China’s next step on COVID, as estimated by Chairman Rabbit

Ren Yi predicts a process taking "several years" and advises caution & prudence.

On January 26, Pekingnology published the first half of Chairman Rabbit’s two-part WeChat blogs on China’s COVID-19 strategy vis-a-vis that in the United States. In a surprise to your Pekingnologist, that, within a mere two weeks, is now the second most-read newsletter in Pekingnology’s brief history of little more than a year.

Partly because of that, Pekingnology today presents a partial translation of the second half of Chairman Rabbit’s blogs on the subject, first published on Jan. 18. It is a vigorous explanation and defense of the Chinese policy so far, followed by his estimation and advice on China’s next step on COVID-19.

As far as your Pekingnologist is concerned, Ren Yi, the real name behind his pen name Chairman Rabbit [links to his Twitter], is certainly well-connected, and his writings are well-read and influential in China. But he isn’t a decision-maker. Only time can tell if his estimation turns out to be accurate.

Nevertheless, his views based on what he wrote as “logic and common sense” that may be shared by China’s upper echelons, could be informative. Moreover, foreign readers may be able to have a glimpse at how the issue may be approached here.

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China’s next step on COVID-19

1) Those who decry China’s current system on COVID-19 control while praising the U.S. model

Nowadays many Chinese misunderstand the COVID-19 situation outside China and are growingly fatigued with China’s zero-COVID policy. So there is a variety of confusion in public opinion.

Those people can’t see the painful process - developed countries in fact had no alternative. 850,000 people died in a major power like the United States, which paid a huge economic and social price. The number is still rising. It is the vulnerable groups in American society that have died: people of color, the elderly, and the impoverished. They sacrificed their lives in paving the way for herd immunity.

China has a population four times that of the United States. In China, the underlying respiratory diseases are serious. In terms of medical resources, China trails substantially behind the United States, with only one-tenth of the number of beds in intensive care units. In China, medical resources are concentrated in first-tier/economically developed cities, and the population is older (the elderly live with the next generation and rely on each other).

If China adopted the U.S. model, I believe the death rate would be ten times higher, if not more. If it were ten times more, that would be more than ten million deaths. And this is just the number of deaths caused directly by COVID-19. Exhaustion of medical resources would result in untold casualties. In that case, no one would know how many miscarriages and heart attacks there would be. That would be China’s version of the Black Death, a catastrophe of the nation.

That would be more than just deaths, but a matter of fundamental [political and social] stability.

In fact, Chinese people are psychologically fragile. If COVID-19 went out of control and hospitals couldn’t operate normally due to exhaustion of medical resources, the public would immediately lose their minds to outpouring negativity and pessimism and direct all their discontent towards the government. This was crystal clear in February 2020.

At that moment [when COVID-19 went out of control], all the people who now attack China’s present stringent COVID-19 control system would turn around and criticize China’s then ineffective control.

However, our country remains committed and hasn’t changed the policy to cater to the rhetorics. Therefore, our policy has stayed consistent, and the Chinese people have been enjoying China’s success in coping with COVID-19 in its own way. As they get used to the success and take it for granted, it is easy to complain about and criticize the flaws of the current policy on COVID-19 control, without giving due consideration to those potential, possibly horrific costs (should there be a change of policy).

This state can be described in a plethora of Chinese proverbs:

“站着说话不腰疼” “It’s easier said than done”;

“身在福中不知福” “Living in plenty without appreciating it”;

“敬酒不吃吃罚酒” “Refuse a toast only to drink a forfeit”;

“不见棺材不掉泪” “Not to shed a tear until one sees the coffin”.

Some have ingrained beliefs that they dare not air publicly, such as “外国的月亮就是圆的” “the moon is rounder seen in other countries than seen in China”, and American stuff is always better than Chinese stuff; China is not as good as the United States, no matter what China does; some people never had any faith in a Chinese model, and they have been keeping their mouth shut for the time being since China has effectively contained COVID-19, but they are skeptical deep in their minds.

Now, the United States “came out of the woods” after leaving 850,000 bodies and printing numerous greenbacks. So those people wrote off everything that happened and began to sing the praises of American strength.

However, if China followed the U.S. model and those people’s family members died, they would be the loudest frontline critics of the Chinese government and system. Nothing can change those people, nor is it necessary to change them.

2) Possible development of China’s future COVID-19 control policy in light of the new situation

Everyone cares about when will COVID-19 come to an end; when will China abandon its zero-COVID strategy, when will the entry-exit quarantine rules be relaxed at the Chinese border to smooth out the external and domestic circulations. As China and the other countries are entering two different worlds (“one is clearing up COVID-19 positive cases and the other one clearing up negative cases”), what should China do in the future?

China is a vast country. Anything involving 1.4 billion people is a big issue, and no mistake is acceptable. When it comes to COVID-19, the government will exercise great caution when making decisions. The current policy will not be adjusted easily. All previous efforts would come to nothing if one mistake were made, and there would be no going back. The policy will be adjusted only when there is absolute certainty.

Complaints from the people, international pressure, and even pure economic considerations will not affect China’s policy on this.

I cannot predict when the existing policy will be systematically adjusted, and I am not a public health professional, but judging from logic and common sense, the following conditions will probably have to be met before that happens:

i) The scientific community/experts including international experts and Chinese experts must have a broad consensus on COVID-19’s prospects and epidemic prevention policies.

Chinese experts must also collaborate with policy-makers to take China’s reality into account. If the scientific community does not have a broad consensus - if there are relatively substantial disagreements - it will be difficult for our policymakers to make decisions.

ii) The World Health Organization’s definition of the severity of and advice on COVID-19 have both changed.

China will abide by international rules, will not march alone, or change its policies unilaterally, which means China will wait for the WHO to change its assessment of COVID-19. For example, the WHO no longer refers to COVID-19 as a “pandemic”, downgrades its significance, signals that COVID-19’s severity can be managed, stops giving strong advice, signals that countries can formulate and/or lower epidemic response standards as they see appropriate, removes COVID-19 from its top agenda, so on and so forth. The WHO would have to need agreement from the scientific community. I am afraid that this is infeasible in the near future.

iii) Adjustment in terms of Chinese laws and regulations.

At present, the Law of the People’s Republic of China on the Prevention and Treatment of Infectious Diseases is cited to classify “pneumonia caused by novel coronavirus” as a “Class B infectious disease”. At the same time, preventive and control measures applied to “Class A infectious disease” are imposed with COVID-19 cases.

According to that law, Class A infectious diseases are plague and cholera, which are very serious diseases. COVID-19 is currently being managed at this level. A change on this would be a significant one, which requires consensus from the scientific community and international organizations/institutions.

At that time, if the dominant SARS-CoV-2 variant mainly affects [only] the upper respiratory tract, it will remain to be seen whether the word “pneumonia” will continue to be employed in the name of the disease.

iv) Enhancement of China’s medical infrastructure.

China needs to strengthen local governments’ capabilities to cope with infectious diseases and increase the supply of medical resources (ranging from ICU beds to medical personnel) in preparation for COVID-19.

Don’t dismiss the epidemic control that local governments make nowadays from time to time in response to newly-discovered COVID-19 cases. These could be seen as drills that can assist local governments in improving their response capabilities.

Medical systems around the United States have exercises for respiratory infectious diseases (mainly targeting seasonal flu), but the epidemic response is not something that one or two hospitals can handle. A divided and fragmented political system makes it very difficult for the United States to deal with large-scale outbreaks at the national level.

v) That the number of new cases, hospitalizations, and deaths in countries around the world decrease, and COVID-19 recedes globally.

This has something to do with international travel restrictions. Today’s world is highly globalized, any large-scale epidemic in one country may spread to others, so imposing travel restrictions on a single country is pointless. A “green channel” can be opened for certain countries as an interim measure, but these countries must have corresponding epidemic prevention policies in place. Given that it is difficult for any country to adopt the same stringent policy as China does, this one-to-one green channel may be challenging.

vi) That “weakened” variants (such as Omicron) become dominant, whereas other “stronger” variants recede and disappear as a result. Although Omicron is now dominant, other more “dangerous” variants exist as well. It’s just that Omicron has stolen the limelight. Other variants (such as Delta) are still highly dangerous. The present COVID-19 response policy cannot be converted into an Omicron-specific response policy right away. In addition, past patterns indicated that new variants emerge every few months. Who knows whether there will be a more powerful variant? Everything is still up in the air.

vii) Continuously strengthen and verify the efficacy of Chinese vaccines, including their efficacy against new variants.

Countries to which China has exported vaccines en masse can be seen as de facto “testing grounds”, such as Chile. China can monitor the efficacy of Chinese vaccines in these countries to see their clinical efficacy against various variants, and the data can be used as an important reference on pondering policy changes.

viii) Develop vaccines against new variants on existing vaccine platforms and vaccinate the population extensively to achieve a very high inoculation rate.

For example, a booster vaccine must be developed for Omicron, the currently dominant variant. After its efficacy is proven, a very high inoculation rate must be achieved in the entire population to build a shield of defense.

ix) Add new vaccine types and platforms as appropriate: In addition to traditional live attenuated/inactivated vaccines, different innovative vaccine “platforms”, such as mRNA, should be added to increase the flexibility in response to a host of new variants. After a new vaccine platform is established, it should be promoted to establish a certain level of inoculation rate. 

x) A pilot program. Given the vast size of China, it could be necessary to choose a place/province/region as a pilot site open to foreigners. This place must have good medical infrastructure; a high inoculation rate of Chinese vaccines (both the basic shot and the booster with good defense capabilities); temporary isolation from other provinces/regions (by imposing requirements for connectivity); strong local governance capabilities; and a certain geographical distance from the capital Beijing.

Some mechanisms can be put in place to attract foreigners to enter China via this place. There must be absolute certainty when promoting this pilot project. People in the province/region must have great confidence in the epidemic response and believe that they will benefit tremendously from the pilot program (instead of letting them become “guinea pigs”).

xi) The general public/public opinion/mediasphere must be prepared to get on board. That some people tout the U.S./Western epidemic response policy should be noted that the same people will criticize China no matter what. The majority of the Chinese people are silent, and they will follow the mainstream on how to control COVID-19 - they will put their own interests first when making judgments. Once a relaxed policy induces a large-scale outbreak, hospitalizations, and deaths, jeopardizes their safety and well-being, the silent majority would decry it. However, the silent majority also have very high hopes for the country/government, hoping that the country will solve their problem.

For a long time, our official narrative has been emphasizing the acute danger of COVID-19, and many people are extremely frightened. This is in stark contrast to the U.S./West, which has suffered massive infections and deaths and become numb. Therefore, the policy cannot be changed all of a sudden - before that, there must be publicity to explain the rationale of potential policy adjustments.

A major public policy must be consistent. We cannot change the existing policy dramatically in a few weeks after seeing some positive news about Omicron. From the people’s standpoint, they shall not be credulous and hope that the policies that have benefited them for a long time are revoked at the vague sight of some uncertain changes.

Given the risks for China’s 1.4 billion people, the irreversibility of policies (there is no turning back for every small movement forward), and the unpredictable nature of COVID-19, it will take a comparatively long time for the Chinese government to adjust its COVID-19 control policies based on the need of the times. Considering China’s different situation from others, the change will see additional delays behind other countries.

Once the decision is made, the impact will be far-reaching.

Such a major decision must not be made hastily. It must be thought over completely before action can be taken.

A wrong step can alter history and change the country’s fate, or in the Chinese proverb: a single slip may cause lasting sorrow.

In my opinion, this process can take 数年 several years.

I think it is better to go prudently and slowly. We must not succumb to short-term pressure and must do what may be difficult but correct that can stand the test of history. (Enditem)

ICYMI here is the first part: A comparison between COVID control in China and U.S.

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