Intended for healthcare professionals


Covid-19: WHO chief calls for a shift in China’s “unsustainable” policy

BMJ 2022; 377 doi: (Published 13 May 2022) Cite this as: BMJ 2022;377:o1199
  1. Luke Taylor
  1. Bogota

China’s pandemic restrictions have become unfeasible and require a rethink, the World Health Organization’s director general Tedros Adhanom Ghebreyesus said in a rare criticism of the country’s zero covid policy.

Experts have questioned China’s uncompromising public health restrictions, saying they are harmful to the economy and health while likely incapable of containing the infectious omicron variant.1 It is the first time that senior WHO officials have voiced such an opinion.

“We don’t think that it is sustainable, considering the behaviour of the virus now and what we anticipate in the future,” Tedros said at a WHO press briefing on 10 May. A “shift in approach would be very important,” he said.

China has ramped up restrictions in Shanghai in the past month in an effort to reign in a covid-19 outbreak.

Millions of people are under stay-at-home orders, those with suspected infections have been sent to quarantine centres, and housing compounds have been evacuated for disinfection. In some cases local authorities erected fences and installed alarms outside communities with confirmed infections to prevent residents from going outside.2

Shortages of food and medicine in the city of 25 million caused by the restrictions have drawn public criticism and there have been reports of people dying from non-covid causes as they cannot access their usual medicines.34

Shortages of chemicals that are made in China and used in imaging tests are being felt as far away as New York. The Greater New York Hospital Association said in a statement on 4 May that although the factory in Shanghai that makes the chemical widely used in scanners was now operating again, image tests should be rationed and other suppliers sought, Bloomberg reported.5

The restrictions in China do appear to be curtailing infections. Shanghai authorities reported 1487 new covid-19 cases on 10 May, down from 3014 on the previous day, and more than 25 000 when the outbreak peaked in mid-April.6

Crucially, none of the cases recorded on 10 May were detected outside of quarantine, said authorities.6

The Chinese government has refused to relax public health restrictions until there are no community infections for three consecutive days.7 More than 1000 daily infections were detected outside of quarantine centres in mid-April.

Cases are also declining in Beijing, where mass testing was deployed in the hope of averting the need for a city-wide lockdown. Local authorities reported 37 cases for 10 May, down from 74 a day earlier.

There are no signs yet of China relaxing other restrictions, such as reopening its borders, despite much of the rest of the world gradually relaxing public health measures over the past year.

Chinese foreign ministry spokesperson Zhao Lijian hit back at Tedros on 11 May, asking the director general to “refrain from making irresponsible remarks.” Chinese censors erased discussion of Tedros’s comments from social media, the Financial Times reported.8

Warning over deaths

If China is to move away from its zero covid policy it should gradually reduce restrictions and focus on protecting the most vulnerable, said authors of a study published in Nature Medicine.9

Relaxing all restrictions would overwhelm intensive care units and lead to an estimated 1.55 million deaths, the researchers at Shanghai’s Fudan University predicted.

Using data from the 2022 omicron outbreak in Shanghai while taking into account vaccine coverage, vaccine efficacy, waning immunity, antiviral therapies, and non-pharmaceutical interventions, the researchers modelled infections across the country in different scenarios.

“The level of immunity induced by the March 2022 vaccination campaign would be insufficient to prevent an omicron wave that would result in exceeding critical care capacity,” the authors concluded.

At their peak the infections in a no-restrictions scenario would cause 112.2 million symptomatic cases and 5.1 million hospital admissions, which would exceed intensive care unit capacity by more than 15 times, they predicted.

Three quarters of deaths would occur among those aged 60 and older or those who aren’t yet vaccinated, the researchers said. Ensuring the most vulnerable have access to vaccines and antiviral therapies while maintaining the implementation of non-pharmaceutical interventions could prevent the healthcare system from collapsing, the authors added, suggesting that the Chinese government should focus on protecting the elderly if it opts to wind down restrictions.

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