Shanghai reaffirmed China’s strict “zero-COVID” approach to pandemic control Wednesday, a day after the head of the World Health Organization said that was not sustainable and urged China to change strategies.
While China’s largest city has seen progress in controlling the COVID-19 outbreak, any relaxation in prevention and control measures could allow it to rebound, deputy director of Shanghai’s Center for Disease Control Wu Huanyu told reporters.
“At the same time, now is also the most difficult and critical moment for our city to achieve zero-COVID,” Wu said at a daily briefing.
“Should we relax our vigilance, the epidemic may rebound, so it is necessary to persistently implement the prevention and control work without relaxing,” he said.
Wu gave no indication he was aware of the comments by WHO Director-General Tedros Adhanom Ghebreyesus, who said he had been holding discussions with Chinese experts on the need to transition to a new approach in light of new knowledge about the virus.
“When we talk about the ‘zero-COVID,’ we don’t think that it’s sustainable, considering the behavior of the virus now and what we anticipate in the future,” Tedros said at a news briefing Tuesday.
“And especially when we have now a good knowledge, understanding of the virus and when we have good tools to use, transitioning to another strategy will be very important,” he said.
Tedros was joined by Mike Ryan, the WHO’s emergencies chief, who said all pandemic control actions should “show due respect to individual and human rights.”
Countries need to “balance the control measures, the impact on society, the impact on the economy. That is not always an easy calibration to make,” Ryan said.
China’s ruling Communist Party has strictly controlled all discussion about its controversial approach, which aims to totally stamp out outbreaks, and said it would tolerate no criticism. The entirely state-controlled media did not report on the comments by Tedros and Ryan and references to them on the Chinese internet appeared to have been removed by censors.
The ruthless and often chaotic implementation of zero-COVID has stirred considerable resentment in Shanghai, where some residents have been under lockdown for more than a month. As of Wednesday, more than 2 million people in the city remained confined to their residential compounds, while restrictions had been slightly relaxed for most of the other 23 million.
However, the easing appears to now be on hold, even as the number of new cases falls in the city that is home to China’s busiest port, main stock market and thousands of Chinese and foreign firms.
Teams in white protective suits have begun entering the homes of infected people to spray disinfectant, prompting worries about damage to property. Residents have in some cases been ordered to leave their keys with a community volunteer when they are taken to quarantine so disinfectant workers can get in, a new requirement that has no apparent legal basis.
People in some areas have been ordered to stay home again after having been let out for limited shopping in recent weeks. On Tuesday, service was suspended on the last two subway lines that were still operating.
Complaints have centered on shortages of food and other daily necessities and the forced removal of thousands of people to quarantine centers after having tested positive or having been in contact with an infected person, standard procedure in China’s zero-COVID approach.
However, the party under leader Xi Jinping shows no sign of backing off amid efforts to ensure stability and shore up its authority ahead of a major party congress this fall.
Chinese experts such as Wu have been careful to toe the party line, saying the strategy has been effective in limiting the official death toll to slightly over 5,000 over the course of the entire pandemic, according to the government’s National Health Commission, and that any let-up risks sparking a major new surge.
Ryan gave China’s death toll as just over 15,000 and the Johns Hopkins University of Medicine Coronavirus Resource center offers a figure of 14,538.
The daily number of new cases in Shanghai reported on Wednesday had fallen to less than 1,500, down from a peak of 26,000 in mid-April. Seven more COVID-19-related deaths were reported, raising the toll from the outbreak to 560.
While China says more than 88% of its population is fully vaccinated, the rate is considerably lower among the vulnerable elderly. Questions have also been raised about the efficacy of Chinese-produced vaccines compared to those from Europe and the United States.
In the capital Beijing, residents have been ordered to undergo mass testing in a bid to prevent a major outbreak like that in Shanghai. The city, which reported 37 new cases on Wednesday, has locked down individual buildings and residential compounds, shut about 60 subway stations and banned dining at restaurants, allowing only takeout and delivery.
Total Doses Distributed = 732,806,655. Total Doses Administered = 579,685,594. Number of People Receiving 1 or More Doses = 258,229,583. Number of People Fully Vaccinated = 220,223,617.
Testing for COVID-19 has plummeted across the globe, making it much tougher for scientists to track the course of the pandemic and spot new, worrisome viral mutants as they emerge and spread.
Experts say testing has dropped by 70 to 90% worldwide from the first to the second quarter of this year — the opposite of what they say should be happening with new omicron variants on the rise in places such as the United States and South Africa.
“We’re not testing anywhere near where we might need to,” said Dr. Krishna Udayakumar, who directs the Duke Global Health Innovation Center at Duke University. “We need the ability to ramp up testing as we’re seeing the emergence of new waves or surges to track what’s happening” and respond.
Reported daily cases in the U.S., for example, are averaging 73,633, up more than 40% over the past two weeks, according to data compiled by Johns Hopkins University. But that is a vast undercount because of the testing downturn and the fact tests are being taken at home and not reported to health departments. An influential modeling group at the University of Washington in Seattle estimates that only 13% of cases are being reported to health authorities in the U.S. — which would mean more than a half million new infections every day.
The drop in testing is global but the overall rates are especially inadequate in the developing world, Udayakumar said. The number of tests per 1,000 people in high income countries is around 96 times higher than it is in low income countries, according to the Geneva-based public health nonprofit FIND.
What’s driving the drop? Experts point to COVID fatigue, a lull in cases after the first omicron wave and a sense among some residents of low-income countries that there’s no reason to test because they lack access to antiviral medications.
At a recent press briefing by the World Health Organization, FIND CEO Dr. Bill Rodriguez called testing “the first casualty of a global decision to let down our guard” and said “we’re becoming blind to what is happening with the virus.”
Testing, genomic sequencing and delving into case spikes can lead to the discovery of new variants. New York state health officials found the super contagious BA.2.12.1 variant after investigating higher-than-average case rates in the central part of the state.
Going forward, “we’re just not going to see the new variants emerge the way we saw previous variants emerge,” Rodriquez told The Associated Press.
Testing increases as infections rise and people develop symptoms — and it falls along with lulls in new cases. Testing is rising again in the U.S. along with the recent surge.
But experts are concerned about the size of the drop after the first omicron surge, the low overall levels of testing globally, and the inability to track cases reliably. While home tests are convenient, only tests sent to labs can be used to detect variants. If fewer tests are being done, and fewer of those tests are processed in labs, fewer positive samples are available for sequencing.
Also, home test results are largely invisible to tracking systems.
Mara Aspinall, managing director of an Arizona-based consulting company that tracks COVID-19 testing trends, said there’s at least four times more home testing than PCR testing, and “we are getting essentially zero data from the testing that’s happening at home.”
That’s because there’s no uniform mechanism for people to report results to understaffed local health departments. The CDC strongly encourages people to tell their doctors, who in most places must report COVID-19 diagnoses to public health authorities.
Generally, though, results from home tests fall under the radar.
Reva Seville, a 36-year-old Los Angeles parent, tested herself at home this week after she began feeling symptoms such as a scratchy throat, coughing and congestion. After the results came back positive, she tested twice more just to be sure. But her symptoms were mild, so she didn’t plan to go to the doctor or report her results to anyone.
Beth Barton of Washington, Missouri, who works in construction, said she’s taken about 10 home tests, either before visiting her parents or when she’s had symptoms she thought might be COVID-19. All came back negative. She shared the results with the people around her but didn’t know how to report them.
“There should be a whole system for that,” said Barton, 42. “We as a society don’t know how to gauge where we’re at.”
Aspinall said one potential solution would be to use technology like scanning a QR code to report home test results confidentiality.
Another way to keep better track of the pandemic, experts said, is to bolster other types of surveillance, such as wastewater monitoring and collecting hospitalization data. But those have their own drawbacks. Wastewater surveillance remains a patchwork that doesn’t cover all areas, and hospitalization trends lag behind cases.
Udayakumar said scientists across the world must use all the tracking methods at their disposal to keep up with the virus, and will need to do so for months or even years.
At the same time, he said, steps must be taken to boost testing in lower-income countries. Demand for tests would rise if access to antivirals were improved in these places, he said. And one of the best ways to increase testing is to integrate it into existing health services, said Wadzanayi Muchenje, who leads health and strategic partnerships in Africa for The Rockefeller Foundation.
Georges Benjamin, executive director of the American Public Health Association, said there will come a point when the world stops widespread testing for COVID-19 – but that day isn’t here yet.
With the pandemic lingering and virus still unpredictable, “it’s not acceptable for us to only be concerned about individual health,” he said. “We have to worry about the population.”
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AP reporters Bobby Caina Calvan in New York and Carla K. Johnson in Seattle contributed to this story.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
The head of the World Health Organization called on Pfizer to make its COVID-19 treatment more widely available in poorer countries, saying Tuesday that the pharmaceutical company’s deal allowing generic producers to make the drug was insufficient.
WHO Director-General Tedros Adhanom Ghebreyesus said during a news briefing that Pfizer’s treatment was still too expensive. He noted that most countries in Latin America had no access to Pfizer’s drug, Paxlovid, which has been shown to cut the risk of COVID-19 hospitalization or death by up to 90%.
“We remain concerned that low- and middle-income countries remain unable to access antivirals,” Tedros said,
The WHO chief warned that the unequal distribution of COVID-19 drugs could ultimately mirror the grossly disproportionate distribution of coronavirus vaccines.
For example, while countries such as Britain have vaccinated more than 70% of their populations, fewer than 16% of people in poor countries have received a single dose.
Pfizer signed an agreement in November with the U.N.-backed Medicines Patent Pool to allow other drugmakers to make generic copies of its pill, for use in 95 countries. Some large countries that suffered devastating COVID-19 outbreaks, like Brazil, were not included.
Tedros said the deal does not go far enough and called for Pfizer to lift its geographic restrictions on where the generic version of Paxlovid might be used, as well as to make the pill less costly for developing countries.
The U.S. paid about $500 for each course of Pfizer’s treatment, which consists of three pills taken twice a day for five days. Its price in developing countries has not yet been confirmed.
WHO’s chief scientist Dr. Soumya Swaminathan said most of the world’s supply of Pfizer’s drug had already been booked by rich countries, similar to how they hoarded the vast majority of last year’s coronavirus vaccines.
She applauded Pfizer’s agreement to let other drugmakers produce its drug, but noted that manufacturing would not start until next year. Swaminathan also appealed to Pfizer to drop its requirement for some developing countries to assume product liability in case there are any problems once it’s rolled out.
Teams in white protective suits are entering the homes of coronavirus-infected people to spray disinfectant as Shanghai tries to root out an omicron outbreak under China’s strict “zero-COVID” strategy.
City official Jin Chen said Tuesday that in older communities with shared bathrooms and kitchens, the homes of anyone else who uses those facilities will also be disinfected. He tried to address public concern about damage to clothing and valuables, saying residents can inform the teams about anything that needs protection.
Shanghai also suspended service on the last two subway lines that were still operating Tuesday, marking the first time the city’s entire system has been shut down, according to The Paper, an online media outlet.
The latest measures come as Shanghai has ordered people in some districts to stay in their homes again after letting some out for limited shopping in recent weeks. The latest steps have further frustrated residents, who were hoping a more than monthlong lockdown was finally easing as the number of new cases in the city falls.
Most of the city of 25 million people appear confined to their apartments or residential complexes, though there has been some easing in outlying suburban areas without new cases in their communities. AP video shot Monday showed a silent and deserted city, with only a very occasional vehicle and a few food delivery drivers on scooters moving down empty roads.
The daily number of new cases in Shanghai fell to about 3,000 on Monday, down from a peak of 26,000 in mid-April. Authorities have kept most of the city bottled up as they try to stop the spread of the virus, even as many other parts of the world are loosening restrictions and trying to live with it. Six more COVID-related deaths were reported in China’s largest city, raising the toll from the outbreak to 553.
Beijing, the capital, began another round of three days of mass testing for millions of its residents Tuesday in a bid to prevent an outbreak from growing to Shanghai proportions. The city, which recorded 74 new cases on Monday, has locked down individual buildings and residential compounds, shut about 60 subway stations and banned dining at restaurants, allowing only takeout and delivery.
Shanghai initially ordered mass testing along with a limited lockdown, but extended that as case numbers rose. Thousands of residents have been forced into centralized quarantine centers after testing positive or having been in contact with an infected person.
Notices issued in several districts in recent days said residents were ordered to stay home and barred from receiving nonessential deliveries as part of a “quiet period” lasting at least until Wednesday. The measures could be extended depending on the results of mass testing, the notices said. The sudden tightening, after some initial opening up, took residents by surprise.
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Associated Press researchers Si Chen in Shanghai and Yu Bing in Beijing contributed.
Total Doses Distributed = 732,209,615. Total Doses Administered = 579,242,327. Number of People Receiving 1 or More Doses = 258,165,428. Number of People Fully Vaccinated = 220,163,884.
