What Does China's Exit From Zero-COVID Mean to the World?

After three years of intensive testing, strict lockdowns, and surveillance, China is abandoning the zero-COVID policy. Despite the surge of infections in the country, experts say China's opening won't change the course of the pandemic globally.

Since the SARS-CoV-2 virus emerged in the Chinese city of Wuhan in late 2019, the country's government has been trying to keep the number of COVID-19 cases as low as possible. This meant mass testing, strict lockdowns of entire neighborhoods and cities, and forcing people into quarantine facilities.

The mounting public's anger erupted into unprecedented protests in November 2022, prompting the Chinese government to cancel almost all COVID-19 measures.

Following the decision, at least 15 countries, including the U.S., now require travelers arriving from China to present a negative COVID-19 test. The Centers for Disease Control and Prevention (CDC) says this measure will help slow the virus's spread.

The number of deaths may be underreported

China's exit from zero-COVID policy is unlikely to make an impact on the pandemic globally, says Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security.

"This is because much of the world has a lot of resilience to COVID-19 in terms of immunity from vaccines, boosters, and natural infections. These countries also have access to antivirals, like Paxlovid, and better hospital capacity," Adalja, MD, told Healthnews.

As China opens up, the media reports and social media posts depict overwhelmed hospitals and decreased economic activity due to new COVID-19 outbreaks.

The Chinese government, however, reported only over 20 deaths due to the virus since December. The low number is associated with China changing the definition of COVID-19 death last month.

The World Health Organization (WHO) says that China underrepresents the true impact of the disease, including deaths, and calls for more transparency.

The data released by China also contradicts a recent analysis predicting that a sudden exit from the zero-COVID policy could result in between 1.3 and 2.1 million deaths in the country.

Gytis Dudas, a senior researcher at Vilnius University Life Sciences Center, also thinks that developments in China are unlikely to affect other countries, most of which are immunized either by vaccines or infections from the Omicron and earlier SARS-CoV-2 variants.

"In many countries, the emergence of significantly different Omicron subvariants caused a small increase in infections, hospitalizations, and deaths. But none of the countries think they should impose additional measures because of this," he told Healthnews.

As no unique SARS-CoV-2 variants are circulating in China, infected travelers could not significantly change the epidemiological situation in other countries, Dudas says.

Scientists are not concerned about BF.7

The current surge of cases in China is driven by the Omicron subvariant BF.7, which is short for BA.5.2.1.7. According to local reports, the sublineage may have a stronger immune-escape capability, as well as a shorter incubation period and faster transmission rate.

Although BF.7 is one of the more efficiently transmitting Omicron variants, says Adalja, MD, it is not a major concern compared to other subvariants.

"Vaccines protect against severe disease and hospitalization. BF.7 is also susceptible to Paxlovid, just like all other COVID-19 variants. So I don't think it is a more concerning variant than the others. It also has already passed in many other countries," he told Healthnews.

The BF.7 subvariant accounts for 2.1% of confirmed COVID-19 cases in the U.S., with XBB.1.5 being the dominant, the CDC data shows.

When the BF.7 subvariant emerged in the United Kingdom, the country's officials identified it as one of the "most concerning variants in terms of both growth and neutralization data at present." In November, British officials said that BF.7 growth rates in the U.K. were low.

Because most of the world population has gained immunity from infections with earlier Omicron subvariants, the burden imposed by reinfections does not require additional restrictions, Dudas explains.

What lessons can we take from China?

Soon after countries started imposing the lockdowns in 2020, there were discussions about whether autocracies are better at handling pandemics than democracies.

Adalja, MD, says that the lesson the world can take from China "is how not to respond to an efficiently spreading respiratory virus that cannot be eliminated or eradicated."

He says that the Chinese government did not take necessary steps, such as ensuring optimal protection of high-risk populations with the best vaccines, gaining access to antiviral medicines, and expanding ICU capacities.

"They did not teach the population how to risk-calculate, how to live in the world where COVID-19 is always going to be present," says Adalja, MD.

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