Medical Workers Are Collateral Damage in China’s Zero-COVID-19 Policy

The costs of a once-effective approach are piling up as omicron cases rise.

By , a science journalist based in Shanghai.
Workers take off their protective gear.
Workers take off their protective gear.
Workers take off their protective gear next to the entrance of a neighborhood in Shanghai on April 5. Hector Retamal/AFP via Getty Images

Wherever COVID-19 popped up, Bai Xiaohui went. As the deputy head of a major hospital’s clinical laboratory, she spent the last two years moving around China to help extinguish the few minor outbreaks that managed to evade the country’s strict and effective zero-COVID-19 measures.

As thousands upon thousands of people were mass tested in Beijing, Xinjiang, and Henan, Bai and her colleagues checked the results in grueling lab shifts that would sometimes last deep into the night.

In early March, COVID-19 came to Bai’s own province, Shandong, on China’s east coast. In the middle of the night, she was sent to port city Weihai, where a multiday social media training course became a superspreader event.

Wherever COVID-19 popped up, Bai Xiaohui went. As the deputy head of a major hospital’s clinical laboratory, she spent the last two years moving around China to help extinguish the few minor outbreaks that managed to evade the country’s strict and effective zero-COVID-19 measures.

As thousands upon thousands of people were mass tested in Beijing, Xinjiang, and Henan, Bai and her colleagues checked the results in grueling lab shifts that would sometimes last deep into the night.

In early March, COVID-19 came to Bai’s own province, Shandong, on China’s east coast. In the middle of the night, she was sent to port city Weihai, where a multiday social media training course became a superspreader event.

On March 19, at 3 a.m., Bai finished her seventh night shift and headed back to her hotel. In the afternoon, after having lunch with colleagues, she stopped responding to text messages. At 11 p.m., a worried colleague asked hotel staff to open the door to Bai’s room. She was found lying on the bathroom floor with no pulse, after a cardiac arrest, which can be induced by stress.

Bai had become collateral damage in China’s COVID-19 calculation: Keep case figures low, whatever the cost. The approach puts a strain on medical workers, asking them to shoulder immense workloads under tight deadlines and intense pressure to prohibit further infections. Although the policy is set from the top, it’s strengthened by the fears of local officials that an outbreak could derail their careers.

To many, this is a defensible approach. Between the end of the initial outbreak in 2020 and the country’s mass outbreak of omicron last month, the country officially counted only four deaths due to COVID-19. Losing control over the virus’s spread would assuredly overwhelm China’s health care system, a situation no less stressful and even more dangerous to its medical personnel.

Nevertheless, zero COVID-19 has created a macabre list of deaths. Over the last year, there have been at least 10 cases where overwork likely caused the death of people involved in COVID-19 containment. And there are other ways in which zero-COVID-19 policy has killed people. In December 2021 and January of this year, in the northwestern city Xi’an, a 61-year-old man and two unborn children died after bureaucratic technicalities delayed access to care.

Currently, China is in the middle of what has quickly become its worst coronavirus wave since the initial outbreak in Wuhan. Fueled by the highly contagious omicron variant, more than 100,000 people have been infected since early March. The virus’s rapid spread but mostly mild symptoms, thanks in part due to China’s almost 90 percent vaccination rate, has many in the country questioning whether a zero-COVID-19 policy is still a worthwhile strategy. Apart from the deadly strain on health care staff like Bai, other costs are piling up, such as disruptions in regular health care, business slowdowns, and serious logistical problems in locked-down cities.

Even in Shanghai, China’s most populous city and home to many of the country’s best hospitals, medical personnel are finding it hard to cope with the current onslaught of cases. Of all province-level regions in China, the city has the third-most physicians per 1,000 residents. Still, so far, more than 38,000 medical workers have been sent to the city from elsewhere to deal with the outbreak.

As the virus rages across Shanghai, the city once known for its more science-based and precise COVID-19 control has been sealing off hospitals with infected patients and suspending public transport to limit the virus’s spread. Strict measures are leaving people who need long-term medical care, such as dialysis or cancer treatment and obstetric checkups, in limbo. Hundreds of patients and their families are calling for help by posting on social media.

Some of them are running out of medicine because they are locked down, and food-sellers are trapped in wet markets and sleeping on boxes. In one video that went viral online, a woman in Shanghai was shown crying to the police. She had been trying to walk to the hospital for her chemotherapy after finding out the subway was suspended, “[but] I really can’t walk any farther,” she said. In an extreme case, a nurse in Shanghai died two weeks ago from an asthma attack. The hospital she worked at, where she went intuitively for help, refused to admit her due to a lockdown.

Several health care workers in Shanghai, where tens of thousands of residents have become infected since March, recently told DXY, a Chinese news outlet dedicated to health care, that the hospitals they work at are running short of staff. Many of their colleagues are called on to conduct mass testing while others are quarantined after getting infected.

One Shanghai doctor said her hospital provided protection equipment that expired a year ago. “The tape on the suits has turned yellow. It doesn’t seal tightly,” she said. Under the circumstances, multiple staff members became infected, including the doctor herself. After she was taken to a quarantine site, only one doctor remained at her department. For the remaining medical workers, shifts lengthened to starting at 5 a.m. and ending at 8 p.m.

Many nonmedical professionals called on to assist virus containment efforts are also experiencing burnout. “I don’t remember when the last time I had a day off was,” said one such worker who requested anonymity because she was not authorized to speak to the media. Usually, she manages a college dorm in the eastern city of Suzhou. With the current outbreak, the building has been converted into a quarantine site for close contacts of people with COVID-19.

The worker, who is in her 30s, has since been tasked with running the quarantine site, making sure the roughly 700 people living there have food and water, and helping medical workers with getting everyone tested. She and her colleagues are also in charge of organizing COVID-19 tests for residents in neighboring communities.

“We only have 30 people on staff, but there’s endless work,” she said. “I can’t put my phone down for a second because someone could call me any moment. Sometimes I hear the phone ringing in my head. Every worker here, medical staff and us, is overloaded.”

So far, the government has been unwavering in sticking to the existing policy. “Under the guidance of its ‘people first, life first’ principle, China has been adhering to the dynamic zero-COVID policy and have succeeded in protecting 18 percent of the world’s population from the disease,” said a commentary published March 29 by state-run Xinhua News Agency.

A day later, Ma Xiaowei, the head of China’s National Health Commission, wrote that even low rates of serious symptoms and death would mean many people would get sick or die given China’s enormous population. “If you don’t care about prevention but only treatment, China’s medical system will face the danger of breakdown,” he wrote.

Of special concern are China’s oldest—and thus most vulnerable—people. Their vaccination rates are low, partially out of fear of side effects. Just about half of people over age 80 have finished a two-shot vaccine regime, and only about half of people over age 60 have received a booster shot. Although China’s homegrown vaccines are less effective than mRNA vaccines, data from Hong Kong—where vaccination rates are similarly low among older residents and a recent omicron wave has killed thousands of people—shows that the additional shot improves protection for the most vulnerable people against severe disease and death from COVID-19.

Political considerations are also a major factor. The Chinese government is proud of its COVID-19 track record and sees it as confirmation that its system is superior to that of the United States, where more than a million people have died due to COVID-19. Later this year, at a National Communist Party Congress, Chinese President Xi Jinping is expected to be given a norm-breaking third term as leader of the country. Staggering infection rates, even with a relatively low case fatality rate, could prove to be a weakness at this critical time.

It seems unlikely, then, that collateral damage from the zero-COVID-19 policy will soon rise high enough for the government to reconsider its approach—unless the virus itself overwhelms defenses.

To the dorm manager in Suzhou, zero COVID-19 is a strategy built on the sacrifices of many people—those who are overworked enforcing lockdowns and those who are locked down. “Honestly, I feel my job is pointless because the virus cannot be stopped,” she said. “I feel desperate because I see no end to this.”

Yvaine Ye is a science journalist based in Shanghai.

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