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ABC News
ABC News
Health
East Asia correspondent Bill Birtles

China might be phasing out of its COVID-zero era, but experts warn 'there is no playbook or exit strategy'

China is gripped by mixed messaging and uncertainty over the direction of Xi Jinping's COVID-zero policy, as cases hit an all-time high and the president quarantines after his own close call.

In the past two weeks, the world's last COVID-zero hold-out has seen case numbers surge from just a few hundred at the end of October to almost 30,000.

Unlike the Shanghai wave earlier this year, where similar numbers of daily infections were officially announced, the latest outbreaks are happening across multiple cities including the capital Beijing.

But the biggest difference is clarity.

In the past fortnight, Mr Xi's government has announced — with fanfare — a slight loosening of COVID-19 control measures that rallied the market as investors pinned their hopes on an eventual reopening.

His state media stressed COVID-zero would remain, but some initial moves suggested otherwise.

Shijiazhuang, capital of the Heibei region and home to 11 million people, announced the suspension of mandatory daily PCR tests for all citizens during an ongoing outbreak, sparking hopes that other cities may follow suit.

Testing requirements for inter-province travel were also relaxed, and quarantine for close contacts and inbound travellers was reduced.

The changes were sold as "optimising" a COVID-zero policy for the long term and doing away with the extreme and wasteful aspects of the policy.

But with case numbers continuing to rise, some of the measures, such as reduced testing in Shijiazhuang, have already been rolled back.

Local business operators who were buoyed by earlier signals fear they are again headed for a slowdown.

"Over the past three years we've hardly had any tourist groups," a tour guide named Deng, based in the south-western province of Yunnan, told the ABC.

"Occasionally there would be a wave of [domestic] tourists, like the past summer, but then it stopped when there was a small outbreak.

"It feels like being unemployed."

Limiting the economic disruption from the constant cycles of testing, lockdowns, restrictions and border closures is a key reason for the recent loosening.

But constant state media pledges to "unswervingly" stick to the existing COVID-zero campaign are creating confusion on how that balance is achieved.

Beijing largely shut down while protests simmer around the country 

China's capital is now in an unofficial state of semi-lockdown, with students returning to online classes at home while restaurants, bars and gyms are shut across the main central districts.

Beijing has recorded three COVID-linked deaths this week, although an absence of deaths among the other cases reported across the country has again called into question how reliable official reports of COVID-linked fatalities in China are.

Some prominent medical figures are being featured in state media seeking to steer public opinion towards acceptance that the dominant COVID-19 strains are not as worrying as those that circulated in the first year of the pandemic.

Zhang Wenhong, a Shanghai-based doctor who has emerged as a widely trusted voice in China during the pandemic, told a news conference this week that the threat to human health from the virus was declining.

State media carried his comments.

But unofficial lockdowns in districts from southern Guangzhou to western Chongqing, right up to the northern capital, continue to test people's patience.

Crowds of people in Guangzhou took their protest to the streets last week, marching through COVID barriers to voice their discontent.

Ben Cowling, an epidemiologist at the University of Hong Kong who has followed developments on the mainland closely, fears the disjointed approach may be limiting the effectiveness of existing measures.

"If they were really transitioning away from COVID-zero, I'd expect a clearer announcement that mass testing is no longer necessary, as it's extremely expensive," he said.

"I worry in some parts of China if they continue with COVID-zero measures – repeated universal testing, trying to identify every single case, trying to quarantine every single contact — that diverts away from approaches that are able to address the health impact of a large epidemic."

Xi's COVID close call

No political leader on earth has subjected their citizens to more restrictions and surveillance to avoid the virus than Xi Jinping.

So to see him sans-mask pressing the flesh with other world leaders at the recent G20 and APEC summits in South-East Asia was again interpreted by some as a signal.

Having returned to China over the weekend, Mr Xi has dropped out of sight in state media, presumably to do quarantine.

And there's a reasonable chance he was exposed to the virus that he has waged an "all-out People's War" to avoid.

Hong Kong's leader John Lee sat next to Mr Xi during the APEC summit and tested positive to COVID upon his return home.

Given the extreme secrecy Chinese Communist Party leaders maintain about their health, it is not clear whether Mr Xi would tell the public if he ever tested positive to the virus.

He only revealed that he and the other top Chinese leaders had been vaccinated against COVID in July this year, very much in contrast to the approach that many other world leaders took, rolling up their sleeves for the cameras and getting their vaccines early on.

Mr Xi's public announcement was seen as an attempt to boost China's lacklustre vaccination rate among the elderly, which has come under renewed focus from the government this month as part of the policy changes.

"They have kicked off a transition but there is no playbook or exit strategy that can be identified," said Yanzhong Huang, director of global health studies at Seton Hall University in the United States.

He noted recent reports that elderly people across Chinese cities were stocking up on antiviral medication over fears the virus may breach their defences.

But Dr Huang believes if Mr Xi does eventually shift the country to a phase of coexisting with the virus, it won't be that difficult to change the public narrative.

"They could just say 'we have deepened our understanding of the virus, we've seen so many cases and not many deaths, which shows our approach has worked and it's time for us to move on to stage two'," he told the ABC.

"I don't think it would be such a daunting task for China's propaganda authorities."

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