When China suddenly scrapped its onerous “zero COVID” measures in December last year, the country was not 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 said the decision to open up was based on “scientific analysis and shrewd calculation,” and was “by no means impulsive.”
Yet in reality, the Chinese Communist Party (CCP) ignored repeated efforts by top medical experts to launch exit plans until it was too late, The Associated Press (AP) found.
Illustration: Mountain People
Instead, the reopening came suddenly at the onset of winter, when the virus spreads most easily.
Many older people were not vaccinated, pharmacies lacked antivirals and hospitals did not 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 (CDC) 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,” University of California, Los Angeles epidemiologist Zhang Zuo-feng (張作風) said. “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-start lockdowns.
However, with the emergence of the highly infectious Omicron variant of SARS-CoV-2 last year, many of China’s top medical experts and officials worried that “zero COVID” was unsustainable.
In late 2021, China’s leaders began discussing how to lift restrictions. As early as March last year, top medical experts submitted to the Chinese State Council detailed proposals to prepare for a gradual exit.
However, discussions were silenced after an outbreak the same month in Shanghai, which prompted Chinese President Xi Jinping (習近平) to lock the city down. “Zero COVID” had become a point of national pride, and Beijing’s crackdown on dissent 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 National Congress of the CCP, 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 draconian controls.
Unrest began to simmer, with demonstrations, factory riots and businesses shuttered. 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 millions, might have died in China’s wave of COVID-19 — far higher than the official toll of fewer than 90,000, but still a much lower death rate than in Western countries.
However, 200,000 to 300,000 deaths could have been prevented if the country was better vaccinated and stocked with antivirals, modeling by the University of Hong Kong and scientist estimates showed.
Some scientists think even more lives could have been saved.
“It wasn’t a sound public health decision at all. It’s absolutely bad timing ... this was not a prepared opening,” said a CDC official, declining to be named as they were speaking candidly about a sensitive matter.
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 South 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 last year, four people with knowledge of the matter said.
It concluded that it was time for China to begin preparations for a possible reopening.
It was more than 100 pages long and included detailed proposals to boost China’s stalling vaccination campaign, increase bed capacity in intensive care units, 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 the same month as the report was submitted, the virus began spreading in Shanghai, China’s cosmopolitan financial hub.
Initially, Shanghai took a light approach with targeted lockdowns, sealing individual buildings — a pioneering strategy led by Zhang Wenhong (張文宏), director of Huashan Hospital’s Department of Infectious Diseases, who had been openly calling on the government to prepare to reopen.
However, officials in neighboring provinces soon complained that they were seeing cases from Shanghai, and asked the central leadership to lock the city down, three people familiar with the matter said.
CDC contact tracing reports obtained by the AP showed that a nearby province was detecting dozens of COVID-19 cases by early March last year, all from Shanghai.
Provincial officials said that they lacked Shanghai’s medical resources and capacity to trace the virus, risking it spreading 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 gain control of the virus, the top leadership stepped in. Partial lockdowns in Shanghai were announced in late March last year.
On April 2 last year, then-Chinese vice premier Sun Chunlan (孫春蘭), a top official known widely as the “COVID-19 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,” Xi said.
KEEPING SILENCE
After Shanghai locked down, Chinese public health experts stopped speaking publicly about preparing for an exit. None dared openly challenge a policy supported by Xi. Some experts were blacklisted from Chinese media, one said.
“Anybody who wanted to say something that is different from the official narrative was basically just silenced,” the blacklisted expert said.
In early April last year, the State Council leaked a letter from the European Chamber of Commerce urging the relaxation of “zero COVID” controls.
Council officials wanted to spark debate, but did not feel empowered to raise the issue themselves, a person directly familiar with the matter said.
The council’s information office did not respond to a fax requesting comment.
Then-CDC director Gao Fu (高福) also hinted at the need to prepare for an exit.
At an internal panel discussion in April last year that was 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, at a private event at the German embassy in Beijing, Gao agreed with foreign experts urging China to plan a reopening, and then strode off the stage, said three attendees who declined to be named as they are not authorized to speak to the media.
Gao did not respond to an e-mail requesting comment.
There were also hints that opinions differed high in the party.
In private meetings with Western business chambers in May last year, then-Chinese premier Li Keqiang (李克強), 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, said one participant and another person who was briefed on the meetings.
It was in stark contrast to prerecorded remarks from Xi that listed defeating COVID-19 as the top priority.
However, under Xi, China’s most authoritarian leader in decades, Li was powerless, analysts said.
Public health experts split into camps. Those who thought “zero COVID” unsustainable, such as Gao and Zhang Wenhong, fell silent.
Yet Liang Wannian (梁萬年), 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. Although 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 (葉雷), founding head of the US Centers for Disease Control and Prevention office in China.
Liang shot down suggestions for reopening in internal meetings in January and May last year, making it difficult for others to suggest preparations for an exit, Yip said.
Liang did not respond to an e-mail requesting comment.
Health authorities also knew that once China reopened, there would be no going back. Some were spooked by unclear data, long COVID-19 and the chance of deadlier strains, leaving them wracked with uncertainty.
“Every day, we were flooded with oceans of unverified data,” a Chinese CDC official said. “Every week we heard about new variants... Yes, we should find a way out of zero COVID, but when and how?”
Authorities might also have been waiting for the virus to weaken further or for new, more effective, Chinese-developed messenger RNA vaccines.
“They didn’t have a sense of urgency,” said Zhu Hongshen, a postdoctoral fellow studying China’s “zero COVID” policy at the University of Pennsylvania. “They thought they could optimize the whole process, they thought they had time.”
The Shanghai lockdown stretched from an expected eight days to two months. By the time Shanghai opened back up, it was just months away from China’s pivotal National Party Congress, where Xi was expected to be confirmed for a controversial and precedent-breaking third term.
Risking an outbreak was off the table. Although scientists from Beijing, Shanghai and Wuhan wrote internal petitions urging the government to start preparations, they were told to remain silent until the congress was over.
“Everybody waits for the party congress,” said one medical expert, declining to be named, as they were commenting on a sensitive topic. “There’s inevitably a degree of everyone being very cautious.”
INCREASING PRESSURE
Officials across China took extraordinary measures to stop Omicron from spreading.
Tourists were locked into hotels, traders were huddled into indefinite quarantine and many stopped traveling for fear of being stranded far from home.
In Inner Mongolia, a state-run ammunition factory forced workers to live in its compound 24 hours a day for weeks on end away from their families, said Moses Xu, a retired worker.
In brutal lockdowns for more than three months in China’s far west, residents in Xinjiang starved, while thousands in Tibet marched on the streets, defying orders in a rare protest.
Still, officials stuck to their guns, as the government fired those who did not keep COVID-19 under control.
Yet Omicron kept spreading. As the congress approached, authorities began hiding cases and resorting to secret lockdowns and quarantines.
Authorities locked down Zhengzhou, a provincial capital home to more than 10 million people, with no public announcement, even though they were reporting only a handful of cases.
They bused some Beijing residents to distant quarantine centers and asked them not to post online about it, one said.
Some village officials deliberately underreported the number of COVID-19 cases to give the sense that the virus was under control.
Local governments poured tens of billions of dollars into mass testing and quarantine facilities. From Wuhan to villages in industrial Hebei Province, civil servants were pressed into testing or quarantine duty because local governments ran out of money to hire workers.
At the congress in the middle of October last year, top officials differing with Xi were sidelined. Instead, six loyalists followed Xi onstage in a new leadership lineup, signaling his total domination of the party.
PUSHING FOR CHANGE
With the congress over, some voices in the public health sector finally piped up.
In an internal document published on Oct. 28 last year, obtained by AP, Wu Zunyou (吳尊友), chief epidemiologist at the Chinese CDC, criticized the Beijing city government for excessive COVID-19 controls, saying that they had “no scientific basis.”
He called it a “distortion” of the central government’s “zero COVID” policy, which risked “intensifying public sentiment and causing social dissatisfaction.”
At the same time, he called the virus policies of the central government “absolutely correct.”
One former CDC official said that Wu felt helpless because he was ordered to advocate for “zero COVID” in public, even as he disagreed at times with its excesses in private.
Wu did not respond to an e-mail requesting comment, but a person acquainted with Wu confirmed that he had written the internal report.
Another who spoke up was Zhong Nanshan (鍾南山), a doctor renowned for raising the alarm about the original COVID-19 outbreak Wuhan. He wrote twice to Xi personally, telling him that “zero COVID” was not sustainable and urging a gradual reopening, a person acquainted with Zhong said.
Businesspeople in finance, trade and manufacturing concerned about the tanking economy were also lobbying authorities behind the scenes, a government adviser said.
Along with the lobbying, pressure to reopen came from outbreaks flaring up across the country. A internal notice issued on Nov. 5 last year by Beijing health authorities and obtained by the AP called the virus situation “severe.”
Early that month, Sun summoned experts from sectors including health, travel and the economy to discuss adjusting Beijing’s virus policies, three people with direct knowledge of the meetings said.
Zhong presented data from Hong Kong showing Omicron’s low fatality rate after the territory’s last outbreak, two people said.
On Nov. 10 last year, Xi ordered adjustments.
“Adhere to scientific and precise prevention and control,” a state media account quoted Xi as saying, signaling that he wanted officials to cut back on extreme measures.
The next day, Beijing announced 20 new measures tweaking restrictions, such as reclassifying risk zones and reducing quarantine times, but at the same time, Xi made it clear that China was sticking to “zero COVID.”
“Necessary epidemic prevention measures cannot be relaxed,” Xi said.
THE EXIT
The government wanted order. Instead, the measures caused chaos.
With conflicting signals from the top, local governments were not sure whether to lock down or open up. Policies changed by the day.
In Shijiazhuang, the capital of Hebei Province, officials canceled mass testing and opened the city, only to reinstate harsh measures days later.
Xi called city officials, instructing them to have measures that were neither too strict nor too soft, a person familiar with the matter said.
Individual apartments were put under sudden lockdowns that lasted hours or days. The sheer number of tests and cases overwhelmed medical workers. Travel, shopping and dining ground to a halt, streets emptied and the wealthy bought one-way plane tickets out of China.
In late November last year, public frustration boiled over. A deadly apartment fire in China’s Xinjiang region sparked nationwide protests over locked doors and other virus control measures. Some called on Xi to resign, the most direct challenge to the CCP’s power since pro-democracy protests in 1989.
Riot police moved in and the protests were swiftly quelled, but behind the scenes, the mood was shifting.
References to “zero COVID” vanished from government statements. State-run Xinhua news agency said that the COVID-19 pandemic was causing “fatigue, anxiety and tension,” and that the cost of controlling it was increasing day by day.
Days after the protests, Sun held meetings where she told medical experts that the state planned to “walk briskly” out of “zero COVID.”
Some were struck by how quickly the tone had shifted, with one saying the leadership had become “even more radical” than the experts, a retired official said.
On Dec. 1 last year, Xi told visiting European Council President Charles Michel that the protests were driven by young people frustrated with the lockdowns, a person briefed on Xi’s remarks said.
“We listen to our people,” the person recounted Xi telling Michel.
The final decision was made suddenly, and with little direct input from public health experts, several said.
“None of us expected the 180-degree turn,” a government adviser said.
Many in the Chinese government believe the protests accelerated Xi’s decision to scrap virus controls entirely, three current and former state employees said.
“It was the trigger,” said one, who asked not to be identified because they were not authorized to speak to the media.
On Dec. 6 last year, Xi instructed officials to change COVID-19 controls, Xinhua reported.
The next day, Chinese health authorities announced 10 sweeping measures that effectively scrapped controls, canceling virus test requirements, mandatory centralized quarantine and location-tracking health QR codes. The decision to reopen so suddenly caught the country by surprise.
“Even three days’ notice would have been good,” a former Chinese CDC official said. “The way this happened was just unbelievable.”
Soon, the sick overran emergency wards and patients sprawled on floors. COVID-19 antivirals sold for thousands of dollars a box on the black market.
In just six weeks, about 80 percent of the country was infected — more than 1 billion people, the Chinese CDC later estimated.
Yet even as deaths mounted, authorities ordered state media to deflect criticism of China’s sudden reopening, a leaked directive obtained by a former state media journalist and posted online showed.
“Make a big propaganda push,” it ordered. “Counter the false claims leveled by the United States and the West that we were ‘forced to open’ and ‘hadn’t prepared.’”
Additional reporting by Kanis Leung in Hong Kong
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