunities variants have to evolve, the worse the odds.

Over the past three years, there have been more than 650 million confirmed Covid cases world-wide. Public-health authorities have identified six “variants of concern”—those that have increased transmissibility, increased disease severity, reduced neutralizing antibodies or reduced effectiveness of existing treatments and vaccines. These include the original variant (alpha), delta and count as one the numerous omicron subvariants. Altogether, there have been nearly seven million confirmed deaths of patients infected with Covid, along with millions of excess deaths from other illnesses as a result of diversion of medical resources, lockdowns and other indirect effects of the pandemic.

Having 800 million people in China infected will increase the likelihood of dangerous new variants. Making matters worse, the Chinese New Year is Jan. 22, and hundreds of millions of Chinese will travel and gather to celebrate. (Three years ago the city of Wuhan went ahead with a massive New Year’s banquet amid the original outbreak.) The easing of China’s international travel restrictions will disperse any new variants to other countries.

Three years ago, the Chinese state’s vast power to impose controls on the population might have appeared to be an advantage in dealing with a pandemic. Instead, Mr. Xi imposed one disastrous policy after another from the top down, putting China at a disadvantage and the world at continued risk.

Dr. Emanuel is a physician and vice provost for global initiatives at the University of Pennsylvania.

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