The Olympics Will be the Ultimate Test for China’s Zero-COVID Policy

Hosting the Olympic Games in any given year is an enormous task. Add a global pandemic, and the logistics of welcoming the world’s athletes in while keeping the virus out become complicated fast. China is confident that its strong stance against COVID-19 will be able to withstand the challenge. While the rest of the world is struggling to keep up with the virus, China’s strategy is to stay ahead of it. With its so-called “dynamic zero-COVID-19” policy, health officials try to contain any new cases by quickly testing, contact tracing, isolating and instituting lockdowns that block the spread of the virus.

China’s plan for crushing COVID-19 during the Beijing Olympics is just as draconian. If it works, the country’s approach could become a leading example of one way to learn to live with SARS-CoV-2: detecting new cases and extinguishing them as quickly as possible. If it doesn’t, this year’s Olympics could be a sobering lesson in the hubris of trying to keep up with a virus as adaptable as this one has proven to be.

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China has used a “zero COVID” approach over the past two years with impressive results—even at the expense of greatly inconveniencing residents. After a series of 20 outbreaks, officials in Tianjin issued restrictions to the city’s 14 million residents. People were restricted to their houses in the area of infection. Residents in the outlying areas had to adhere to restrictions such as staying inside (only one per household was permitted to go on food shopping trips every two days) and remaining in their communities. After a Beijing worker had tested positive, all the building’s employees were locked up. The government officials brought in food and bedding to provide comfort for the workers. Workers will not be allowed back into their homes until they have tested negative. Also, the home of the positive office worker was sealed and his neighbors tested.

The measures are extreme but they seem to be effective, at least according the most recent COVID-19 government statistics. These tallies were criticised by public and political health leaders for downplaying actual pandemic impact. If accurate, China’s reported case numbers are “way, way, way lower than what we have in the U.S.,” says Jeremy Luban, a professor at the University of Massachusetts Medical School. Currently, China has reported just over 5,000 cases in the past month, compared with more than 15 million in the U.S. “The idea that we have taken in the U.S. is to flatten the curve so fewer people die. China’s concept is even before that: don’t get a curve.”

China’s graph of new infections over the past year is the complete opposite of that of the U.S. While average cases in China peaked in February 2020 at just under 70,000 per month and then steadily declined—with only a small blip due to Omicron—the U.S. case count was stable at a relatively low rate over the summer as more people became vaccinated, but has climbed steadily over the past few months because of Omicron, hitting a pandemic high in January 2022.

Continue reading: Asia Keeps COVID-19 Away for Two Years Omicron could change that

Much of China’s success in quashing SARS-CoV-2 can be traced to strict travel restrictions into the country and rigid quarantine rules that require any visitors from overseas—who are already required to test negative before boarding their flights—to remain in an isolation hotel for 14 days to ensure they aren’t harboring an infection. The same applies for Chinese citizens who return home from the abroad. To avoid quarantines for athletes, coaches and support staff, all Olympic visitors must be immunized. However, Chinese officials have devised a semi-isolation and intensive testing policy to protect them from any potential risk. Travelers to the Games must be negative for 72 hours prior to their Beijing flights. They will also be tested with deep throat and nasal swabs upon arrival at Beijing airport. Then, they will be transferred to their hotel where they can stay until their results are confirmed.

Negative results will result in athletes, coaches and media being kept inside a bubble. Only designated transportation may be used and they can only eat at approved restaurants. Everybody will be tested every day and they are expected to immediately isolate if they have a positive result. No one is allowed to leave isolation until they’ve been negative two times within 24 hours. These measures aren’t foolproof, however. It’s not clear, for instance, whether local volunteers and support staff for the Olympics—bus drivers, food service personnel, health care workers performing the testing—will also be required to remain within the bubble or whether they will be allowed to return to their homes each evening. “The bigger the bubble, the more opportunity you have for something to go wrong,” says Tara Kirk Sell, senior scholar at the Johns Hopkins Center for Health Security. “And it’s more difficult when you have something so transmissible like Omicron.”

There’s a lot at stake for Chinese officials, both politically and from a public-health perspective. They will be judged on how they handled the pandemic six months back, when there were 865 confirmed cases. It will become very clear that an aggressive, dynamic approach to controlling transmission isn’t the best way to manage major outbreaks during the Olympics.

Continue reading: Omicrons have the best choice of masks: N95 Here’s Why

Even if China’s zero-COVID policy succeeds at keeping Olympics visitors safe, this approach has potentially dire downsides for the overall population in the long term, including a lower level of immunity to the virus. Once lockdowns are eventually lifted, people could still be vulnerable to infection and—more concerning—serious disease. Even though 87% Chinese are vaccinated every year, the high vaccination rate might not offer enough protection. In fact, recent lab research has shown that the Omicron vaccine was not effective in neutralizing the Omicron variant.

As a result, some experts predict that reaching herd immunity—in which most of the population is protected, either by vaccination or by having been infected with COVID-19—will be much more elusive for China than for many other countries. Because Omicron tends to cause less severe disease in vaccinated people, some experts say it could help some populations in which it circulates widely to reach herd immunity more quickly, and—hopefully—with less disease and death than could be expected from previous variants. In this light, while eradicating the virus whenever it is present may be a temporary solution (albeit costly and labour-intensive), but not necessarily one that will last. In a recent report, the risk-assessment firm Eurasia Group, whose president writes a column for TIME, warned that “China’s policy will fail to contain infections, leading to larger outbreaks, requiring, in turn, more severe lockdowns.”

Omicron’s stunning ability to spread so quickly and efficiently will pose obstacles to China that no other Olympics host country has faced. Omicron’s high transmission rate means that even the most rigorous testing may not be able to detect cases and cause outbreaks. “Omicron is the ultimate challenge to any program based on zero cases,” says Michael Osterholm, director of the center for infectious-disease research and policy at the University of Minnesota. Studies show that Delta, which was circulating during the Tokyo Olympics last summer, is twice as contagious as previous variants—and Omicron is up to four times more infectious than Delta. While vaccines can protect against severe disease, they can’t fully prevent people from getting infected, as the growing number of breakthrough infections reveals. “I’m not sure we will ever get to the point of zero COVID-19,” says Jeremy Farrar, director of the Wellcome Trust, a global health research foundation. “I would suspect that SARS-CoV-2 is not going away; when it’s been in this number of people and beautifully adapted to humanity, why would it leave? The best hope is that it shifts over time, as more people develop immunity, to become the 21st century flu.”

Australia and New Zealand were among the countries to drop zero-COVID policies. The Delta variant crushed these nations’ efforts to stay on top of cases, and lockdowns became socially unbearable and detrimental to people’s mental health. In accepting that it may not be possible to eliminate SARS-CoV-2, Australian Prime Minister Scott Morrison said it was time to “come out of the cave.” His admission acknowledged that while vaccines provide protection, they can’t prevent people from getting infected, so cases are inevitable. It is important to stop people infected from becoming seriously ill and requiring hospitalization.

The U.S. has never, intentionally or not, adopted the fortress mentality. Instead, it relies on vaccination to as large a population as possible. More recently, they encourage more testing, so those who have been positive can be safe and avoid interactions with the public. While cases have skyrocketed in the U.S. since Omicron emerged, some models predict that the combination of immunity from the shots and from natural infections will ultimately throw up a formidable enough wall to relegate significant damage from COVID-19 to outbreaks among the more vulnerable people, who are either unvaccinated or have weakened immune systems—at least that’s the hope.

“Countries are going to have to accept a period of high transmission in communities,” says Farrar. “And I think that is the path that China will ultimately have to go through.”

For now, China’s aggressive approach to COVID-19 may put it in a strong position to host the Olympics as safely as can be expected. But how the virus will ultimately perform there throughout the Games—and after them—will be the contest everyone watches most closely.


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