In Pictures: Food of Pearl Dragon in Macau, China

Fine Dining Cantonese Cuisine

The 2022 Michelin 1-star Restaurant

Chart: The Bank of England Raised Its Key Bank Rate by 25bps in March 2023

Source : Reuters

Chart: U.K. Annual Inflation Rate Unexpectedly Edged Higher in February of 2023

Source : AP

Chart: Global Debt to GDP Since 2006

Source : International Monetary Fund

China Could Control a Third of The World’s Lithium by 2025

China’s efforts to ramp up lithium extraction could see it accounting for nearly a third of the world’s supply by the middle of the decade, according to UBS AG.

The bank expects Chinese-controlled mines, including projects in Africa, to raise output to 705,000 tons by 2025, from 194,000 tons in 2022. That would lift China’s share of the mineral critical to electric-vehicle batteries to 32% of global supply, from 24% last year, according to a note on Friday.

The race to secure lithium is playing out at the highest levels, with nations including the US prioritizing access to the materials necessary for making batteries as the world turns away from fossil fuels. China’s needs are particularly acute because it’s home to the world’s biggest market for new energy vehicles.

The rise in Chinese output will include an increase in material derived from lepidolite, a lithium-bearing rock often overlooked as poor quality and environmentally unsound because of its low yield and high energy costs. UBS sees lepidolite in China accounting for 280,000 tons of lithium in 2025, or 13% of global supply, from 88,000 tons last year, as the government continues to support the sector.

Beijing has already moved to curb unlicensed lepidolite extraction in Jiangxi province, a major mining hub, as it seeks to exert more control over its deposits.

Source : BNN Bloomberg

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Source :S&P Global

Infographic: Which Countries Hold the Most U.S. Debt?

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Source : Visual Capitalist

Long COVID Comes Into the Light

Jeff Wise wrote . . . . . . . . .

Even before 2020’s first horrific wave of COVID-19 deaths subsided, reports surfaced warning of a brutal second punch: Instead of recovering quickly after a mild infection, some people were suffering from symptoms that lingered or even intensified in the weeks and months that followed.

The condition came to be called long COVID. In those early days, everything about it was uncertain, from what symptoms it caused to how long they’d last and how hard they would hit. Some speculated that the effects might be effectively incurable, and that a large percentage of those infected with SARS-CoV-2 would wind up succumbing to this life-altering condition. “Months of illness could turn into years of disability,” warned the Atlantic’s Ed Yong. Given the bodies piling up in makeshift morgues, it seemed reasonable to assume the worst.

The first reports of how COVID seemed to fundamentally change people were scrabbled together from anecdotal accounts and preliminary studies. The picture they painted was frightening: As many as a third of all people who’d tested positive went on to report long COVID, according to a report published a year after the pandemic began. Few of these people had recovered much, and many were debilitated, unable to work or attend school. Newspapers and magazines ran articles that vividly described the complex litany of suffering endured by patients who weren’t getting any answers from their doctors. One early and influential story was by the British epidemiologist Paul Garner, who wrote in the medical journal BMJ about being flattened by a “roller coaster of ill health, extreme emotions, and utter exhaustion.” He described experiencing relentless, extreme fatigue, a “muggy head,” breathlessness, muscle pain, and a “weird sensation in the skin”—a parade of “constantly shifting, bizarre symptoms” that left him bedridden.

Long COVID is an unusual condition not only in its kaleidoscope of symptoms but also in the fact that it hadn’t been identified initially by doctors who encountered similar sets of symptoms in their patients. It was, rather, described by COVID patients themselves who, in the early months of the pandemic, found themselves mysteriously unable to get better. The complaints of early “long-haulers” were then picked up and amplified by activists, whose lobbying persuaded the government to allocate more than $1 billion in research funds. “Long COVID has a strong claim to be the first illness created through patients finding one another on Twitter,” researchers Felicity Callard and Elisa Perego wrote in the journal Social Science & Medicine. (They both suffered from long COVID themselves.) Patients desperately searching for answers were understandably dismayed to find little clarity from the medical community about their strange illness.

Now, three years later, the research is catching up to the anecdotal reports and the early evidence, and a clearer picture of long COVID has emerged. It turns out that, like COVID-19 itself, a lot of our early guesses about it turned out to be considerably wide of the mark. This time, fortunately, the surprises are mostly on the positive side. Long COVID is neither as common nor as severe as initially feared. As the U.S. government moves to end the country’s state of emergency, it’s another reassuring sign that, as President Biden put it during his State of the Union address, “COVID no longer controls our lives.”

As vaccines rolled out across the country in 2021, researchers at the Mayo Clinic analyzed the symptoms of 108 patients who’d come for post-COVID care. Their results suggested that these patients fell into two main camps. Some, mostly men, suffered severe illness and were still being plagued by symptoms like chest pain and shortness of breath. Then there were others, mostly women, who had experienced relatively mild illness, or no symptoms at all, but were subsequently dogged by “widespread pain, fatigue,” and “cognitive impairment, including the commonly reported ‘brain fog.’ ” The authors noted that this cluster of symptoms resembled a class of broadly similar conditions like chronic fatigue syndrome, fibromyalgia, and POTS (postural orthostatic tachycardia syndrome), all of which can leave sufferers incapacitated for years at a time.

How long could long COVID symptoms be expected to last? Researchers in Australia tried to answer that question by conducting phone interviews with every single person who was diagnosed with COVID-19 in the state of New South Wales between January and May 2020. They found that recovery followed a curve, with 80 percent of patients fully recovered after 30 days and 91 percent recovered after 60 days. Thereafter, the population of symptomatic patients continued to slowly dwindle, with 4 percent of the original patient population still suffering symptoms after four months. Their most common complaints were coughing and fatigue.

Other work suggested that long COVID could affect a much larger slice of the population. In one influential study from early 2021, researchers at the University of Washington sent a questionnaire to 234 COVID patients between three and nine months after they fell ill. Of the 177 who responded, about a third reported ongoing symptoms like fatigue, brain fog, and loss of smell. A subsequent Brookings Institution report used this statistic to estimate that 31 million working-age Americans “may have experienced, or be experiencing, lingering COVID-19 symptoms.”

There are several problems with survey-based research, however. One is that there’s a risk of selection bias, in that people who feel that they have long COVID are more likely to want to complete a questionnaire on the topic. Another is that people may report having symptoms post-COVID that they also had pre-COVID, and so their maladies may not actually have been caused by the disease.

To get around these problems, scientists began carrying out what are called retrospective cohort studies. These involve sifting through anonymized electronic medical records to find patients who tested positive for COVID and then returned complaining of subsequent symptoms. Patients who experienced the same symptoms both before and after they got COVID are filtered out. Those remaining are then compared with a second population, of COVID-negative patients, with whom they have been matched by age, gender, and other medically relevant criteria. The difference in the groups’ rate of post-COVID symptoms reveals just what medical mayhem the SARS-CoV-2 virus is leaving in its wake.

This kind of research isn’t quick, because, by definition, it concerns the patients whose maladies take the longest to resolve. But as 2022 progressed, results started to come in.

Researchers expected to find many chronic aftereffects of COVID. Instead, they concluded there were very few.

One study of patients in an Israeli health network looked at the incidence of 70 commonly reported long COVID symptoms in 150,000 patients. The researchers found that patients who’d been infected were more likely than people in a control group to suffer for extended periods from certain symptoms, in particular loss of taste and smell, concentration and memory problems, difficulty breathing, weakness, hair loss, palpitations, and chest pain. But the difference between the infected and controls largely disappeared by the end of the first year, and to the extent that they remained, they affected a relatively small number of patients. For instance, 407 of the COVID patients reported having persistent concentration and memory problems at the end of the first year, while 276 of the controls also did. That meant that for every 10,000 people, only about 13 had cognitive difficulties that were attributable specifically to COVID.

The researchers had gone into the project expecting to find a large number of chronic COVID aftereffects. Instead, they concluded that there were actually very few. “As we analyzed the data,” the lead authors told Stat in January, “we were surprised to find only a small number of symptoms that were related to COVID and remained for a year post infection and the low number of people affected by them.”

Other studies produced similar results. Researchers at the University of Oxford in the U.K. combed through the health records of more than a million patients in a retrospective cohort study that compared those who’d tested positive for COVID with those who’d had other respiratory infections but had not been diagnosed with COVID-19 or tested positive for SARS-CoV-2. After following patients’ symptoms for two years, they reported in the Lancet Psychiatry last August that they “found no evidence of a greater overall risk of any first neurological or psychiatric diagnosis after COVID-19 than after any other respiratory infection.” There was an elevated risk for certain symptoms, however. They found that 6.4 percent of COVID patients experienced “cognitive deficit (known as brain fog),” compared with 5.5 percent of patients who’d had other respiratory infections. Although the Oxford researchers were looking at a different set of cognitive symptoms than the Israeli researchers were, the upshot was similar: In both cases, nearly as many controls suffered the symptom as COVID patients did.

Meanwhile, researchers at Montefiore Medical Center in the Bronx looked at 18,811 patients who’d tested positive for COVID-19 and 5,772 who’d had influenza. The number of patients reporting new-onset neuropsychiatric symptoms after COVID-19 was 388, or 2 percent. This figure was actually less than that for patients with influenza, which was 2.5 percent.

There’s another way to look at long COVID’s impact, and that’s by examining how it has affected the workforce. “The COVID-19 pandemic will almost certainly create a substantial wave of chronically disabled people,” Ed Yong wrote in 2020. Others argued that this surge of long-haul cases would not only mean enormous suffering but would actually pose a threat to economic recovery. “Long COVID is contributing to record high numbers of unfilled jobs by keeping millions of people from getting back to work,” a Brookings report suggested last year.

There is no evidence that any of this has actually happened. Not only did disability claims not rise during the pandemic, they fell. “You see absolutely no reaction at all to the COVID crisis,” Nicole Maestas, an associate professor of health care policy at Harvard, told Benjamin Mazer of the Atlantic in June 2022. “It’s just not a mass disabling event.”

Further data bear this out. In January, the New York State Insurance Fund, which administers disability claims, released a report analyzing long COVID claims made between Jan. 1, 2020, and March 31, 2022. It found that while there were several hundred successful claims after the initial wave in March and April of 2020, the number subsequently fell to fewer than 10 per month, and spiked into the double digits only after the alpha and omicron waves. “The percentage of people meeting the report’s definition of long COVID in the overall COVID claimant population is declining,” said Gaurav Vasisht, the NYSIF’s CEO and executive director. The most recent data, from March 2022, shows that only about 5 claims for long COVID were being granted per month out of about 3,000 disability claims in the entire state.

The best available figures, then, suggest two things: first, that a significant number of patients do experience significant and potentially burdensome symptoms for several months after a SARS-CoV-2 infection, most of which resolve in less than a year; and second, that a very small percentage experience symptoms that last longer. I want to be clear about this: Long COVID is a real illness that has dramatically affected many people’s lives. But its prevalence does seem significantly less worrisome than originally thought.

Another insight that emerges from the cohort studies into long COVID is that it’s not so easy to prove causality between a particular infection and a symptom. Almost all the symptoms associated with long COVID can also be triggered by all sorts of things, from other viruses to even the basic reality of living through a pandemic. Fatigue, for instance, can be caused by COVID-19—or by stress, depression, sleep disorders, anemia, and cancer, among other things. So, even though many patients insist that they are COVID long-haulers—and their symptoms align entirely with the common understanding of the condition—it’s entirely possible that they’re dealing with something slightly different from long COVID. Data from the Census Bureau and the National Center for Health Statistics released in January, collected in 20-minute online surveys, shows that 11 percent of American adults who have had COVID say they are currently experiencing lingering symptoms. But this self-reported information has not been borne out by more rigorously collected data. In the absence of any test for the disease, there is no way to definitively say that their symptoms are actually directly caused by the SARS-CoV-2 virus.

There is no question that many people experiencing long COVID (or something like it) are struggling, both with symptoms and with a medical community that often fails to properly treat them. There are patients describing debilitating fatigue and neuropsychiatric symptoms today, just as there were in 2020; they are still expressing a sense of frustration at the lack of answers they’re getting from doctors. In February, Atlantic writer Katherine Wu described a Brazilian long COVID patient whose ordeal sounds worryingly similar to those of the very first long-haulers: Her “days revolve around medications and behavioral modifications she uses for her fatigue, sleeplessness, and chronic pain,” and she “no longer has the capacity to cook or frequently venture outside.” The patient tells Wu: “Sometimes I think the person I used to be died in April of 2020.” Even if the cohort of these patients with long COVID represents a very small percentage of those who have been infected with SARS-CoV-2—and even if it includes people suffering not from COVID but from other lingering viruses or underlying conditions—their needs are real.

But one cannot conclude that there is, as Wu puts it, “an ocean of patients with titanic needs” attributable specifically to COVID. The ocean of patients who experience long COVID appear to do so usually only to a moderate degree and for a limited time; the titanic needs are experienced by a relative few.

Despite the ongoing failure of the long COVID tsunami to arrive, the media has continued to sound the alarm.
Indeed, even patients who suffer the most debilitating form of long COVID can find themselves improving after weeks and months, not years. In January 2021, eight months after his first essay ran in the BMJ, Paul Garner published a follow-up article in which he described how he had achieved a total recovery through a process that included plenty of exercise. “I’m back to normal,” he told me. Today he believes that the perception of a long COVID public health crisis—one his own experience helped to fuel—is overblown. “The predicted long-term disability from tissue damage simply has not materialized,” he said. “The public narrative has morphed into continued catastrophic thought.”

Despite the ongoing failure of the long COVID tsunami to arrive, the media has continued to sound the alarm. Last month the editorial board of the Washington Post ran an opinion, under the headline “Long covid haunts millions of people,” that is typical of the prevailing mindset. The piece contends that while “it is not yet known how many people have long COVID, why and what their prospects for recovery are, let alone what the long-term impact on society will be,” the condition nevertheless must be regarded as a serious problem: “The entire world will have to prepare for a legacy of long-COVID sufferers.”

That’s pretty much the same attitude Yong took when he wrote about long COVID in 2020. But back then, there was no data; everything was based on anecdote and speculation. Now COVID should have a clearer foundation. But it doesn’t. Defining long COVID “isn’t an easy thing to do,” said Paul Glasziou, a professor of medicine at Bond University and director of the Institute for Evidence-Based Healthcare in Queensland, Australia, “because there is no absolutely clear boundary that you can draw around the condition.” Patients can present with dozens of symptoms in any variety of combination, and none of them are unique to the ailment. To be blunt, long COVID doesn’t much look like what would normally be a called a disease.

As Science columnist Derek Lowe wrote last year, “So far there are no diagnostic findings that would allow you to even say for sure that post-Covid even exists, biochemically.” (Critically, this means that no test can definitively diagnose long COVID as a unique condition. Studies have shown that symptoms following a COVID infection are associated with real changes in the body.)

Instead, it looks more as if people who complain of long COVID are suffering from a collection of different effects. “I think there’s quite a heterogeneous group of people all sailing under the one flag,” said Alan Carson, a neuropsychiatrist at the University of Edinburgh in Scotland. Some patients may be experiencing the lingering aftereffects that occur in the wake of many diseases; some patients with chronic comorbidities might be experiencing the onset of new symptoms or the continuation of old ones; others might be affected by the sorts of mood disorders and psychiatric symptoms you’d expect to find in a population undergoing the stress of a global pandemic.

“I think the problem is, this was given a name before anyone had really worked out what it was,” Carson said. “And from then, people have been playing catch-up and trying to work out what the thing is, rather than the more traditional way of trying to work out what things are and then naming them accordingly.”

What’s important to understand, said Dacre Knight, a professor of medicine at the Mayo Clinic in Jacksonville, Florida, is that whatever symptoms they experience, most long COVID patients do get better. “There’s a lot of talk about long COVID that has made patients concerned that, because they’ve had symptoms for more than a week or two, maybe they’re going to be stuck with it for months and years,” he said. “So it’s reassuring for them to know that the majority actually do recover with full resolution of their symptoms.”

Now that cases of COVID have started to recede, there’s evidence that long COVID is fading too. The Census Bureau’s survey data—however imperfect a measurement—show that the percentage of COVID-19 patients who currently say they have long COVID fell by 42 percent between June 2022 and January 2023. Knight said he’s seen a decline in the number of long COVID patients coming into his clinic. “It’s just gradually decreasing,” he said. Last year, his clinic was typically seeing 15 to 20 new patients a month; now, he said, “I would say maybe 10 to 15.”

For those whose fatigue, sleeplessness, and chronic pain have proven more stubbornly persistent and debilitating, the tremendous concern about long COVID over the past few years might ultimately prove to be a blessing, regardless of whether it’s fair to call long COVID itself a major public health crisis. Whether their diagnosis is for chronic fatigue syndrome or fibromyalgia or POTS, many other people have been suffering such symptoms for a long time too, and long COVID research has demonstrated that viruses are capable of tinkering with the body in ways we do not yet understand. If research funding unleashed by fears of long COVID ultimately explains why, then that itself would be a significant achievement—an acceleration toward the day when not only long COVID patients but a lot of other suffering people as well will be able to put their illnesses behind them for good.

Source : Slate

Ignoring Experts, China’s Sudden Zero-COVID Exit Cost Lives

Dake Kang wrote . . . . . . . . .

When China suddenly scrapped onerous zero-COVID measures in December, the country wasn’t ready for a massive onslaught of cases. Hospitals turned away ambulances, crematoriums burned bodies around the clock, and relatives hauled dead loved ones to warehouses for lack of storage space.

Chinese state media claimed the decision to open up was based on “scientific analysis and shrewd calculation,” and “by no means impulsive.” But in reality, China’s ruling Communist Party held off on repeated efforts by top medical experts to kickstart exit plans until it was too late, The Associated Press has found.

Instead, the reopening came suddenly at the onset of winter, when the virus spreads most easily. Many older people weren’t vaccinated, pharmacies lacked antivirals, and hospitals didn’t have adequate supplies or staff — leading to as many as hundreds of thousands of deaths that could have been avoided, according to academic modeling, more than 20 interviews with current and former Chinese Center for Disease Control and Prevention employees, experts and government advisers, and internal reports and directives obtained by the AP.

“If they had a real plan to exit earlier, so many things could have been avoided,” said Zhang Zuo-Feng, an epidemiologist at the University of California, Los Angeles. “Many deaths could have been prevented.”

For two years, China stood out for its tough but successful controls against the virus, credited with saving millions of lives as other countries struggled with stop-and-start lockdowns. But with the emergence of the highly infectious omicron variant in late 2021, many of China’s top medical experts and officials worried zero-COVID was unsustainable.

In late 2021, China’s leaders began discussing how to lift restrictions. As early as March 2022, top medical experts submitted detailed proposals to prepare for a gradual exit to the State Council, China’s cabinet.

But discussions were silenced after an outbreak the same month in Shanghai, which prompted Chinese leader Xi Jinping to lock the city down. Zero-COVID had become a point of national pride, and tightening controls on speech under Xi had made scientists reluctant to speak out against the party line.

By the time the Shanghai outbreak was under control, China was months away from the 20th Party Congress, the country’s most important political meeting in a decade, making reopening politically difficult. So the country stuck to mass testing and quarantining millions of people, even as omicron evaded increasingly harsh controls.

Unrest began to simmer, with demonstrations, factory riots, and shuttered businesses. The pressure mounted until the authorities suddenly yielded, allowing the virus to sweep the country with no warning — and with deadly consequence.

Experts estimate that many hundreds of thousands of people, perhaps more, may have died in China’s wave of COVID — far higher than the official toll of under 90,000, but still a significantly lower death rate than in the United States and Europe. However, 200,000 to 300,000 deaths could have been prevented if the country was better vaccinated and stocked with antivirals, according to modeling by the University of Hong Kong and scientist estimates. Some scientists think even more lives could have been saved.

“It wasn’t a sound public health decision at all,” said a China CDC official, declining to be named to speak candidly on a sensitive matter. “It’s absolutely bad timing … this was not a prepared opening.”

PLANS DERAILED

Toward the end of 2021, many public health experts and leaders began thinking about how to exit from the zero-COVID policy. The less lethal but far more infectious omicron made curbing COVID-19 harder and the risks of its spread lower, and nearby Korea, Japan and Singapore were all loosening controls.

That winter, the State Council appointed public health experts to a new committee tasked with reviewing COVID-19 controls, which submitted a report in March 2022, four people with knowledge of it said. The existence of the document is being reported for the first time by the AP.

It concluded it was time for China to begin preparations for a possible reopening. It ran over 100 pages long and included detailed proposals to boost China’s stalling vaccination campaign, increase ICU bed capacity, stock up on antivirals, and order patients with mild COVID-19 symptoms to stay at home, one of the people said. It also included a proposal to designate Hainan, a tropical island in the country’s south, as a pilot zone to experiment with relaxing controls.

But then things began going awry.

A chaotic, deadly outbreak in Hong Kong alarmed Beijing. Then in March, the virus began spreading in Shanghai, China’s cosmopolitan finance hub.

Initially, Shanghai took a light approach with targeted lockdowns sealing individual buildings — a pioneering strategy led by doctor Zhang Wenhong, who had been openly calling on the government to prepare to reopen. But soon, officials in neighboring provinces complained they were seeing cases from Shanghai and asked the central leadership to lock the city down, according to three people familiar with the matter.

China CDC contact tracing reports obtained by the AP show that a nearby province was detecting dozens of COVID-19 cases by early March, all from Shanghai. Provincial officials argued that they lacked Shanghai’s medical resources and capacity to trace the virus, risking its spread to the entire country before China was ready.

At the same time, China’s flagging vaccination rate for older residents and the deaths in Hong Kong spooked authorities, as did reports of long COVID-19 abroad. When Shanghai failed to get control of the virus, the top leadership stepped in. Partial lockdowns in Shanghai were announced in late March. On April 2, then-Vice Premier Sun Chunlan, a top official known widely as the “COVID czar,” traveled there to oversee a total lockdown.

“They lost their nerve,” said an expert in regular contact with Chinese health officials.

Shanghai was ill-prepared. Residents exploded in anger online, complaining of hunger and spotty supplies. But Beijing made it clear that the lockdown would continue.

“Resolutely uphold zero-COVID,” an editorial in the state-run People’s Daily said. “Persistence is victory,” said Xi.

KEEPING SILENCE

After Shanghai locked down, Chinese public health experts stopped speaking publicly about preparing for an exit. None were willing to openly challenge a policy supported by Xi. Some experts were blacklisted from Chinese media, one told the AP.

“Anybody who wanted to say something that is different from the official narrative was basically just silenced,” the blacklisted expert said.

In early April, China’s State Council leaked a letter from the European Chamber of Commerce urging relaxation of zero-COVID controls. Council officials wanted to spark debate but didn’t feel empowered to raise the issue themselves, according to a person directly familiar with the matter.

The State Council’s information office did not respond to a fax requesting comment.

Gao Fu, then head of the China CDC, also hinted at the need to prepare for an exit. At a mid-April internal panel discussion recently made public by the Beijing-based Center for China and Globalization think tank, Gao was quoted as saying “omicron is not that dangerous,” that there were public discussions on whether zero-COVID needed to be adjusted, and that they “hope to reach a consensus as soon as possible.”

Weeks later, Gao appeared at a private event on COVID exit strategies around the world at the German Embassy in Beijing and urged more vaccinations in China, according to three attendees who declined to be named because they weren’t authorized to speak to the press. Gao did not respond to an email requesting comment.

There were also hints that opinions differed high in the party.

In private meetings with Western business chambers in May, then-Premier Li Keqiang, who was head of the State Council and the party’s No. 2 official at the time, appeared sympathetic to complaints about how zero-COVID was crushing the economy, according to a participant and another briefed on the meetings. It was a stark contrast with pre-recorded remarks from Xi that listed defeating COVID as the top priority. But under Xi, China’s most authoritarian leader in decades, Li was powerless, analysts say.

Public health experts split into camps. Those who thought zero-COVID unsustainable — like Gao and Zhang, the Shanghai doctor — fell silent. But Liang Wannian, then head of the central government’s expert working group on COVID-19, kept vocally advocating for zero-COVID as a way to defeat the virus. Though Liang has a doctorate in epidemiology, he is sometimes accused of pushing the party line rather than science-driven policies.

“He knows what Xi wants to hear,” said Ray Yip, the founding head of the United States CDC office in China.

Liang shot down suggestions for reopening in internal meetings in January and May of 2022, Yip said, making it difficult for others to suggest preparations for an exit. Liang did not respond to an email requesting comment.

Health authorities also knew that once China reopened, there would be no going back. Some were spooked by unclear data, long COVID and the chance of deadlier strains, leaving them wracked with uncertainty.

“Every day, we were flooded with oceans of unverified data,” said a China CDC official. “Every week we heard about new variants. … Yes, we should find a way out of zero-COVID, but when and how?”

Authorities may also have been waiting for the virus to weaken further or for new, more effective, Chinese-developed mRNA vaccines.

“They didn’t have a sense of urgency,” said Zhu Hongshen, a postdoctoral fellow studying China’s zero-COVID policy at the University of Pennsylvania. “They thought they could optimize the whole process, they thought they had time.”

The Shanghai lockdown stretched from an expected eight days to two months. By the time Shanghai opened back up, it was just months away from China’s pivotal 20th Party Congress, where Xi was expected to be confirmed for a controversial and precedent-breaking third term.

Risking an outbreak was off the table. Though scientists from Beijing, Shanghai and Wuhan wrote internal petitions urging the government to start preparations, they were told to stay quiet until the congress was over.

“Everybody waits for the party congress,” said one medical expert, declining to be named to comment on a sensitive topic. “There’s inevitably a degree of everyone being very cautious.”

INCREASING PRESSURE

Officials across China took extraordinary measures to stop omicron from spreading.

Tourists were locked into hotels, traders were huddled into indefinite quarantine and many stopped traveling for fear of being stranded far from home. In Inner Mongolia, a state-run ammunition factory forced workers to live in its compound 24 hours a day for weeks on end away from their families, according to Moses Xu, a retired worker.

In brutal lockdowns for over three months in China’s far west, residents in Xinjiang starved, while thousands in Tibet marched on the streets, defying orders in a rare protest. Still, officials stuck to their guns, as the government fired those who didn’t keep COVID under control.

Yet omicron kept spreading. As the congress approached, authorities began hiding cases and resorting to secret lockdowns and quarantines.

Authorities locked down Zhengzhou, a provincial capital home to over 10 million people, with no public announcement, even though they were reporting only a handful of cases. They bused some Beijing residents to distant quarantine centers and asked them not to post online about it, one told the AP. Some village officials deliberately underreported the number of COVID-19 cases to give the sense that the virus was under control.

Local governments poured tens of billions of dollars into mass testing and quarantine facilities. From Wuhan to villages in industrial Hebei province, civil servants were pressed into testing or quarantine duty because local governments ran out of money to hire workers.

At the Congress in mid-October, top officials differing with Xi were sidelined. Instead, six loyalists followed Xi onstage in a new leadership lineup, signaling his total domination of the party.

PUSHING FOR CHANGE

With the congress over, some voices in the public health sector finally piped up.

In an internal document published Oct. 28, obtained by The Associated Press and reported here for the first time, Wu Zunyou, chief epidemiologist at China’s CDC, criticized the Beijing city government for excessive COVID controls, saying it had “no scientific basis.” He called it a “distortion” of the central government’s zero-COVID policy, which risked “intensifying public sentiment and causing social dissatisfaction.”

At the same time, he called the virus policies of the central government “absolutely correct.” One former CDC official said Wu felt helpless because he was ordered to advocate for zero-COVID in public, even as he disagreed at times with its excesses in private.

Wu did not respond to an email requesting comment. A person acquainted with Wu confirmed he wrote the internal report.

Another who spoke up was Zhong Nanshan, a doctor renowned for raising the alarm about the original COVID-19 outbreak Wuhan. He wrote twice to Xi personally, telling him that zero-COVID was not sustainable and urging a gradual reopening, said a person acquainted with Zhong. Business people in finance, trade, and manufacturing concerned about the tanking economy were also lobbying authorities behind the scenes, a government adviser told the AP.

Along with the lobbying, pressure to reopen came from outbreaks flaring up across the country. A Nov. 5 internal notice issued by Beijing health authorities and obtained by the AP called the virus situation “severe.”

In early November, Sun, China’s top “COVID czar,” summoned experts from sectors including health, travel and the economy to discuss adjusting Beijing’s virus policies, according to three people with direct knowledge of the meetings. Zhong, the prominent doctor, presented data from Hong Kong showing omicron’s low fatality rate after the city’s last outbreak, two said.

On Nov. 10, Xi ordered adjustments.

“Adhere to scientific and precise prevention and control,” Xi said, according to a state media account, signaling he wanted officials to cut back on extreme measures.

The next day, Beijing announced 20 new measures tweaking restrictions, such as reclassifying risk zones and reducing quarantine times. But at the same time, Xi made clear, China was sticking to zero-COVID.

“Necessary epidemic prevention measures cannot be relaxed,” Xi said.

THE EXIT

The government wanted order. Instead, the measures caused chaos.

With conflicting signals from the top, local governments weren’t sure whether to lock down or open up. Policies changed by the day.

In Shijiazhuang, the capital of Hebei province, officials canceled mass testing and opened the city, only to reinstate harsh measures days later. Xi called city officials, instructing them to have measures that were neither too strict nor too soft, according to a person familiar with the matter.

Individual apartments were put under sudden lockdowns that lasted hours or days. The sheer number of tests and cases overwhelmed medical workers. Travel, shopping, and dining ground to a halt, streets emptied, and the wealthy bought one-way plane tickets out of China.

In late November, public frustration boiled over. A deadly apartment fire in China’s far west Xinjiang region sparked nationwide protests over locked doors and other virus control measures. Some called on Xi to resign, the most direct challenge to the Communist Party’s power since pro-democracy protests in 1989.

Riot police moved in and the protests were swiftly quelled. But behind the scenes, the mood was shifting.

References to “zero-COVID” vanished from government statements. State newswire Xinhua said the pandemic was causing “fatigue, anxiety and tension,” and that the cost of controlling it was increasing day by day.

Days after the protests, Sun, the COVID czar, held meetings where she told medical experts the state planned to “walk briskly” out of zero-COVID. Some were struck by how quickly the tone had shifted, with one saying the leadership had become “even more radical” than the experts, according to a retired official.

On Dec. 1, Xi told visiting European Council President Charles Michel that the protests were driven by youth frustrated with the lockdowns, according to a person briefed on Xi’s remarks.

“We listen to our people,” the person recounted Xi telling Michel.

The final decision was made suddenly, and with little direct input from public health experts, several told the AP.

“None of us expected the 180-degree turn,” a government adviser said.

Many in the Chinese government believe the protests accelerated Xi’s decision to scrap virus controls entirely, according to three current and former state employees.

“It was the trigger,” said one, not identified because they weren’t authorized to speak to the media.

On Dec. 6, Xi instructed officials to change COVID-19 controls, Xinhua reported.

The next day, Chinese health authorities announced 10 sweeping measures that effectively scrapped controls, canceling virus test requirements, mandatory centralized quarantine and location-tracking health QR codes. The decision to reopen so suddenly caught the country by surprise.

“Even three days’ notice would have been good,” said a former China CDC official. “The way this happened was just unbelievable.”

Soon, the sick overran emergency wards and patients sprawled on floors. COVID-19 antivirals sold for thousands of dollars a box on the black market.

In just six weeks, about 80% of the country was infected — more than a billion people, the China CDC later estimated. But even as deaths mounted, authorities ordered state media to deflect criticism over China’s sudden reopening, according to a leaked directive obtained by a former state media journalist and posted online.

“Make a big propaganda push,” it ordered. “Counter the false claims leveled by the United States and the West that we were ‘forced to open’ and ‘hadn’t prepared.’”

Source : AP