Neglecting experts, China abruptly abandoned zero-Covid, costing lives

China wasn't prepared for a huge influx of cases when it abruptly dropped onerous zero-COVID regulations in December.

Due to a shortage of storage space, hospitals turned away ambulances, crematoriums burnt corpses continuously, and families transported the deceased to warehouses.

According to Chinese official media, the decision to open up was "by no means impetuous" and was the result of "scientific investigation and cunning calculation." But, The Associated Press discovered that China's governing Communist Party repeatedly disregarded requests from leading medical authorities to initiate escape arrangements until it was too late.

Instead, the reopening happened abruptly as winter arrived, when the infection is most contagious. According to academic modelling, more than 20 interviews with current and former employees of the Chinese Center for Disease Control and Prevention employees, experts and government advisors, as well as internal reports and directives obtained by the AP, there may have been hundreds of thousands of deaths that could have been prevented because many older people were not immunised, pharmacies lacked antivirals, and hospitals lacked adequate supplies or staff.

"So many things might have been prevented if they had a genuine strategy to depart early," said Zhang Zuo-Feng, an epidemiologist at the University of California, Los Angeles. Numerous fatalities may have been avoided.

Although other nations battled with stop-and-start lockdowns, China stood out for two years with its strict but effective restrictions against the virus, which are credited with saving millions of lives. The development of the extremely contagious omicron variety last year, however, caused many of China's top medical professionals and policymakers to worry that zero-COVID was not a viable strategy.

China's top officials started debating how to relax restrictions in late 2021. The State Council, China's cabinet, received comprehensive plans to set up for a phased disengagement as early as March 2022 from leading medical professionals.

But, following an outbreak in Shanghai the same month, which led Chinese leader Xi Jinping to close the city down, conversations came to a halt. Due to Beijing's crackdown on dissent under Xi, scientists were unwilling to speak out against the official stance of the party since Zero-COVID had become a source of national pride.

The 20th Party Congress, the nation's most significant political gathering in a decade, was months away by the time the Shanghai epidemic was under control, making reopening politically challenging. Consequently, despite omicron eluding more strict regulations, the nation continued to test and quarantine millions of individuals.

Demonstrations, industrial riots, and closed shops signalled the onset of unrest. The pressure increased until the authorities abruptly gave up, enabling the virus to swiftly and fatally spread across the nation.

More than the official death toll of under 90,000, according to experts' estimates, although still a significantly lower mortality rate than in Western nations, may have perished in China's COVID wave. Nevertheless, modelling by the University of Hong Kong and expert estimates suggest that 200,000 to 300,000 fatalities would have been avoided if the nation had been well immunised and supplied with antivirals. According to some experts, many more lives may have been spared.

That wasn't a sensible public health choice at all, according to a Chinese CDC official who declined to be identified because it was a delicate subject. "This wasn't a rehearsed opening. It's just terrible timing."

Planning were halted

Several authorities and specialists in public health started considering ways to abandon the zero-COVID policy around the end of 2021. The omicron, which is less deadly but far more contagious, made it harder to stop COVID-19 and reduced the likelihood that it would spread, and Singapore, Korea, and Japan, which are all close, all loosened regulations.

Four persons with knowledge of the matter stated that in the following winter, the State Council recruited public health specialists to a new committee charged with examining COVID-19 rules, which delivered a report in March 2022. The AP is revealing the document's existence for the first time.

It came to the conclusion that China should start making plans for a potential reopening. According to one of the sources, it was more than 100 pages long and included comprehensive recommendations to advance China's flagging immunisation effort, expand the number of ICU beds, stockpile antivirals, and instruct patients with moderate COVID-19 symptoms to remain at home. It also contained a suggestion to designate the tropical island of Hainan in the country's south as a pilot zone to test loosening restrictions.

But then things started to go wrong.

China was frightened by a disorderly, fatal outbreak in Hong Kong. The virus then started to spread in Shanghai, China's international financial centre, in March.

With targeted lockdowns that sealed certain buildings at first, Shanghai adopted a light policy under the innovative leadership of doctor Zhang Wenhong, who had been vocally urging the authorities to be ready to reopen. But shortly, according to three individuals with knowledge of the situation, authorities in neighbouring provinces reported that they were seeing instances from Shanghai and begged the central leadership to shut down the city.

By the beginning of March, a neighbouring province was discovering scores more COVID-19 cases, all coming from Shanghai, according to China CDC contact tracing records acquired by the AP. Provincial authorities stated that they were at danger of the virus spreading throughout China before China was prepared because they lacked Shanghai's medical resources and ability to track it down.

Authorities were alarmed at the same time by China's declining vaccination rate for senior citizens, fatalities in Hong Kong, and rumours of a lengthy COVID-19 outbreak overseas.

Shanghai's senior leadership intervened after efforts to contain the virus proved unsuccessful. In Shanghai, partial lockdowns were announced in late March. On April 2, the "COVID czar," then-Vice Premier Sun Chunlan, travelled there to supervise a complete lockdown.

They "lost their nerve," according to a specialist in constant communication with Chinese health authorities.

Shanghai wasn't ready for this. People vented their rage online, lamenting their lack of food and resources. China, though, emphasised that the lockdown would remain in place.

Continue to support zero-COVID, a People's Daily editorial in the official press said. "Determination is triumph," Xi said.

remaining silent

Chinese public health specialists ceased discussing departure strategies in public after Shanghai was evacuated. No one dared to publicly oppose a Xi-supported programme. One analyst told the AP that several were banned by Chinese media.

The banned expert said that anybody who dared to disagree with the official line was essentially silenced.

Early in April, a letter from the European Chamber of Commerce demanding easing of zero-COVID regulations was released by China's State Council. According to a source with firsthand knowledge of the situation, council members wanted to start a discussion but didn't feel qualified to do so.

An inquiry fax sent to the State Council's information office received no response.

Gao Fu, the former director of the China CDC, also made a suggestion on the need to be ready to leave. Gao was quoted as saying "omicron is not that dangerous" at an internal panel discussion in mid-April that was recently made public by the Beijing-based Centre for China and Globalization think tank. He also mentioned that there were open discussions about whether zero-COVID needed to be adjusted and that they "hope to reach a consensus as soon as possible."

According to three guests who refused to be identified because they were not authorised to talk to the press, Gao agreed with foreign experts encouraging China to arrange a reopening at a private event held at the German Embassy in Beijing a few weeks later before sauntering off stage. An email asking Gao for a comment received no response.

There were also signs that there were disagreements among party leaders.

A participant and another who was briefed on the meetings say that in private meetings with Western business chambers in May, then-Premier Li Keqiang, who was also the party's No. 2 official and the head of the State Council, seemed sympathetic to complaints about how zero-COVID was harming the economy.

That was in direct contrast to Xi's recorded words, which said that stopping COVID was the highest priority. Analysts claim that Li was helpless under Xi, China's most dictatorial leader in decades.

Experts in public health divided into groups. Gao and Zhang, the Shanghai doctor, as well as others who believed zero-COVID was untenable, remained mute. Nevertheless, Liang Wannian, who was at the time the chairman of the central government's expert working group on COVID-19, persisted in vehemently supporting zero-COVID as a means of eradicating the virus. Liang has a degree in epidemiology, yet he has sometimes been charged of advocating for the party line as opposed to measures that are based on evidence.

Ray Yip, the first director of the US CDC office in China, remarked, "He understands what Xi likes to hear.

At internal meetings in January and May of 2022, Liang rejected proposals for reopening, according to Yip, making it hard for others to propose departure strategies. An email asking Liang for a comment received no response.

Health officials also understood that there would be no turning back once China reopened. Uncertain data, a lengthy COVID, and the potential for deadlier strains alarmed several people, leaving them filled with anxiety.

We were inundated with vast amounts of unreliable data every day, according to a Chinese CDC officer. "We learned about different variations every week. Undoubtedly, there should be a means to escape zero-COVID, but when and how?"

Officials could have possibly been waiting for the virus to weaken much more or for fresh, improved mRNA vaccinations from China.

They lacked urgency, according to Zhu Hongshen, a postdoctoral scholar at the University of Pennsylvania researching China's zero-COVID programme. They believed they had time and could optimise the whole process.

The projected eight-day duration of the Shanghai shutdown turned out to be two months. By the time Shanghai reopened, China's crucial 20th Party Congress, where Xi was anticipated to be affirmed for a contentious and ground-breaking third term, was only a few months away.

A possible epidemic was not an option. Despite writing internal petitions encouraging the government to begin planning, scientists from Beijing, Shanghai, and Wuhan were instructed to keep quiet until the conference was finished.

"Everyone waits for the party congress," said one medical specialist, refusing to be identified to remark on a delicate matter. Everyone is unavoidably too cautious to some extent.

greater pressure

China's government made unprecedented steps to halt the spread of omicron.

Visitors and merchants were confined to hotels, and many people avoided travelling out of concern that they might get lost far from home. According to Moses Xu, a retired worker, a state-run munitions plant in Inner Mongolia compelled employees to spend extended periods of time away from their families living in the business's property.

Residents in Xinjiang starved under cruel lockdowns for more than three months, while thousands of Tibetans disobeyed orders by marching in the streets in a rare form of protest. The government dismissed individuals who failed to keep COVID under control, but authorities continued to stand by their positions.

Omicron, however, continued expanding. Authorities started concealing instances and using covert lockdowns and quarantines as the congress drew near.

Despite reporting just a few instances, authorities shut down Zhengzhou, the provincial capital and home to over 10 million people, without making any announcements.

One told the AP that they bused some residents of Beijing to far-off quarantine facilities and instructed them not to post anything online about it. With the purpose of creating the impression that the virus was under control, some village authorities purposefully underreported the number of COVID-19 cases.

Tens of billions of dollars were invested in mass testing and quarantine facilities by local governments. Civil officials were forced into testing or quarantine duty from Wuhan to villages in the industrial Hebei region as local governments ran out of money to pay personnel.

Top officials at the Congress in mid-October who disagreed with Xi were excluded. Instead, six devoted followers of Xi entered the stage after him in a new leadership lineup, signifying his complete control over the party.

promoting change

When the conference was done, a few public health industry opinions were heard.

Wu Zunyou, chief epidemiologist at China's CDC, criticised the Beijing city government for its excessive COVID controls in an internal document that was published on October 28 and which The Associated Press obtained and first reported here. Wu Zunyou claimed that the COVID controls had "no scientific basis" in the document. He described it as a "distortion" of the zero-COVID policy of the central government that ran the danger of "intensifying popular discontent and triggering social unrest."

He also referred to the central government's anti-virus initiatives as "totally right."

According to a former CDC official, Wu felt powerless because he was required to promote zero-COVID in public, despite occasionally disagreeing with its excesses in private.

Wu did not reply to a comment-request email. Wu's writing of the internal report was confirmed by a person who knows him.

Zhong Nanshan, a physician well known for sounding the alarm about the first COVID-19 epidemic in Wuhan, was another who spoke out. According to an individual familiar with Zhong, he emailed Xi twice, explaining that zero-COVID was unsustainable and encouraging a phased reopening.

A government adviser told the AP that industry executives in banking, commerce, and manufacturing who were worried about the faltering economy were also pressuring officials behind the scenes.

In addition to lobbying, epidemics that were spreading throughout the nation added to the pressure to reopen. The AP was able to get an internal Beijing health notification dated November 5 that described the viral condition as "serious."

Three persons with firsthand knowledge of the talks said Sun, China's top "COVID czar," convened specialists from the health, tourism, and economic fields in early November to talk about modifying Beijing's anti-virus regulations. The eminent physician Zhong revealed statistics from Hong Kong demonstrating omicron's low death rate during the city's most recent epidemic, according to two sources.

On November 10, Xi issued corrections.

Xi reportedly stated, "Adhere to scientific and exact prevention and control," indicating he wanted authorities to reduce the use of drastic measures.

China unveiled 20 fresh steps the next day to modify limitations, including reclassifying danger zones and shortening quarantine periods. But Xi also made it clear that China will continue to adhere to zero-COVID.

The necessary precautions for preventing epidemics cannot be loosened, according to Xi.

the exit

The state desired law and order. Instead, the actions led to anarchy.

Local authorities were uncertain about whether to shut down or open up due to contradictory messages from the top. Daily policy changes occurred.

Authorities halted mass testing in Shijiazhuang, the capital of Hebei province, and allowed the city to reopen a few days later. According to an individual acquainted with the situation, Xi phoned local authorities and told them to take steps that were neither too severe nor too lenient.

Lockdowns were abruptly imposed on certain residences and might persist for hours or days. Medical personnel were overwhelmed by the sheer volume of tests and patients. Streets emptied, travel, eating, and shopping all came to a standstill, and the affluent began purchasing one-way tickets out of China.

Public discontent reached a boiling point in late November. Nationwide demonstrations against barred doors and other viral control measures were spurred by a fatal apartment fire in Xinjiang, in the far western section of China. The greatest blatant threat to the Communist Party's authority since the 1989 pro-democracy demonstrations was the request for Xi to step down.

Once riot police arrived, the demonstrations were quickly put down. But, the atmosphere was changing behind the scenes.

The administration stopped mentioning "zero-COVID" in its announcements. According to the official newswire Xinhua, the epidemic was generating "fatigue, worry, and stress," and the expense of containment was rising daily.

Sun, the COVID czar, conducted meetings days after the demonstrations when she informed medical professionals the state intended to "move swiftly" out of zero-COVID. Several others were surprised by how abruptly the tone had changed; one, according to a former official, said that the leadership had become "even more extreme" than the experts.

According to a source informed on Xi's comments, he told visiting European Council President Charles Michel on December 1 that the demonstrations were motivated by young people who were upset about the lockdowns.

They remembered Xi saying Michel, "We listen to our people," to Michel.

According to many sources who spoke to the AP, the final decision was made abruptly and with little direct participation from public health specialists.

Nobody anticipated the 180-degree shift, according to a government expert.

Three current and former state officials claim that a large portion of the Chinese government thinks that Xi's decision to completely abandon virus controls was hastened by the demonstrations.

"That was the trigger," said one, not named because they weren't permitted to talk to the media.

According to Xinhua, on December 6 Xi gave authorities orders to modify COVID-19 regulations.

The next day, Chinese health officials announced ten broad reforms that essentially eliminated regulations, including the elimination of obligatory centralised quarantine, requirements for viral testing, and location-tracking health QR codes. The nation was taken aback by the decision to reopen so abruptly.

A former Chinese CDC official said that even three days' warning would have been sufficient. "The manner in which this occurred was beyond incredible."

Patients were soon strewn over floors in emergency rooms as the ill took control. In the illegal market, COVID-19 antivirals fetched thousands of dollars every box.

The Chinese CDC eventually calculated that in only six weeks, more than a billion individuals, or 80% of the population, had been sick. According to a leaked directive received by a former state media journalist and uploaded online, officials urged state media to deflect criticism over China's abrupt reopening even as the number of casualties increased.

Make a significant propaganda drive, it instructed. "Refute the bogus allegations made by the West and the United States that we were 'forced to open' and were not ready."