Intended for healthcare professionals

Rapid response to:


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

Rapid Response:

Is it time to end China’s “zero covid” policy?

Dear Editor,

The recent outbreaks of covid-19 in various metropolitan areas of China has made the government that insists on "zero-covid policy" nervous again. Cities with tens of millions of citizens such as Shanghai and Beijing have been blocked on a large scale, and the basic life of urban residents has been greatly affected. The Chinese government displayed determination and capability by implementing lockdowns and large-scale testing at the beginning of the pandemic.

Under the Chinese government's insistence on a "zero covid" policy, many Chinese metropolises issued new guidelines to normalize nucleic acid testing, all tourists or residents are obligated to provide a negative nucleic acid test result taken within 48 hours to enter public facilities and use public transporters, the cost will be mostly covered by the public expenditure for healthcare.[1] According to the estimates on exsiting data, if all second-tier cities and above implement normalized nucleic acid testing, the annual cost will be about 1.7 trillion yuan (25.5 million dollars), accounting for 1.5% of China's nominal GDP and 8.7% of public revenue in 2021, more than the expenditures on public health, pension, and basic education services, which is an unaffordable burden on economic development for most countries. [2] Moreover, as the executors of control strategies, blind obedience to the “nucleic acid test first” of government leaders from all levels catastrophically disrupted access to healthcare services during the lockdown, children and the elderly died as several hospitals refused to treat them without nucleic acid test results, a pregnant woman lost unborn child because her covid test results were not up to date.[3]

Since the beginning of the pandemic in Wuhan, the Chinese government has insisted on the "zero-covid policy", and has promulgated regulations to ban the sale of a series of medicines including fever and cough medicines in order to prevent potential infected cases from masking their symptoms through self-medication. [4] The Chinese government is promoting its effective control of the epidemic, are they also aware of the obstacles that these measures pose for residents' daily lives? When almost all countries over the world are exploring models of coexistence with the coronavirus, we hope the Chinese government will also be touched.

As the executors of control strategies, government leaders from all levels will not seriously consider scientific evidence but bureaucratically continue to extend the period to reduce the probability of travelers with abnormal long incubation periods and new cases in the local area that may affect their political future. This strategy is a significant step backward in the era of evidence-based medicine. Implementing an epidemic prevention strategy that is not based on the best medical evidence, people's health, and the regular running of society and the economy but their personal political benefits. The strict implementation of the long-period quarantine policy without consideration and even continually increasing the length of the quarantine period has dramatically restricted the relationships between China and the rest of the world. Even within China's borders, such bureaucratic obstacles exist everywhere in the communication between the provinces and residential communities. A large part of China's vast price paid for strictly implementing the "zero covid" policy is unnecessary and only supports the bureaucracy.

Dong Qu[1], Zhong Huang[2,3], Zhi Qu[4]

Professional affiliations of the authors:
1 Institute of Legal Medicine, Hannover Medical School, 30625, Hannover, Germany
2 Institute of Neuroanatomy and Cell Biology, Hannover Medical School, 30623 Hannover, Germany
3 Center for Systems Neuroscience (ZSN) Hannover, 30559 Hannover, Germany
4 Institute of Epidemiology, Social Medicine, and Health System Research, Hannover Medical School, 30625, Hannover, Germany.

1 Chinese cities move to normalize nucleic acid testing, to achieve a balance between coronavirus control, economic growth - Global Times 2022. Available at: Accessed May 05, 2022.
2 东吴宏观:常态化核酸检测的经济账 2022. Accessed May 05, 2022.
3 (2022). ‘People are scared’: Xi’an residents struggle to find food and medical help. Financial Times, 8 January 2022. Available at: Accessed January 18, 2022.
4 Coronavirus: Chinese cities ban sale of fever and cough medicines in risky new strategy. The Telegraph. Available at: Accessed January 18, 2022.

Competing interests: No competing interests

19 May 2022
Dong Qu
Research Scientist
Zhong Huang, Zhi Qu