Analysis: China grapples with political challenges as Covid death toll rises

And Beijing is pointing to the past successes of this strategy — including just two reported Covid-related deaths for all of 2021 — to polish its claims of superiority over Western governments.

“No effort should be spared to attend every case, save every patient and truly respect the value and dignity of every human life,” Chinese leader Xi Jinping – who has recently expressed his explicit support for the “zero -covid” policy weeks — said at a global health summit last year.

Now that picture is changing, as for the first time in nearly two years, China’s Covid death toll is rising daily amid an outbreak in Shanghai that has placed the city of 25 million people under a seemingly never-ending, strict lockdown.

Since April 17, city officials have reported 238 Covid-related deaths – mostly elderly people, all of whom, authorities say, have died from underlying conditions in an outbreak that has spread to more than 500,000 people since March 1.

The deaths mark a new phase of loss for China and a high-risk political challenge.

Reporting deaths is “something of a double-edged sword for authorities,” said health security expert Nicholas Thomas, an associate professor at the City University of Hong Kong.

“If the numbers are too low, not only will there be a confidence problem, but the quarantine restrictions will also seem excessive. If the numbers are too high, the lockdowns are justified, but the authorities have not contained the virus.”

To date, government officials have prioritized containment of the virus above all else, even as public resentment and economic risks mount under harsh lockdown restrictions.

So far, there’s been no sign of a change in policy, with Beijing instead “doubling down on its message to stop the virus” even as the outbreaks spread, Thomas said.

And as the zero-covid policy remains explicitly linked to Chinese leader Xi, it is clear that “this line will be maintained for the foreseeable future,” he said.

according to the numbers

As the number of deaths and serious Covid cases has risen in recent days in Shanghai, city health officials have spoken with increasing urgency about further strengthening intensive care response and increasing vaccination among the elderly – although lockdowns and mass testing appear to be a priority over vaccination to date.

“We need to coordinate the city’s medical resources, increase critical medical teams… reduce the number of serious patients… and do our best to reduce the death rate,” said Zhao Dandan, deputy director of the Shanghai Health Commission, Sunday. †

“Elderly people who qualify should be vaccinated as soon as possible,” he said.

Shanghai officials said earlier this month that 62% of Shanghai’s over-60s have been vaccinated, with 38% rising, but that number has fallen to just 15% for the most vulnerable over-80s, according to state media. Of the 238 deaths in recent days, only 13 have been vaccinated, authorities said Wednesday, without giving details of full vaccination or booster shots.

The lack of vaccination coverage in this group is a fatal flaw in China’s Covid-19 planning: While it devoted huge resources to developing and producing homegrown vaccines, it fell short to ensure that they got into the arms of the elderly population, most likely to die from Covid-19.

Now that authorities have confirmed expectations that death rates in the country will remain low, they have no choice but to rely on lockdowns to protect the vulnerable.

But already an unknown number of fatalities appear to be linked to tight controls in the city, as restrictions on access to medical care have created problems – a disruption that city officials have repeatedly promised to address.

One of the fears was that Shanghai could experience a crisis similar to that of Hong Kong, where an outbreak that started at the beginning of the year made the city’s death rate one of the highest worldwide since the start of the pandemic.

Hong Kong also experienced low vaccination rates within a large elderly population: at the beginning of this year, only 48% of people aged 70 or over had been fully vaccinated and only 25% of residents aged 80 or over.

counting cases

But the comparison with Hong Kong also raises questions about how Shanghai has managed to keep the death rate so low.

Hong Kong reported more than 9,000 Covid-19 deaths out of 1.19 million total cases since January this year.

At that rate, Shanghai should have counted as many as 700 deaths for every 100,000 cases, according to infectious disease physician Peter Collignon, also a professor at the Australian National University Medical School.

Experts have also pointed to a lack of transparency about the criteria used by Chinese officials to classify a death from Covid-19.

“If there’s no black-and-white definition for Covid deaths or Covid-related deaths or how these deaths should be reported, then it’s all up to that panel of experts to decide,” said Jin Dongyan, a professor at the University of Hong Kong . School of Biomedical Sciences. “That’s the reality.”

Some of these reflect concerns about whether there were full accounts of infections and deaths during China’s first 2020 outbreak in Wuhan, which overwhelmed hospitals — though China has defended its transparency during the pandemic.

China’s foreign ministry said in a 2020 statement: “China has calculated and reported its confirmed cases and fatalities based on facts … the relatively low number of confirmed cases and deaths can be attributed to the extensive and strict measures taken. taken by the Chinese government.”

But experts also warn that it’s difficult to make comparisons between places with different testing and disease control strategies, social factors and demographics.

For example, Shanghai’s intensive testing has picked up hundreds of thousands of asymptomatic cases, some of which may have been missed in the number of cases in other places, potentially skewing comparisons.

Bureaucratic processes and the time it takes for positive cases to succumb to the disease may also leave reported deaths lagging, with some experts suggesting the worst in Shanghai may be yet to come.

Meanwhile, understanding the total toll — not just of the virus — but of the lockdowns rolled out in Shanghai and other cities is critical to assessing the true costs of China’s control measures, experts say.

Xi Chen, an associate professor at the Yale School of Public Health, said the long-lasting effects of the lockdown in Shanghai, including missed cancer screenings or mental health problems, will take time and data to become apparent, and even then perhaps difficult to measure.

“We will often look at two types of negative shocks,” he said of the consequences after the initial burden of death. “One, for those people who eventually died, and, the other, those who survived but live with trauma attached to it.”

The Beijing Bureau of DailyExpertNews contributed to this report.