Drugstore shelves throughout the country have been emptied of all medicines related to fever and cold symptoms. The few vetted, prescription antiviral COVID-19 treatments available in much of the rest of the world, such as Paxlovid, are almost impossible to find; when available, they cost an arm and a leg. Ambulance services are completely overstretched by the deluge of emergency calls. And crematoriums operating around the clock cannot keep up with the number of cadavers being delivered in body bags.
Following the government’s sudden and unplanned dropping of strict quarantine and testing rules, hospitals in even the biggest and richest of the country’s cities, starting with Beijing, have been overrun. Patients struggling to breathe or showing other signs of distress are seeking urgent care.
Most reasonable people would agree that after years of what appeared to be remarkable success in containing the virus, China’s COVID-19 situation has turned to outright disaster.
Following the government’s sudden and unplanned dropping of strict quarantine and testing rules, hospitals in even the biggest and richest of the country’s cities, starting with Beijing, have been overrun. Patients struggling to breathe or showing other signs of distress are seeking urgent care.
Drugstore shelves throughout the country have been emptied of all medicines related to fever and cold symptoms. The few vetted, prescription antiviral COVID-19 treatments available in much of the rest of the world, such as Paxlovid, are almost impossible to find; when available, they cost an arm and a leg. Ambulance services are completely overstretched by the deluge of emergency calls. And crematoriums operating around the clock cannot keep up with the number of cadavers being delivered in body bags.
I imagine few will be prepared for the conclusion that follows. The COVID-19 crisis in China is not primarily a public health crisis. In fact, it could be argued that even on its present course, in public health terms, China will not come out of the current emergency phase as a global outlier in terms of the numbers of people killed by the pandemic and may even be counted as having done reasonably well. The real scene of the COVID-19 disaster in China is to its once confident and seemingly unshakable political system.
Three years ago, China’s early response to COVID-19, characterized by extraordinary lockdowns affecting big cities and even entire subregions, struck many people around the world (especially in affluent countries that place a priority on personal freedoms) as crude and even brutal. This first phase of what became known as country’s zero-COVID policy was followed, or more accurately supplemented, by the implementation of mass testing regimes that became more and more obsessive and even invasive in nature.
As I have written before, this was clearly not a way out of the pandemic. It was obvious all along to anyone with even a basic understanding of epidemiology or public health that once this regime was lifted, COVID-19 would spread in China just as it had in most other parts of the world. What the long experiment with lockdowns and endless mandated testing and tracking apps arguably accomplished was a postponement of the day of reckoning—until less deadly strains of the virus, as many believe Omicron and its sub-variants to be, had become prevalent.
I lived through the worst of the pandemic in an utterly devastated New York City, when the city’s infection rate was five times higher than the rest of the country (nearly 44,000 people have died in the city due to COVID-19 as of Dec. 27). In those days, depressingly, the incessant sound of ambulances, sometimes several at a time, drowned out everything else.
Had China taken something like the U.S. response at the outset of the pandemic, with few quarantine measures or other social controls, one imagines an even worse catastrophe, given that the country has ten cities roughly as large as New York (or much larger), and over 100 cities with more than a million residents. With no specific treatments for COVID-19 yet available, zero native immunity, and an early strain prone to murder, there is no telling how many people would have died.
In the United States, impressively effective vaccines were rolled out in December 2020, representing an extraordinary triumph of sheer science that helped make up for the grave and persistent weaknesses of the U.S. public health system. I eagerly made an appointment and was grateful to receive my first shot of the new mRNA vaccines in early January 2021, and I kept getting boosters whenever I could (currently, up to five total shots).
As a matter of pride, or rather a deep-seated but foolish sense of nationalism that is incessantly drummed into the public by the country’s leaders, China failed to introduce foreign-made mRNA vaccines, instead pursuing a native vaccine breakthrough. This same mistake was made later, when antivirals effective against COVID-19, such as Paxlovid, were not widely imported, produced, or distributed in China because they were of Western origin; China’s rulers often rigidly insist on having native solutions even to problems that have been long solved by others.
Much has been written about how China squandered the time bought by its quarantine and surveillance efforts by neither pushing for a much higher vaccination rate in the country, especially among the vulnerable elderly, nor stockpiling antivirals or even ordinary fever medicines. But there were very real practical obstacles that stood in the way of near universal vaccinations.
China spent much of the past three years using the pandemic for crude propaganda purposes. Simply put, the rest of the world was getting sick, and China was not. The West, in particular, was afflicted with untold ravages from long COVID-19. The Chinese public was inundated with messaging, both direct and indirect, that concluded that the West’s troubles proved China’s overall system superior, and the Chinese Communist Party (CCP) the best possible guardian of people’s welfare. And in a land where actual COVID-19 cases were few and far between throughout most of this period, getting the public to line up for shots and then more shots, was a very hard sell. (Just think about how hard it has been to get elderly U.S. citizens, who live in a country where COVID-19 has never gone away, to get the latest boosters.)
Add to this indifference the fact that many Chinese people—nationalist state propaganda be damned—have had little faith in the country’s home-grown vaccines. Outside of China, too, much has been made about the country’s inferior vaccines—perhaps a bit too much. There is little doubt that Western vaccines, particularly those using mRNA technology, are more effective than China’s shots, which use older designs. But there are reasons to believe this difference in efficacy, much emphasized in Western coverage and perhaps even acknowledged by Chinese citizens who lack trust in their own system, is substantially overestimated, at least in practical terms. Although the Chinese vaccines are lower performing, staying up to date with repeated doses nonetheless appears to provide substantial protection against the worst effects of a COVID-19 infection—that is, hospitalization and death.
This brings us to the true nature of the ongoing catastrophe in China. The current situation is a self-dealt hand suffered by the CCP that both underpins and stands above the state, and the issue is trust. In the annals of self-ridicule, it would be hard to beat Beijing’s COVID-19 Dec. 21 death toll. In the face of overwhelming anecdotal evidence to the contrary, the government insisted that almost no one had died due to the forest fire-like spread of the disease.
But this is just the tip of the iceberg.
Up until the very moment of the policy turnaround, the Chinese public had been inundated with messages about why zero-COVID was necessary, why they needed to submit to ceaseless PCR tests and even invasions of their homes. The propaganda masters are failing, even now, to come up with a good explanation of the government’s reversal, much less a statement acknowledging that grave mistakes were made at the very top.
There was a time not so terribly long ago when suffocating censorship and national isolation made it possible for the propaganda system to brush aside inconvenient facts and incriminating narratives. In the aftermath of the 1989 Tiananmen Square killings, the CCP masked the facts of what happened through sheer fabulation. The cover story offered by former Communist party chairman Deng Xiaoping for the massacre of hundreds of people at that monumental square in the heart of Beijing was that “a few released prisoners who were not properly reformed, a few political hooligans, the residual dregs of the Gang of Four[,] and other social detritus” were responsible for the violent disturbance that swept China’s capital, and that it had all been instigated by “hostile foreign forces.” Someone deemed that the lily needed further gilding, though, so the propagandists stressed that the soldiers who had carried out the killings were the true victims and filled televisions for days with images of soldiers recovering in hospitals and wreckage of charred army vehicles.
But that era has passed. The present crisis signals the advent of an entirely new epoch, one that has been long in coming. No, this is not a prediction of the pending demise of a system of government that many had believed until only recently to be formidable. (I must add here a macabre thought: From the Chinese state’s point of view, the COVID-19-induced deaths of hundreds of thousands of people over the age of 65 might even have their benefits. That’s because the country is embarking on a globally unprecedented wave of aging that will drastically reduce the size of the workforce and make paying for so called entitlements, or long term health care for people with chronic diseases and retirement benefits, vastly more onerous. A large number of relatively quick deaths, eliminating the need for decades of dialysis or dementia care, for example, might be counted as a fiscal and actuarial blessing.)
Serious foundational cracks are now on display, reminders that even a state that relishes control is susceptible to losing it. In my more than 20 years combined of living in, traveling to, and working extensively on China, I have never seen the credibility of the state and of its propaganda messaging dip so low. What is different from the era of Tiananmen and of other previous crises is that Chinese society has become increasingly dominated by a big and growing middle class. It is much more educated than before. And despite Beijing’s unstinting efforts at information control, people now receive much more news from sources of all kinds, whether domestic or foreign, through formal or informal networks. Big questions loom about whether the country’s political system in its present configuration can endure without major reforms. Will the CCP be able to retain control only at the expense of an exodus of vast numbers of talented Chinese, and a slowing of middle-class economic growth?
The frontlines to watch are threefold. To what degree can the state abide the truth? Can it ever acknowledge its mistakes? And how much criticism can it allow from its own citizens, the overwhelming majority of whom are patriotic? What seems certain is that the state’s customary guise of all-knowing, never erring, and not accepting independent thinking has never fared worse.