China's 'COVID Zero' policy, explained

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China is in turmoil. Protests over the government's "zero COVID" policy have erupted in cities across the country and some demonstrators are openly calling for President Xi Jinping to resign. In one video from Shanghai, The Associated Press reports, crowds can be heard chanting: "Xi Jinping! Step down! CCP! Step down!" That's a rare and striking challenge to the authoritarian rule of the Communist Party, which has governed the country since 1949.

The protests are "a setback for China's efforts to eradicate the virus," Reuters reports, but perhaps not unexpected. The policy — which locks down entire cities at the first sign of a COVID outbreak — requires the Chinese people to sacrifice "income, mobility, and mental health" to keep illness from spreading. How does China's zero COVID policy work, and could the backlash threaten Communist rule? Here's everything you need to know.

How does China's policy work?

Call it a lockdown on steroids. It's a "two-pronged" policy that emphasizes both prevention and containment, Reuters reports. The prevention part focuses on massive and frequent testing of the country's population, and a recent negative test "can be a requirement to enter a business or public facility." People who test positive are quarantined in their homes or in a government facility.

Containment is the more far-reaching part of the policy, with "buildings, communities, or even entire cities" put under quarantine when a COVID outbreak occurs. That even extends to the entire country: China's borders are closed to most visitors — and those who are allowed are confined in isolation for eight days before they can travel more freely. The point of all this? To eradicate the virus where it appears, before it can spread to the entire country.

What are the downsides?

Shutting down entire communities is obviously disruptive. "In some cases, lockdowns have led to widespread shortages of food and other daily necessities," The New York Times reports. During the spring of 2022, the city of Shanghai — a financial hub with a population of more than 26 million people — was locked down for more than 60 days. "Unable to secure fresh produce, many residents lived on instant noodles or rice porridge," The New Yorker reported in June. "Some of them protested with loudspeakers, or banged pots and pans." The policy has also taken a toll on the economy and disrupted worldwide supply chains.

Does the policy actually contain COVID?

"China's approach won praise during the beginning of the pandemic, and there is no doubt it has saved lives," The New York Times reports. In early 2020, The Guardian pronounced the early shutdown of the city of Wuhan to be "brutal but effective" at containing COVID. But the policy's effectiveness seems to have diminished: Now China is routinely reporting record numbers of new cases — nearly 40,000 new cases on Nov. 26 alone.

Still, those case spikes must be put in context. CBS News reports that China's record numbers are still "dwarfed by cases in many other developed nations." Through much of late November, for example, the United States was still reporting more new daily cases than China — even though the U.S. has a much smaller population.

Why haven't vaccines ended the policy?

The Chinese vaccines are not very effective, Wired reported in February, as the omicron variant was on the rise. "The numbers are stark: Sinovac is 51 percent effective in preventing symptomatic COVID infection. Pfizer is 95 percent effective." (China agreed in early November to allow the use of the vaccine developed by Pfizer and BioNTech — but only for foreigners.) There's also the "anti-vaxx" problem familiar in the United States: Only 40 percent of Chinese people over the age of 80 have taken the full three-dose regimen required for full protection.

One other issue: China's hospitals aren't ready to treat all the COVID cases that might result if the policy is dropped. "The medical system will probably be paralyzed when faced with mass cases," an anonymous doctor tells the Financial Times. That could change soon, however. Bloomberg reports the country's health authorities have pledged to "strengthen hospital networks to more effectively treat COVID patients."

Why are people protesting now?

There have been growing signs of unrest: Workers at Foxconn, which makes iPhones for Apple, spent much of November rebelling against COVID restrictions. But the latest protests started spreading after a deadly fire in the Xinjiang region killed 10 people, The New York Times reports. Internet users shared evidence the building was under a strict COVID lockdown that made it harder for residents to flee.

"The incident was also the latest in a series of horror stories linked to COVID restrictions," the BBC reports, including a "quarantine bus" crash that killed 27 people, and a mid-November report that a baby died in the city of Zhengzhou because paramedics delayed care while her family was isolated in a quarantine hotel. As a result, "the stage was set for widespread demonstrations."

The World Cup may also have provided a spark. Televised images of maskless crowds in Qatar moved Chinese social media users to complain about the contrast "with the severe isolation they felt under President Xi Jinping's zero-COVID policy," The Guardian reports. China began censoring the broadcasts.

What's next?

There could be a backlash to the backlash. While the anti-government protests are "incredibly significant," China analyst Rory Green tells CNBC that Xi could respond by veering "towards a more authoritarian approach to governance in China."

But it is also possible that Xi could back down. Bloomberg reports that analysts at Goldman Sachs believe "China may end its COVID zero policy earlier than previously expected" in the face of protests. "The central government may soon need to choose between more lockdowns and more COVID outbreaks," an analyst wrote for the firm. The government may also have to choose between more lockdowns and more protests.

Updated Nov. 28: This piece has been changed throughout to reflect new developments. 

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