China officially ended its zero-COVID-19 policy on Jan 8, 2023. The management of
COVID-19 is now downgraded from Class A to Class B in accordance with the country's
law on infectious diseases prevention and treatment. There is no more centralised
quarantine, close contact tracing, or mass nucleic acid testing. China now enters
a new phase of the COVID-19 response.
The end of the zero-COVID-19 policy reminds us to reflect on its gains and losses.
Beyond all doubts, the dynamic zero-COVID-19 policy has protected the most vulnerable
populations from five global COVID-19 waves and avoided widespread infections with
the original strain and the delta variant. Its border closure policy blocked, or at
least postponed, the entry of variants from abroad. It also won precious time for
the whole society to be better prepared for high infection rates in the population.
Nevertheless, the zero-COVID-19 policy also had some disadvantages: a low number of
infections among the population resulted in a low level of natural immunity compared
with other countries; a lack of urgency to get vaccinated fostered vaccine hesitancy;
stringent border measures halted international cooperation; policies such as frequent
mass testing and quarantine treatment have disrupted people's life and work, as well
as increased the financial burden on government; and other diseases have been neglected
due to an excessive focus on COVID-19. Moreover, the abrupt lockdowns in several cities
last year in response to outbreaks of the omicron variant exposed the adverse effects
of the stringent zero-COVID-19 policy, such as family separations, food supply shortages,
and impaired access to medical care.
In this new phase of the pandemic, China is facing unprecedented challenges, as well
as opportunities for strengthening its public health systems. The domestic impact
of the shift from the strict policy is immediate—people are going through an abrupt
outbreak of COVID-19 before life returns to normal. Despite the small number of reported
cases, there are signs of a sharp rise in recent infections nationwide and the actual
number could be much larger than the official data due to the change in testing requirements.
According to a recent preprint, the infection incidence might have already peaked
in Beijing on Dec 11, 2022. A model developed by the Institute for Health Metrics
and Evaluation projects over 300,000 deaths in China in the coming months, and more
than a million over the course of 2023 after the policy shift. In fact, hospitals
are already overwhelmed due to the increased numbers of people with fever attending
clinics, and anti-fever drugs were out of stock for weeks. Large numbers of medical
staff are infected while still going to work sick, staying on the frontline, and coping
with the surge in patients with fever. Long-term, China will face looming challenges
such as the health burden of post-COVID-19 condition (also known as long COVID).
Hopefully, the following efforts might help to address these challenges. A modelling
study posted on medRxiv suggests the combined effect of vaccination (≥85% coverage
of the fourth dose as a booster) and antiviral treatment (≥60% coverage) could substantially
reduce COVID-19 morbidity and mortality as China transitions from dynamic-zero to
normality. China is on the way to achieve these targets. The government is speeding
up the booster vaccinations, especially for the older population. It has also started
administering a fourth COVID-19 vaccine dose. Antiviral drugs are now allocated at
hospitals and primary medical care centres in major cities such as Beijing, Shanghai,
and Guangzhou, with the daily output increased by more than four times in late December
compared with early December. China has always wanted to strengthen its primary health-care
system. Now, by promoting a tiered diagnosis and treatment system, expanding internet-based
medical services, and allocating medical resources to the primary health-care centres,
there is a good opportunity to let people get used to and build trust in primary health-care
systems such as community hospitals and online medical services, instead of the over-reliance
on top-grade hospitals.
From a global perspective, China's reopening has been welcome, but has also led to
some concerns. Several countries are setting inbound travel restrictions targeting
only Chinese travellers, owing to concerns about the sufficiency and adequacy of Chinese
data on COVID-19 infections. China can do better in co-operating with the global community
to overcome the pandemic by sharing information in a more timely, open, and transparent
manner. Clinical data on the current COVID-19 situation, medical treatment, and vaccination,
as well as research findings of the transmissibility, severity, vaccine escape of
variants and antiviral resistance, and vaccine effectiveness should be made available.
Data reporting should also be as consistent as possible, and in this respect, China
is encouraged to change its COVID-19 death definition in line with the WHO recommendation
to accurately calculate excess deaths. With the end of the zero-COVID-19 policy in
China, nationwide coordination is more important than ever amid the continuing global
fight against the pandemic.