The arrival of the Delta variant of COVID-19 in mainland China has led some to reassess the country’s strategy of lockdowns and mass testing. Rather than endlessly cycle through such disruptive, costly measures, why not vaccinate, mask up, and learn to live with the virus? This was the suggestion made on social media by Zhang Wenhong, Director of the Department of Infectious Diseases at Huashan Hospital in Shanghai. The Chinese government and nationalist keyboard warriors pounced, complete with a People’s Daily editorial by former health minister Gao Qiang calling for a “fight to the death” with COVID-19. Bill Birtles reports for the Australian Broadcasting Corporation:
China’s former health minister, most likely with the top leadership’s blessing, used an official People’s Daily editorial this month to firmly reject Dr Zhang’s suggestion.
Without naming him, former minister Gao Qiang wrote: “Some experts [in China] think that Britain, the US and other countries’ approaches of ‘coexisting with the virus’ promotes ‘openness’, while China’s approach with quarantine control is restrictive.”
He said Western nations “blindly lifted or relaxed” containment measures to “demonstrate their dominance and influence”.
[…] “The history of human survival and reproduction is also a history of fighting viruses to the death,” he wrote. [Source]
The day after Gao’s editorial appeared, news media outfit Mr. Middle (中产先生) mounted a direct challenge to Gao and the zero-sum strategy, arguing for a “middle-of-the road approach” to managing COVID-19. The day after that, Mr. Middle’s post was censored, and their WeChat public account was suspended until September 9. The article is archived at CDT Chinese, and translated below:
1
In recent days, amid the sexual harassment scandal at Alibaba, there’s something that many people may have overlooked, which is that two factions have arisen in the discussion of COVID-prevention measures.
One faction advocates total eradication of the virus; the other advocates coexistence with it.
The internet has already erupted into arguments about these two different approaches.
The divide was made especially clear in a statement issued yesterday [August 9] by Gao Qiang, the former health minister:
“Coexistence” is completely unacceptable. Humankind and the virus are locked in a life-and-death struggle. Ultimately, victory will rely on medicines that can kill the virus. At this stage, we cannot relax, and in fact must increase our efforts. We must “cast the virus from our borders” and drown it in the vast ocean of the People’s War.
This statement has emboldened the “eradication faction.” The original proponent of “coexistence,” Zhang Wenhong (a top infectious disease expert), was savaged and tarred with accusations by a bunch of Weibo users with little more than a middle school education.
I don’t know whether to laugh or to cry.
But rather than rant about it, let’s analyze the positions of the two factions.
2
Let’s talk about the “eradication faction” first.
I seem to recall that Gao Qiang, who was appointed to the Ministry of Health at the height of the SARS epidemic in 2003, once said, “It is better to sacrifice economic prosperity in order to protect the health of the people.”
He actually made this statement ten years after SARS. During that epidemic, cases were sporadic and regional, not global, and the economic impact was quite small. If it were today, I’m not at all certain he would say the same thing.
Also, when he referred to “sacrificing the economy,” Gao Qiang was speaking from his background as a graduate of the economics department of Renmin University, rather than from a background in public health or medicine.
When he made yesterday’s statement, I expect a lot of experts were left scratching their heads:
1. “Humankind and the virus are locked in a life-and-death struggle.”
In reality, humans coexist with a number of viruses, whether we like it or not. For example, we live with the flu virus, which we cannot eradicate.
2. “Victory will rely on medicines that can kill the virus.”
Humans have never been able to kill a virus using any type of medicine. Not even once. There are no truly effective drugs for the vast majority of viruses, nor was SARS eliminated by the use of some powerful drug. In contrast to medical treatment, prevention and the administration of effective vaccines are much more important.
It’s easy to see that former minister Gao is not a public health expert.
Despite this, his words have resonated with many people.
I don’t think this arises from any scientific basis, but rather, from the desire to be protected.
Basically, everyone on the internet who supports eradication has the same argument:
Are you OK with someone in your family dying of COVID? Are you OK with an older relative contracting COVID? If you want to coexist with the virus, we should kick you out of the country and let you get a taste of the virus yourself.
It’s very hard to engage these eradication-faction types in a discussion based on science and disease prevention, because every discussion ends with them repeating some version of what I have paraphrased above.
If you keep pressing them, all you’ll get is “NMSL.”
From their perspective, it’s simply unacceptable to entertain the notion of coexisting with COVID.
Put somewhat indelicately, the majority of the eradication faction are from the lower tier of society. On the one hand, they are frightened and unable to accept the risk or pay the price of contracting COVID. On the other hand, they admire strength and hope that some powerful force can forever protect them from harm. If anyone dares disabuse them of this fantasy, then that person is their sworn enemy.
They don’t take science, methodology, or cost into account. Their calculations are based solely on what they personally stand to gain or lose.
We’ve discussed before why China has, so far, taken the “eradication” approach. Even though this approach is costly, there is a rationale behind it:
Medical resources are insufficient. If there are too many infections, there will be a shortage of hospital beds.
A shortage of hospital beds will cause mild cases to become severe cases, and severe cases to become deaths. This will lead to widespread panic.
Wuhan is the classic example of what happens when there is a shortage of hospital beds. The situation there was the most severe, but other cities were essentially able to avoid this.
With respect to eradication, there are two main points: cost and effectiveness.
More specifically, the questions are: Can we afford the cost of eradicating the virus? And in the end, will we be able to achieve eradication and end the pandemic?
Costs
Obvious costs:
The reagent used in COVID tests costs 80 yuan, and in some places, 65 yuan. If you add the processing costs at testing sites and labor costs for medical workers, then it comes to around 100 yuan per test.
Take Nanjing, for example: its 10 million residents went through five rounds of nucleic-acid COVID testing in 20 days, at a cost of five billion yuan.
COVID testing is free [for the individual], but who pays for it? Social security? If everyone has equal access to testing, do you really think it’s free?
Hidden costs:
Hidden costs include lockdowns of hot spots and business closures in key industries, such as retail, dining, tourism and air travel. On top of this, there has been a recent crackdown on card-playing and mahjong halls.
What’s the sum of all these economic losses? I’m afraid it’s impossible to calculate accurately.
The eradication faction needs to think about these questions and consider how many rounds of this back-and-forth can be sustained.
Let’s Go Back to Effectiveness
If we are just looking at China, there’s nothing wrong with the eradication approach.
Chinese exports drove global economic growth last year because this approach worked. Within a few months, industry had returned to normal.
However, outside of China the pandemic has exploded, and it is impossible to prevent the virus from [re-]entering our borders.
Outbreaks have been caused by a flight from Russia that landed in Nanjing, a flight from Myanmar that landed in Zhengzhou, and international flights into Shanghai. COVID can also be introduced via illegal border crossings and imported frozen food.
You cannot completely sever international contact. With the Winter Olympics coming to Beijing next February and the Asian Games to Hangzhou next September, it is inevitable that the nation will open its doors to the world.
What the eradication faction needs to consider is this: when, and under what conditions, will the doors to the nation be opened?
If we are waiting on foreign countries to eradicate the virus, who knows how long that will be. If the virus mutates again, will we be able to shoulder the cost? Can the unemployed survive this? What about shop owners?
The nation has been pouring capital into small and medium enterprises, but the economy still hasn’t gotten off the ground, and people have been unable to return to the normal routines of life and economic production. How long can this situation persist?
These are the issues that the eradication faction must consider. It’s not as simple as asking whether you are willing to let someone in your family die from COVID.
3
Let’s talk some more about the coexistence faction.
A lot of people oppose the idea of living with the virus, but they don’t understand that achieving coexistence is itself no simple task.
Coexistence requires two conditions:
- Adequate distribution of medical resources: Not treating young people with mild symptoms so that the elderly and those with underlying health conditions who develop serious cases can receive adequate medical care.
- Effective vaccine coverage: In order to achieve herd immunity, at least 80% of the population must receive two injections. If the virus mutates, booster shots may be required.
Based on data from Singapore, breakthrough cases in people who received one of the mRNA vaccines were almost all asymptomatic or had mild symptoms, with the majority of cases occurring among the elderly. There were no serious cases or deaths.
This illustrates that with effective vaccine coverage, even the Delta variant is about as frightening as the flu. Decreased virulence is the hoped-for outcome.
Although the WHO and mainstream academics are in consensus on the issue of coexistence, few countries, besides the UK and Singapore, explicitly acknowledge a strategy of coexistence.
Living with COVID seems like lying down, when in fact it requires an even greater exercise of state power.
Coexistence can come in different forms.
One form is a proactive coexistence, like that adopted in the U.K. and Singapore. I think that in the future, other developed countries will follow suit.
Another form is a passive coexistence, seen earlier this year in India, Africa and Southeast Asia.
Coexistence, of course, carries risks:
Proactive coexistence might lead to a loss of immunity due to antibody-dependent enhancement (whereby the virus bonds to suboptimal antibodies, allowing it to enter host cells). Passive coexistence can simulate a petri dish, where the disease can mutate into new variants.
Here is what some of the experts are saying:
Wang Chen: “It is quite possible that COVID will be with us for a long time.”
Zhang Wenhong: “The Nanjing outbreak has shown that we must learn to live with the virus.”
Zhong Nanshan: “COVID and humankind may enter into a long-term coexistence, requiring regular immunizations.”
Gao Fu: “Vaccination is the ultimate weapon in defeating infectious disease. Humankind may well coexist with COVID.”
Gao Qiang: “Coexistence is completely unacceptable. Humankind and the virus are locked in a life-and-death struggle. We must cast the virus from our borders.”
4
In conclusion, allow me to share my opinion.
First, let me say that I’m just discussing the possibilities, not making concrete recommendations.
One option is a middle-of-the road approach.
Focus on targeted eradication, but adopt a general strategy of coexistence. Relax some controls, but maintain vigilance. Restore order.
Of course, this is premised on the widespread administration of an effective vaccine.
The country should maintain stringent standards for international flights, border controls, imports and exports, while adopting an eradication approach for key industries and key personnel.
We should go back to the basic pre-pandemic order of things. All businesses should be open, and we should implement coexistence strategies such as semi-annual immunizations, mandatory prevention measures, masks, QR codes that display health status, and immunization passports. COVID shouldn’t be allowed to govern our lives.
What do you think? You can leave a message to share your thoughts.
That’s all. [Chinese]
Translation by Anonymous.
