China has abandoned zero-Covid. What happens now?

China is rapidly opening up after years of its “zero-Covid” policy, with strict lockdowns, mandatory testing, and major travel restrictions. But the major policy shift could pose further complications in China as people resume international travel, and geopolitically as a patchwork of countries impose restrictions on Chinese air travelers.

The US, the UK, Italy, India, Israel, Spain, Canada, South Korea, and France are all implementing some form of restrictions on air travel from China; that typically means a passenger embarking in China and heading to one of these countries can’t board without a negative test, or, in Spain’s case, without being vaccinated. But policies surrounding infectious diseases are hard to make without accurate data about caseloads, hospitalizations, and deaths, which China has failed to collect and disseminate since rolling back zero-Covid in late December.

It’s much too early to tell exactly what effect the policy shift will have; though China appears to be experiencing a major wave of infections presently, that hasn’t translated into major infections outside the country. But because Chinese air travelers haven’t gone through multiple variant waves, they could be more vulnerable to infection.

What’s more, there’s not great scientific evidence to back up travel restrictions; “We have seen time and time again with this pandemic that a patchwork response, whether nationally or globally, does little to contain the disease,” Saskia Popescu, an assistant professor in the biodefense program within the Schar School of Policy and Government at George Mason University, told Vox via email. “Moreover, travel bans and testing requirements are not as effective as they neglect the porous nature of borders, the realities of disease transmission, and are reactive rather than preventative.”

China is rolling back Xi Jinping’s zero-Covid policy, and cases are rising

Chinese President Xi Jinping rolled back restrictions to his signature policy after widespread protests against stringent lockdowns and mandatory testing began in November. Though Xi’s government had announced a 20-point plan to ease those restrictions earlier that month, the protests, some of which called for Xi to step down, seem to have expedited the unraveling of Xi’s policy.

Draconian lockdowns, notably in Shanghai, at the FoxConn iPhone factory in Zhengzhou, and in Urumqi, Xinjiang, reportedly left people without access to food, and many in Xinjiang believe that the zero-Covid measures there, which barred people from leaving their apartments, prevented emergency workers from aiding people locked in their homes when a fire broke out in an Urumqi apartment building.

In the month since, the set of policies Xi once said “prioritized the people and their lives above all else,” has swiftly crumbled, leaving in its wake a significant rise in cases and a strained healthcare system.

“I think we should be concerned about what’s happening in China — for the Chinese,” Andrew Pollard, the chair of the UK’s Joint Committee on Vaccination and Immunization, told BBC News Hour on Saturday. “Within the country, there is a large amount of Covid spreading at the moment, the omicron variant is there, and it spreads extremely well between people. And they haven’t had Covid waves before … so we would expect an enormous number of infections to occur.”

Officially, China has recorded just over 5,000 deaths from Covid-19 since the pandemic began, which Pollard conceded is possible if that number counts only people who died from the disease without any other underlying conditions. But the numbers are likely much higher, he said, if those cases are included, and they are likely to rise as the disease spreads, particularly among older people who are less likely to be vaccinated.

Already, reports coming out of China indicate a hospital system in duress due to the increase in Covid-19 cases, as well as crematoriums and funeral homes straining under the death toll.

Shutting down zero-Covid was, as Victor Shih, an expert in Chinese politics at the UC San Diego School of Global Policy and Strategy told the New Yorker’s Isaac Chotiner, likely a complex decision motivated by economic and employment problems domestically as well as general dissatisfaction and protest. But Xi will have to contend with the fallout of his decisions — both the draconian lockdowns he employed and trumpeted for three years, and the likely wave of Covid-19 infections and deaths that will follow China’s re-opening. That fallout, Shih said, is likely to mean more protests of the kind seen in November, and quite possibly increased skepticism of China’s economic and governance models, both from inside and outside China.

“Some serious damage is being done to public trust,” John Delury, a China expert at Seoul’s Yonsei University, told the Financial Times. “We may not see the immediate effects of that. But it’s going into the public calculus about how competent their government is. This is the worst possible start to Xi’s third term.”

The world is better equipped to deal with Covid-19, but there are still many unknowns

The end of covid-Zero also means the end of disease surveillance on a national level. As Yang Zhang, a professor of sociology and Chinese politics at American University tweeted in December regarding the tracking of China’s Covid-19 cases, “I don’t think the Chinese state had the capacity to collect, model, and assess provincial/municipal infection data on a daily base [sic] over the last month. After the sudden opening, this is a daunting job (for any state). They simply gave up.”

Without adequate information about vaccine efficacy, infections, hospitalizations, and deaths, it’s difficult to model how the disease might spread and make sensible policies around disease mitigation — hence the patchwork of air travel restrictions now.

“We’re flying blind without more information, but that’s also an issue we’re facing in the US as the CDC changed community transmission level thresholds, testing centers were closed, and at-home tests are not reported,” Popescu said. “Ultimately this should be a lesson in that we can’t truly address an outbreak or pandemic if data is incomplete anywhere.”

Just as in the beginning of the pandemic, countries aren’t in agreement in how they’ll deal with potential new cases coming in via air travel; three years later, Popescu said, the countries that do impose restrictions aren’t necessarily choosing effective ones. “Even [in the beginning of the pandemic] a travel ban was not backed in science and frankly proved to be ineffective in control.” The best travel restrictions can do with a disease of this magnitude is buy governments time to prepare for its spread.

Italy, which has in place a testing restriction for air travelers from China, has encouraged other European Union countries to do the same; France and Spain have implemented restrictions too, but the EU overall has thus far declined to do so. In a place like Europe where travel overland between countries is fairly painless, “testing passengers from one country is not effective in disease containment (the horse is out of the barn essentially),” Popescu said. Furthermore, she said, “testing is reactive,” not proactive, she said — Italy implemented its testing mandate after cases were detected in flights arriving in Milan on December 26.

One positive sign from Italy’s testing program is that there don’t seem to be new variants coming in from China — meaning as far as researchers can tell, Covid-infected travelers from China don’t pose any greater risk to, say, the US population than an American citizen infected with Covid-19 does.

The risks are possibly higher for Chinese travelers, who might be introduced to an unfamiliar variant during their travels, or might not be vaccinated, though around 91 percent of the population fully vaccinated, according to the New York Times.

Though the world is better equipped to manage Covid-19 than in 2020, the patchwork of restrictions in response to China’s re-opening still shows major flaws in the world’s ability to deal with the pandemic in a united, consistent manner, Popescu said. Covid-19 is likely to be endemic for years to come; incidents like China’s re-opening and the potential for new disease variants and waves “should be a reminder of the importance of global health, vaccine equity, and partnerships in proactive public health interventions.