Hot Topics: What comes next after China eased zero-Covid policy? Public health experts, past experiences give a peak

China began relaxing some of its strict pandemic control restrictions in mid-November, but this has triggered confusion and anxiety among the public. Many welcomed the recent measures but were also worried about infection.

The relaxed steps include allowing those with no or mild symptoms of Covid-19 to be quarantined at home instead of at designated facilities. Chinese health authorities have stopped reporting asymptomatic cases.

China’s international borders remain largely closed. But it has lowered the quarantine time for international arrivals from seven to five days at a designated location, followed by three days of isolation at their place of residence. People travelling across Chinese regions are no longer checked for negative Covid-19 status.

But after the central government’s easing-up messages, local authorities have taken different approaches. This has resulted in inconsistency and rapid changes.

Entry into some public spaces no longer requires a negative test result on a smartphone app. However, in Beijing, some places, including restaurants, still require a negative test result issued within the past 48 hours.

But authorities seem to have stopped tracing positive cases. Some testing sites put up notices saying, “When your test results do not come out, do not make inquiries.”

Since those with mild symptoms can isolate at home, items such as cough medicines were sold out at some pharmacies, and online sales required one month for delivery. Officials have pledged to deal with issues quickly.

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Public health experts have urged China to establish a more transparent communication mechanism and provide the public with a clear road map for an exit strategy. Experts worry about how quickly the country is opening up, since only about 40 per cent of people aged 80 years or older had received a booster dose by last month.

The easing followed rare nationwide protests against lockdowns and other severe restrictions in late November. Since the start of the protests, China has increasingly called for “optimised” antivirus measures. It has stressed that the harmfulness of the Omicron variant is weakening.

China previously emphasised the early detection of infections through mass screenings. But it became difficult to maintain the testing regime due to mounting costs and a lack of manpower amid a recent surge in Covid cases. The size of the outbreaks is unclear now that intensive PCR testing is no longer required.

Kyodo, Agence France-Presse and staff writers

Question prompts:

• Why has the easing of Covid restrictions triggered “confusion and anxiety among the public”?

• To what extent do you agree with the relaxed rules mentioned in Context? Explain using your own knowledge.

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Question prompts:

• Describe the “Covid Roadmap” depicted in this cartoon. What is strange about how the people are wearing their face masks?

• Using Context, explain what this cartoon might symbolise.

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• A top epidemiologist cautions that the new Covid rules will put China to the test as cases rise

• Country’s healthcare system may not be prepared to deal with the outbreak that is surging

One of China’s top epidemiologists, Zhong Nanshan, warned of a surge in Covid-19 cases as the government abandons its hardline coronavirus strategy. He told state media in an interview published on December 11 that the Omicron strain of the virus prevalent in the country was highly transmissible.

“Currently, the epidemic in China is ... spreading rapidly, and under such circumstances, no matter how strong the prevention and control is, it will be difficult to completely cut off the transmission chain,” said Zhong, a leading adviser to the government throughout the pandemic.

On December 11, 22,000 patients visited Beijing’s fever clinics, 16 times more than a week earlier, said Li Ang, spokesperson for the Beijing Municipal Health Commission last Monday. Pharmacies are low on medicine and delivery drivers are falling sick, meaning residents are struggling to purchase daily necessities.

China is facing a surge of cases it is ill-prepared to handle, with millions of elderly still not fully vaccinated and underfunded hospitals lacking the capacity to take on huge numbers of patients. The country has one intensive care unit bed for 10,000 people, Jiao Yahui, director of the Department of Medical Affairs at the National Health Commission, warned early this month.

She said 106,000 doctors and 177,700 nurses would be redirected to intensive care units to cope with the spike in coronavirus patients, but did not offer details on how this would affect the health system’s ability to treat other diseases. Whether those from second or third-tier cities and in rural areas can even access these resources remains a concern for the government.

Catherine Bennett, inaugural epidemiology chair at Deakin University in Australia, said that based on other countries that eased pandemic restrictions, the first wave after reopening could hit hard.

“We do expect high infection rates as the virus first starts to circulate widely in the community,” she said.

“The transition as people begin to build immunity from both vaccination and infection will have a higher rate of serious illness initially, with most countries showing higher hospitalisation rates in the first wave, with it reducing afterwards.”

Agence France-Presse and staff writers

Question prompts:

• Based on News, conclude TWO problems China faces as Covid cases surge.

• Why does Catherine Bennett say that this first wave of Covid-19 cases after easing restrictions in China could “hit hard”?

Top China expert says the virus ‘spreading rapidly’ after easing of zero-Covid

• Experts are using Hong Kong data as a model for the mainland due to similar elderly vaccination situation

• Low booster rates among older people in a vast population yet to develop hybrid immunity have sparked forecasts of over 1 million deaths

As China eases its zero-Covid policy, models suggest over a million elderly people could die if a huge Covid-19 wave hits the country, overwhelming the health system.

Experts are basing their forecasts on Hong Kong data, as the city’s situation about a year ago was similar to the current status in mainland China. It is helping scientists to gauge the protection offered by inactivated vaccines, the kind received by most of the mainland population.

When a deadly fifth wave of Covid-19 hit Hong Kong last February, it had relatively low vaccination coverage for those aged 80 and above, and there were millions of people who had never been exposed to Covid-19.

Similar conditions are causing worries about the mainland, with Omicron and its subvariants spreading quickly and only 40 per cent of those above 80 having received booster shots.

Kwok Kin-on, assistant professor at the Chinese University of Hong Kong’s School of Public Health, cited Hong Kong data from January to August for people aged 60 and above. It showed the case fatality rate for those who had received three doses of the inactivated vaccine Sinovac was 0.21 per cent. The outcome for recipients of three shots of the BioNTech mRNA vaccine was better, at 0.01 per cent. China has yet to approve any mRNA or imported vaccines for its own citizens.

“Even in the best-case scenario, even if China manages to give all its elderly a third shot within a short time, two among 1,000 confirmed cases above 60 years of age could still die,” he warned. He added it was crucial to target the elderly by vaccinating care home staff and household members to create a safer setting for aged residents.

University of Hong Kong virologist Jin Dongyan said the availability of antivirals like Paxlovid could put mainland China in a better position than Hong Kong earlier this year.

“China is in a better position because there is a better road map for the use of Paxlovid ... The government should design an effective mechanism for distributing Paxlovid to those who need it,” Jin said.

Staff writer

Question prompts:

• Based on Issue, what are TWO similarities and TWO differences between Hong Kong’s experience during its fifth wave and mainland China’s current situation? Explain why these similarities and differences are important.

• Using Context, News and Issue, identify and explain THREE steps China should take to safely transition out of its zero-Covid policy.

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Context:

• Why has the easing of Covid restrictions triggered “confusion and anxiety among the public”? It is confusing because there has not been clear communication and consistent implementation among local authorities in China. People are anxious because the country is opening up quickly even though only about 40 per cent of people aged 80 years or older had received a booster dose by last month

• To what extent do you agree with the relaxed rules mentioned in Context? Explain using your own knowledge. I agree with some of the relaxed rules, for example allowing people to quarantine at home, but I believe individuals travelling across Chinese regions should still be checked for Covid-19 to minimise the spread of the virus between these places, especially since the country is currently experiencing a surge in cases.

Cartoon:

• Describe the “Covid Roadmap” depicted in this cartoon. What is strange about how the people are wearing their face masks? The “Covid Roadmap” winds in circles and seems to lead nowhere. People are wearing their masks over their eyes instead of over their mouths.

• Using Context, explain what this cartoon might symbolise. It might symbolise the confusion over how China has eased its zero-Covid policy. They have a face mask over their head to show their confusion. This symbolises the Chinese government’s lack of clear guidelines regarding how it will safely transition from its previous restrictions.

News:

• Based on News, conclude TWO problems China faces as Covid cases surge. China’s healthcare system will struggle to handle the surge in Covid cases because there is only one intensive care unit bed for 10,000 people; those who are isolating at home will struggle to get the basic medicine and food they need because pharmacies are low on medicine and delivery drivers are falling sick.

• Why does Catherine Bennett say that this first wave of Covid-19 cases after easing restrictions in China could “hit hard”? Evidence from similar situations in other countries show that many people will have serious symptoms as the virus circulates widely in the community for the first time.

Issue:

• Based on Issue, what are TWO similarities and TWO differences between Hong Kong’s experience during its fifth wave and mainland China’s current situation? Explain why these similarities and differences are important. Two similarities include relatively low vaccination coverage for the elderly and strict social distancing restrictions that meant millions of people had never been exposed to Covid-19. These are important because they give a glimpse into what could happen as cases surge in the mainland. One difference is that Hong Kong residents had access to mRNA vaccines in addition to inactivated vaccines, while mainland citizens do not. Another is that China has access to a better road map for how antiviral drugs can help treat serious Covid symptoms. These differences are important because they show what the Chinese government needs to do if it wants to protect its people.

• Using Context, News and Issue, identify and explain THREE steps China should take to safely transition out of its zero-Covid policy. The Chinese government should approve mRNA vaccines for use and inoculate the most vulnerable segment of the population, the elderly, with booster shots. / It must also ensure sufficient healthcare facilities and personnel are in place, especially in second and third-tier cities and rural areas. / It needs to store up Paxlovid and other antiviral drugs and create a plan to distribute them where they are needed most. / Authorities should order more over-the-counter medicine and rapid test kits to help those with mild cases isolating at home. (any THREE, accept all reasonable answers)