China’s hidden COVID catastrophe Analysis by Foreign Affairs

The Foreign Affairs magazine has published an article describing how the Chinese leader obscured a lethal viral wave and what it Means for the future of his regime. Caliber.Az reprints the article.

Over the past three months, the Chinese government has faced a seemingly debilitating series of crises. In late November, after years of large-scale lockdowns, closures, quarantines, and almost constant mass testing, Chinese citizens took to the streets and, for the first time, called into question the leadership of President Xi Jinping.

Soon after, in response to the simmering discontent and other pressures, the government ended, virtually overnight, the “zero COVID” measures it had staked its public reputation on for nearly three years. Perhaps not surprisingly, what followed was a public health emergency in which the virus spread across some 80 percent of China’s highly vulnerable population. Hospitals and morgues overflowed, and more than one million people may have died. On top of all this, by the end of 2022, economic growth—long a sustaining pillar of the communist regime—had fallen to its lowest level in years.

Yet instead of going into crisis mode, Beijing has largely shrugged off these setbacks. It offered no official explanation for its abrupt reversal of zero COVID, and it weathered the high death rates that followed mainly by suppressing official data and not talking about COVID fatalities.

On January 14, the government asserted that the viral wave had peaked. And to herald the Lunar New Year a few days later, state censors even launched a campaign aimed at “preventing the exaggeration of gloomy emotions.” To the outside world, meanwhile, China announced that it is open for business and that its economy is back.

For now, the strategy appears to have worked. Unlike the zero-COVID measures, the chaos and death that followed reopening produced little domestic backlash against the government. Many ordinary Chinese seem to have concluded that the health crisis was not a big deal; in rural areas, where the health system is weak and the virus ran rampant, many people who experienced symptoms or even died were unaware that they had been infected.

In the go-go atmosphere of Beijing’s reopening, COVID-19 seemed to be quickly forgotten. “The virus has gone away . . . . God blesses China,” Hu Xijin, the former editor in chief of Global Times, a nationalist tabloid newspaper, wrote on Weibo, the Chinese social media platform, in late January.

In fact, Beijing’s response to the pandemic—both before and after zero COVID—could have significant implications for the one-party state over the long term. For one thing, as the years wore on, the zero-COVID strategy, sustained at enormous social and economic cost, seemed to have more to do with tightening the government’s grip on society than with effective pandemic mitigation, as the protests in November made clear. And the strategy was ultimately unable to prevent a devastating viral wave.

Moreover, the high death toll that followed the sudden reopening—and the lack of active government engagement—raised new doubts about the ability of the regime to keep the population healthy. If the lesson for the Xi regime is that it is strong enough to weather a severe public health disaster, the government’s handling of the virus has also made clear that it is willing to sacrifice effective governance and even science in the interest of extending its power and control. In the long run, by breaking down the trust between Chinese society and the state, this power grab will create new challenges for Xi when the next crisis comes.

ONE MILLION DEATHS

The combined human toll of Beijing’s prolonged zero-COVID measures and its abrupt policy U-turn is by no means small. A growing body of evidence shows that during the three years that China maintained zero COVID, the very low rates of infection and mortality from the virus were achieved at significant cost to public health in other areas.

For example, according to data from the National Health Commission, in 2020–21, deaths caused by cerebrovascular and cardiovascular diseases in urban areas increased by 700,000 over 2019 levels—a soberingly large number, even taking into account China’s population size. This very likely was the result of anti-COVID measures preventing timely access to health care.

Beijing’s excessive pandemic measures also had far-reaching psychological and economic consequences. By December 2022, some 530 million Chinese were subject to lockdowns—more than the entire population of the European Union. Quite apart from the economic costs, such harsh measures, prolonged over weeks and months, also created profound social ruptures.

In December, Qiao Zhihong, a leading Chinese psychologist, observed that over the past three years, there has been a considerable increase in the number of students with depression, anxiety, self-injury, and suicide. This trend became all the more pronounced in the later stages of the pandemic, when many Chinese began to see the government’s actions, such as the full-scale lockdown of Shanghai in the spring of 2022, as increasingly arbitrary and punitive. Out of step with the rest of the world, these measures also ran contrary to science and common sense, with some residents deprived of access to food and even medicine.

The rampant spread of infection and death that followed the abandonment of zero COVID on December 7 was in some ways even more traumatic. According to the official government tally, there were 82,238 COVID-19 deaths recorded in Chinese hospitals between December 8 and February 2, but both anecdotal evidence and case fatality data indicate that this is a vast undercount of the actual number.

According to Wu Zunyou, the chief epidemiologist of the Chinese Center for Disease Control and Prevention (China CDC), by January 21, more than 80 percent of the population, or 1.13 billion people, had been infected with COVID-19. If we use his own case fatality ratio for the winter, which he put at between 0.09 percent and 0.16 percent, the reopening would have been associated with at least one million COVID deaths.

Wu’s data is supported by other models, including the Economist’s projection of 1.0 to 1.5 million deaths, based on assumptions about the unencumbered spread of COVID-19 after the reopening; the British-based Airfinity’s estimate of 1.3 million COVID deaths between December 1 and February 6; and a New York Times analysis, published on February 15, also estimating between 1.0 and 1.5 million deaths since the reopening.

Anecdotal evidence from clinics, hospitals, morgues, and obituaries published by state-backed institutions suggests that the true death toll may have been closer to the high end of these estimates. Of course, the viral wave was playing out over a far larger population, but it is very likely that there were more COVID-19 deaths in China in two months than there were in the United States over the span of three years.

Even leaving aside the human lives lost because of the stringent zero-COVID measures, the estimated deaths the Chinese government claims to have avoided—950,000 during 2020–21, according to Wu himself—have very likely been canceled out by the deaths associated with the messy and chaotic policy reopening. In other words, China spent billions of dollars maintaining an economically disruptive and ultimately socially damaging zero-COVID program for years only to suffer the same, if not worse, health consequences in the end.

CONTROL AT ANY COST

China’s misguided and erratic COVID policies have exposed some fundamental truths about Xi’s regime. For one thing, they have demonstrated that contrary to his predecessors from Deng Xiaoping to Hu Jintao, who sought to make decision-making more technocratic and collective, Xi has strengthened the nonscientific and nondemocratic features of Chinese governance. Rather than providing the most effective and efficient solutions to the pandemic, many of the zero-COVID strategies served to extend the reach of the state.

With the onset of the pandemic, Beijing saw an opportunity to pursue almost unchecked surveillance and control of the population. Reuters has reported that Chinese provinces spent more than $50 billion on COVID containment measures in 2022; over the three years that zero-COVID was in effect, the government is estimated to have spent as much as 200 billion yuan—$29.2 billion on PCR testing alone, according to data compiled by Hua Chuang Securities and Goldman Sachs.

These immensely costly and invasive programs came at the expense of more efficacious policies such as full vaccination programs for the elderly. As Yasheng Huang, a scholar of international management at MIT, has observed, in implementing these far-reaching measures, Xi also broke the post-Tiananmen social contract “in which the Party would observe certain boundaries in exchange for society observing its own.”

By restricting the movement and freedom of hundreds of millions of Chinese citizens for almost three years, however, Xi also fell into a trap. He overestimated the extent to which preventing the spread of COVID-19 could be used to justify any measure, no matter how extreme or for how long.

Indeed, it had already become clear during the lockdown of Shanghai in April 2022 that public tolerance was reaching its limit. Yet lacking effective feedback mechanisms, China’s top decision-maker evidently failed to realize the extent of public dissatisfaction until street protests erupted across major cities seven months later, calling for the zero-COVID program to end and even for Xi to step down.

Beijing’s failure of governance was also apparent in the abrupt policy shift that followed. Although a winding down of zero COVID was long overdue, the government’s December 7 decision immediately went awry because of the capricious and reckless way it was implemented. Rather than taking an incremental approach and preparing for the shift—say, by vaccinating the elderly or investing in surge capacity at hospitals and health clinics—Beijing simply announced the policy was ending. Worse, the government encouraged a “let it rip” approach to viral spread.

Instead of trying to “flatten the curve”—the strategy that epidemiologists around the world have generally advocated—local administrations across China implicitly encouraged what was known as yingyang jinyang, “those who should be infected are all infected,” and kuaisu guofeng, “quickly bring the population to the viral peak.” That strategy, in combination with the shortage of medical supplies, hospital beds, and ICU equipment, led to the explosive rise of COVID-19 infections and deaths in December and January. And as the virus raged throughout the country, the government quickly shifted its policy agenda to economic growth.

In addition to exposing Xi’s policymaking as fundamentally autocratic, the shift from one extreme to the other also undercut people’s trust in government. After all, Beijing had spent nearly three years highlighting the grave danger of the disease and vowing to avoid the approach taken by other countries of living with the deadly virus, or tangping—“lying flat” as Chinese officials derisively called it.

Yet in December, the government was suddenly saying the exact opposite: it justified the pivot away from zero COVID by downplaying the severity of the virus, and it adopted precisely the accommodationist approach it had once ridiculed.

At the same time, Chinese authorities also reneged on their promise to do whatever it takes to maximize people’s safety and health, abandoning much of the state’s vast testing infrastructure and asking people to bear the “first responsibility” for their own health.

On social media, people shared information on their symptoms—which were often more severe than government health experts had described—and mocked the government’s official data on infections and mortality. As the columnist Yuan Li noted in late December, “Having nearly exhausted its resources and the good will of the public, the government has now simply disappeared, just as many Chinese are getting very ill with the virus or dying from it.”

THE HELMSMAN WILL NOT SAVE YOU

Despite the multiple ways they have undermined the government’s credibility, Xi’s COVID blunders do not pose an existential threat to his regime. The government has continued to show it can cope with even deep challenges to its rule. Notably, it took officials just three days to quell the massive late November protests, which represented one of the most significant challenges to the party’s rule since the Tiananmen uprising. And although the abrupt, unplanned reopening did lead to many of the worst-case outcomes that zero COVID had been expressly designed to avoid—an overwhelmed health-care system and an exponential increase of COVID deaths—the widespread anguish and anger did not lead to mass panic or protests.

Part of Beijing’s resilience was due to its control of information. Through obfuscation, stonewalling, and misinformation, the government managed to deflect the frustration of ordinary people away from itself. Instead, popular anger was directed at public health experts, who were accused of misleading people on the severity of the virus, and those who favored living with COVID-19, who were blamed for pressuring the government to reopen without any preparation.

For the large portion of Chinese who think of themselves as being tizhinei (inside the system) or who have access only to government-sanctioned information, it was also relatively easy to buy into the narrative that the state had protected the people against the pandemic for three years, and now it was their turn to protect themselves.

Nowhere was this attitude more apparent than in rural areas. In the countryside, the fragile health-care system was woefully unable to handle the explosive growth of COVID-19 cases. But abetted by poor information and a fatalistic approach toward the pandemic among many local populations, rural areas weathered the crisis in large part because of the underutilization of local health-care institutions and the lack of access to COVID testing.

In a strange twist, then, the weakness of the system proved to be its strength: since only those who were tested for COVID-19 and died in hospitals were officially registered as COVID fatalities, many deaths simply didn’t count. “The death of one man is a tragedy,” Joseph Stalin famously said. “The death of a million is a statistic.” But during China’s reopening, many who died did not even become a statistic.

By mid-January, it was clear that COVID death rates had peaked and that the government had muddled through. For all its daunting magnitude, the viral wave was fleeting and its exact extent, for many people affected by it, uncertain.

The outcome paved the way for the government to declare, on February 16, a "major decisive victory" over COVID-19, similar to the one it proclaimed after the lifting of the lockdown in Wuhan three years ago. It is a stark display of the ability of a strong authoritarian regime to withstand even large-scale social crises through the control of information and the levers of power.

Still, Xi’s extreme COVID strategies have left lasting scars on the Chinese state and its ability to govern. In 2022, China’s economic growth fell to three percent, the slowest growth rate since 1974. And although the economy is expected to rebound in 2023, it will be difficult for the hundreds of millions of Chinese who were affected by Beijing’s power overreach over the past three years to forgive and forget.

In addition to eroding public trust in the government, the COVID crisis has made clear that a political system that has been tailored to a single superordinate figure is highly susceptible to disruption, shocks, and arbitrary decision-making. For now, like their government, ordinary Chinese may be glad to return to business as usual. But barring fundamental changes in the highly centralized and personalized rule under Xi, there is no guarantee that similar catastrophes will not be repeated with even greater consequences in the future.