China and Hong Kong are seeing their largest spike in Covid cases in more than two years, despite determinedly pursuing one of the world’s strictest virus elimination policies.

Most countries are now trying to live with coronavirus – so how long can China hold on to its “zero-Covid” goal?

Striking a balance

For the last two years, China’s strict measures to contain Covid, enforced by swift lockdowns and aggressive restrictions, seemed to be largely paying off.

As the rest of the world grappled with surges in cases and deaths in 2020, China’s President Xi Jinping declared the country’s handling of the pandemic through lockdowns and widespread testing a success – and touted its methods as being the most effective in dealing with the virus.

The zero-Covid model was therefore strictly enforced both in mainland China and Hong Kong.

But things soon began to change.

The first signs of strain on the much-vaunted zero-Covid model in China began to appear when authorities were forced to impose increasingly large lockdowns triggered by the more infectious Delta variant in 2021. These started to raise questions about how long China could maintain this policy.

And now Omicron has called it further into question.

In mainland China, thousands of cases are now being reported each day and millions of people in the north-eastern province of Jilin have been placed under lockdown – the first time China had restricted an entire province since the early days of the pandemic in Wuhan.

Hong Kong, which was previously almost untouched by the virus, is now seeing 30,000 cases and more than 200 deaths a day. The city’s healthcare system has been overrun, with shocking images of people in need of hospital care receiving rudimentary treatment outside medical facilities.

It’s a situation unlike anything the country has seen for the past two years.

Officially, the Chinese government has not budged from its zero-Covid position. But there have been some signs that it may be softening its stance on how best to deal with the virus.

Earlier this week, China’s National Health Commission said it was changing its rules so that mild cases would be isolated in centralised locations, rather than treated in hospitals. The criteria for a patient to be discharged from quarantine has also been lowered.

“In the past, China would actually admit every patient – whether they were asymptomatic or with just mild symptoms – to the hospital,” Prof Jin Dong-yan of The University of Hong Kong told the BBC.

“The fact they’re now proposing to [locally isolate] them – that’s one step to show they recognise that there’s a large group of people that do not need much help.”

During China’s recent National People’s Congress meeting, Chinese Premier Li Keqiang also said China would continue to make its Covid-19 response more “scientific and targeted”.

“[Premier Li’s speech] hints that the government is ready to be more flexible and loosen restrictions gradually,” said Prof Chen Gang of the National University of Singapore.

“Under [a more] dynamic policy, more emphasis will be placed on striking a balance between disease control and enabling people to live normal lives.”

On the ground as well, there’s also been a noticeable shift in attitudes.

Last year, top Chinese epidemiologist Zhang Wenhong suggested that China would eventually need to “co-exist” with the virus. He was met with a barrage of criticism, with some calling him a traitor, and others saying he was colluding with foreign forces to undermine China’s Covid response.

But just this week, Dr Zhang posted another message on Chinese social media that got a very different reception.

While he said that it was necessary for China to maintain its zero-Covid strategy for now, he added that it should not be afraid to eventually move towards a more “sustainable coping strategy” in the future.

“With this virus, alleviating fear is the first step we must take,” he said. “Omicron has become so mild, in countries that have achieved widespread vaccination and natural infection rates, it may be less deadly than even the flu.”

This time, he was not met with vitriol – and was instead widely praised.

“Thank you Dr Zhang for your scientific and rational [take] on issues,” one comment said.

Others shared their struggles over the past years – a sign of growing frustration after more than two years of lockdowns.

“These past few years, I have suffered a lot. I have lost my freedom – all in the name of the virus,” one said.

According to Professor Huang Yanzhong, a senior fellow for global health at the Council on Foreign Relations, there is a sense that “public support for zero-Covid is in decline”.

“My sense is that especially in bigger cities like Shanghai, some people are saying it’s just too much. While there’s still overall public support for zero-Covid – it’s being undermined by the recent Omicron wave,” he said.

Politics and the pandemic

So how much longer can China hold on?

Experts say we are unlikely to see any big moves this year, especially not now while it is in the throes of its biggest outbreak in years.

Many believe loosening restrictions now could lead to an overwhelmed healthcare system – and a huge spike in the death rate.

All mainland China needs to do is look to Hong Kong to see a city struggling to contain its outbreak, with morgues filled to capacity and hospitals swamped with patients.

Prof Huang says China’s Centre for Disease Control and Prevention (CDC) has been proclaiming the fact that it has avoided a significant number of deaths, and “there is no doubt that opening will lead to a rapid increase in cases”.

“The dilemma is do you want to accept short-term pain – a significant increase of cases, deaths – for long-term stability?”

Analysts believe the answer is unlikely to be yes – especially right now.

“If restrictions are loosened, the number of deaths may shoot up, leading to social panic – something that will not be allowed in the politically sensitive year of the 20th party congress,” said Prof Chen.

This Chinese Communist Party 20th party congress is one of the country’s most important political events of the decade, and on paper, was when President Xi Jinping was supposed to step down, having come to the end of his two term-limit in office.

But this limit was removed and there is growing certainty that Mr Xi will secure another term in power as party chief and come out of the congress “more powerful than ever”, according to Michael Cunningham of research institution the Heritage Foundation.

“The government usually shifts the pendulum toward preserving stability in party congress years, as those in power seek to avoid crises rather than make bold decisions that, if unsuccessful, could negatively impact their career prospects,” said Mr Cunningham in a report.

Mr Xi himself said in a politburo meeting on Thursday that China would stick to its dynamic zero-Covid policy, saying: “Victory comes from perseverance”.

With this clear instruction coming from the top, its more likely that officials will instead put in place smaller and gradual measures, similar to those already being made – but with no “fundamental” change – for now.

“The problem with the zero-Covid policy is that it doesn’t accept risks,” says Prof Huang.

“And unless [the Chinese government] is no longer obsessed with worst-case scenarios, you cannot expect to see a fundamental change to its policy.”

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