Even locking down 51 million people may not be enough to contain China’s ‘tipping point’ Omicron outbreak

China’s COVID-prevention measures stymied waves of previous COVID variants, but experts say the defenses may not have been enough to contain the highly infectious Omicron subvariant BA.2, which Chinese officials say is the dominant strain spreading through the country.

“China has a population that’s very vulnerable to this new variant,” Dr. Scott Gottlieb, former commissioner of the Food and Drug Administration, told CNBC this week. “This is a much more contagious variant; it’s going to be harder to control.”

But China appears intent on trying to quash it anyway.

This week, China placed 51 million people in cities across the country in lockdown, its largest mass containment measure in nearly two years. The current lockdown is nearly the same size as the 57 million people China confined to homes in February 2020 when the world’s first wave of COVID-19 spread in Wuhan and surrounding cities. China has also announced localized lockdowns and mass testing measures in major cities like Shanghai, Beijing, and Shenzhen, disrupting life for hundreds of millions of citizens across the country.

“The current new outbreak represents the most serious challenge to China since the initial Wuhan outbreak,” says Chen Zhengming, a professor of epidemiology at the University of Oxford.

The outbreak may prove a “tipping point” that shifts China from zero tolerance for COVID to “living with the virus,” Chen says. But even if China’s new outbreak is a wake-up call that Beijing must change its pandemic strategy, China is unlikely to lower its defenses all at once to prevent its hospital system from being overwhelmed. Rather, experts say, China’s move to living with the virus may be subtle and gradual—and there are early hints that the shift is already underway.

Different signals

China’s current lockdown measures may not be enough to make a meaningful difference in stopping the spread, says Dr. Jennifer Bouey, an epidemiologist at the Rand Corporation. The thousands of daily cases, coupled with cases cropping up in 28 of China’s 31 provinces, mean that authorities may have already lost control. “[The outbreak] qualifies as widespread community transmission,” she says. “A nationwide lockdown would reduce transmission…but so far we have only seen citywide or regional lockdowns.”

Nonetheless, China’s official stance is that it’s doubling down on its COVID-zero approach.

On Tuesday, an editorial in state-owned news outlet Xinhua said that any deviation from COVID zero would be disastrous for China, and that the country needs to abide by its current pandemic strategy.

“China will stick to the dynamic zero-COVID policy until the battle against the virus is won,” the editorial says. It argued that COVID zero remains the best way for China to keep its population safe and its economy growing.

But even as state media outlets support “dynamic zero COVID,” Chinese officials seem to be easing some parts of the policy.

In a speech at China’s Two Sessions conference last week, an annual political meeting of China’s top leaders, Premier Li Keqiang said China would adapt to new developments in the pandemic and focus on ensuring that the virus would not disrupt people’s life and work, language that seemed to dial down Beijing’s past determination to eliminate all COVID cases, no matter the cost.

In a Tuesday post on Weibo, China’ Twitter-like social media platform, China’s top epidemiologist, Zhang Wenhong—a public figure who’s often referred to as China’s Dr. Anthony Fauci—said the country needs to chart a new path forward in its pandemic response.

“We need to figure out what we should do in the future rather than discussing whether we should stick to the zero-COVID policy or coexist with the virus,” Zhang said. “What is most important is to get the wave caused by the fast-spreading Omicron under control, but that does not mean we will endure a long-term lockdown and mass testing.”

Rapid antigen tests (RATs)

The relaxing of testing measures is one sign that China’s COVID-zero strategy is changing.

On Friday, China’s National Health Commission approved the commercial use of rapid antigen tests (RATs), making at-home COVID tests available to the Chinese public for the first time.

Previously, Chinese citizens could only get COVID tests at government testing centers, which use more accurate but slower PCR tests. For the entire pandemic, Chinese authorities have isolated every positive COVID case—often away from their homes and families—and tracked and tested their close contacts.

Dong Xuming—VCG/Getty Images

Chen said that the new policy acknowledges that China’s test and trace system may be overwhelmed by the influx of new cases.

“This is an important development, suggesting that China is moving towards more home testing and isolation rather than centralized quarantine in makeshift hospitals or hotels,” says Chen. Xi Chen, a public health professor at Yale University, says the introduction of RATs are a “step towards normalcy.”

There are additional signs that China’s pandemic response is changing, says Bouey. She noted that Chinese authorities have begun to prioritize care for severe cases and at-risk patients, rather than hospitalizing all mild and asymptomatic cases, and have increased calls for people to get vaccinated. China also reduced the at-home quarantine period for recovering patients from 14 to seven days.

“China is getting ready to switch the zero-tolerance policy to a more tolerant policy,” says Bouey. “China is expecting the worst and focusing on sustaining its health care system rather than the zero-case policy.”

Vaccines

Even with that shift underway, China may have no choice but to continue imposing lockdowns in the short term, experts say.

“In China, a large proportion of the elderly and those with underlying diseases are not fully vaccinated due to fear of the side effects,” Zhang writes. As of the beginning of March, China had fully vaccinated just over half of its elderly. “If widespread infection were to occur, there will be hell to pay,” Zhang writes.

VCG/Getty Images

Mainland Chinese officials don’t have to look far to see the consequences of an outbreak among a largely unvaccinated elderly population. Hong Kong, a Chinese territory of 7.4 million people, is battling the world’s deadliest outbreak of COVID-19. Omicron has killed thousands of unvaccinated elderly people after Hong Kong kept its population largely COVID-free until the start of this year, just like the mainland.

China’s intensive care units lack capacity compared with much of the rest of the world, with 3.6 beds per every 100,000 citizens compared with 25.8 in the U.S. The ICU shortage helps explain why Jilin—a city in northeastern China that has logged the majority of China’s new cases this week—is rapidly building temporary hospitals with tens of thousands of beds to house COVID patients.

For now, it remains unclear whether China’s new Omicron outbreaks will overwhelm its virus control measures. But the outbreak may prove a landmark moment in forcing China to change its COVID-19 strategy, even if it does so quietly.

“[The outbreak] won’t fundamentally alter the dynamic zero-COVID policy in the near term,” says Yale’s Chen. “[But the outbreak] is likely a major milestone that pushes authorities to ramp up vaccinations and optimize health care systems.”