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Covid-19: Protests against lockdowns in China reignite amid crackdown

BMJ 2022; 379 doi: (Published 30 November 2022) Cite this as: BMJ 2022;379:o2896
  1. Owen Dyer
  1. Montreal

The Chinese government has been struggling to quell protests against lockdowns throughout the country that have exposed the growing strain on its “zero covid” policy in the face of increasingly contagious variants.

Police in seven Chinese cities flooded the sites of recent demonstrations on the morning of 29 November, and university students were sent home. But by the evening there were renewed reports of unrest, as social media videos showed police and protesters facing off in the large southern city of Guangzhou.

The police were seen advancing down the street in hazmat suits, with riot shields raised against a barrage of thrown objects as they entered the district of Haizhu, a covid hotspot that has been largely locked down since late October.

At the People’s Square station in Shanghai on 29 November police were checking pedestrians’ phones for virtual private networks, which are illegal in China, and for messaging apps such as Telegram, which have been used to organise protests. In Hangzhou the central square that had drawn thousands over the weekend was instead occupied by police.

The weekend vigil was held to commemorate 10 residents of an apartment block in Urumqi, Xinjiang province, who died in a blaze on 24 October. Angry neighbours poured into the streets the next day, many blaming pandemic restrictions for the victims’ inability to escape and the slow response of fire services.

The events in Urumqi unleashed a storm of online criticism, briefly overwhelming China’s censors. Protesters poured into the streets around the country this weekend, calling for an end to harsh covid restrictions and, in some cases, for free elections and the resignation of President Xi.

“Unsustainable” approach

Earlier this month China’s government announced “20 measures” aimed at softening its zero covid approach. The quarantine period for suspected disease contacts was cut, and the dependence on centralised quarantine was reduced in favour of isolating at home. Authorities’ insistence on transporting contacts to quarantine centres, often over long distances at night, came under fire in September after a bus crash killed 27 people bound for such a centre.

Instead of the planned relaxation, however, many local authorities have tightened restrictions over the past fortnight as cases have surged in what is effectively China’s third wave. From about 500 new cases a day at the beginning of November, new daily cases passed 40 000 for the first time on 27 September, reaching 40 347. On 30 November authorities reported 37 828 new cases, down slightly for the second day in a row, although cases in Beijing continued to climb.

Few experts believe that China can hold off mass infection indefinitely. The zero covid approach has been extraordinarily effective at keeping case numbers down in comparison with the rest of the world. China’s 9.6 million total cases to date equate to a per capita infection rate just one 50th that of the United States. But, as a result, China’s population has almost no natural immunity.

The US government officially joined the ranks of doubters this week. “We think it’s going to be very difficult for the People’s Republic of China to be able to contain this virus through their zero covid strategy,” said President Biden’s National Security Council in an unusual statement. And the US infectious disease expert Anthony Fauci told NBC’s Meet the Press that the Chinese policy was “unsustainable” because the lockdowns had been pursued with no “endgame” in view.

In May China accused the World Health Organization’s director general, Tedros Adhanom Ghebreyesus, of making “irresponsible remarks” after he called the zero covid policy “not sustainable.”

China has refused to import foreign mRNA vaccines, preferring domestically produced but less effective shots. It prioritised vaccinating people of working age and has since struggled to achieve strong coverage among elderly people.

Amid a renewed booster campaign relying partly on a new inhaled vaccine, the government announced on 29 November that 66% of people aged over 80 have received a third vaccine dose, up from 40% on 11 November. But many of those 40% received their booster more than six months ago, and the protective effect by now will be negligible.

China is developing its own mRNA vaccines, with 10 candidates in the pipeline, but the earliest phase 3 trial results are not expected until next May.

“One option for China is to embark on an energetic supplementary vaccination programme using more effective, imported vaccines,” said Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh. “But there is inevitably a political dimension to any country’s covid response, so this may not happen. If it doesn’t happen then it is hard to see how the cycle of virus incursions and lockdowns will end for many months and quite possibly years.”

Few ICU beds

Another worry is the shortage of intensive care beds, which number only four per 100 000 population. China is belatedly scrambling to add capacity, but official anxiety was palpable in a recent frontpage editorial in the People’s Daily, which acknowledged that China’s health system “currently has far fewer ICU beds than those of other developed countries.”

The editorial page, widely considered to be the direct voice of the government, cited a Bloomberg analysis that had found that a full reopening could lead to 5.8 million Chinese people needing intensive care, in a country with only 57 000 intensive care beds.1 The party newspaper relayed a warning from the pharmaceuticals analyst Sam Fazeli that “there’s no way an uncontrolled wave of infections can be managed.”

China watchers continue to scan state media for signs of a shift to a middle course that would seek to keep infections at a manageable level while allowing natural immunity to build. The government is acutely aware of the public anger at lockdowns—this week it was censoring footage of unmasked football fans in Qatar—and is also facing a record slump in economic growth this year.

On the ground, there are signs of a looser approach. Residents in several cities said on social media that local governments had ended lockdowns early after the weekend’s protests. The People’s Daily reminded overzealous local officials that only counties and higher authorities may impose controls. Beijing city authorities ordered an end to the barricading of residents in apartment blocks, a practice blamed by some for the deaths in the Urumqi fire.

But on 29 November the newspaper said that recent adjustments should be seen only as fine tuning. The zero covid policy, it said, was the work of President Xi, had “withstood the test of practice,” and would be “unswervingly implemented.”

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