Views on zero-COVID policy from head of China's National Health Commission

“If we let up even slightly then we risk undoing all of the progress we have made.”

Below is a full translation of the article on China’s zero-COVID policy by 马晓伟 Ma Xiaowei, director of the National Health Commission (NHC). It was published on May 16 in the Qiushi Journal, the CPC Central Committee's flagship magazine.

The article divided China's fight against COVID into four stages: 1) the battles against the virus in Hubei and Wuhan; 2) an exploratory phase for routine pandemic control; 3) the battle against the Delta variant; 4) the current stage, which is the battle against the Omicron variant.

In addition, the article outlined five major actions for the epidemic control and prevention against Omicron, including dealing with cluster cases more quickly, upgrading early prevention and control, improving category-based treatment systems, advancing vaccine research, and improving access to routine medical care and daily necessities.

While there are a couple of signs that China is continuously easing its restrictions on inbound overseas travelers, the article shows that China is committed to a zero-COVID policy domestically. Besides the reasons mentioned in the article, some observers see the policy as a way to balance China’s adjustments on inbound travel to keep the infections in the country under control as the number of inbound travelers grows.

Meanwhile, 吴尊友 Wu Zunyou, chief epidemiologist with the Chinese Center for Disease Control and Prevention, and 张文宏 Zhang Wenhong, head of the Center for Infectious Diseases with the Shanghai-based Huashan Hospital of Fudan University， published articles on social media platforms explaining why China keeps finding COVID cases in controlled areas and communities (Chinese) and China’s epidemic control model in the future (Chinese), respectively, which can be used as a supplement in understanding China’s current struggle against the virus.

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坚定不移贯彻“动态清零”总方针 坚决巩固疫情防控重大战略成果

Unswervingly adhere to the dynamic zero-COVID policy, and resolutely consolidate major strategic accomplishments in the fight against COVID-19

马晓伟 国家卫生健康委党组书记、主任

Ma Xiaowei, director of the National Health Commission (NHC)

Since the outbreak of the COVID-19 pandemic, General Secretary Xi Jinping personally took charge and planned our response. Xi set out the general requirements of "staying confident, standing united, and adopting a science-based approach and targeted measures," formulated the general strategy of "preventing inbound cases and domestic resurgences" and the general policy of "dynamic zero-COVID". Xi also gave important instructions at critical moments to provide scientific guidance and fundamental guidelines for the prevention and control of the pandemic. In response to the complex situation of the recent domestic COVID-19 resurgences, Xi Jinping has on many occasions given important instructions. On March 17, 2022, Xi chaired a meeting of the Standing Committee of the Political Bureau of the Communist Party of China (CPC) Central Committee, and delivered an important speech; Xi further made deployments at the meeting of the Political Bureau on April 29; On May 5, he again chaired a meeting of the Standing Committee of the Political Bureau of the CPC Central Committee to hear a report and delivered an important speech, in which he fully recognized major achievements made under routine prevention and control measures, analyze the current pandemic situation, set clear goals and tasks of pandemic control under the current stage, and drew up a comprehensive plan for pandemic control. We must thoroughly study and understand General Secretary Xi Jinping’s instructions, and, with a strong sense of responsibility and mission, maintain strategic focus, unswervingly implement the prevention and control policies adopted by the CPC Central Committee, resolutely consolidate major strategic accomplishments in pandemic control, and set the stage for the Party’s 20th National Congress with concrete action.

1. First of all, we should maintain political resolve, and align ourselves with the important instructions of General Secretary Xi Jinping and the decisions and arrangements of the CPC Central Committee and the State Council in both thought and deed.

General Secretary Xi Jinping's important speeches and instructions have set the course for our pandemic prevention and control work, fully demonstrating his profound grasp of the development of COVID-19 at home and abroad, as well as his deep understanding of the underlying dynamics of the pandemic and China’s national conditions. They showcased his long-term perspective, a strong sense of mission, and profound care for the Chinese people, and should play a decisive role in making sure that the whole country stay on the same page, maintain our faith in ultimate victory, and bring the pandemic under effective control. We need to support "两个确立" [the establishment of both Comrade Xi Jinping’s core position on the Party Central Committee and in the Party as a whole and the guiding role of Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era], and commit to "两个维护" [upholding the core position of Comrade Xi Jinping on the Party Central Committee and in the Party as a whole and uphold the Central Committee’s authority and its centralized, unified leadership], so as to align ourselves with the important instructions of General Secretary Xi Jinping and decisions and arrangements of the CPC Central Committee and the State Council in both thought and deed.

Currently, the COVID-19 pandemic is still running rampant globally, as the virus is still mutating. Uncertainty remains as to where the epidemic is headed in the long run, hence it is not yet time to pause or slacken our pandemic control efforts. We must keep our heads clear, foster a stronger sense of responsibility, and fully comprehend the complex, arduous and enduring nature of COVID-19 control. We need to adhere to the general strategy of “preventing inbound cases and domestic resurgences,” and the general policy of “dynamic zero-COVID.” We cannot let our guard down and need to get rid of any weariness or fluke mind. Nor can we fall into the trap of taking the pandemic lightly and of the belief in our own infallibility. We must resolutely overcome contempt, indifference, self-righteousness, and other ideas, and resolutely fight against all words and deeds that distort, question, and rebuke our pandemic prevention policy, and never let our hard-won accomplishments in pandemic control be lost.

China's epidemic prevention and control policy is determined by the nature and mission of the CPC. The fundamental mission of our Party is to serve the people wholeheartedly, and our country is a socialist country where the people are the masters. Our Party always puts the interests of the people in the first place, and the safety and health of the people are the basis on which we formulate our pandemic control policies and evaluate the effectiveness of our work. This is also the fundamental reason why we have chosen a different path for COVID-19 prevention and control compared to some Western countries. According to figures from the World Health Organization, globally some 15 million people had died from the COVID-19 epidemic by the end of 2021. As a developing country with a large population, China has maintained the lowest rate of COVID-19 infections and death rates in the world and has achieved significant strategic results in pandemic control. What has happened proves that China's pandemic control policy has maximized the protection of people's safety and health, and minimized the pandemic’s impact on economic and social development. Our pandemic control policy is the best interpretation of our people-centered philosophy of development, and fully reflects the political advantages of the CPC's leadership and the remarkable advantages of the socialist system with Chinese characteristics, which must be implemented unswervingly.

When looking at China’s response to the once-in-a-century pandemic, we need to take a balanced approach to take into account both the conditions of certain regions and of the country as a whole, and view them from the present as well as from a long-term perspective. In the face of the COVID-19 pandemic, the worst of its kind for a century, sound prevention and control work is the basis for economic and social development and contributes to the most favorable business environment. Some regions hold the view that pandemic control has impacted economic development. Yet they should have borne the overall interest of the country in mind. At the current stage, the dynamic zero-COVID policy is the one with the lowest overall social cost to combat the COVID-19. The sooner the pandemic is brought under control, the less impact it would have on our economic and social development. Since the outbreak of the COVID-19 pandemic, China was among the first to contain the virus, to reopen the economy safely, and to restore economic growth. China has done better than most countries in both economic development and COVID-19 containment in 2021, and these were made possible thanks to our sound pandemic control. We must bear in mind "国之大者" [country's most fundamental interests] and view our pandemic response from a broad and long-term perspective, taking immediate action to tackle resurgences, so as to contain the pandemic at a faster pace and at a smaller cost, and keep the initiative for pandemic control firmly in our own hands.

We should always view our prevention and control measures based on China’s national context. The Omicron variant is neither a "natural vaccine" nor a "big flu." We must fully understand that "躺平" [or "lie-flat", which describes the youngsters who give up ambitions and do the bare minimum to get by] and "coexistence with the virus" will inevitably lead to huge losses in terms of public health and economic and social development. A U.S. study and a recent Eurostat report show that since the start of the COVID-19 pandemic, the average life expectancy in both the United States and EU countries has declined to various degrees. China is a populous country with a large aging population, uneven regional development, and insufficient total medical resources. There is still a gap between China and developing countries in terms of per capita medical resources and the medical and technological level. But the average life expectancy in China has steadily increased in the past two years, thanks to our scientific and powerful pandemic control work. If we did not focus our efforts and resources on "prevention" measures such as nucleic acid screening and quarantine, there would have been a large number of infections, which in turn would exert high pressure on "treatment" of those infected, and thus undermine the health of vulnerable groups such as patients with underlying medical conditions, the elderly, children and pregnant women. In that scenario, there would have been a large number of severe cases and deaths, and the smooth development of the economy and society would have been seriously impacted. The people will not agree to this, and the Party and the government will never allow such a scenario to become reality.

2. Second, we should get a clear understanding of the pandemic control situation, and have a deep, complete, and comprehensive grasp of the guidelines and policies for pandemic control set forth by the CPC Central Committee

For more than two years, we have been optimizing the pandemic control measures according to the development of the pandemic situation, by learning how to fight from fighting. So far, our fight against the pandemic has entered the fourth stage.

The first stage involves emergency response and containment of the COVID-19 outbreak, during which we won the battles against the virus in Hubei and Wuhan. General Secretary Xi Jinping saw Hubei and Wuhan as a top priority and the decisive battlegrounds in the fight against the pandemic - he made a series of important arrangements, and dispatched a central guidance team, mobilized more than 340 medical teams and more than 42,000 medical personnel to assist Hubei. The principle of "四集中" [concentrating patients, experts and resources in designated facilities to provide treatment] was implemented, and traditional Chinese medicine was incorporated with Western medicine in treatment. We constantly optimized the treatment plan, and did everything to treat and save those in severe conditions. The cure rate of patients on the main battlefield in Hubei exceeded 93 percent. We have creatively set up “方舱医院” [temporary treatment centers] which allowed us to treat patients with minor illnesses on a large scale within a short time frame, and quarantine patients with minor symptoms, to ensure hospital beds were no longer in short supply. We also carried out a community-based "拉网式排查"[mass screening of households] to cut off community transmission, and ensured that all those in need are tested, isolated, hospitalized or treated. Thanks to the unremitting efforts, we have achieved decisive results in the battles to defend Hubei and Wuhan in about 3 months.

The second stage is the exploratory phase for routine pandemic control, as we expanded prevention measures centering on nucleic acid testing, and managed to largely contain the spread of the outbreak within 2 to 3 incubation periods. It was during this stage that General Secretary Xi Jinping made a timely decision to adjust the overall national prevention and control strategy to "preventing inbound cases and domestic resurgences," stressing the need to remain vigilant on COVID-19 prevention and control, and that "针尖大的窟窿能漏过斗大的风" [The wind can cut through even a small needle hole]. In the wake of the victory of the battle to defend Wuhan, we promptly proposed to “expand prevention measures centering on nucleic acid testing” based on the characteristics of the spread of the virus by asymptomatic infected persons, and adopted five measures for the disposal of local outbreaks. On preventing inbound cases, we enforced strict measures for people, goods, and environments and implemented closed-loop management. On preventing domestic resurgences, we have adopted a differentiated and targeted prevention and control approach, issued 85 prevention guidelines and more than 60 technical manuals, ensured testing for 12 groups of personnel in need, and implemented prevention and control measures for key places, key people and key links. On the disposal of local outbreaks, we have summarized the experience of different regions in handling the pandemic, and guided all localities to improve the rapid response of command systems, nucleic acid screening in targeted ranges, quarantine for all high-risk groups, treatment of those infected by concentrating patients, experts and resources in designated facilities, and timely release of information. All of the above five measures helped us contain the spread of local outbreaks within 2 to 3 incubation periods.

The third stage featured targeted measures along with all steps of pandemic control. In the face of the spread of the Delta variant, we highlighted the importance of identifying problems early and at grassroots levels, so as to contain the spread of the pandemic within one incubation period. During this stage, General Secretary Xi Jinping brought forward the general policy of “dynamic zero-COVID” by combining targeted routine control and local emergency response. In August 2021, we drew lessons from the outbreak of the Delta variant at the Nanjing Lukou International Airport, and proposed to make full use of the "golden 24 hours" after the outbreak, and contain the outbreak within one incubation period. Local authorities across the country were instructed to instantly report positive screening results to ensure monitoring of pandemic outbreaks could be initiated at earlier stages, on the basis of registration at fever clinics and ensuring “应检尽检” [nucleic acid testing for all in need]. We strengthened regional coordination work in timely data pushing and risk management. To counter the pandemic, we stepped up the epidemiological investigation and building of supervisory teams, and brought forth the practice and experience of "五个结合"[combining basic medicine and clinical practice, clinical treatment and multidisciplinary support, medicare and nursing care, medicare and medical management, traditional Chinese medicine and Western medicine]. We integrated routine and emergency response into the command system, ensuring that the entire country as well as individual provinces and cities could initiate emergency responses immediately and simultaneously. We incorporated administrative work with medical practice, putting government officials and medical experts onto the front lines of the pandemic control. We combined both full-time and part-time task forces, highlighted epidemiological investigation and building of supervisory teams and strengthened coordination between public security, industry and information as well as public health to make epidemiological investigations more effective. We integrated mass work and public health to win over the people and solicit their support. We also combined targeted routine pandemic control and emergency response to reinforce capability building in pandemic control. Most localities managed to contain the spread of the pandemic within one incubation period, thus successfully dealing with the spread of the Delta variant.

The fourth stage features all-round comprehensive pandemic control. In the face of the spread of the Omicron variant, we must underline the dynamic zero-COVID approach with science-based and targeted measures. General Secretary Xi Jinping has stressed on many occasions that victory comes from perseverance, and that efforts must be taken to make epidemic response more science-based and targeted. The Omicron variant can spread swiftly through populations, and has a shorter incubation period and less obvious symptoms. When two outbreaks of the Omicron variant were reported in Tianjin and Henan Province this January, we promptly reviewed past experiences and practices, proposed a rapid response to adapt to changes, and swiftly strengthened our pandemic control preparations. In particular, we upgraded early detection measures for the pandemic, promoted the monitoring model that featured both antigen screening and nucleic acid diagnosis, improved local quarantine and treatment capabilities, and set clear standards for quarantine facilities and temporary treatment centers. We also streamlined the nucleic acid testing system, improved a category-based hospitalization and treatment mechanism for different groups of patients, and worked to ensure public access to routine medical services. What has happened proves that we can achieve the goal of "dynamic zero-COVID" with our currently enhanced pandemic control measures - the vast majority of chains of virus transmission have been cut off within one incubation period, sometimes even sooner. For instance, large-scale outbreaks have recently been reported in Jilin Province and Shanghai. In Jilin, we implemented a series of comprehensive prevention and control measures such as static management, nucleic acid testing for all citizens, and comprehensive epidemiological investigations. In Shanghai, we took the initiative to conduct background surveys for those infected at the community level, and ensured that all those in need are hospitalized while close contacts of those infected are quarantined. In addition, we introduced a categorized and tiered management system for local districts, and category-based treatment for differentiated groups of patients, and treatment mechanism for different groups of patients, and worked to ensure stability in industrial and supply chains. As of this moment, the outbreak in Jilin has entered its ending stage, and the situation in Shanghai is stable and improving. Under the guidance of the general policy of "dynamic zero-COVID," we have withstood the most severe test of pandemic control after the battle of Wuhan, and have achieved major results.

Our fight over the past two years proves that, as long as we resolutely implement the important instructions of General Secretary Xi Jinping and decisions and arrangements of the CPC Central Committee and the State Council, give full play to the advantages of the socialist system with Chinese characteristics, stay confident, and stand united in our fight against the pandemic, we can win the battle of Wuhan, and we will certainly win the battle of Shanghai.

3. Third, we should stay confident and determined, and give the pandemic control measures a boost in accordance with China’s ground realities.

The Omicron variant is highly contagious and there are many asymptomatic infections, which puts forward higher requirements for our pandemic control work and measures. We must resolutely follow through on the spirit of General Secretary Xi Jinping's important speeches, conscientiously implement decisions and arrangements of the CPC Central Committee and the State Council, improve our pandemic control system, optimize prevention and control measures, and strive to contain resurgent outbreaks within the minimum scope and the shortest time frame, and at the lowest cost, to build a solid barrier for the prevention and control of the pandemic.

In particular, we must focus our work on dealing with cluster cases at a faster pace. Emergency command and response should be escalated to a higher level and coordinated through flat management to stave off over-fragmentation at different levels and among individual city districts and counties. We must implement necessary close-off management, hospitalization and quarantine measures more resolutely, 以“空间换时间” [to take advantage of temporary restriction measures in a certain physical space to earn more time]. In scenarios where circumstances are unclear, we should immediately enforce strict control measures, to keep all people at risk within the management and control area. Meanwhile, a joint mechanism focusing on hospitalization and quarantine should be established to identify all people at risk and place them under control, to ensure that all those in need are transferred to the designated hospitals, treated or quarantined. We must speed up screening and epidemiological investigations, and promote antigen+nucleic acid screening. Coordination between public security, industry and information as well as public health should be strengthened to identify potential risks. Risk management and control work must be carried out at earlier stages, lest large-scale enterprises, construction sites, farmers' markets, schools, nursing homes, and other institutions become "amplifiers" for the pandemic. More targeted measures are required to “拔钉子” [overcome difficulties like pulling out nails] in key areas, by timely identifying the most seriously affected blocks, streets or buildings, and defusing potential risks by concentrating all available resources and strength. At present, we must continue to strengthen pandemic control in Shanghai, and fully implement "四应四尽" [the policy to admit, treat and isolate every infected person, and test every suspected one]. We should unswervingly carry out the mission to ensure zero-COVID, and resolutely win the battle to defend Shanghai. We also need to step up emergency response to the pandemic in Beijing and other key areas, and speed up risk identification and control, in order to achieve “社会面清零” [societal zero-COVID, meaning to cut off community transmission] as soon as possible.

Early prevention and control capabilities should be upgraded and strengthened. We still need to focus on improving early detection, as well as early admission and quarantine for those infected. The pandemic detection should be initiated at earlier stages, and routine monitoring mechanisms should be further streamlined. In particular, provincial capitals and cities with populations of over 10 million must make nucleic acid testing available within 15 minutes' walk for all city residents, and conduct regular weekly testings. The frequency of testing should be increased for priority groups of the population. We also need to further enhance nucleic acid testing capabilities, with a focus on mobile testing capabilities, and strengthen the construction of public testing laboratories, urban testing bases, and third-party laboratories. Staffing of sampling personnel should avoid draining routine medical human resources as much as possible, and COVID testing capabilities at medical institutions should be reserved for routine disease diagnosis and treatment. In addition, we must further enhance our hospitalization and quarantine capacity, and plan in advance the setting up of designated hospitals, permanent treatment centers and facilities for centralized quarantine. Authorities should prepare in advance human and material resources necessary for pandemic control, so that they can be activated as soon as any infection is detected. On the social level of pandemic control, we need to continue to adhere to "preventing inbound cases and domestic resurgences," enforce strict measures for people, goods, and environments, and step up work to require mask-wearing, temperature taking and health code checking in public venues.

The category-based treatment system of differentiated groups of population should be perfected. The rapid spread of the Omicron variant has brought about changes in the model of treatment for those infected. We must ensure that the admission and treatment of asymptomatic patients would not drain our medical resources, and that the treatment should prevent both the aggravation of the COVID-19 symptoms and further deterioration of the patients’ underlying disease. We should actively build a medical treatment system that caters to both routine and emergency medical treatment. The number of intensive care unit (ICU) beds and the ambulance service staff should be increased by an appropriate margin. In addition, division of labor in times of the pandemic should be further optimized, to set up a gradient mechanism for hospitals to admit patients and conduct flexible inter-hospital patient transfers. We must also strengthen our multidisciplinary treatment mechanism and capacity building, and carry out the admission and treatment of severe COVID-19 patients and those with severe underlying diseases. Hospital turnover rates should be high - patients with Ct value above the threshold of 35 should be discharged and stay home for health monitoring. Patients who received treatment at designated hospitals must be timely transferred to temporary treatment centers after their symptoms turn mild, lest they put an overwhelming burden on our medical resources.

Inculcation and research on vaccines should continue to advance. We should step up research on and guard against virus mutations, closely track and analyze their impacts on vaccine development, testing reagents, and therapeutic drugs, and accelerate clinical trials and market approval of Omicron-specific vaccines. We should timely keep track of the global pandemic development and improve our prevention and control measures. Efforts should be made to promote homologous and sequential COVID-19 booster vaccinations, by focusing on elder groups especially those aged 80 and above. We should attach equal importance to traditional Chinese medicine and Western medicine, advocate homogenization and standardization of the treatment process as well as the scientific use of small molecule drugs, and improve our pandemic treatment capabilities.

Access to routine medical care services and daily necessities supply should be strengthened across the board. We should strive to contain the pandemic without affecting the people’s access to basic medical services and daily necessities. In a likely scenario where an outbreak took place, medical institutions at all levels should remain open to the public as under normal circumstances. The overall closure and suspension of service at medical institutions need to be approved by the local health administration authorities, and should be limited to no more than two days. Emergency rooms, dialysis rooms, operating rooms, ICUs, and delivery rooms "should not undergo close-off management unless necessary." Local authorities must arrange for medical staff in their jurisdiction closed-loop hotel rooms and public transportation vehicles, and ensure that they could go to work under normal circumstances. Authorities should also designate hospitals to provide services to dialysis and chemotherapy patients, and to children as well as pregnant and birth-giving women, to provide unimpeded access to medical treatment. We should also integrate resources delivery medication to those in need and ensure the public’s access to safe medication. Close-off management of communities and nucleic acid testing should not stand in the way of patients receiving medical treatment. We should also promote inter-recognition of nucleic acid testing results, and put a stop to practices such as arbitrarily increasing the required time for quarantine, expanding the preset scope for close-off management, and requesting nucleic acid testing results without proper cause. Nor could local authorities restrict vehicle traffic by citing “pending test results” as an excuse, or take restrictive measures against people traveling from low-risk regions. We must refrain from implementing policies in an oversimplified or one-size-fits-all fashion. Close-off management in urban villages and old urban residential communities must be implemented in light of local conditions. The transfer and quarantine of the elderly, children, and people with limited mobility should be conducted on a categorized basis, to make our work more thorough and more people-centered.

4. Fourth, we should fully carry forward the fighting spirit to ensure the effective implementation of all measures

Currently, our pandemic control work is at a critical stage like “逆水行舟、不进则退” [rowing a boat against the current - if we let up even slightly then we risk undoing all of the progress we have made]. We should take the pandemic control as our top political priority, and as a fierce struggle to protect the lives and health of the people, to further strengthen organization and leadership, stay on guard without slackening, to ensure effective implementation of all pandemic control measures.

We must redouble our efforts in shouldering responsibilities for pandemic control. Victory comes from perseverance. This is not just a slogan, but our firm belief in holding our ground against the pandemic. In the face of the pandemic, all of us must are charged to do our best to fulfill our duties. In particular, leading cadres should command pandemic control from the front line, so that they could timely track the development of the pandemic situation, timely give orders, and timely take actions. Industries and organizations should rigorously fulfill their responsibility in pandemic control, to keep out inbound cases and contain the spread of the pandemic. We should resolutely put a stop to formalism and bureaucracy in our pandemic control work, lest those who have yet to fully understand the pandemic situation, have perfunctory work conduct or have lost the drive to compromise our prevention and control work.

We must step up supervision, constantly stay vigilant, and give inspections a greater role to play in pandemic control. Authorities at all levels must timely report and rectify all problems found in our work, and put all pandemic control measures in place. We should keep track of the current situation, and step up analysis and inspection. On-site inspections should be carried out in organizations where multiple problems have been exposed. For those who failed fully rectify the problems, and those whose dereliction of duty led to drastic escalations of the pandemic, we will recommend local governments act and hold them accountable.

We must also reinforce our publicity and guidance campaign, and continue our work to communicate the important instructions of General Secretary Xi Jinping and the decisions and arrangements of the CPC Central Committee and the State Council to the public. Our information-sharing mechanisms must be improved, and we will take the initiative to respond to public concerns, and help pool consensus from all sides to the greatest extent. Society-wide efforts to contain the virus are the foundation to ensure the stability of our epidemic control. We should guard against talks of policy relaxation, and encourage the general public to get vaccinated and adhere to healthy lifestyles such as washing hands regularly, wearing masks, and keeping social distance. Grassroots Party branches should perform a decisive role in this battle, while Party members and officials should play an exemplary role, to ensure that our pandemic control does not lose steam until we claim the ultimate victory. 

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