Opinion | China Has an Extraordinary Covid-19 Dilemma

Health & Wellbeing

Is it thinkable now? This week, my colleague Paul Krugman wrote that the protests were a sign that “China lost the Covid war,” emphasizing that, despite appearances early in the pandemic, democracies now seem to have definitely outperformed autocracies, and calling on Chinese leaders to recognize the error of their ways and change course. In The Guardian, Yu Jie wrote that “zero Covid can’t continue,” with reopening “the only way to quell public anger.” But personally, I would bet only on much smaller-scale adjustments, of the kind that had already been floated by Beijing in the weeks before the protests began.

That’s because the best model of what might transpire in a truly opened-up China is Hong Kong’s experience with Omicron. By mid-February 2022, there had been a reported total of just over 200 deaths in the city since the beginning of the pandemic. By mid-April, it was over 9,000. And while a much more aggressive mainland campaign to deliver mRNA vaccines to older people could lessen the death toll, the experience of other countries largely credited with doing everything right suggests that even best-case exits from the emergency phase of the pandemic can be quite messy.

Consider the experience in Japan, one of the world’s most celebrated pandemic success stories. Covid deaths there are 70 percent higher this calendar year than they were in the first two years of the pandemic combined. In Iceland, another often-cited success story, five times as many people have died from Covid in 2022 as in the first two years of the pandemic. In Australia, it is six times as many. This past January, Taiwan had registered under 1,000 deaths; today that figure is over 14,000. According to The Economist’s gold standard tracker, New Zealand is now the only nation in the world with negative excess mortality across the whole span of the pandemic — meaning that the country has had fewer deaths since 2020 than would have been expected in a world without SARS-CoV-2. And yet even there, the last year has upended some narratives: As recently as January 2022, only 52 New Zealanders had died from Covid; today the figure is above 2,000, more than 40 times as high.

In each of these countries, rapid increases in Covid mortality this year come from very low and presumably unsustainable baselines, but even so, they tell a striking story. Mitigation measures mattered, particularly until the arrival of vaccines, when vaccination mattered even more. But in any particular country the dream of actually defeating the pandemic outright — or even holding it at bay long enough to fully protect the population through universal vaccination — was no match for the disease itself. Eventually, every country got it.

Or almost every country. Throughout the pandemic, many international observers questioned the reliability of official Chinese data about the toll of the pandemic. But given the global context, that data remains pretty astonishing, even correcting for its unreliability: In January, China reported just under 5,000 total Covid deaths. Today that figure is just over 5,000. A nation of 1.4 billion registered barely 500 official deaths over the course of the year in which their pandemic policy began to crumble. In total, over three years, the country has reported only 1.6 million official infections, and while that is surely a gross underestimate, it suggests that only about one-tenth of 1 percent of the country has ever gotten sick with Covid. In the United States, a larger share of our population has died from it — nearing 1.1 million deaths in total.

That isn’t at all to suggest that China’s permanent lockdowns are a better model, or that any of the world’s major countries would or should want to trade places with China. But the binary contrast between the approaches is not as illuminating as it may seem.

In the United States, where people sometimes say “lockdowns” and mean “mask mandates” and “school closures” or sometimes just “widespread testing,” even relatively mild mitigation measures have grown politically and socially toxic. But the most obvious tools to limit ongoing spread are not especially obtrusive: investments in air quality and better workplace safety standards, paid sick leave, aggressive rollout of those nasal vaccines and an emphasis on the vulnerability of the country’s older people, who make up about 90 percent of its distressingly high ongoing deaths. In China, pandemic policy only became significantly more restrictive than it was in the United States and Britain in the summer of 2021, according to a “stringency index” calculated by the University of Oxford’s government response tracker, and the country faces tough choices now not because of how effective those restrictions have been but because of unrelated problems in vaccine rollout and efficacy.

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