China has abandoned zero-Covid. What happens now?

China is opening rapidly after years of a “zero-Covid” policy, with strict lockdowns, mandatory testing, and major travel bans. But the major policy change could lead to further complications in China as people resume international travel, and geopolitically as a patchwork of countries impose restrictions on Chinese air travelers.

USA, UK, Italy, India, Israel, Spain, Canada, South Korea, and France all implemented some restrictions on air travel from China; which usually means that passengers entering China and going to one of these countries cannot board without a negative test, or, in the case of Spain, without being vaccinated. But policy on infectious diseases is difficult to implement without accurate data on caseloads, hospitalizations, and deaths, which China has failed to collect and disseminate since zero-Covid returns the end of December.

It is much too early to say exactly what the effect of the policy change will be will have; although China appears to be experiencing a major wave of infections right now, which has not yet translated into major infections outside the country. But since China’s air travel has not experienced such waves, it may be more susceptible to infection.

What’s more, there is no good scientific evidence to back up travel restrictions; “We have seen many times with this pandemic that the patchwork response, national or global, does not contain the disease,” said Saskia Popescu, assistant professor in the biodefense program at the Schar School of Policy and Government at George Mason. University, told Vox via email. “In addition, travel bans and testing requirements are ineffective because they ignore porous borders, the reality of disease transmission, and are reactive rather than preventive.”

China is reversing Xi Jinping’s zero-Covid policy, and cases are on the rise

Chinese President Xi Jinping lifted restrictions on his signature policy after widespread protests against the strict lockdown and mandatory testing that began in November. Although Xi’s government had announced a 20-point plan to ease the ban earlier this month, the protests, some of which have called for Xi to step down, appear to have accelerated Xi’s policies.

Draconian lockdowns, especially in Shanghai, at FoxConn’s iPhone factory in Zhengzhou, and in Urumqi, Xinjiang, have reportedly left people without access to food, and many in Xinjiang believe zero-Covid is there, banning people from leaving their apartments, preventing emergency workers to help people who were locked in their homes during the fire in the Urumqi apartment building.

That month, a set of policies Xi once said “put people and their lives above all else,” quickly collapsed, prompting a surge in cases and straining the health care system.

“I think we have to worry about what’s happening in China – for the Chinese people,” Andrew Pollard, chairman of the UK’s Joint Committee on Vaccination and Immunisation, told BBC News Hour on Saturday. “In that country, there’s a lot of Covid circulating now, the omicron variant is there, and it’s very widespread among people. And they’ve never had a wave of Covid before… so we expect a lot of infections to happen.

Officially, China has recorded more than 5,000 deaths from Covid-19 since the pandemic began, which Pollard admits includes only those who died from the disease without other underlying conditions. But the number could be higher, he said, if such cases were included, and could rise as the disease spreads, especially among the elderly who are less vaccinated.

Now, reports coming out of China show the hospital system is suffering from an increase in Covid-19 cases, as well as crematoriums and funeral homes that are experiencing high death tolls.

Killing zero-Covid is, as Victor Shih, a Chinese political expert at the UC San Diego School of Global Policy and Strategy told the New Yorker’s Isaac Chotiner, likely a complex decision driven by economic and labor issues at home as well as public discontent. and protests. But Xi will have to contend with his decision – both the draconian lockdown he imposed and has been in place for three years, and the potential wave of Covid-19 infections and deaths that will soon reopen China. The fallout, Shih said, could mean more of the protests seen in November, and could increase skepticism about China’s economic model and government, from inside and outside China.

“Some serious damage was done to public confidence,” John Delury, a China expert at Seoul’s Yonsei University, told the Financial Times. “We may not see the immediate effects of that. But it will be the general calculus of how his government will fare. This is the worst start to Xi’s third term.

The world is better prepared to handle Covid-19, but there are still many unknowns

The end of covid-Zero also means the end of disease surveillance at the national level. As Yang Zhang, professor of Chinese sociology and politics at American University tweeted in December about the tracking of Covid-19 cases in China“I don’t think the Chinese state has the capacity to collect, model, and assess provincial/municipal infection data on a daily basis. [sic] over the last month. After the sudden opening, this is a very difficult project (for any country). He just gave up.”

Without adequate information on vaccine efficacy, infections, hospitalizations, and deaths, it’s difficult to model how the disease might spread and make sensible policies about disease mitigation — hence the current ban on air travel.

“We are flying blind without more information, but this is also a problem we are facing in the US as the CDC changes the community transmission rate threshold, testing centers are closed, and home tests are not reported,” Popescu said. “Ultimately this should be a lesson that we cannot deal with outbreaks or pandemics if the data is incomplete everywhere.”

As at the beginning of the pandemic, countries disagree on how to deal with new cases arriving via air travel; three years later, Popescu said, countries that have imposed restrictions have not always chosen effective ones. “Indeed [in the beginning of the pandemic] travel bans are not supported by science and are frankly ineffective at controlling them. The best travel restrictions we can do for a disease of this magnitude is to buy the government time to prepare for its spread.

Italy, which has restrictions on testing for air travelers from China, has encouraged other EU countries to do the same; France and Spain have also introduced bans, but the EU as a whole has so far resisted. In a place like Europe where traveling by land between countries is not sick, “testing passengers from one country is not effective in containing the disease (the horse is out of the barn),” said Popescu. Further, he said, “reactive testing,” not proactive, he said — Italy imposed a testing mandate after a case was detected on a flight that arrived in Milan on December 26.

One positive sign from Italy’s testing program is that no new variants have come from China – which means that as far as researchers can tell, people infected with Covid from China are not at greater risk than, say, the US. population than Americans infected with Covid-19.

The risk may be higher for Chinese travelers, who may have been introduced to unfamiliar variants while traveling, or may not have been vaccinated, although about 91 percent of the population is fully vaccinated, according to the New York Times.

Although the world is better at managing Covid-19 than it was in 2020, the restrictions imposed in response to China’s reopening still show a major flaw in the world’s ability to deal with the pandemic in a coherent and consistent way, Popescu said. Covid-19 may be endemic for years; events like China’s reopening and the potential for new disease variants and waves “should serve as a reminder of the importance of global health, vaccine equity, and partnerships in proactive public health interventions.