Photo: AP
Beijing, Mar 24: When China suddenly scrapped onerous zero-COVID measures in December, the country wasn't ready for a massive onslaught of cases. Hospitals turned away ambulances, crematoriums burned bodies around the clock, and relatives hauled dead loved ones to warehouses for lack of storage space.
Chinese state media claimed the decision to open up was based on “scientific analysis and shrewd calculation,” and “by no means impulsive." But in reality, China's ruling Communist Party held off on repeated efforts by top medical experts to kickstart exit plans until it was too late, The Associated Press has found.
Instead, the reopening came suddenly at the onset of winter, when the virus spreads most easily.
Many older people weren't vaccinated, pharmacies lacked antivirals, and hospitals didn't have adequate supplies or staff — leading to as many as hundreds of thousands of deaths that could have been avoided, according to academic modeling, more than 20 interviews with current and former Chinese Center for Disease Control and Prevention employees, experts and government advisers, and internal reports and directives obtained by the AP.
“If they had a real plan to exit earlier, so many things could have been avoided,” said Zhang Zuo-Feng, an epidemiologist at the University of California, Los Angeles. “Many deaths could have been prevented.”
For two years, China stood out for its tough but successful controls against the virus, credited with saving millions of lives as other countries struggled with stop-and-start lockdowns. But with the emergence of the highly infectious omicron variant in late 2021, many of China's top medical experts and officials worried zero-COVID was unsustainable.
In late 2021, China's leaders began discussing how to lift restrictions. As early as March 2022, top medical experts submitted detailed proposals to prepare for a gradual exit to the State Council, China's cabinet.
But discussions were silenced after an outbreak the same month in Shanghai, which prompted Chinese leader Xi Jinping to lock the city down. Zero-COVID had become a point of national pride, and tightening controls on speech under Xi had made scientists reluctant to speak out against the party line.
By the time the Shanghai outbreak was under control, China was months away from the 20th Party Congress, the country's most important political meeting in a decade, making reopening politically difficult. So the country stuck to mass testing and quarantining millions of people, even as omicron evaded increasingly harsh controls.
Unrest began to simmer, with demonstrations, factory riots, and shuttered businesses. The pressure mounted until the authorities suddenly yielded, allowing the virus to sweep the country with no warning — and with deadly consequence.
Experts estimate that many hundreds of thousands of people, perhaps more, may have died in China's wave of COVID — far higher than the official toll of under 90,000, but still a significantly lower death rate than in the United States and Europe.
However, 200,000 to 300,000 deaths could have been prevented if the country was better vaccinated and stocked with antivirals, according to modeling by the University of Hong Kong and scientist estimates. Some scientists think even more lives could have been saved.
“It wasn't a sound public health decision at all,” said a China CDC official, declining to be named to speak candidly on a sensitive matter. “It's absolutely bad timing … this was not a prepared opening.”
PLANS DERAILED
Toward the end of 2021, many public health experts and leaders began thinking about how to exit from the zero-COVID policy. The less lethal but far more infectious omicron made curbing COVID-19 harder and the risks of its spread lower, and nearby Korea, Japan and Singapore were all loosening controls.
That winter, the State Council appointed public health experts to a new committee tasked with reviewing COVID-19 controls, which submitted a report in March 2022, four people with knowledge of it said. The existence of the document is being reported for the first time by the AP.
It concluded it was time for China to begin preparations for a possible reopening. It ran over 100 pages long and included detailed proposals to boost China's stalling vaccination campaign, increase ICU bed capacity, stock up on antivirals, and order patients with mild COVID-19 symptoms to stay at home, one of the people said. It also included a proposal to designate Hainan, a tropical island in the country's south, as a pilot zone to experiment with relaxing controls.
But then things began going awry.
A chaotic, deadly outbreak in Hong Kong alarmed Beijing. Then in March, the virus began spreading in Shanghai, China's cosmopolitan finance hub.
Initially, Shanghai took a light approach with targeted lockdowns sealing individual buildings — a pioneering strategy led by doctor Zhang Wenhong, who had been openly calling on the government to prepare to reopen. But soon, officials in neighboring provinces complained they were seeing cases from Shanghai and asked the central leadership to lock the city down, according to three people familiar with the matter.
China CDC contact tracing reports obtained by the AP show that a nearby province was detecting dozens of COVID-19 cases by early March, all from Shanghai. Provincial officials argued that they lacked Shanghai's medical resources and capacity to trace the virus, risking its spread to the entire country before China was ready.
At the same time, China's flagging vaccination rate for older residents and the deaths in Hong Kong spooked authorities, as did reports of long COVID-19 abroad. When Shanghai failed to get control of the virus, the top leadership stepped in. Partial lockdowns in Shanghai were announced in late March. On April 2, then-Vice Premier Sun Chunlan, a top official known widely as the “COVID czar," traveled there to oversee a total lockdown.
“They lost their nerve,” said an expert in regular contact with Chinese health officials.
Shanghai was ill-prepared. Residents exploded in anger online, complaining of hunger and spotty supplies. But Beijing made it clear that the lockdown would continue.
“Resolutely uphold zero-COVID," an editorial in the state-run People's Daily said. “Persistence is victory,” said Xi.
KEEPING SILENCE
After Shanghai locked down, Chinese public health experts stopped speaking publicly about preparing for an exit. None were willing to openly challenge a policy supported by Xi. Some experts were blacklisted from Chinese media, one told the AP.
“Anybody who wanted to say something that is different from the official narrative was basically just silenced,” the blacklisted expert said.
In early April, China's State Council leaked a letter from the European Chamber of Commerce urging relaxation of zero-COVID controls. Council officials wanted to spark debate but didn't feel empowered to raise the issue themselves, according to a person directly familiar with the matter.
The State Council's information office did not respond to a fax requesting comment.
Gao Fu, then head of the China CDC, also hinted at the need to prepare for an exit. At a mid-April internal panel discussion recently made public by the Beijing-based Center for China and Globalization think tank, Gao was quoted as saying “omicron is not that dangerous," that there were public discussions on whether zero-COVID needed to be adjusted, and that they “hope to reach a consensus as soon as possible.”
Weeks later, Gao appeared at a private event on COVID exit strategies around the world at the German Embassy in Beijing and urged more vaccinations in China, according to three attendees who declined to be named because they weren't authorized to speak to the press. Gao did not respond to an email requesting comment.
There were also hints that opinions differed high in the party.
In private meetings with Western business chambers in May, then-Premier Li Keqiang, who was head of the State Council and the party's No. 2 official at the time, appeared sympathetic to complaints about how zero-COVID was crushing the economy, according to a participant and another briefed on the meetings. It was a stark contrast with pre-recorded remarks from Xi that listed defeating COVID as the top priority. But under Xi, China's most authoritarian leader in decades, Li was powerless, analysts say.
Public health experts split into camps. Those who thought zero-COVID unsustainable — like Gao and Zhang, the Shanghai doctor — fell silent. But Liang Wannian, then head of the central government's expert working group on COVID-19, kept vocally advocating for zero-COVID as a way to defeat the virus. Though Liang has a doctorate in epidemiology, he is sometimes accused of pushing the party line rather than science-driven policies.
“He knows what Xi wants to hear,” said Ray Yip, the founding head of the United States CDC office in China.
Liang shot down suggestions for reopening in internal meetings in January and May of 2022, Yip said, making it difficult for others to suggest preparations for an exit. Liang did not respond to an email requesting comment.
Health authorities also knew that once China reopened, there would be no going back. Some were spooked by unclear data, long COVID and the chance of deadlier strains, leaving them wracked with uncertainty.
“Every day, we were flooded with oceans of unverified data,” said a China CDC official. “Every week we heard about new variants. … Yes, we should find a way out of zero-COVID, but when and how?”
Authorities may also have been waiting for the virus to weaken further or for new, more effective, Chinese-developed mRNA vaccines.