And Beijing cites past successes of the strategy – including just two reported Covid-related deaths for 2021 – to clear up its claims of superiority over Western governments.
“We must spare no effort to be present in every case, to save every patient and to truly respect the value and dignity of every human life,” said Chinese leader Xi Jinping, who explicitly reiterated his support for the zero-sum policy. COVID “recently weeks,” he said at a global health summit last year.
Now that picture is changing, as for the first time in nearly two years, Covid’s death toll in China is rising on a daily basis amid an epidemic in Shanghai in which the 25-million-strong city was placed under a seemingly endless, stern blockade. As of April 17, city officials reported 238 deaths involving Covid, mostly elderly people, all of whom, according to authorities, died of a major condition in a fire that has spread to more than 500,000 people since March 1.
The deaths mark a new phase of loss for China, as well as a high-risk political challenge.
Reporting deaths is “something like a double-edged sword for the authorities,” according to health security expert Nicholas Thomas, an associate professor at Hong Kong City University.
“If the numbers are too low, not only is there a problem with trust, but this will also make quarantine restrictions seem excessive. If the numbers are too high, then the block is justified, but the authorities have failed to control the virus. ”
To date, government officials have given priority to suppressing the virus over everything else, even as public outrage and economic risks increase with blunt restrictions on blocking.
So far, there are no signs of a change in policy, with Beijing “doubling its messages to stop the virus” instead, even as outbreaks spread, according to Thomas.
And as Zero Covid’s policy remains explicitly linked to Chinese leader Xi, it is clear that “this line will be maintained for the foreseeable future,” he said.
By numbers
As the number of Covid deaths and severe cases has risen in Shanghai in recent days, city health officials are speaking with increasing urgency to further increase the response to critical care and increase vaccination in the elderly – although blockades and mass tests appear have given priority to vaccination so far.
“We need to coordinate the city’s medical resources, increase critical medical teams … reduce the proportion of critically ill patients … and try to reduce mortality,” said Zhao Dandan, deputy director of the Shanghai Health Commission, on Sunday. .
“Eligible adults should be vaccinated as soon as possible,” he said.
Representatives in Shanghai said earlier this month that 62% of those over 60 had been vaccinated in Shanghai, with 38% reinforced, but that number had dropped to just 15% fully vaccinated for the most vulnerable age group over 80. according to state media. Of the 238 deaths in recent days, only 13 have been vaccinated, authorities said on Wednesday, without giving details about full vaccinations or booster vaccines. Lagging vaccination levels in this group are a fatal flaw in China’s planning for Covid-19: although it focuses huge resources on the development and production of home-grown vaccines, it fails to ensure that these vaccines fall into the arms of the elderly population. most likely to die from Covid-19.
Now that authorities have reaffirmed expectations that mortality in the country will remain low, they have no choice but to rely on a blockade to protect the vulnerable.
But it now appears that an unknown number of deaths are linked to tight controls in the city, as restrictions pose challenges to access to medical care – a disruption the city has repeatedly promised to address. One fear is that Shanghai may see a crisis similar to that in Hong Kong, where an epidemic that began earlier this year brought the city’s death toll to one of the highest in the world since the pandemic began. Hong Kong also faced low levels of vaccination among a large adult population, with only 48% of people aged 70 and over fully vaccinated by early March and only 25% of people aged 80 and over vaccinated at the beginning of March. year.
Counting cases
But the comparison with Hong Kong also raises questions about how Shanghai has managed to keep its mortality so low.
Hong Kong reported more than 9,000 Covid-19 deaths, up from 1.19 million in total since January this year.
With that percentage, Shanghai should have up to 700 deaths out of every 100,000, according to infectious disease physician Peter Colinon, also a professor at the Australian National University School of Medicine.
Experts also noted a lack of transparency about the criteria used by Chinese officials to classify Covid-19 deaths.
“If there is no black-and-white definition of Covid deaths or Covid-related deaths, or how these deaths should be reported, then it’s up to the panel to decide,” said Jin Dongyang, a professor at Hong Kong University. . School of Biomedical Sciences. – This is the reality.
Some of these reflect concerns about the full coverage of infections and deaths during China’s initial outbreak in 2020 in Wuhan, which clogged hospitals – although China defended its transparency during the pandemic.
China’s Foreign Ministry said in a statement in 2020: “China has calculated and reported its confirmed cases and deaths on the basis of facts … the relatively low number of confirmed cases and deaths may be due to comprehensive and stringent measures, undertaken by the Chinese Government. “
But experts also warn that it is difficult to make comparisons between sites with different strategies for testing and controlling diseases, social factors and demographics.
For example, intensive testing in Shanghai found hundreds of thousands of asymptomatic cases, some of which may have been missed in the number of cases elsewhere, potentially distorting comparisons.
Bureaucratic processes and the time it takes for positive cases to succumb to the disease can also lead to delays in reported deaths, with some experts suggesting that the worst is yet to come in Shanghai.
Meanwhile, understanding the common fee – not just the virus – but the blockade imposed in Shanghai and other cities is crucial in assessing the true cost of China’s control measures, experts say.
Xi Chen, an associate professor at Yale School of Public Health, said the long-term consequences of the blockade in Shanghai, including missed cancer or mental health stress tests, would take time – and data – to become clear, and even then it is difficult to measure.
“We will often look at two types of negative shock,” he said of the aftermath of the initial burden of death. “One for those people who eventually died and the other for those who survived but live with the trauma associated with them.
CNN’s Beijing bureau contributed to this report.
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