A comparison between COVID control in China and U.S.

Chairman Rabbit's views

With the spreading of the Omicron variant, lately, the discussion of China’s “dynamic zero COVID” policy is heated.

For example, The New York Times ran China’s Zero-Covid Policy Is a Pandemic Waiting to Happen (a guest essay) today, and China Holds the Line on ‘Zero Covid,’ but Some Wonder for How Long and Zero-Covid Policy Shakes Hong Kong’s Economy and Its ‘Soul’ last week. In the week before that, The Army of Millions Who Enforce China’s Zero-Covid Policy, at All Costs induced particularly harsh feedback from Chinese media.

Below is translated from a January 18, 2022, post on the WeChat blog 兔主席 Chairman Rabbit [links to his Twitter]. Behind the blog popular among usually better-informed Chinese readers is Ren Yi, as many of you probably have already known.

Your Pekingnologist is pretty sure many subscribers will probably not agree with his views - but he thinks exposure to some different Chinese views is at least partly what you signed up for.

This is the first half of Ren’s two-part series on the issue. The translation hasn’t been reviewed by him. The highlights are by Pekingnology.

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对不同抗疫模式的回顾（主要是中美比较）

A review of different models for combating the pandemic - a comparison mainly between China and the U.S.

1. How developed countries coped with the pandemic

Two years ago, China imposed a lockdown on Hubei Province and its capital Wuhan when COVID-19 just broke out, and the pandemic was largely under control in China by March 2020. Then SARS-CoV-2 spread around the world, spiraling out of control.

This can be seen as students taking an exam, as the initial test taker, China gets full marks on it. At the time, the Chinese people had faith in developed countries’ public health systems, believing that they could pass the test, and by working together, SARS-COV-2 would be wiped off from the surface of the earth. That would not be without precedent: severe respiratory infectious illnesses like SARS and MERS had been brought under control before.

However, it was quickly discovered that the Chinese model could not be replicated. After a period of struggle, the vast majority of the developed countries resigned themselves to allow the virus to run its course. This, however, resulted in widespread infections and deaths. The countermeasures of major developed countries can be summarized in fact as follows:

1) Vaccination – develop and promote vaccines, and vaccinate as many people as possible to boost their immunity against SARS-COV-2 to lower the rates of severe cases and mortality. Vaccination is a reflection of medical technology capabilities and contributes to public health, but it is not synonymous with public health. A major problem is that in some developed countries which place a high premium on individual liberty and rights, not everyone is willing to be vaccinated, and the people can’t be ordered to vaccinate. In the U.S., for example, the vaccination rate struggles to surpass 60%, beyond which increasing vaccination rates is very challenging. About 20% of eligible adults are firmly against vaccination. The reasons are complex: they have their own beliefs, which include the refusal to be vaccinated. It’s as if Trump has a political base of around 40% of the voters, which the Democrats/Left simply can’t poach.

2) “Natural infection”: If a large number of persons are infected with SARS-CoV-2, “herd immunity” will be gradually achieved. Aside from the people who died from COVID-19, the people who have been infected and recovered will have enhanced immunity. Although these individuals may become infected again, or die as a result of infection, and the virus may still mutate as it spreads, the general trend is that large-scale infection of humans will definitely accelerate “herd immunity”. In fact, the virus is “working overtime” in this direction. This is a “two-way” effect (This concept will be mentioned hereunder). However, despite that the UK flirted with the concept of “herd immunity” in 2020, it should be said that this is neither the intended goal of public health policy nor the active selection of public health policymakers, to begin with. Judging from the evolution of pandemic-control policies in various countries, it is mainly a passive choice because there is no alternative: in the case of COVID-19, no country has the capability to replicate China’s model of "dynamic Zero COVID": trying to mimic that would be a double whammy of economic and social paralysis as well as a failure in pandemic-control. Therefore, it would be better to keep it real, “let nature take its course”, and allow the natural human mechanism (and SARS-CoV-2) to work.

If “natural infection” was previously seen as a passive, last resort, it gradually becomes part of public policy after the COVID vaccine’s efficacy has been demonstrated, although most policymakers will not say so in public.

2. Conditions for developed countries’ coping “model” and the problems

The following are the main problems with the developed countries’ “model”:

First, deaths. Massive infections naturally result in a large number of people being hospitalized, with the elderly and frail bearing the brunt. This reduces the average life expectancy. For example, in the U.S., the COVID-19 pandemic has shortened the average life expectancy by 1.5 to 2 years, the first significant drop in average life expectancy since World War II. (Before that there were the 1918 influenza pandemic and World War II)

Moreover, people who have recovered from infection may not be completely immune in the future. Re-infection is still possible as long as the virus is still spreading (or even mutates to become a worse variant). People could possibly die if they become infected again.

The second is the exhaustion of medical resources. Competition for medical resources could deprive COVID-19 patients of sufficient assistance, and also lead to some indirect pain and death. One miscarriage in Xi’an recently gripped Chinese public opinion.

In fact, similar problems would occur in any society where there is an exhaustion of medical resources due to COVID-19 unless the resources are sufficiently plentiful. The original goal of China’s “dynamic zero COVID” is to avoid the exhaustion of medical resources.

In comparison to China, Western societies/developed countries are better positioned to deal with the two aforementioned issues, primarily because of two factors.

The first is the general public’s expectation of the government’s responsibility. The more dispersed political power is, the lower the people’s expectations for government. An extreme example is the U.S., with political power dispersed throughout federal, state, and local governments, as well as the separation of power. It is difficult for the people to attribute the blame for anti-pandemic problems to a single government or politician. Changing the President will not be able to change the public health capacity. The general public does not have high expectations for the government. On the contrary, the general political ideology tends to limit the power of the government. Furthermore, people’s dissatisfaction can be diffused by replacing leaders via elections (for example, the election of Joe Biden is, among other things, an expression of the dissatisfaction with Donald Trump’s pandemic control), without targeting the political system itself.

In short, the comparison between China and the U.S. shows that the more decentralized the power of the government, the weaker the integrated public health and anti-pandemic capacity. Therefore, the U.S. is one of the worse performers among developed countries. However, the people, in turn, have lower expectations and less dissatisfaction with the government/political system.

The situation in China is quite the opposite. In China, the government is omnipotent and bears all political and ethical responsibilities. The people’s expectations for the government have no limits and may change at any time. Their demand for the government may change rapidly - the people don’t even have to be reasonable in their demands. The government must solve problems by all means and take responsibility, and this responsibility is both political and moral.

Therefore, that a million people die due to COVID-19 is acceptable in the U.S., but it isn’t in China. If a similar situation arises in China, it will severely jeopardize social stability and become a political issue.

Second, personal health, as well as the accessibility and abundance of medical resources and infrastructure.

If a person is in poor health, their ability to resist COVID-19 is weak. Therefore, the mortality rate from COVID-19 will, ceteris paribus, be higher.

A society’s ability to cope with epidemics is determined by its medical resources and infrastructure. If medical resources are plentiful, a public health crisis can be transformed into a matter of personal medicine: the key to public health is prevention and control, while the key to personal medicine is medical treatment. If prevention and control fail, then the burden falls onto treatment: “just give up prevention and control, let the hospitals treat them - no matter how many there are.”

If the medical resources are not accessible and plentiful, there is no way to deal with an epidemic. The medical system will collapse in a very short while in face of waves of patients.

China has a few cities with good resources, but it is still a developing country that lags far behind developed countries. For example, the number of intensive care unit (ICU) beds per capita in China is only one-tenth of that in the U.S.

Therefore, China’s current strategy can only focus on prevention and control - the key to public health in infectious diseases.

In fact, the United States, in the pandemic, with its social governance model, can still function without resulting in a collapse - even absent the public health agencies of the Government or the CDC.

However, it is still a huge hemorrhage of medical resources in the U.S., aside from the death of 850,000 people.

For example, the press report U.S. Faces Crisis of Burned-Out Health Care Workers in November 2021 said

“……[S]ince the start of the pandemic with some 60% to 75% of clinicians reporting symptoms of exhaustion, depression, sleep disorders, and PTSD, Dzau said, while nurses are equally if not more stressed. About 20% of health care workers have quit during this period, he said, and 4 out of 5 of those who remain say that staff shortages have affected their ability to work safely and to satisfy patient needs”

Another one from April 2021: More than 3,600 US health workers died in COVID's 1st year.

Those are the figures for 2020. If the year 2021 is counted, it is likely that the death toll of medical professionals will exceed 5,000. The U.S. spent decades building its medical system, and COVID-19 has wreaked havoc with it. The COVID-19 will definitely affect the public’s access to medical resources in a direct or indirect manner, bringing collateral damages.

Globally, the numbers are even more mind-boggling. The United Nations estimates that up to 180,000 health workers have died of COVID-19 infections. I think a large portion of the death is from developing countries which have been hit disproportionately harder due to their limited medical resources.

Imagine how much collateral damage has this brought?

And imagine the consequences if this happened in China?

Third, the attitude towards the elderly and the weak.

I talked to some [my?] children about history on the weekend. I talked about ancient humans, including the Neanderthals. Neanderthals looked after their elders/the weak. A fossil unearthed shows a person with a broken eye socket and a splintered fractured arm (possibly because of an armed struggle with wild animals). However, he lived to old age. There is only one possibility: he was taken care of by the community.

This shows that Neanderthals had community values, and were not barbarians.

Many primitive tribes of modern Homo sapiens show greater respect for their elders. If an elder was toothless, the younger chewed food for them to aid eating and swallowing.

Protecting the elderly and the weak has been associated with the civilization of society since ancient times.

It is relatively easy to stress (or stress disproportionately) individual freedoms and individual rights because it consummates with selfish individual desires and is in the interests of individuals. However, it is not easy to stress everyone’s responsibilities and obligations to the community. Having individuals prioritize the interest of the group and sacrifice for the community - to sacrifice personal interests to take care of the elderly and the weak - is difficult. This requires a strong sense of community values, and this value has to be cultivated from a very young age.

This is, however, the value of Chinese society. We have a tradition of respecting the elderly and a vision for prosperity for all and the common good for the world. These are in our cultural heritage and genes.

In some societies, people are selfish, independent, and only watching for their own good. There can be - there is - philanthropy and the public good - people can choose to help others, but they are not obliged to do so. In turn, people are not obligated to offer help when help is demanded. Ultimately, everyone fends for themselves - they are not entitled to anything. This is the New World born from settling and occupation - the “free world”. That is to say, the United States of America.

Between China and the U.S., which can be more tolerant of the death of the elderly? The death of the weak? The death of a million people?

The U.S., of course.

In pursuit of “herd immunity”, society can overlook these burdens - carry on without the burden. A million are “abandoned” so that those who remain can move on.

The U.S. is a racial society. If observed with a magnifying glass, the race with the highest mortality rate is the most vulnerable race.

In other words, black people.

In the first half of 2020 alone, the life expectancy of black men in the U.S. plummeted by three years, according to the CDC.

The price of “abandoning” public health is borne by the vulnerable and discriminated ethnic groups. This is the United States in its racism.

However, even in the U.S., those who are “abandoned” will in fact not necessarily complain. They live in a society with the value system of “relying on ourselves”, believing that’s just what happens. This is the “free world” for the “survival of the fittest”.

Many values in today’s humanity ​​are not universal, but relative. We can’t say which is “right” and which is “wrong”. This is not simply a matter of right and wrong, and I’m not judging. This is an issue of different values and different ways of social organization.

Different societies deal with epidemics in different ways. The method adopted is ultimately the one based on their own values ​​and method of social organization. This is also the case for the political systems.

In the U.S., the American model is correct. In China, the Chinese model is correct.

The U.S. cannot adopt the Chinese way. China cannot adopt the American way.

However, the author is of the opinion that the U.S. is even more “barbaric”, given that we are in the 2020s. This is a selfish society with little people-to-people connection. The advanced material civilization/medical technology cannot cover up the flaws in values, nor make up for the loss in the value system ​​(850,000 people died, after all).

3. Moving forward “over dead bodies” cannot be called “civilization” and “success”.

Actually, only a few countries in the world have made an “active selection”. The so-called active selection means that the public health policy that you have adopted could positively change the outcome, reverse the trend, and avoid unnecessary deaths.

The West, led by the U.S., has never had the capability to make “an active selection”. They can only make passive choices, that is, let nature take its course. Their only reliance is vaccines built on advanced modern medical technology. However, vaccines have also strengthened people’s determination to “let nature take its cause” and weakened the functions of public health: because vaccination is also voluntary, public health has become a personal choice: individuals choose whether to get vaccinated and bear the consequences of not being vaccinated.

Therefore, there is no “public health model” in the West led by the U.S. What they have is “let nature take its cause” + vaccination.

Some may say that the pandemic is coming to an end in the U.S./West, while China still insists on the “dynamic zero COVID” and will fall behind. Moreover, the experience has proved that the Western model is superior, as they say!

If we disregard the morality in the many deaths, disregard the enormous social costs, regard the total value of those who perished as zero, and even regard their deaths as a positive (a remarkable contribution to herd immunity) - if we follow such a value system, what is the point of discussing public health?

Or what is the point of talking about advances in medical technology?

In history, the Black Death killed between 75 million and 200 million people in Eurasia, and probably wiped out about half of Europe’s population in merely four years.

Haven’t human beings survived? Haven’t they achieved great development afterward? However, can we say that Europe achieved a resounding “success” at that time? Can we say that Europe at the time was “civilized”?

Obviously, it cannot be described using words like “success” and “failure”, or “civilization” and “barbarism”. Historically, human beings paid a costly price (the death of hundreds of millions of people) to overcome that pandemic based on the conditions at the time.

The fact is that human beings could “overcome” SARS-CoV-2 in the most primitive way: without any public health system, hospital, medicine, or vaccination, but by achieving herd immunity through massive infections and deaths.

The hypothesis here is that the dead are worthless. They are like the eliminated people in the “squid game” and their only function in the game is to let others survive. They did not make any lofty self-sacrifice in the process, but they were “selected” as the “cannon fodder” and “denominator” due to tough luck.

In terms of medical resources and infrastructure, China, which has a population four times that of the U.S., pales in comparison with the U.S. In China, a lot of people have pre-existing respiratory diseases, the population is aging and many elders live with their offspring. If China controls as the U.S. does, the number of deaths caused by COVID-19 may not be a four-fold increase of 850,000 (3.4 million) but will reach an astronomical figure. The resulting economic and social costs would be unbearable.

In that scenario, every family may see the death of an elderly person. (In such a scenario, every one of the critics of the current Chinese COVID control policies may face the risk of the death of their elders. At the time, they would attack the Chinese government and its political system from a standpoint that is completely opposite to their current position.)

China’s unique pandemic control may have avoided the deaths of millions and tens of millions of people. Are these efforts worthless? Isn’t it a huge contribution to human society and Chinese society?

Many Chinese may have paid a price to prevent the deaths of millions or tens of millions of compatriots. Are these sacrifices worthless? Shouldn’t this deserve respect?

Chinese society is different from others thanks to these sacrifices. This could be the cornerstone for building a great civilization. (Enditem)