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China hopes it can snuff out a Delta-fuelled coronavirus outbreak with mass testing, longer quarantine and surveillance

By abc.net.au , in World News , at July 30, 2021 Tags: , ,


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China’s successful COVID-19 containment strategy is being put through one of its biggest tests yet as the contagious Delta coronavirus variant rips through Asia.

Health officials have recorded dozens of new daily cases in the eastern city of Nanjing after the outbreak first started among workers at the city’s airport.

Government officials were quick to act, organising a staggering 9 million tests in just a few days.

But already the capital, Beijing — which has additional measures to prevent infected people entering — has recorded a local transmission case, in a major test of China’s strict and technology-driven containment efforts.

The country has been more successful at suppressing the virus than any other major country since the initial outbreak began in Wuhan in late 2019.

While some areas have had occasional outbreaks stemming from overseas arrivals, they are usually snuffed out within days or weeks.

Now China’s health authorities, like their counterparts everywhere, are facing a much tougher challenge — the fast-spreading Delta variant.

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It overwhelmed hospitals in India, prompted makeshift burial sites outside Jakarta and caused a surge in both US and British case numbers despite high vaccination rates.

And while countries across Asia have imposed lockdowns and new restrictions in response, China’s measures are the most coordinated as well as the most strict.

And so far they appear to be holding back a surge, with figures released on Thursday showing 24 local transmission cases of the virus from the Delta outbreak, down from 31 the day before.

Testing is a key part of China’s strategy

Government media now suggest the Delta outbreak in Nanjing may have started as early as July 10, even though the first infections weren’t announced until last week.

A woman in full PPE sticks a swab down a man's throat A woman in full PPE sticks a swab down a man's throat
Everyone in the south-west Yunnan Province will also be tested following a spike in infections there. (

Xinhua via AP: Wang Guansen

)

Many of the positive cases in the first round of testing in Nanjing were in an area close to Lukou International Airport, which has since been closed.

Zhang Nuo, who lives in the city, has had to cancel an upcoming family trip to Beijing this week to see relatives because of the lockdown.

“If they lock down the city, there’s nothing I can do — we’ve all come to understand why they have to do it, and no one wants this virus to spread more widely,” Ms Zhang, a mother of a six-year-old girl in Nanjing, said.

Rapid compulsory mass testing drives in response to new cases has been a distinctive feature of China’s response to COVID-19, with the authoritarian government able to quickly mobilise resources, testing staff, laboratories and millions of citizens with little opposition.

But the impressive testing numbers obfuscate the difficulties on the ground.

“It was very sudden — they announced cases and then our compound management said everyone had to get tested,” she told the ABC.

“Our compound management was really quick to organise everyone to go and do tests, but then it was really chaotic at the testing site.”

“They weren’t able to enforce everyone to keep at an effective safe distance, people were cutting in line, some were ordering food delivery while they lined up.

 “And people lined up for hours only to be told the staff had run out of testing kits, so we were very angry.”

Ms Zhang later got tested at a better-organised site and her trip to Beijing may be back on, with trains still allowed to depart Nanjing for passengers who pass two COVID-19 tests within a 48-hour period.

Another resident of Nanjing, Zhiming Yan, said the district government has sent medical staff into the community to carry out three rounds of mass testing since the outbreak emerged.

A young Chinese man in a purple t-shirt and blue face mask. A young Chinese man in a purple t-shirt and blue face mask.
Zhiming Yan said he thinks a strict lockdown is necessary in Nanjing to stamp out the cluster.(

Supplied: Zhiming Yan

)

“Generally speaking, the residents are actively complying with the tests,” he told the ABC.

“All education facilities are closed.

“Schools and kindergartens are registering travel details and PCR test results of the children and their parents.”

A ring of steel and strict surveillance 

China earned a reputation for strict containment measures with the 76-day lockdown in Wuhan in early 2020, which literally involved residents being forced to stay inside their apartments for much of that time.

The government also sealed off Wuhan’s surrounding province Hubei, banning travel in and out and setting a precedent for the state border closures later seen in Australia.

Much like Melbourne’s prolonged lockdown last year, the measures worked, with Wuhan eventually eliminating cases of the virus, while other parts of China remained largely COVID-free except for occasional outbreaks that were quickly contained.

As a result, there was a huge economic bounce-back, which was reflected in record prices for Australia’s iron ore exports.

Since then, the nature of lockdowns has evolved, with authorities targeting individual housing compounds for lockdowns instead of entire cities, in a way not dissimilar to the police guarding of two Sydney apartment blocks in recent weeks.

A man opens his mouth while a health worker in full PPE holds a swab in front of his face A man opens his mouth while a health worker in full PPE holds a swab in front of his face
The Nanjing cluster is the second most serious outbreak in China since February, with most cases caused by the Delta variant. (

Reuters 

)

“Monitoring and surveillance is far better in China than what you get in Australia, partly because most people live in communities of housing compounds,” John Nicholls, a clinical professor of pathology at the University of Hong Kong, said.

“By contrast you have predominately low-density suburban housing in Australia without the established surveillance systems of CCTV or building management that you get in high-density buildings.”

China’s pioneering of hotel quarantine for people entering the country — a largely effective approach copied by Australia — had evolved too, with travellers now forced to spend three weeks in hotels instead of two.

In some cases, they’ve also been subjected to antibody blood tests and even, controversially, anal swabs.

Upon leaving 21 days of quarantine, some cities then order travellers to home quarantine for a further week.

The strict measures and compliance by citizens have been eye-opening to many Australians on the ground, like businessman Mike Harding, who experienced an outbreak in Guangzhou at the start of the year.

He was reluctant to undergo the throat and nasal swabs, but ended up doing it three times.

“And if you still didn’t do it, your health code app would change from green to yellow or red — meaning you’re basically housebound anyway because they wouldn’t let you into the subway or shopping centres [unless it was green].

“I know what the free world has to think and say about mandatory things like this, but it allowed me to get back to business quite literally to normal levels within two and a half weeks of the outbreak.”

Beijing’s health code app based on tracked data

China’s ubiquitous health code apps differ from the “check-in” software used in Australia.

A health worker in full PPE gear talks to a group of people holding their phonesA health worker in full PPE gear talks to a group of people holding their phones
China’s health code app prevents people from entering public spaces like shopping malls if they have a yellow or red warning. (

AP: Mark Schiefelbein

)

They utilise location tracking and other data to automatically give each person a green, yellow or red status that changes if people have been near outbreak areas.

But it would be nearly impossible to replicate such a system here.

Associate Professor Jeanne Huang, a Chinese legal specialist at the University of Sydney, said “different concepts of privacy and political systems” make it hard for Australia to put in place apps that are equally effective.

“The use of the COVID Safe app in Sydney is voluntary and it’s not related to obtaining employment, entering premises, participating in an activity, or the exchange of goods and services,” she said.

“A fundamental difference between the check-in app and China Health Code is that if the latter turns yellow, the person cannot go shopping and take public transport.

“In contrast, the check-in app has no such function.”

With a much larger workforce and lower labour costs, shops, offices and restaurants in China can also employ far more staff to man the doors to check people’s health codes compared to Australia.

At the end of the day, Professor George Liu from La Trobe University said each country needs to design its own public health response.

“There is no one-size-fits-all solution,” he said.

“We can learn lessons from other countries, but we can’t simply copy what other countries do just because they are successful.

“Every country is different.”

A sports stadium with temporary tents set up on the floor A sports stadium with temporary tents set up on the floor
Temporary laboratories for COVID-19 testing were set up in a sports stadium in Nanjing when cases began. (

Xinhua via AP: Li Bo 

)

He also says the suburban nature of Australian cities and different governance makes the China model unfeasible.

“I know that in Australia we can’t divide communities into grids and assign a leader for each grid to take responsibility of implementing the public health measures because we don’t have that kind of hierarchical structure,” he said.

Nor, he says, can state governments monitor and keep tabs on citizens in the same way they can in China.

But he thinks community organisations could play a greater role in helping communicate public health messages and ensure compliance.

“Many community organisations are keen to offer help,” he said.

Like Australia, China’s strategy has its critics

China’s strategy, like Australia’s, is keeping virus numbers relatively low but a population locked in.

The government says Chinese pharmaceutical companies have distributed more than 1.5 billion vaccines, but even if the majority of the population can be vaccinated, authorities may be cautious about a proper reopening.

A medical staffer in PPE looks at vials at a testing laboratory in a Nanjing hospital on July 24, 2021A medical staffer in PPE looks at vials at a testing laboratory in a Nanjing hospital on July 24, 2021
Authorities implemented a citywide mass testing for the coronavirus disease in Nanjing after an outbreak linked to the city’s airport.(

Reuters: cnsphoto

)

“China’s CDC has acknowledged the current vaccine strategy needs to be upgraded to include something like mRNA vaccines,” Professor Nicholls said.

He believes that could mean a push by China’s government to manufacture the more effective mRNA-type vaccines that Pfizer in the US produces to give boosters to complement the current vaccination drive.

“In the meantime, Chinese authorities will likely use the existing lockdowns to put out the bushfires that pop up to stop the virus from spreading to the rest of the population,” he said.

While the country’s borders are technically open for some foreign workers to enter, many international students and some work visa holders are still unable to return.

Chinese nationals abroad have also faced difficulties getting flights back into the country due to flight shortages.

The public discussion in China now has some parallels with Australia.

However, one of the country’s most prominent epidemiologists, Zhang Wenhong, wrote this week that China hasn’t experienced the most difficult phase of the pandemic yet.

“Learning to live with the virus and returning to normal without fear of the virus,” he wrote, will be the real challenge.

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