The horizon is not so far as we can see, but as far as we can imagine

China’s Zero-Covid Is the Right Policy Done Stupid (How China/The West Could Kill Covid)

Imagine policy on two axes: Good vs. Bad Policy, and either type of policy done well vs. done badly.

Invading Iraq was Bad Policy, and it was done badly beyond the initial conquest.

Quantitative easing was Bad Policy (unless you were very rich, it was good for the rich and bad for everyone else) and it was done well: It saved the rich then made them much richer. (They aren’t concerned about long term downsides.)

Social Security, Medicare, or Canada’s Universal Health care system (when first created and for a few decades afterwards) was Good Policy done well.

Zero-Covid in China is Good Policy, but in most cities, and generally across the country, it has been done badly. (A lot of these criticism are taken from Naomi Wu, who is worth reading — don’t be fooled by her appearance.)

Understand first that China doesn’t have nearly as many hospital beds, and especially ICU beds, per capita, as most of the West. If Covid gets out of control, a higher percentage of people will die than did in most Western countries. Indeed, probably many more. Even if they only lost as many as the US has so far, we’re talking about five million people or so, but it would easily be double that.

Second, understand that China has an onrushing demographic issue and is still a manufacturing state. They need workers. They fundamentally regard their population as a productive asset, while most Western elites regard their populations as passive assets to be consumed. (One argument for why Japan has handled Covid better than most developed nations is that they need their population. They regard the people as a productive asset.)

A third principle to understand: Long Covid would disable a lot of Chinese. That number, today, would probably be around 40-50 million, and would increase every day. Again, in China, people are productive assets, and you especially don’t want working age people disabled.

There is also a moral argument: Stopping people from dying or being disabled is ethically the right thing to do.

Keeping Covid under control via a “Zero Covid” policy is thus firmly in the Good Policy bucket. Even if there are some short- and mid-term economic costs (and actually, in a lot of metrics, China has done better economically than the “let’er’rip” countries) the long-term costs are much more significant.

Now the next thing to understand is that the way most people think of China, in terms of authoritarianism, is essentially wrong. Oh, China is an authoritarian one-party state, for sure, but regional elites have a lot of freedom. Only about 30 percent of the overall government budget is controlled from the center, for example. In the US, that figure is about 45 percent. States and cities are often rich, not poor (i.e., they have discretionary money), but they also have a lot of policy freedom within the guidelines set from the center.

So, different cities have done Zero-Covid differently. In Shenzen, where Naomi Wu comes from, there has been a total of one week in full lockdown. That’s it. Other cities have had more. When Hong Kong and Shanghai lost control in the summer, they had not been doing the same thing as most cities – they, in fact, didn’t lock down early, or totally, but tried a more “Western” approach.

We’re now seeing some fairly significant anti-Zero-Covid protests in some cities, including Beijing. This thread is a fairly good and balanced summary:

The issue isn’t that Zero-Covid is Bad Policy, it is that it has been done stupidly. To pick out a few major points:

One: Surgical masks are still being used. n95 masks are much more effective, and China has the capacity to manufacture them on a mass scale, almost trivially.

Two: Most Chinese homes don’t have p-traps (that little bend in your pipes under your sinks and toilet). P-traps keep water in the trap so that fumes from the sewer system below don’t get into your house. Not only does that mean your home smells better, it’s reduces disease transmission significantly.

Three: There is no mass move to install proper filtration or use of ultraviolet light in ventilation systems.

All of these actions would be low-hanging fruit for China. They can easily manufacture and install p-traps, filtration, and UV: China is the manufacturing capital of the world, and with the construction slow down there are plenty of people who need the work and are capable of doing it with respect to upgrading ventilation. It would be a win/win — more economic activity and an improved chance of achieving Zero-Covid.

Public health methods like testing, track and trace, and lockdowns work, but the real method is to fix the air quality and transmission through structural changes — exactly as we did in the 19th and early to mid-20th century to defeat diseases like Cholera, but with the water and sewage systems. Studies on the effectiveness of filtration, p-traps, n95 masks, proper ventilation, and so on show decreases in transmission that are massive — often over 90 percent.

Public health measures like mass testing and lockdown should be largely temporary; you use them until you figure out how to deal with a disease more permanently. In Covid’s case, that is NOT going to be vaccines. While they are helpful, they are not a silver bullet. Instead, what is required is the infrastructure transformation — make buildings and cities more healthy, thus reducing transmission massively (and in the meantime, for mitigation, move to n95 masks).

China has no excuses here: The science is clear and they have the industrial and installation capacity.

For China to achieve “Zero Covid,” they must move beyond emergency public health measures to permanent fixes. We know how to do it, and they actually have the capacity to do it.

That would be Good Policy, done well.

China’s mistake is trying to control Covid, not end it. The West’s mistake is not even trying to control it, let alone end it.

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13 Comments

  1. VietnamVet

    Clearly, N95 Mask makers, including 3M, are not connected, anywhere in the world. The US government mailed Chinese made antigen home tests to anyone who has an address but did not use the Defense Production Act to make or distribute US N95 masks. Masks are not profitable for insiders. However, a positive antigen test will sell Pfizer’s Paxlovid, COVID-19 pills. This is true of all of the non-pharmaceutical interventions; especially, air filtration and ventilation. What is worse, without comprehensive and accurate testing plus contact tracing, the virus is being fought blind. Today’s revolving door political scientists are no better than medievalists always reacting badly to the next calamity.

    The coronavirus pandemic demonstrates that global corporate human culture is built around autocratic feudal hierarchical castes who accumulate wealth and who basically do not give a damn for the lower masses. The Korean War was the last clash of people’s armies. Mercenaries are fighting the proxy WWIII except Ukraine from the start and now Russia have been forced to start conscription.

    Everything that serves the public is being privatized to make a profit for stockholders. Everyone is playing Russian roulette. The chamber is firing decades early. That’s life in a hot war between autocracies with science and politics only used for profiteering.

  2. capelin

    The Chinese routinely breath sewer fumes in their homes? As someone who has lived with a number of sewer drain “systems”, I can attest that a draft up a 20′ kitchen-sink-only drain is not something one lives with, let alone a direct vent to a public sewer main. Dwellings without a p-trap would use a stopper at the sink, cruder but almost as effective. P-traps are better though. Some other diseases, sure; but It-came-from-the-drain with Covid?

    Anyways, Zero-Covid always was a fantasy, and for sure is now. 30+ animal species and counting, billions of humans. The Covid Cat is long, long, long out of the bag, and is now 200 billion feral interbreeding cats.

    Give it up, and let us out of our houses; we want our societies back.

    The point of all this drama and “mishandling” was never to “help” people, it was to deliver a body blow to society, knocking it into an uber-tracked and controlled world, with a concurrent upwards wealth transfer to the elites. No? Well, oddly, that is what is happening, methodically.

    Different cultures, different variations of what-can-we-get-away-with. The Chinese lockdowns et al are just a more extreme version of Canada’s and other western nations. So far. Remember, Trudeau famously said (paraphrased) he “envied China, their basic dictatorship, which allows them to respond quickly”

    Waiting to see a Trucker banner in China.

  3. Dan Lynch

    I read Naomi Wu until she blocked me, along with seemingly everyone in the U.S., even though I had never interacted with her.

    I follow a number of people in China, just to try to keep up with what is going on there. Of course we can’t believe the oligarch-owned media.

  4. Dan Lynch

    Agree on the N95’s. Covid could probably be 90% controlled merely by mandating N95s, and while none of us enjoy wearing a mask, it’s a small price to pay compared to the alternatives.

  5. Willy

    P traps require a functioning vent system (especially in bathrooms) lest toilet flushes create pipe vacuums which suck the other traps dry. I hope China considers that. But then, I did see a surprising amount of carefree spitting and smoking when I was in Kowloon. Seems it’s always something.

    I like the idea of governments using science to help mandate public health concerns. It seems they succeeded at getting the Dutch to become avid cyclers (albeit without helmets), and the Japanese to become avid mask wearers, to the point where these things are now considered cool in those places.

    And despite having mega airports, both Japan and the Netherlands score low in covid deaths per capita, at least relative to the other developed countries. It seems we need to be more effective at fighting the coolness wars better (sometimes known as “culture wars”). Speaking science doesn’t always work, not even when Trump does it with his really good brain. Maybe, perhaps… this is because too many USAians did poorly in science classes. Or other reasons like libertarian billionaires funding propaganda influencers I suppose. I’m not sure how well mandating tough love would work with a citizenry which doesn’t consider tough love to be cool, unless they themselves get to administer it.

  6. Astrid

    Chinese inaction is mystifying for me too, but may be best understood in the context of how they bungled the original Wuhan outbreak. There was a chance (likely a false one given what we have since learned about the extent of the spread by that point) to firebreak Covid in November/December 2019. But the local officials didn’t want to try anything radical or report bad news. So they stalled and hoped it would die down by itself.

    Here too, the implications of aerosol transmissions, long COVID, and non-sterilizing vaccines may be simply opening too many can of worms for anyone to take the lead. The lower risk for officials and individuals is to stick with the consensus until the cost of doing so is high enough to force a break (from someone else) from the pack. It might be getting to that point and I think the local officials all know about aerosol and poor vaccine efficacy, but all want the central government or another provincial level government to take the change risks.

    I think enough COVID leaked out to support nonhuman reservoirs in the rats and mice populations, so they’re going to deal with this forever even if they do seal the borders. Limiting external travel is not a big deal except for a pampered elite (businessmen, tourists, and students at western universities). Limiting internal travel even for a short period is absolutely painful for literally hundreds of millions of people in all economic classes.

    I think the biggest genuine discontentment is not with lockdowns (Chinese people can manage to veg out at home to TV, social media, and video games) but financial viability, especially of small to medium size businesses. The central government had been reluctant to intervene because of the distortions/instability that it would introduce to the market, but they may not be able to avoid this choice for much longer.

  7. Stormcrow

    Ian, have you been spending time in the CSPAM Covid thread at somethingawful? 🙂 Your remarks re China’s Zero Covid strategy, mention of Naomi Wu’ Twitter posts, and discussion of masking and air filtration are practically a Xerox copy of the prevailing opinion in that thread. Gold is where you find it.
    I’m not being snarky, mind you. The content in that thread was why I bought myself a membership there about a year ago. I’m living on SSRI, so that fact alone is a measure of the respect I have for those people. That’s also why I decided to upgrade my masks from KN-95s to 3M 9210+ “Aura” N-95s just over a year ago, and upgraded again to an elastomeric back in March. It’s just possible that particular collection of SomethingAwful “goons” may have saved my hide, and much more probably my health, such as it is.

  8. Ian Welsh

    This is mostly from reading Naomi Wu and a scattering of news articles and other twitter feeds. I don’t read somethingawful. However, I have been on the air filtration and n95 thing since last year as a perusal of my Covid articles will indicate. They are also part of my standard reccomendations for Western countries (along, in their case, with proper public health procedures including travel bans). The lack of p-traps is not something I would know if I didn’t follow Wu.

    This is almost all common sense. I admire Wu, but she’s mostly useful in this case for information and perspective which is hard to get on China because Western media is so biased against ZeroCovid, and perspective, especially on how much policy differs between different cities.

    I find it very interesting that Shenzen, where she lives, for example, has only had a week of shutdown. Even without n95 and filteration and traps there’s vast difference in competence between Chinese cities.

    People with sense who examine a straightforward situation tend to come to the same solutions if they aren’t blinded by ideology or by their personal incentives. It’s always been obvious how to fight Covid, which is what makes it so tragic no one is doing it properly.

  9. Ian Welsh

    Wu’s blocking policy is that if she blocks someone for a tweet she doesn’t like, she blocks everyone who liked or retweeted that tweet. If she blocks an account that she considers a “bad actor” I believe she blocks all its followers, since she considers followers as supporting them.

    Super-aggressive and possibily not entirely fair (I follow some people I despise to keep track of what people I disagree with are saying), but bear in mind that Patreon banned her and YouTube demonetized her, despite the fact that she has a huge audience.

    Anyway, she provides useful perspective. She’s not the only China account I follow, but her perspective has been the most useful because she’s fairly objective about some important things.

  10. bruce wilder

    “science” in the sense of a state being able to “think” adroitly and adapt and design an effective policy architecture has taken a beating worldwide. China is still sending hazmat-suits to spray surfaces including streets — oy!

    The “right” policy done stupidly is still the wrong policy for any practical purpose. It is using a club where a surgical steel knife should be cutting a precise line.

    I remain skeptical about the practical possibility of a zero-covid policy at this late date for most of reasons already adduced in comments. I will gloss over that.

    But I go back to the failure of “science” with quotation marks fully earned by “believe the science” and related official propaganda drivel. I am not sure I blame the feckless manipulators or the endlessly credulous / pointlessly paranoid speculators more.

    The reality of a pandemic called for knowledge early and applied earnestly and effectively, which means (to my naive mind) finding out quickly.

    I look back and I do not see honest inquiry anywhere (outside twitter). pre-pub became a sewer from which headline-writing hacks fertilized click farms. critical thinking was ignored. and few voices ask for better.

    vaccine efficacy was wildly exaggerated. (I am still waiting for NR to apologize for retailing Florida news reports over and over supposedly confirming the bs about the pandemic of the unvaccinated) wildly exaggerated in the most cynical way imaginable.

    some basic issues were never investigated — how rapidly a person infected cleared the virus, if they ever do, was as far as I can tell, never competently investigated to this day (when we know that a few (??) individuals are Darwinian incubators indefinitely

    the whole aerosol vs droplet “stylized fact” is concerning. Those p-traps in China could be a problem if farts are lethal — Sars1 was sometimes transmitted that way; not a joke.

    Really, though, why was it so hard to figure out what was going on with transmission on those cruise ships and early quarantine hotels?

    Why were treatments not a research topic? They were not — regardless of what anyone thought of ivermectin the effort to evaluate it was incompetent even more among the establishment skeptics than the true believers and the Media were happy to echo “horse paste”. And there were many more treatment ideas that never got investigation.

    “Stupid” policy — right or wrong — was locked in in the West and in China by determined ignorance and an inability think collectively and critically. I see much the same collective stupid dooming any response to climate change / resource exhaustion / ecological collapse.

  11. Ché Pasa

    I’ve said this from the beginning: public health officials know what to do in the face of a pandemic. The protocols are well understood and detailed. They work where they are applied.

    China came close to doing so, a little late but still they tried far more comprehensively than any government in the West (although some few of them tried too.) The issue was not “the science”, it was the widespread and now nearly universal collapse of the infrastructure of public health practice and the failure of — if you will — faith and respect for “experts” which has been foundational in pretty much all societies at least since the advent of Progressivism.

    Fauci as the face of COVID scientific expertise drove me up the wall; he’s not an “expert,” he’s a spokesperson, a bureaucratic politician, and a squeezer of the teats of the System. He bungled HIV-AIDS and he bungled COVID, but in both cases he was doing his job. He was there to please his masters — our rulers as it were — and mollify the masses into believing “the experts” were on top of it. Bullshit. The experts were told to sit down and shut the fuck up. And for the most part they did. Fauci did his little dance for public consumption and believers believed. Skeptics spit through their fingers. And we found that many more of us are now skeptics.

    How widely was this scene and practice repeated around the world? Even in China.

    As long as there’s no common assumption that People Who Know Best actually do know best and can/will follow through on it we’ll have endless Twitter debate that gets nowhere, fruitless conflict over such minor but effective means as masks, and wrong headed advice and lack of funded studies over potential treatments. No efforts in common after the first few. And ultimately what we see now: lack of concern by the Overclass — except for themselves — and a Party On group think by practically everyone else. The outliers are those of us who still bother with precautions.

    The death toll in China is still very low — which is part of why that fire triggered so much outrage. More people died in the fire than die of COVID, and those people died in part because of COVID restrictions. In the West, a “tolerable” death rate is being maintained, in the US something like 500 a day or so. It’s been steady for some months, and so long as that’s the case, attention will not be paid. Even if children become the primary victims — which, so far, they are not. The old and frail are headed for the Reaper as usual.

    Ultimately, we’ll need new experts and a new, vital set of rulers. Trotting out tired old fossils like Fauci who serve Overlords and not the People is a futile game. It’ll only work until it doesn’t, and it looks like it’s not going to work any longer anywhere.

    Interesting times, indeed.

  12. Ashley C

    China doesn’t seem to understand aerosol transmission and hence all the snafus reg ventilation. Instead stupid measures like massive spraying etc, Naomi pointed out this too.No effective zero COVID until they get this.

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