China's 'zero COVID policy' could finally falter : Goats and Soda For nearly three years, China has enforced incredibly strict rules to keep coronavirus transmission in check. But now they're facing a potentially deadly omicron surge.

Why China's 'zero COVID' policy is finally faltering

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STEVE INSKEEP, HOST:

What does the world's most populous nation do now that its COVID policies are under stress? China has kept the number of COVID cases exceptionally low. In fact, its policy is called zero-COVID. The trouble is that cases are now well above zero, and protests are spreading against COVID restrictions. Many, many lives are at stake, not to mention one of the world's most important economies. So let's talk through the science with NPR global health correspondent Michaeleen Doucleff. Good morning.

MICHAELEEN DOUCLEFF, BYLINE: Good morning.

INSKEEP: What has China's policy been up to now?

DOUCLEFF: So the idea really is to stop transmission of the virus inside the country. You might have cases that get imported, or there could be outbreaks. But the government tries to quickly limit the spread. New Zealand and Singapore are among other places that have tried this. But here's the thing - omicron is so transmissible that you need incredibly harsh and severe restrictions on people's movements - so very strict quarantines, where you can't leave a room for days, even weeks, and enormous amounts of testing. So for example, recently, the Chinese government started testing millions of people in Shanghai daily. And back in the summer, they locked down the entire city.

INSKEEP: Wow. For how long?

DOUCLEFF: Two months, Steve. I mean, imagine a city of 26 million people with everyone inside their homes more than two years into the pandemic.

INSKEEP: Well, that helps to explain why there have been so many widespread protests just in recent days, a specific incident leading to some of that. But it spread to many cities, it would seem, based on social media. But is zero-COVID even possible?

DOUCLEFF: You know, that's the question. You know, for right - for most of the pandemic, it has worked. China has kept cases and deaths very low. The country has recorded only about 6,000 deaths among 1.4 billion people. In the U.S., there've been more than a million deaths among...

INSKEEP: Yeah.

DOUCLEFF: ...Only 330 million people, right? The problem, though, is this approach isn't sustainable year after year. I was talking to Jennifer Nuzzo about this. She's an epidemiologist at Brown University. She says other countries that have tried this approach basically abandoned it months ago. And right now, she says, it looks like it might be failing in China as well.

JENNIFER NUZZO: Despite very aggressive measures, despite high mask usage, massive testing efforts and quarantine and isolation, they are still dealing with what is probably more community spread than is being recognized.

INSKEEP: In the face of these protests, Chinese officials have been suggesting through state-run media, well, we're already easing the restrictions. Is it inevitable they have to abandon their policy?

DOUCLEFF: So every researcher I spoke to about this question said, yes, it's inevitable. One of them is Yanzhong Huang. He's a global health fellow at the Council on Foreign Relations. He says China will probably be forced to reopen within the next year, perhaps the next few months. And that's because people are just tired of these harsh restrictions.

YANZHONG HUANG: Yeah, it's simply people are tired of it. The more people got to know the nature of the virus, you know, they started to question, why the zero-COVID policy?

DOUCLEFF: The policy has had huge consequences on people's lives. There have been food shortages. People have lost jobs. And they're cut off from the rest of the world.

INSKEEP: But let me ask about the other side. If China were to end the restrictions for 1.4 billion people, would millions of people die?

DOUCLEFF: You know, some people have speculated yes. But it's not clear what's going to happen. One concern is that the vaccination rates for elderly people are quite low. Only about 40% of people over 80 have been vaccinated with two shots. That leaves about 20 million people at high risk for severe COVID and death. But China is preparing. They're building more ICU beds across the country. That all said, Huang says it's really hard to predict because no country has been in this situation where they've held off COVID for so long. If China can reopen very slowly to limit transmission, it could possibly avoid a big crisis.

INSKEEP: NPR global health correspondent Michaeleen Doucleff, always a pleasure talking with you. Thanks.

DOUCLEFF: You're welcome, Steve.

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