Intended for healthcare professionals


Covid-19: Lockdowns spread in China as omicron tests “zero covid” strategy

BMJ 2022; 376 doi: (Published 31 March 2022) Cite this as: BMJ 2022;376:o859
  1. Owen Dyer
  1. Montreal

The force of the omicron BA.2 variant this week met the immovable object that is China’s zero covid policy as Shanghai locked down amid the country’s worst outbreak since early 2020. World oil prices fell and Indian drug manufacturers warned of ingredient shortages as the city responsible for 4% of China’s gross domestic product posted record case numbers on 30 March.

About 9 million residents of Pudong, the eastern half of Shanghai, have been locked down since 28 March. Bridges across the Huangpu River are closed. On the other bank, roughly 15 million people in the west of the city, centred around Puxi, were to begin a lockdown on 1 April as Pudong reopened. But many western districts were locked down two days early as city authorities released figures showing a continued steep rise in cases.

In Puxi, a robot patrolled the streets, announcing the new schedule. In Pudong, residents were warned that drones with facial recognition technology would identify those illegally outdoors. A new lockdown was also imposed on 30 March in Xuzhou, a city of three million in Jiangsu province.

Shanghai reported a record 5962 new cases on 30 March, including 326 that were symptomatic, up from 4477 new cases the day before, of which 96 were symptomatic, detected through universal testing. The purpose of the two stage lockdown is to test everyone in the city, with over 8 million tests administered on the first day. China cites this testing policy as one reason why it reports only symptomatic cases as “confirmed cases” to the World Health Organization. Hence global covid tracking websites were only reporting 1629 new cases across the country on 30 March.

In Pudong, several financial firms summoned their workers to spend the lockdown in an office bubble, sleeping at their workplace. In west Shanghai, residents scrambled to buy food as their lockdown was brought forward. Supermarket prices have soared despite a city government promise to control them.

Fears of food shortages during lockdown have risen sharply in China since earlier this month when Jilin City, in the country’s north east, failed to follow through on a promise to deliver vegetables to all locked down residents. Jilin’s mayor was dismissed earlier this month, and this week the city’s deputy Communist Party secretary, Liu Renyuan, said that the party was “particularly anxious and angry about this, and we express our deep apologies to the public.”

Under China’s “dynamic clearance” policy, exposed contacts who test negative may isolate at home, but all who test positive must isolate at central quarantine centres or hospitals. China announced on 30 March that 82 new temporary hospitals are being built, up from 33 announced last week.

At one temporary quarantine centre, the Shanghai World Expo Centre, a video circulating on Chinese social media showed an angry crowd confronting a hazmat suited worker. “There’s repeated cross-infection here,” complained one resident.

A new temporary hospital at Jilin City admitted its own construction workers as 90 of the 160 member crew contracted the virus. State media interviewed angry Jilin residents and criticised the response of the city and province, where 24 million people remain locked down or unable to travel.

China’s current wave remains tiny by international standards, with only two deaths reported so far this year. Even if China were reporting its asymptomatic cases internationally, it would have under three cases for each 100 000 people a day over the past week compared with 128 cases for 100 000 people a day in Hong Kong, where the zero covid strategy has broken down, or 672 of 100 000 in South Korea, which has no zero covid strategy.

Hong Kong hospitals overwhelmed

Cases are now falling in South Korea and Hong Kong and, despite Shanghai’s surge, across China overall. Hong Kong has experienced a brutal two months, encapsulated by a photo from a Hong Kong covid ward that showed corpses in body bags stored between living patients on ventilators, for lack of space.1

Seven weeks ago, Hong Kong’s pandemic toll had stood unchanged for six months at 213 deaths. Now it stands at 7706 deaths, more lives lost than in China, which has nearly 200 times its population. Hong Kong’s official case fatality rate this month was among the highest in the world, reaching 12% in unvaccinated people aged over 80.

Hong Kong University’s modelling unit concluded that most recent cases went undetected, and that about two thirds of the population have been or will be infected in the current wave.2 Hong Kong is 76.7% fully vaccinated, compared with 87.9% in mainland China.

An opening for traditional medicine

The halting reaction of Hong Kong’s semi-autonomous city government, which considered but rejected a lockdown, has opened the door to tighter control from Beijing. The central government has stepped in with advice, temporary hospitals, and traditional Chinese medicine.

“Anti-epidemic packages” sent from the mainland this week include test kits, masks, and pills of the herb Lianhua Qingwen, which has been widely traded online after Chinese state media claimed it offers protection against covid. Several other countries’ regulators have warned that there is no evidence of such benefit. Chinese students abroad received similar packages in 2020, part of the government’s drive to promote traditional Chinese medicine.

This week Hong Kong’s chief executive Carrie Lam introduced a team of traditional Chinese medicine experts sent from the mainland to advise Hong Kong on the treatment of covid patients. “Chinese medicine can also be applied to infection prevention and help speed up the recovery process,” she said.

Traditional Chinese medicine will play a larger role in Hong Kong’s future, said Lam, arguing that the public hospital system’s embrace of western medicine had constrained development in the field.

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