The Success of China's "Zero-COVID" Policy

"We've been locked up in our home for more than 40 days. We are short of everything, especially food."

"There are so many difficulties, I feel like crying just by mentioning them."

"We only eat naan and congee [flatbread and porridge]. There is no milk or vegetables."

Gulnazar, resident of Ili, Xinjiang region, China

"All supermarkets and small stores where you can buy groceries are closed."

"The online shopping platforms designated by the government are also having shortages and you cannot buy stuff or receive deliveries."

Guiyang resident posted on Weibo

Millions of migrant workers in Shanghai were unable to earn any income during the months-lockdown as China pursued a zero-Covid policy. Photograph: Aly Song/Reuters

 

China, the very place where the pandemic raised its head, remains fixated on a "zero COVID" policy, no exceptions and no complaints permitted. But there have been and continue to be plaintive messages posted on social media from people desperate for food and medical care. Tens of millions of people are once again under weeks-long coronavirus lockdowns. And they're there, locked into a now-too-familiar scenario of SARS-CoV-2 punishment they can do nothing about, while a meeting of the Communist party is set to begin. 

There will be no relief for these people hit with this misfortune until that key meeting has been concluded -- if then. By orders of Communist Party leader and President of the country, Xi Jinping; "zero COVID" must be maintained and protocols upholding that goal are not to be questioned. Localized outbreaks are kept from spreading through these lockdowns at a tremendous economic and psychological toll on a long-suffering population.

This is a momentous occasion for President XI as he prepares to launch a third five-year term in office in October, irrespective of the precedent of stepping down following two terms in executive office. So at least through that meeting, the 20th National Chinese Communist Party Congress is over, lockdowns are to continue. Some faint hope is offered that post-meeting some of the sweeping COVID controls may be rescinded.

Ili prefecture in northwestern Xinjiang region is where some of the most serious reports are emanating from. One woman who gives only one name, explains that local authorities locked their apartment door from the outside, opening it only when medical workers appear to perform coronavirus tests. Neighbourhood committees in some cities deliver free groceries to those in lockdown. But this woman says the neighbourhood committee where she is locked down offers only to sell food at higher-than-normal prices and even that not frequently enough.

 

Residents stand behind barricades in a sealed-off portion of Shanghai   Aly Song/Reuters

 

Online postings in Ili speak of an inability to take their sick children to hospital. Some post of the death of elderly family members during lockdown. Widely reported on Chinese social media leading the Ili government to apologize for problems in the lockdown response while also rejecting reports as mere rumours. Four people were punished with five to ten days' detention each for "spreading rumours" about the lockdown. Residents are warned to watch their words.

The official case count in the entire population would cause joy in any other country, but not China. A mere 949 locally transmitted cases were reported nationwide on Sunday, within an immense population of 1.4 billion people. Residents in lockdown are unable to work to sustain themselves through a regular income, ending up surviving on fast-disappearing savings. President Xi projects an image of himself as a populist leader who has declared elimination of poverty central to his administration.

In Guiyang where a lockdown in parts of the city commenced on September 5, a wildlife park published a public plea for food to keep its tigers, pandas and other wild animals from starvation. In Lhasa, the capital of occupied Tibet, parts of the city began locking down a month ago.  Shanghai's earlier months-long lockdown echoes what is occurring once again in parts of China. In Shanghai, supply chains were disrupted in the wealthy city, leaving residents begging for food, pleading for ill family members to be permitted to go to hospital.

Beijing maintains China is unable to halt lockdowns since a substantial number of the population, in particular the elderly who were not given priority status, remain unvaccinated. The country's refusal to import the most effective foreign vaccines against coronavirus, relying totally on domestic vaccines that provide much less immunity explains in part its predicament. Censorship and detentions aid the government in suppressing domestic criticism of its "zero COVID" policy.

Residents line up to register to get their routine COVID-19 throat swabs at a coronavirus testing site in Beijing, Monday, Sept. 5, 2022. (AP Photo/Andy Wong)

The Science of Disagreement

"Smoking causes cancer, the earth is round, and ordering people to stay at home ... decreases disease transmission."

"A study purporting to prove the opposite is almost certain to be fundamentally flawed."

Critique, Dr.Seth Flaxman, University of Oxford

"[A hands-off strategy could yield] hundreds of thousands of deaths."

"Suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members."

COVID-19 Response Team, Neil Ferguson, epidemiologist, Imperial College London, U.K.

"Johns Hopkins itself did not even put out a press release about this study, and if you look at the media coverage, it's one of the biggest stories in the world today, and yet certain media outlets have not even covered it."

Professor Martin Makary, Johns Hopkins

 

During the prolonged stay of the global pandemic most research carried out on COVID out of the highly respected Coronavirus Resource Center at Johns Hopkins University has been the work of medical scientists affiliated with the university's world renowned medical school. Not so the recently published study led by economists associated with the university drafted by three economists with the unaffiliated Krieger School of Arts and Sciences.

That study indicated that lockdowns were largely inefficient, costly and just barely effective in preventing COVID deaths by a marginal 0.2 percent. A conclusion viewed by some scientists as utterly outrageous; tinged with political ideology. The University of Oxford's lead author on a 2020 study, Seth Flaxman, points out, that study estimated lockdowns to have succeeded in saving up to three million lives across Europe.

The paper in question, a preprint meta-analysis of 34 previous studies focusing on examining the link between lockdowns and COVID mortality has led to the charge that the study downplayed the role of lockdowns in society's efforts to control infection by the coronavirus. A Thursday post published by the Science Media Centre, a non-profit located in the United Kingdom that functions as a conduit between scientists and the media, saw four prominent public health researchers agreed in their criticism of the 'flawed' study.

 

 

In engaging in their study the economists, led by Jonas Herby of Denmark, sought data on COVID     mortality exclusively, ignoring effects of pandemic strictures on other factors like hospitalizations or overall case rates. Any study based on forecasts to account for lives saved was excluded. A primary criticism of the Johns Hopkins latest study was that of defining 'lockdown' with a broad brush when it identified the term as "the imposition of at least one compulsory, non-pharmaceutical intervention".

A metric that painted any country whose only COVID stricture would be a five-day mandatory quarantine as being no different than a country deciding to utilize curfews and blanket closures on public venues. Another criticism was that the meta-analysis failed to account for lockdowns that may have arrested the rate of increase of deaths, if not the raw number of deaths, at all. 

"Many countries locked down before seeing exponential growth and therefore saw no reduction in deaths", noted Samir Bhatt, a statistician with Imperial College London, directly involved with the COVID-19 response in New York State. All three authors of the Johns Hopkins paper were reported in Forbes to reflect the "free market" inclination; one of whom, the lead author, works for the Center for Political Studies, in Copenhagen.

It has been so far only news outlets considered to be right-leaning, such as the Daily Mail, Fox News and the National Review that have to date cited the study, with mainstream media giving it no attention. Which led Professor of surgery Martin Makary, to accuse Johns Hopkins University, which employs him, of deliberately downplaying the study and its conclusions.

A mostly deserted street in Montreal during a Quebec-wide COVID lockdown, January 10, 2021. Photo by Graham Hughes/The Canadian Press/File

Pandemic Mortality Rate Reduction in Lockdowns

"[Global pandemic lockdowns prevented a mere 0.2 percent of COVID-19 deaths], not an effective way of reducing mortality rates during a pandemic."

"We find no evidence that lockdowns, school closures, border closures, and limiting gatherings have had a noticeable effect on COVID-19 mortality."

"[Given the] devastating effects [of lockdowns, they should be] rejected out of hand as a pandemic policy instrument."

"Researchers [in both Europe and the United States found lockdowns could be expected to bring mortality rates down by 02 percent] as compared to a COVID-19 policy based solely on recommendations."

Johns Hopkins University meta-study

"There are other elements of lockdown that should be considered ... hospital overload and general burden of disease, including the need for hospitalization in those who fall ill and long-term consequences for the infected."

"It made little sense to prevent young people from living normally because they are at very low risk of getting very sick, but have been very, very heavily hit by the impacts of lockdown."

Dr.Jennifer Grant, infectious diseases physician, University of British Columbia

In both Europe and the United States, researchers found that a lockdown could only be expected to bring down mortality rates by 0.2 per cent “as compared to a COVID-19 policy based solely on recommendations.” Photo by PETER J. THOMPSON/NATIONAL POST

 

The study the paper is based on represents a review of 34 pre-existing COVID-19 studies. The finding of a minimal impact on death rates related to the pandemic expedient of closing down society for prolonged periods of time made a difference in a country like Canada with a population of 38-million of 70 fewer fatalities due to the coronavirus. As for border closings, that measure was found to be even less effective; death rates diminishing roughly 0.1 percent.

Partial credit was given to policies shutting down 'non-essential' businesses, which the study concluded could bring COVID death rates down by up to 10 percent; the qualifier being that this would have been "likely to be related to the closing of bars". Studies where researchers found they had sufficient data to draw a link between lockdown policies and subsequent effect on COVID-19 fatalities formed the basis for the meta-analysis conclusions.

Restaurant closures and mask mandates saved lives, but closing spas resulted in no effect whatever. A July 2020 paper from The Lancet tallying up COVID-19 outcomes in the 50 hardest hit countries of the world was cited and compared to factors ranging from border closings to obesity rates, finding that 'full lockdowns' and 'rapid border closures' could reduce a country's case rate, but had not much effect on death rates.

Close to 83 studies were excluded from the study by the Johns Hopkins researchers who wanted only to study death rates; in the process discarding any study that examined the effect of lockdowns on hospitalizations or case rates. The researchers also omitted any study that evaluated lockdowns based primarily on 'forecasts' of anticipated deaths, absent controls for factors such as 'season' or 'behaviour' that might explain why death rates in Europe failed to reach the level virologists had predicted.

The new Johns Hopkins paper was produced by research economists and not by epidemiologists, unlike much of the research that has been media-cited. Steve Hanke, the lead author, is a senior fellow at the libertarian Cato Institute, a contributor to the National Review. It is not the sole or the first study to take the edge off the belief that lockdowns played a significant role in saving lives during the pandemic.

Published in the Proceedings of the National Academy of Sciences in April, a study determined that American 'shelter-in-place' orders "had no detectable health benefits". In that study, the conclusion was that the policy failed, resulting from Americans taking up social distancing protocols of their own sensible volition. If lockdowns were ineffective, wrote the Johns Hopkins researchers, "this should draw our focus to the role of voluntary behavioural changes".

While it will take years of research to come, for a complete picture of the destructive effects related to lockdown policies -- damage to mental health and spikes in cancer and overdose fatalities among them -- government-imposed lockdowns are known to have spurred one of the most expensive single events in economic decline in human history,

An empty restaurant in Lower Alsace Township, Pennsylvania amid the coronavirus pandemic. (Photo by Ben Hasty/MediaNews Group/Reading Eagle via Getty Images)

Confronting Delta in New Zealand

"At the moment, it's not totally beyond hope that New Zealand could control its new cluster, but the odds are against it"

"In a very short space of time, they could be trying to slow the spread and flatten the curve just as Britain was more than a year ago."

"All power to New Zealand for keeping deaths so low, but the issue is that if your policy fails and you haven't got anything else in place, it will be as bad as if you had let it rip right from the start. New Zealand could find all the sacrifices of the past year wasted if they do not get their population immunized quickly enough."

Paul Hunter, professor of health protection, University of East Anglia

"The government is realizing it can't go another year without opening up, but it can't do that without a high level of vaccination and societal license."

"It's a lot easier to lock down than to open up."

"Meanwhile, the tech sector is crying out for high quality labour that can't get into the country, and the hospitality sector is crying out for imported labour. These sectors are hurting and they can't take advantage of New Zealand's position."

Sir Peter Gluckman, former chief scientific adviser, director of the Koi tu Centre for Informed Studies, New Zealand

"Early on in the outbreak, New Zealand was a great example of how you could deal with the virus through lockdowns and social distancing."

"We have to accept that now we've moved on from that. It's incredibly difficult to secure your borders forever, and the only thing New Zealand is left with is vaccination, otherwise they are pretty much fighting a losing battle because you are always going to have the virus knocking on your door."

Professor Jonathan Ball, expert on emerging viruses, University of Nottingham

Wellington, New Zealand, during lockdown last week. Credit...Hagen Hopkins/Getty Images

New Zealand, as of a number of countries able to defend themselves from the onslaught of the SARS-CoV-2 virus that causes COVID-19, because like them, it represented a castle with a watery moat surrounding it for defence purposes, cloistered itself from the potential of infection from outsiders, with closed borders. There was no emphasis on inoculating its population against the infectious virus, only keeping it at bay, until presumably, it would 'give up' and 'go away'. But it never did, and was highly unlikely to do so, in its ongoing revisiting of previously successful countries suddenly assailed by a more virulent strain of what they had previously evaded.

So few New Zealanders have been vaccinated against COVID, an estimated 80 percent, not inoculated, are now vulnerable to the hugely infectious Delta strain doing its geographic rounds and successfully leaving an island nation suddenly finding itself confronting the variant. There is no demographic which had been naturally exposed to COVID with useful antibodies against re-infection, much less the greater numbers susceptible to infection, never vaccinated. The island has become a proverbial sitting duck.

Scientific circles now look in on the dilemma facing the country with the plunging popularity of its Prime Minister, Jacinda Ardern, now on the horns of a predictable dilemma. So confident in locking away the island from outside infection it was thought by the country's medical authorities that there would be no need to inoculate the public against a virus whose presence would be receding. Only, of course, that's not what happened; the virus has come roaring back in a more infectious variant.

Ardern saw no help for it but to once again re-impose another lockdown; no longer is New Zealand     COVID-free. Not that it has yet been completely overrun with cases, they're still in low numbers albeit rapidly advancing. Yet on the other hand, to remain in isolation is to ensure that its declining economy has nowhere else to go but down, and yet further down, its surpluses enjoyed in the years before COVID now a dim memory.

In its favour still, is that it is an island with natural protection afforded by surrounding seas, that it is  relatively sparsely populated, that a start has been made on inoculation, with confidence that by the end of December the majority of New Zealanders will have been vaccinated. The concern remains, however, that despite its tiny death toll resulting from the past year-and-a-half's protective measures the future may reveal some unexpected turns with deaths in the thousands reflecting its over-reliance on isolation and lack of focus on vaccination.

New Zealand is grappling with increasing COVID infections   Getty Images

The Children Are Not All Right

"Kids are not doing well. This is really taking its toll."

"They spend 24/7 in their bedrooms. They are not getting out of bed. Even when schools open up, they have no motivation."

"They are so far behind, they can't even bring themselves to go to school." 

"These kids are on a downhill trajectory."

Dr.Jane Liddle, pediatrician, Ottawa Community Pediatricians Network

"[Closing schools might have been the right response to the pandemic], but it is having some pretty big implications on the pediatric situation on a daily basis."

"All of us are seeing an increased referral volume from family physicians [for eating disorders] that is out of proportion to what we typically would see."

Dr.Kelley Zwicker, founder, Ottawa Community Pediatricians Network

"We are the doorkeepers. We are the ones who keep children from coming to CHEO [Children's Hospital of Eastern Ontario]."

"What CHEO is seeing is the tip of the iceberg in terms of what we see in our practices."

"In a situation where everything is taken away, including the routine of school, this makes very much sense that these children who see a complete loss of control concentrate on the one thing they can do [refuse food or eat too much food]."

Dr.Andrzej Rochowski, chief of pediatrics, Queensway Carleton Hospital

Discipline, purpose, opportunities for physical exertion, playtimes, school routines, exposure to other children in their peer group, casual decision-making, have all been extracted from the daily lives of children living under the new life-rules of COVID-inspired restrictions. Parents are pressed to expose their children to opportunities for learning, at a time when the home has become the learning centre, with the closure of public and private schools as part of an effort to maintain distancing to tamp down rising numbers of COVID cases and more infectious transmission with the presence of new variant strains.

Children are now increasingly exhibiting symptoms of mental disturbance in the most troubling of ways, going from puzzlement to reaction and graduating to severe mental health crises. Some children have been left feeling suicidal, suffering from major depression and extreme anxiety. Their world has been overturned and nothing is the same as it always has been. An exponential rise in young patients presenting with clear signs of increasing mental disturbance has alarmed area pediatricians, and what they are experiencing is obviously occurring everywhere that COVID has locked down entire communities.

Medical professionals belonging to the recently-inaugurated Ottawa Community Pediatricians Network are raising the alarm over frightening levels of mental and physical illness being seen among children and teens in reaction to a pandemic stretching into its second year of disrupting daily life. Their concerns are not only for the current situation which appears to be growing in the numbers of children presenting for care, but for the prospect of what lies ahead as the situation continues to grow.

 

Children in a playground outside Hastings Elementary School in Vancouver. Anxiety, depression, behavioural issues and post-traumatic stress could become far more common in children both during the pandemic and in its aftermath, the research review found. (Ben Nelms/CBC)

 

When the schools are opened, children find support in the presence of others like themselves. When they close, during lockdowns occasioned by the upward swings of coronavirus cases, physicians start seeing growing numbers of patients, as mental health disorders begin to surge. Some of these doctors specialize in caring for patients under the age of six. Doctors are witnessing alarming signs of poor mental health, including anxiety and clinical depression in five-year-olds.

In some of these children body mass index has rapidly increased, partially as a result of the children spending so much more time at home and parked in front of computer screens. Many of these children have completely lost any interest in schools, and have no wish to return when they do re-open for in-person classes. The concern over their academics, over eating disorders which have rapidly increased during the pandemic is shared by family, family physicians and the specialists these ailing children are referred to.

 

A volunteer takes a call at the Crisis Centre B.C office in Vancouver. (Ben Nelms/CBC)

 

The Children's Hospital of Eastern Ontario reports a fifty percent increase in emergency assessments for eating disorders, pandemic-induced, even while community pediatricians see many more cases, not yet admitted to hospital. Some of these children presenting with eating disorders represent a much younger cohort than seen in the past, becoming sicker more quickly than in the past. Food is something youth and children feel they can control, explains Dr.Rochowski, reflecting the dangerous spike in severe eating disorders seen now nation-wide.

 

The group of pediatricians have in mind the need to dispel a prevailing attitude that children have not and will not be severely affected by the fallout of the pandemic. "There has been a false sense of security that kids were going to be fine out of this. Kids are not fine", stressed Dr.Liddle. All of the doctors concerned agree that the detrimental effects of the pandemic will be seen for months and years into the future, for the children so badly affected.

Often, children will present signs of mental illness in ways that are not quite the same as adults. You may observe changes in behaviour, mood, sleep patterns, appetite and/or interactions with others that are having a negative effect on your child’s day to day activities. It is important to seek help.

Is your child experiencing any of these?

• Extreme outbursts or excessive mood swings
• Worrying so much that they are getting stomach aches or headaches
• Persistent nightmares and a lack of sleep that are affecting your child’s day
• Avoiding formerly enjoyable activities, including spending time with friends
• Unusually quiet, sad or reserved, preoccupied
• Change in appetite – eating considerably less, or more.

CMHO Family Health Centre