China’s chaotic COVID re-opening

Below is a complete transcript of the live Sinica Podcast with Deborah Seligsohn.

Kaiser Kuo: Welcome to the Sinica Podcast, a weekly discussion of current affairs in China, produced in partnership with The China Project. Subscribe to Access from The China Project to get, well, access. Access to not only our great daily newsletter but to all the original writing on our website at thechinaproject.com. We’ve got reported stories, essays and editorials, great explainers and trackers, regular columns, and of course, a growing library of podcasts. We cover everything from China’s fraught foreign relations to its ingenious entrepreneurs, from the ongoing repression of Uyghurs and other Muslim peoples in China’s Xinjiang region, to Beijing’s ambitious opening plans “post-COVID.” It’s a feast of business, political, and cultural news about a nation that is reshaping the world. We cover China with neither fear nor favor.

I’m Kaiser Kuo coming to you this week from Berkeley, California.

The Beijing leadership’s termination of its longstanding and controversial zero-COVID policy has generated quite a bit of controversy, with some arguing that it was simply too abrupt and that China wasn’t ready for the wave of infections that followed. What caused the change? Just how unprepared was China? And what is happening now? For my money, there is no one I can think of who I’d rather hear from on this than Deborah Seligsohn, who has been on the show many times just in the last couple of years, to talk about many facets of the pandemic, because as I’ve described her before, she’s just really one of the most reliably informed, insightful, and fair-minded observers of all the debates around COVID-19 and China.

But this time, I’m especially keen to talk to her because she is just back after a trip to China that lasted from mid-October of last year to just last week. Debbi is Assistant Professor in political science at Villanova University. She served as the Environment, Science,Technology, and Health counselor at the U.S. Embassy in Beijing from 2003 to 2007. And then from 2007 to 2012 was principal advisor to the World Resources Institute’s China Energy and Climate Program. After coming back to the U.S., she got her PhD in Political Science from UC San Diego. Debbi, welcome back both to the States and to Sinica, and thank you so much for making the time.

Deborah Seligsohn: Thanks so much, Kaiser.

Kaiser: Debbi, let’s start with a quick chronology of your time in China this time around — starting with maybe why you went in the first place and how difficult it was for you to get there. And maybe tell us where you were, how the places where you spent time contributed to the perspectives that you formed on what’s happened there over this period.

Debbi: So, I went to China to work on a project looking at U.S.-China climate relations, and especially the cooperative projects over the past 30 years. This was a project that we developed after the Glasgow meeting in 2021, where the U.S. and China put out a joint declaration. And my partners at Tsinghua University and I felt that both China and the U.S. had made a lot of progress on climate, that the things that might have been relevant to work on together in the past maybe weren’t the things to work on in the future since technologically, policy-wise, every which way a lot of advances have happened. So, it seemed a good moment to sort of review what had happened in the past, what kinds of things work, what doesn’t work, and think about the future.

So, that was the plan. The visa process itself took months and months and months because China is so restrictive during this COVID period to who can get there. In the past, an academic only needed an invitation letter from the university for that period. And it’s no longer true, happily. Those invitation letters had to actually go through the city government. So, that was a huge extra step.

Kaiser: Wow.

Debbi: And then the consulate also had this crazy extra step where you had to email them all your documents to get permission to be allowed to send in the hard copies of your documents, and then it just took them a long time. I started this discussion in December last year, and I finally got to China in October of this year. I then went through the required quarantine period. There’s a 10-day closed-loop quarantine, which I did in Shanghai. I came to Beijing, then Beijing said, “Oh, there are cases in Shanghai, so you need to quarantine again for seven days.” That was a different kind of quarantine because it wasn’t in an official quarantine hotel, but on a floor of a regular hotel, which led to all kinds of crazy situations. Like they had to send me out for my tests every day, so it wasn’t exactly like I was quarantined.

And actually, 10 days means 11 because they test you on the 10th day, and then you have to wait till the following morning. Seven days means eight for the same reason. In the end, it was about 19 days of quarantine. Got out of quarantine into Beijing in November. Then, on November 11, the Chinese issued the “20 Points” or “20 Measures” that seemed to be about trying to do a gradual opening. And we can get into more detail on this, but it sort of backfired probably because Omicron was already moving through the population kind of stealthily. I was out and about in November, but a lot of people, I would want to meet them, but they would be in their complexes, quarantined or… And, of course, by the time I got out, the Chinese delegation was already leaving for Sharm el-Sheikh Egypt for the climate conference, so there were a whole bunch of people I couldn’t see.

And some people, like one of my dear friends, was in her own home quarantine till the day before she left for Egypt. So, there was all this kind of crazy stuff going on. And during the month of November, it just got more and more tense as people realized the number of cases were going up and up and up. I was there through the then-official opening and elimination of zero-COVID in December and the 10 measures that kind of did a lot of things, and we can talk about what they did and didn’t do. Then I, like almost everybody I knew, caught COVID. So, I had that adventure.

Kaiser: Oh.

Debbi: Then I got better along with everyone I actually personally know, although I have many friends and contacts who have lost people. That part has been really tough. Then I had a couple weeks where I was out and about and really saw the reopening of Beijing in terms of 80% to 90% of the population had already had COVID, and especially for most of the people, 60 and under, they were out and about. People were going to restaurants again and everything else. The subways were back to sort of their ridership numbers, all of that. And then I came back this past weekend. I left Beijing on the 7th of January.

Kaiser: Wow. Amazing. Debbi, we’ve had people on the show talking about how different folks have dealt with zero COVID, and in some cases their experiences with very onerous lockdown conditions. But maybe with your trained academic perspective, you can zoom out and offer a wider range of views on how people in different walks of life, at different stages of life experienced zero COVID — older folks, younger folks, frontline healthcare workers; people consigned to work as dàbái 大白, people in the hazmat suits, or migrant workers, that sort of thing. Can you give us a kind of an overview of how zero COVID affected different demographics in China?

Debbi: Sure. And I wanted to say also, I think in terms of my personal experience, I think what is useful about it is that it was very ordinary. I don’t think I had the worst experience. I mean, and yeah, you have talked to some people who did. I also didn’t have the mildest experience. I do know people who never, ever were locked down in any way, and because they didn’t leave the country, never experienced any sort of quarantine except maybe in that first period back in 2020. I sort of experienced a very ordinary urban experience. And yeah, I think you’ve talked to some people who’ve had a sort of a much worse experience. You also had that wonderful article in The China Project [The China Project] about the guy in Dali who basically never was tested. [Editor’s note: This was Alec Ash]. I think you have well illustrated the range. So, I think that’s part of what was going on. Especially for a lot of older urban residents with urban 戶口hùkǒu.

Kaiser: Hukou are residence permits.

Debbi: They really liked zero COVID. It made them feel safe, and they didn’t mind the restrictions very much. They often were the people determining the restrictions because, and I think your new podcast, Strangers in China, really helps to illustrate one of the important things, which is that a lot of the decision-making is made by the local residence committee, the jūwěihuì 居委會. And the juweihui is often dominated by the elderly people in the compound. And the elderly people in the compound who are on that are the ones with hukou. So, for people who had a salary or who had a nice pension, the fact that zero COVID was really hurting the economy maybe didn’t affect them very much. And if you had an ordinary job where you just went to the office and you came home, certainly by the time I got to China in November of 2022, you weren’t going out and about very much, because every time you went anywhere, there was a risk that you might go somewhere where you were exposed. But maybe you were going to work, you were coming home, your work was not being adversely affected.

A lot of the expats who were still in China, which were a tiny percentage of what had been there in 2019, had jobs where they had to travel. And of course, there are many Chinese who have to travel as well. And if you had to travel, you, again, were constantly faced with these restrictions. Anytime you left, especially a major city like Beijing or Shanghai, you ran the risk that if there were COVID cases wherever you went to, you wouldn’t be allowed back in. I have one contact who I think basically finally made it back to Beijing after two months because he got stuck in Guangzhou because there were a lot of cases there relatively early in this current wave, and then actually had to go home to his hometown to take care of his elderly parents. And finally made it back, I think, a couple days before I left.

But people kept getting stuck all over the place. And then people who were in the service sector often just lost their jobs because people weren’t going out, people weren’t going to restaurants. I mean, even when I got there in November and restaurants were still open, they were really empty because people didn’t want to risk catching COVID. That’s a lot of migrant workers who work in the service sector. A lot of migrant workers in a place like Beijing or Shanghai are actually the people who’ve invested in these things. There’s a group of migrants in these cities who’ve been there for quite a while at this point and own a little restaurant or barber shop or whatever, right? And those people often lost their businesses over the last couple of years. And so, migrants were really badly hurt.

So, when you looked at a scene like that big clash in a huge housing development in northern Beijing where there are a lot of migrants, probably the people on the residence committee are all hukou holders, and the really angry people are non-hukou holders. So, that was a big divide. Then when you look at the factories, you often had this situation where the people who were in the factory at a time, where there was increasing number of cases, got stuck in the factory working many more hours than they wanted to. And the people who would’ve come in for the next shift are stuck outside the factory, unable to get their hours. So, for a lot of poor Chinese, this has been just a really, really tough time economically. For students, I think it’s been a tough time emotionally and socially just like it has been in the United States.

But the stresses are worse because when they’re confined to their dorms, of course, there are more people in a room than is typically true in the United States. The whole time I was in Beijing, students really didn’t have permission to leave campus, and they had not been able to leave campus as far as I can tell the entire full semester.

Kaiser: Wow.

Debbi: Even after December 7, when they supposedly opened up, I mean, the students who stayed on campus, which initially, certainly in the campuses I know in Beijing, was a lot of them because they didn’t really have the facilities — the internet and everything else — to be able to study from home. They actually divided the students from the faculty, and they were still locked down, basically. So, I think it’s been this huge range. I think the thing that I feel has not been conveyed enough, even though it’s certainly been in some of the articles, is that this whole thing was administered very much locally. That what your experience had a huge amount to do with what happened to be which city you were in, your particular district government, which was, in theory, the decision maker, in a lot of cases, chose to do. And then how your local residence committee chose to interpret it.

It was not a national unified system. We all had these health codes, and the health codes were city or provincial level software. And they didn’t interact with each other. They didn’t communicate with each other. And in fact, I don’t know, I heard a hilarious, well, not for the people involved hilarious, but just illustrated how crazy the system was of expats that had a trip to Dunhuang in Gansu Province, and arrived only to discover that the Gansu Health Code simply had no facility for using passport numbers instead of ID numbers.

Kaiser: Oh, gosh.

Debbi: So, they were unable to get the green code they needed to do anything, right? You needed the green code to get in a taxi, to register at a hotel, to eat at a restaurant, to, I’m sure, get into the Dunhuang monument, caves, etc., itself. And so, they just had to turn around and fly home.

Kaiser: Oh no.

Debbi: That is an extreme example, but that was sort of how very local everything was. What I don’t think it was, was a comprehensive way for the central government to track every person in China because these systems just didn’t communicate with each other that well.

Kaiser: Do you think that that was clear to people on the ground in China, just ordinary people who, as you know, you arrived a little over a month before the protests broke out right around the time of American Thanksgiving toward the end of November, do you think that this was something, the very local nature of administration of actual healthcare policies was something they were aware of? Because it seemed like a lot of the ire was directed toward the center? Am I wrong there, or…?

Debbi: So, I think the ire was directed at all levels, honestly.

Kaiser: Sure. Sure.

Debbi: And the stuff that the media chose to focus on was whenever somebody happened to mention, somebody from the central government. Like the Tsinghua students negotiated directly with the deputy party secretary, I think it was, of Tsinghua University. First of all, for somebody that high level to come out and negotiate directly with students within, seemed like an hour of the protest starting, I mean, you don’t usually see that on American university campuses when students go out and protest. I think that illustrated a lot of sympathy for what the students were upset about. And a lot of their demands were incredibly specific. I mean, the deal that they cut, of course, did not address any national political issues. And it dealt a lot with the very specific ways that quarantine was being administered within the campus.

I think there was a lot of variation in what people were upset about and who they saw. The fact that they knew it was all very local, and that people also knew that their residence committee was often overinterpreting things became really clear in this whole movement that started in late November for these various housing developments that were being put under these sort of temporary lockdowns to demand that they see the official stamped letter from the local district CDC requiring the lockdown.

Kaiser: They understood that it could be just their juweihui overinterpreting something, and they wanted to see that this actually came from the district CDC.

Debbi: Right. And in fact, it also had the function of clogging up the works. Because the truth is sometimes the juweihui wasn’t necessarily overinterpreting, that they were doing what was required, but by the end of November, there were so many outbreaks everywhere that the local district CDC simply couldn’t keep up with issuing enough certificates. So, people were able to sort of use the bureaucratics that were required by the regulations as a way to make the regulations unworkable. I think there was an understanding that the problems existed at all levels, but I think there was also a feeling that a lot of the way things were happening harken back to what I think of as kind of the cultural revolution style of administration, where you have some kind of order from the top, and then everybody tries to outdo each other with their jījíxìng 积极性, their enthusiasm.

Kaiser: Yeah. Working toward the furor, as they call it. Right.

Debbi: Well, I call it “learn from Dàzhài 大寨,” right?

Kaiser: Yeah.

Debbi: And everyone I mentioned that to in China, certainly of a certain age, because, of course, the young people would never… The culture revolution is ancient history to them.

Kaiser: …what was Dazhai. Yeah.

Debbi: Yeah. But everybody was like, “Absolutely.” So, there was a feeling that the central policy had to go because the local governments were all overinterpreting and trying to show that they were stricter. I was on a campus that had its own health code, in addition to the National Health Code or the Beijing City Health Code, that had stricter requirements. Talked to someone recently in a national government department who is still not allowed to travel outside Beijing, even though, theoretically, zero COVID is over. Because if you read those 10 measures, one of them is that government departments are allowed to still have their own restrictions, and they require special authorization to travel. Absolutely, this was a national policy, it’s just that it was chaotic and local in its administration.

Kaiser: Yeah. A narrative has emerged that talks about what precipitated the protests of November. For instance, of course, the Urumqi fire, which I think obviously was a major precipitating factor. But there are other things that people have cited, like the Foxconn breakouts, the frustration over the fact that the 20 points that came out right after in November 11th weren’t being implemented. What, in your mind, were the real factors that we should be focusing on in trying to understand what caused the actual outbreak of protests in late November?

Debbi: I think that Foxconn breakout is a separate story of a protest. I don’t think that people in cities were protesting because somebody else was protesting. But other than that, I think all of those things were factors. I mean, I think the fundamental thing is that Omicron was making the system unworkable. There were just so many cases everywhere that lots and lots of people who, until then, had been able to live close to normal lives, were now suddenly under a great deal of pressure and worried that they were going to be locked down at any moment. And this fear of being trapped in your apartment was reified by the Urumqi fire, right?

Kaiser: Yeah.

Debbi: So that everybody’s greatest fear of being trapped in an apartment, trapped in a fever hospital, just trapped somewhere, just became sort of pervasive. And this feeling that things were just getting worse and worse because when I got out of all of my quarantines and moved into an apartment in Haidian, near Tsinghua, everybody was telling me, “Don’t go to Chaoyang District. There are too many cases in Chaoyang District.” And then there’d be like, “Don’t go to Dongsheng or Xicheng. There are too many cases there too.” Everybody is like restricting their movements. They’re trying to figure out where the cases are likely to pop up next. It’s very hard. You looked at this map of where cases were, and it’s just these red dots all over the place. And so, nobody felt like they could have a normal life. And they were getting more and more worried about it. As I said, for a lot of people, there was enormous economic pressure connected to that.

That their businesses were not going well. Salaried people were sort of still functioning, but were they going to have a job next year? Students looking at the economy were like, “What about me, when I come out of college, am I going to, have a job?” And as you know, for the last decade or more, students were often paving their way for future jobs with lots of internships and external activities to try to get good relationships and experience. And they weren’t able to do any of that because they couldn’t leave campus. I just think there was so much fear and so much sort of frustration and feeling like things just were getting worse and worse and worse. That fire just-

Kaiser: It just came to a boil, yeah.

Debbi: It came to a boil. I think it’s worth noting that the vast majority of people in China were not involved in these protests. And even in Beijing, most people I knew had no idea how many protests there were, where they were, exactly what happened. They might have heard an inkling about them, but they had no real knowledge actually. And that includes people I know who certainly had access to VPNs but maybe weren’t using them. I mean, the other thing is that people were, by then, so involved in trying to figure out their own life. That was also the period when we were all being told to stockpile food in case there was a Shanghai-style lockdown.

Kaiser: Yeah. And there’s just a lot of panic buying and yeah, all that.

Debbi: Well, I mean, all my friends told me to stockpile, and then there was… The U.S. Embassy put out a notice to citizens advising everyone to stockpile. And all my Chinese friends were sending me this U.S. embassy notice. They also seemed to think it implied the embassy knew something that nobody else knew, which I don’t think it did. I think they were just reacting to the same things as everybody else. And, of course, people who had kids, certainly in Beijing, and I think in many other cities, they were all sent for homeschooling, right? They were doing online schooling. Chinese apartments are a lot smaller than American houses, and you know how crazy Americans went when they had to have their kids home for homeschooling. Now, try imagining in a 400-square-foot apartment that you have to have two kids doing online education, plus the parents doing at home work. I mean, people were going a bit nuts.

Kaiser: I can totally understand that. So, that takes us all the way up to the eve of the December 7 lifting. Why wasn’t there a gradual lifting of COVID regulations? I mean, what happened after the November 11 20 points? I mean, you suggested that it backfired. Maybe you can unpack that a bit. And I guess the million dollar question that everyone has been trying to answer is, what precipitated this sudden lifting on December 7? You’ve seen all the speculation. There have been pieces that have come out in the Wall Street Journal and other outlets that are now saying, “Here is what Xí [Jìnpíng 习近平] was thinking. Here are the factors that…” What’s your take on this?

Debbi: So, I think the system imploded on itself. The 20 points had this sort of counterproductive response where every time a locality tried to open a little bit, they suddenly realized they had way too many cases and they would crack down. But mostly, most places didn’t even try to open. They just were busy imposing more and more lockdowns because the number of cases were going up. And the way the system was designed is, as cases increased, the system became more and more unwieldy. And this all had to do with Omicron. So, I think one of the things that you have to realize is, until Omicron, the system did not involve regular PCR testing of the whole population. Until 2022, people were not regularly being tested at all. The health code thing was… it was green as long as you stayed in an area that didn’t have cases.

And then it might turn yellow if you had been in an area where there are some cases, and red, if there were, I don’t know, more cases or something. But it was all based on location, which is why you had to keep scanning QR codes whenever you went to the subway, got in a taxi, went into a supermarket or restaurant or an office building or whatever, because it was tracking where people were, and then that was what determined whether you had been exposed. And only if you had been exposed did you have to go get a PCR test. And then, every so often there was a big outbreak in a city and they would test the whole city, right? million people in Qingdao this week or whatever. But it wasn’t like week in, week out, everybody getting PCR tests all the time.

That started with Omicron. And the way they were doing that number of tests was by doing something called pooled testing, which, at least in Beijing, was literally called shí hùn yī 十混一, “10 mix one.” So, you knew they were doing a pool of 10 because it was actually in the name. And so, you’d go in, you’d get your PCR test. If anyone in the pool was positive, everybody had to be retested. And so, as long as there weren’t many people who were positive, this worked great because it kept the burden on the PCR machines within a manageable amount. But if you have a lot of positive cases, then all of these pools become positive and you start having to retest everyone in every pool, which means everyone. Prior to December 7, if you were in one of these 10 positive pools, you also, your whole… Usually your entryway or something would be locked down while they were retesting everybody.

And, of course, many people tested at these booths on the street. I usually tested either at the university or inside my compound, there was a testing place. So, the possibility that people in a pool were in the same entry or whatever was a little higher. But for most people, they were just being tested somewhere out on the street. And so, these 10 people who had to retest were most likely to be living in 10 different housing areas, or at least 10 different entries or buildings. And so, suddenly, all of these districts in juweihui are having to run around and lockdown all these different places. Depending on their resources, like I saw one in my compound where they put a guy in the white suit, in the full PPE, standing up the door, and he was clearly deciding whether people could go in or out.

And that would feel a little safer, but if they didn’t have enough resources, they’re chaining the door, which is causing people to be really scared. And it’s also this massive inconvenience and frustration. But it also, by the end of November, beginning of December, was causing the whole system to just slow down. So, you go get your COVID test, and instead of getting the result right away, it’s getting delayed because they have so many positives. And one of my friends told me they’d heard that every time they got a positive, they were also doing some massive disinfection of the PCR place, which, I mean, that should be handled in such a clean way that whether you get a positive or a negative test doesn’t affect how it’s run. Who knows? But what I know is that it could take days for them to tell you were in a pool positive. And so, by that point, you’ve already infected everybody if you were the positive person.

The testing was no longer catching people in time to reduce the spread of the disease. And so, it was just building and building. And I think, between the fact that the testing system couldn’t keep up, the fact that housing developments were demanding that the local CDC issued the proper documentation, the whole system was just toppling of its own accord. And then, I think the case that was being made about the economic implications of continuing this, I suspect had the biggest influence. And one of the reasons why I think it’s the economics and not as much the protests was that when they lightened up, they lightened up much more outside in the real economy than on university campuses where there were still a lot more rules in place. And as you know, there were a lot of protests on the campuses.

Kaiser: Sure. Because that seem to be the driver. It’s the economic necessity then-

Debbi: I mean, everybody knows about Terry Gou’s letter, the Foxconn guy. We also know about the European Chamber because they’ve been very public in what they say. I would be surprised if there weren’t lots of state-owned enterprise presidents and whatnot also making this case, just doing so much more quietly. I think the economic implications of continuing with zero COVID were just very clear. And I think that in the middle of the winter, there was just no logistical way to manage a gradual opening that the 20 points had clearly failed to enable gradualism. I do think, had they tried last summer, they might have been able to pull it off. But that in the winter, with Omicron, there just was too much disease around to do it. I do think they were in the process of thinking through how to do a gradual opening.

Because I mean, you have the 20 points, and then you also have a new vaccination campaign that started like two days after the protest. There’s no way they had a vaccination campaign all ready to go in two days. They clearly had been working on that.

Kaiser: Right. Of course, not.

Debbi: I think they had an idea that involved, let’s finish the vaccination work that got delayed, let’s get all of our sort of everything in place and then we’ll start opening. And the reality of the speed within with which this disease was moving just overwhelmed them.

Kaiser: So, Deb, a lot of people have criticized Beijing, and I think rightly, for not using the time that it bought through its very strict measures to buttress its capacity. Like you said, this vaccination campaign was set to kick off only a few weeks after the close of the Party Congress. And why not a whole lot earlier? First of all, what did they think was going to happen? That COVID would just vanish in the rest of the world outside China, and that eventually China would be able to reopen into a COVID-free world, or what? I mean, it’s just very frustrating to me that there seems to have been a lot of time lost. So, what were the issues with vaccination, with building more ICU beds, with stockpiling more ventilators, stockpiling more therapeutics like Paxlovid, building out more just hospital capacity more generally? Why were they caught so unprepared?

Debbi: What they were thinking is one of the big mysteries that I am…

Kaiser: Yeah. I thought you might have some insight into that.

Debbi: They clearly got themselves in this sort of unproductive feedback loop, where, as the number of cases increased, they invested more and more in this national PCR testing and building fever clinics, which were very basic, required no equipment, and were just places to hold people with mild disease, right? But they were spending so many resources on that, that they didn’t have the resources to do the things that you rightly point out they needed to do. They needed to get more comprehensive in immunization coverage. They needed to get more ICU capacity, and they needed to think about therapeutics. And clearly they were thinking about the vaccination gap that, that was the one they were focused on. They now have like 11 different vaccines authorized for the boosters that they’re offering right now. And so, they clearly were working on that, and I suspect they were partly waiting for some of these new Chinese vaccines to be ready to move out.

I do think they deluded themselves into thinking they had the luxury of time until all the Chinese vaccines were ready. And that was a mistake. The Paxlovid thing is a big mystery to me because there was a deal signed between Pfizer and some Chinese company for domestic manufacturer of Paxlovid last spring, and then it just appears like it never happened. So, they wound up with very little in the country at the beginning of the outbreak, and then importing what clearly were inadequate supplies of it. I saw there was a big announcement when they imported 620,000 treatments.

Kaiser: It’s woefully inadequate. Yeah.

Debbi: Yeah. I’m trying to think, the five day, the full treatment, so 620,000 of those. One of the modeling estimates were that they needed 130 million, because you want to give it to everyone above, I mean ideally above 50 or 55, but certainly above 60 or 65, who gets the disease. Now, I will say Paxlovid has been one of the most poorly used drugs in the United States. I mean, the vast majority of physicians do not give it out correctly. They often advise their patients to wait and see, which, of course, is completely wrong because what you’re doing is taking it in the first week to prevent complications of the second week. And so, there’s no way to predict how someone is going to do. They also tend to give it to young healthy people for which it’s been shown to have absolutely no impact.

I don’t know how well Paxlovid would’ve been used in China. We certainly have an example of a society with the free flow of information and doctors who go through an insane number of years of education and are still not doing a very good job. But it certainly, in urban China, a lot of people themselves were aware of it, and knew they wanted it, and wanted to take it, and were unable to get it. That’s been really shocking. And then, on the ICU front, I mean, what’s really interesting about all the film of Chinese hospitals is often Chinese hospitals look like that, right?

Kaiser: Right.

Debbi: I mean, people absolutely everywhere. Total chaos. I mean, I think the thing is that Chinese hospitals are already overcrowded at normal times, certainly normal winter flu conditions. And so, they simply didn’t have any excess capacity, and that just doesn’t appear to be something that they were planning for. One of the problems is that that administration and the CDC disease, as in the United States, the sort of the treatment system and the disease prevention systems are not in any way integrated.

Kaiser: Yeah.

Debbi: And so, the people who were thinking about disease prevention and busy running, thinking about PCR tests and stuff, they have no influence over the size of the amount of hospital capacity. That is very expensive investment and it requires knowledge and technology, right? I mean, one of the problems with the way the Chinese did things is they were relying on very low-tech solutions. I mean, none of us have any idea what the qualifications of the people actually manning all these PCR booths were. But I mean, my guess is that they’re all the people who are unemployed as waitresses and whatnot. I mean, nobody thinks they had any medical training of any kind. People kept saying on Twitter, “Why don’t they just have all these people who were doing PCR tests do the vaccine campaign?” And I’m like, “Because I don’t think they’re trained to give anyone a shot in the arm.”

Kaiser: Yeah. Maybe a swab up the nose, but not a shot in the arm. Yeah.

Debbi: Well, they swabbed in the throat, and most of our experience most of the time was that they never got anywhere near your throat. They would kind of stick the swab in and wave it around in your mouth. I had one week where they kept swabbing my cheek as if it were some 23andme test. But it’s very low tech. And then, of course, the fever hospitals were just warehouses.

Kaiser: Yeah. So, I want to move away from the hospital capacity and from therapeutics and back to vaccines. We often hear that the Chinese vaccines just aren’t as effective as the mRNA vaccines offered from Pfizer-BioNTech and Moderna. So, how true is this? How well actually do they work or not work, at least in decreasing hospitalization and death?

Debbi: So, we’re going to have a lot more data on that after this outbreak. But the data from Hong Kong suggested that if people had gotten three vaccines, it actually was pretty similar in terms of preventing severe disease and death.

Kaiser: There was a gap still, right?

Debbi: Very small. The huge gap was if they’d only had two. It was very clear that two mRNAs did much better than two Chinese vaccines. But the Chinese had offered everyone the three — two and a booster. And most people who were vaccinated had done that, but not all. And the data from Singapore, again, found a gap if you’d had four of the mRNA versus four Chinese vaccines. But I don’t think the Chinese were ever going to be able to give everybody four. I mean, that was just like an extreme. It doesn’t appear that most people in Hong Kong had had that. So, yeah, you really, really needed three was the biggest problem. And a lot of people didn’t have three. And the biggest problem with the Chinese vaccine was not the quality of the vaccine. As I say, if you got three, you were probably fine. The biggest problem was who had not gotten vaccinated.

Kaiser: And it was the older people who hadn’t.

Debbi: It was older people, and especially older urban people. The rural vaccine rate was actually higher, which-

Kaiser: Interesting.

Debbi: I don’t have a reason that anyone’s told me. I suspect it’s because these districts were given targets, and there are no middle-aged people in rural areas. They’ve all gone to the city to work. And these villages are mostly old people and kids. So, to meet their targets, they had to convince the old people to get it, whereas in the city, they didn’t.

Kaiser: Yeah. No, that makes sense. I mean, that’s at least a solid theory.

Debbi: So, the big question was why didn’t old people get vaccinated?

Kaiser: Yeah. So, the vaccine hesitancy is something we’ve talked about before, but I want to… After you spent so much time in China talking to people directly, maybe you have a new perspective on why wasn’t everyone vaccinated? I mean, so there’s vaccine hesitancy on the one hand, and then there’s also maybe China not bringing to bear its vaunted state capacity in the service of universal vaccination, even if that meant some coercion. They were happy to coerce people into testing. So, yeah.

Debbi: Well, so they coerced people into testing to a certain degree. But in fact, for most of the time, if you just chose to go nowhere and just stay home, you could avoid testing. I think it’s worth noting, by the end of November, everybody was telling everybody don’t go get a test because of this problem of positives in the pool. And so, there was a lot of testing evasion, which is why the thing was spreading so thoroughly in October and November before they got a hold of it, right? So, the coercion was always partial. The thing that they seemed to feel comfortable coercing was locking people down as opposed to anything that was physically invasive.

Kaiser: Okay, sure.

Debbi: And I think that’s worth noting. But in terms of the vaccines, I mean, I think there were so many reasons why it was hard. The first thing is that they originally did the vaccine campaign for the under 60s. Now, the reason they did that was, in significant part, because they actually weren’t facing immediate severe disease and death. And so, the idea was, let’s vaccinate the people who are more likely to have a lot of contacts to reduce the number of vectors for spread in case there’s new disease introduced. Because older people typically get together with fewer people, young people who go out to work, are more likely to spread the disease, as our kids in school, so we’ll start with them and we’ll get to the older people later. It had a certain logic to it, but it created this perverse message that the vaccine wasn’t very good for old people. And a lot of old people, and a lot of doctors took that on. I mean, I’ve heard from many people whose parents were told by their doctor, “Well, wait till your cancer treatment is over before getting the vaccine.”

Or, “Well, you’re kind of weak, so maybe you shouldn’t get it.” I mean, there was a lot of that going on. There’s been a bit of that in the U.S., but I think in terms of doctors advising against, it was actually an even bigger problem in China.

Kaiser: Interesting.

Debbi: So, that was like the first reason. The second thing was, of course, just that the elderly in particular felt safe. They didn’t feel any urgency for zero COVID to end. They liked it. They didn’t sort of think — “Oh, it’s got to end sometime. I need to get ready.” They just felt comfortable with it. And so, they just didn’t feel the urgency. The third reason is the wackiest one is that the Chinese vaccine is particularly non-reactogenic. When you get it, it doesn’t hurt. You don’t feel anything. Your arm doesn’t get sore. You don’t get sick. It’s the exact opposite of the mRNAs. And that should be a good thing. But as soon as I got to Beijing, and I mean, started asking my friends, “Did you get vaccinated?” A very common answer was, “Yes, but I have no idea if I got the real vaccine, or they just shot saline in my arm because I felt nothing.”

Kaiser: So, they assumed that you had to have an adverse reaction in order for there to be any efficacy. I heard that a lot from people. Yeah.

Debbi: Right. I mean, I asked one guy, he said, “My mom got one vaccine, and then refused to get any more.” And he said, “And my dad got all three.” And I was like, “Well, why didn’t your mom get the other two?” I mean, clearly, if you went and got a vaccine, you weren’t totally opposed to vaccines. And he said, “Well, she said it didn’t work on her.” His dad had some kind of reaction to the vaccine, and they interpreted that as the vaccine working. And since she didn’t have any reactions, she figured didn’t work. So, the non-reactogenicity actually… I mean, and this is, of course, in the wake of the fact that China has had multiple fake vaccine scandals in the past. So, people are just skeptical to begin with. And the idea that they were just being shot up with a saline solution, people just felt that might be true. And that was true of the people who got the vaccine and the people who were like, “Yeah, no, I don’t believe it.”

So, that was another reason. A fourth reason was the amount of anti-vax stuff that they were all getting subjected to all the time. The Chinese government was constantly putting out negative stuff about the mRNA vaccines. And if you put out negative stuff about any vaccines, it tends to seep over to all vaccines. A lot of Chinese will still think, “Well, the most modern stuff is out there somewhere else in the world. And if it’s bad, then I don’t believe my local stuff either.” Right?

Kaiser: Right.

Debbi: Plus, a significant amount of the vaccine skepticism about the Chinese vaccines was coming through the great firewall, right? The fact that every Western article says the Chinese vaccines aren’t as good, especially for urban Chinese. And remember, it was the urban elderly choosing not to vaccinate more than the rural elderly. They’re getting that message. And so, they’re getting a message, the Chinese vaccines don’t work from overseas. They’re getting a message, the U.S. vaccines don’t work from Chinese government propaganda, which is all using Fox News to do this. So, it looks like reputable Western information, right? So, they’re just getting sort of overwhelmed with negative information all the time. I think all of that, in that sense, overdetermined that there was just a lot of reasons why people were skeptical and no real sense of urgency.

Kaiser: Yeah. I think that’s a great breakdown. Those four reasons, they add up to enough to produce the effect that we saw, as regrettable as it is. So, Deb, I know, I mean, this is anecdotal, of course, but I was just scratching my head thinking, I can think of four people I know who live in China who have not gotten COVID in just since December. What do we actually know about how many have been infected, what strains are prevalent in China right now, how many deaths there have been, and how China’s healthcare system is bearing up?

Debbi: Okay. So, we don’t know a lot. A number of people who I think know pretty are more likely to be basing it on some knowledge, and certainly prior experience, have told me that they estimate 80% to 90% of the population in Beijing has gotten COVID over the last several months.

Kaiser: Wow.

Debbi: And I think Beijing is pretty representative of all of North China, through to Sichuan. Cities like Chongqing and Baoding clearly were ahead of Beijing in terms of when they had their big wave. Eastern China is behind Beijing. I was estimating that Shanghai was two to three weeks behind Beijing. Somebody who, I think might know, told me he thought it was more like a week, but clearly, they’re sort of still coming out of the big struggle now. Beijing’s been out of it now for a couple weeks. I think the situation in South China may be quite different. If you go back to October, November, you’ll recall that the big lockdown fights in Guangzhou were almost constant. I think they had a lot more cases early on than North China did. But it does seem like the percentage of people who got the disease at any given time was lower, that it’s been sort of a longer curve than was true in North China. I mean, what’s been extraordinary in Beijing is pretty much everyone I know who got it, got it within the same three weeks.

Kaiser: Yeah. Yeah.

Debbi: And while I think it was absolutely seeded for… The curve started sometime, maybe even in late September, and sort of slowly grew, and that’s what exponential curves do. They kind of grow slowly and then they suddenly explode. It’s been this very, very rapid rise, I think on a level that we’ve never seen anywhere else. But it may be a little bit different in the South. I’m not sure, but it does seem like in all of North China it was that way. I think one of the things that people are only now coming to grips with is it doesn’t really appear that rural China was on some different timeframe than urban China. And I think a lot of that has to do with the way people were evading the tests and the fever hospitals prior to the end of those things on December 7. That if you were a taxi driver or a waitress or whatever, and you started to feel your throat tingling, your immediate reaction was not to rush out and get a PCR test. Your immediate reaction was to come up with a place to hide while you weathered the disease.

Kaiser: Right. And that was often your hometown or…

Debbi: Yeah. For taxi drivers, it was often their taxi. But at any rate, you were going to go hide out, and that was often by going home. So, a lot of these villages may have actually gone through it a little earlier than some of the urban areas, especially when we’re talking about villages that are relatively close to the city. And that’s, I would guess why Sichuan may well have been ahead of Beijing, because, as you know, Sichuan is a source of enormous numbers of migrant workers.

Kaiser: Speaking of huge pools of humans, one of the things that I often hear is that given the size of China’s population, the density of it, a lot of people who hadn’t previously been infected, might there be an uptick in new variants?

Debbi: Right. So, the first thing I wanted to say is we don’t know very much about what strains are out there in China. What we do know is out there in the world is only Omicron. So, people suddenly saying, I mean, a lot of Chinese people were saying, “Well, you never know. It might be Delta or something.” “But there’s no Delta out there, so it’s going to be some kind of Omicron.” I have heard people hypothesize in all different ways, and I think even the virologists really don’t know. I mean, one argument is because Chinese haven’t… I mean, so it’s not that they’re completely immunologically naive because so many people have been vaccinated, right? And the estimate is at least 90% of the population is at least partially vaccinated, right?

But you’re right that they haven’t had it before. They haven’t had as many vaccines. One idea is that this virus is so fit already, it’s moving so quickly that there’s very little evolutionary pressure for it to change. That’s kind of the “maybe we won’t see a lot of new strains.” The flip side argument is just yeah, the sheer volume of number of people getting sick, that there might be some new variants. Because every time it replicates, it changes.

Kaiser: This is the law of large numbers. Yeah.

Debbi: But will those be extreme or very different? I mean, the theory behind where Omicron came from is the most likely is that it was in a severely immunocompromised person who spent months fighting off the disease, and it just kept changing as they kept fighting it, and neither winning nor losing. China has immunocompromised people. It certainly doesn’t have as high a percentage of them as in Southern Africa where they think Omicron came from, right?

Kaiser: Are you saying because of the prevalence of AIDS there, or?

Debbi: Yeah. And China actually has a very low percentage of people living with HIV/AIDS, much lower than the United States. But I mean, I think we often don’t talk about China’s public health victories after they happen. And one of the ones that never gets talked about is how well they did on HIV once they chose, in 2003, to really focus. But even low percentages in China are still a lot of people because it’s got so many people. I think that’s one of those “who knows”. We have so much COVID running around in the U.S. and in Europe that I think assuming that it’s… I mean, who knows? But I think there’s a lot of finger pointing right now that is not warranted by our global collective failure.

Kaiser: It leads me to my next question, which is how do you feel about the requirement for a negative test that many countries have imposed on people traveling from China? I mean, do you think that that’s just unnecessary and performative, or do you think there’s a good reason that we should be requiring this?

Debbi: Let me tell you how performative it is. So, I wound up having to waste two and a half hours racing to the complete opposite end of Beijing in order to be sure that I would have COVID test with what I thought I needed in terms of paperwork that was signed and stamped and all of that within the required time. If I could have just used the Chinese app, except the Chinese apps die the minute you leave China, so I couldn’t do that. Anyway, and then I get to the airport, and at check-in, United asked me to sign a piece of paper saying I had a COVID test. So, I did that, which is true — I did have the COVID test. On arrival in the United States, no one asked me for it.

Kaiser: I mean, the policy was already in place, ostensibly?

Debbi: Yeah. It started January 5th. So, I arrived in San Francisco on January 7th. And yeah, at customs, immigration, the whole shebang, nobody asks for the form. I can’t guarantee that to others traveling. And you do sign this stupid piece of paper at the United checking counter, but when I flew out of the UK, back when the U.S. was still requiring it of everyone, I believe, at the check-in desk in Edinburgh, they actually asked to see the paper. Again, on the U.S. side, literally no one asked for it, even back then. That still seems to be the method of our madness. So, in terms of, is this just performative? Yes. I think it’s just performative. I don’t think it’s the worst thing the U.S. has done in terms of stigmatizing other nations. I think the travel ban last year on 11 southern African nations was beyond reprehensible.

Omicron was identified in South Africa, in part because the South Africans are so good at sequencing, and it wasn’t actually… I mean, it’s still not known whether that’s really where it arose or not.

Kaiser: Yeah, no good deed. Yeah.

Debbi: By the time we put that travel ban on, there had already been cases of omicron identified elsewhere in the world. So, unless you were going to put a travel ban on everyone, you knew that you were closing the barn door after the horse or the cow, or whatever had left. And we’ve had these crazy travel bans on immigrants and asylum seekers, and all this other kind of nutty stuff going on. In truth-

Kaiser: This isn’t the worst that we’ve done. Yeah.

Debbi: This is not the worst that we’ve done, but it fits into a pattern of stigmatizing others for what is truly a global failure, including our own. And we have so much Omicron floating around in the United States right now. I just have another relative who had managed to avoid COVID for three solid years, just got COVID.

Kaiser: Oh gosh.

Debbi: She’s fine, but I’m just saying… And the number of travelers coming from China is minuscule right now, right?

Kaiser: Yeah.

Debbi: Because there are almost no flights, right? It costs thousands and thousands of dollars to fly to or from China. There are no tourist visas to China. So, to get into China, you need all this extra stuff. I mean, they claim 23,000, I don’t even know if that’s a day or a week because there aren’t enough flights for that to be a day. And millions of people arrive in the United States every day. 23,000 in any timeframe is just nothing. So, I do think it was for show. They also claimed they were doing it because they were mad at the Chinese for not publishing sequences of the virus. This doesn’t give you sequences. If supposedly there’s some system where they’re going to test people and ask people at the airport who arrive with it, to get to test them so they can sequence, that would work if they let people fly back with COVID. I don’t know. But I certainly didn’t see any evidence of it when I arrived.

I don’t know whether the Chinese are sequencing right now or not. My sense of everything right now is that there’s a lot of chaos going on. But of course, there are a lot of scientists who are not frontline doctors, and therefore the thing that they would do is collect samples and do some sequencing. I think, throughout this thing, one of the issues with the Chinese system that rarely gets acknowledged is that they’ve taken our publish-or-perish type philosophy and essentially put it on steroids. So, a lot of the time you discover that this kind of data, when it’s not being revealed, is because people want the Science, Nature or Lancet publication with all the citations from that. And that they’re holding onto it in order to get the splashy publication. I just wouldn’t be shocked if that isn’t what’s going on.

Kaiser: So, Deb, I think probably a lot of our listeners have seen these reports coming out of China showing satellite photos, for example, of really long lines outside of crematorium, offered as evidence that China is severely under-reporting its death rate. What do you make of all that?

Debbi: I think it is evidence that the Chinese are severely under-reporting the death rate. The concern I have is, if you read the Washington Post headline, it says, “As COVID surges,” as if the surge were in the present tense. And I think the important thing to remember is that the peak of deaths will come three to four weeks after the peak of cases. And the photos that they show, like the before and after for Beijing, the first one I think, I can’t remember if it’s late November, early December, but the after is December 24. And similarly for Chengdu is sometime in December, around Christmas time. The ones from East China are a little later from early January. But so I think they are evidence of how bad the outbreak became and fit in well with the idea that 80% to 90% of the population may have gotten COVID in some northern Chinese cities.

But I think they are a lagging indicator of what happened. And one of the concerns I’ve had with the media coverage of this, which I think is in part driven by the fact that so much of this media work is being done from outside China, thanks to the fact that the Chinese have restricted foreign media and China so much, is that it tends to be reported with a lag. And people assume that things are happening now that actually have already happened. But I don’t think there’s anybody who thinks the Chinese death numbers are in any way accurate at this point, including most people in China.

Kaiser: That’s right. Yeah. That’s right. I mean, everyone I know knows, I mean, I’ve heard them say “Well, I guess I know half of the people who have died then.”

Debbi: Right. I mean, I think everyone I know in China has certainly a friend or an elder relative, or certainly knows someone whose elder relative died. I mean, I know several. It’s everywhere. And most people have gotten sick at this point, which means an awful lot of people have gotten severely ill.

Kaiser: Well, you’ve helped us to make quite a bit of sense and impose a little bit of order on the chaos. And so, I thank you for taking the time to really help us talk through this because yeah, as I said, there are a few people in the world who I think would have as valuable perspective on this; having just come back here, having been there, having talked to so many people and having lived through these different periods of it up close. So, thank you so much. Let’s move on now to recommendations.

First, a really quick word that if you want to help The China Project to keep the Sinica Network going, the Sinica Podcast and all the other shows in the network, the best thing you can do is subscribe to The China Project Access. That’s what keeps the lights on. So, yeah, help us out and then become a subscriber. And I hope you can join us actually on January 24 in New York City. There’s a few seats left, and so snag them if you can. We are going to be interviewing Ian Johnson, live in New York, details at TheChinaProject.com. Okay. On to recommendations, Debbi, what you got for us?

Debbi: I want to recommend, oh, well, a two-part podcast to you.

Kaiser: Great.

Debbi: What I was really in China doing was working on climate change and U.S.-China climate relations. And the thing that has me really hopeful that those can move forward in a more productive way was the passage of the Inflation Reduction Act last year in the United States, that the problem for now, almost two decades really, has been that while many other countries in the world have national climate policies, and in particular all the other major emitters do, right? That China clearly has had a national climate policy for about a dozen years now; the Europeans were way ahead; the Japanese have one, etc., the U.S. didn’t. And the Inflation Reduction Act really is a comprehensive game-changing set of measures that really do add up to a U.S. national climate policy and are moving us forward in a big way.

And the best way to learn about it is a two-part interview that Dave Roberts, who has a podcast called Volts, that is focused entirely on climate, did with a Princeton guy named Jesse Jenkins. And Jesse Jenkins was very much involved in helping design the Inflation Reduction Act. And he’s a modeler, and he has modeled out what each and every provision in that law, plus the related climate provisions in the Infrastructure Bill and the CHIPS Act will do, and how much reduction in climate gasses are going to come out of the act and how each part works. And he and Dave Roberts just go through it in incredible detail, and I’ve given you the links to put into the show notes. They’re from August of this year when that bill was passed. And I think it’s really interesting and really exciting. And in terms of news that you can use, there are a lot of tax credits that homeowners in particular can use to upgrade every part of your home — your heating, your hot water, your appliances, etc. I think a lot of people know about the tax credits for electric vehicles, but there are so many for your home that you really should learn about. So, that’s what I’ll say.

Kaiser: Thanks. That’s great. No, excellent recommendations. I’ll definitely check out just a two-part podcast and sounds like I’ll come away knowing a whole lot more about what’s actually in the Inflation Reduction Act, the CHIPS, the Infrastructure Bill, all of that. Wonderful. Thank you. My recommendation is a novel I just finished, which is Barbara Kingsolver’s latest. It’s called Demon Copperhead. And it takes its inspiration from David Copperfield, from Dickens, but it’s set in Appalachia. It’s in the southwestern corner of Virginia mostly. And wow, it is a wonderful book. It is so well written. Think of it as the antidote to J. D. Vance’s Hillbilly Elegy and its nonsense. This is so good. It’s a work of fiction told in first person by the narrator whose name is Damon. And he’s a redhead.

He’s actually Melungeon, which is people that I didn’t really know much about who are descended from African-Americans, from Native Americans, from white settlers in the area. And It’s a really interesting and distinct ethnic group in Southern Appalachia that I learned a lot about through this book. But it’s just a fantastic novel. I mean, she’s just such a great prose stylist. And I listened to the audiobook which is masterfully read. So, if you are into audiobooks, I highly recommend this one. But Demon Copperhead by Barbara Kingsolver. Hey, well, Deb, thanks so much.

Debbi: Thank you so much, Kaiser. Really great to have this conversation as I try to adjust to Eastern Standard Time.

Kaiser: Okay. Well, we look forward to having you back on the show. You are always such a great font of wisdom and insight. So, welcome back.

Debbi: Thanks. Bye.

Kaiser: The Sinica Podcast is powered by The China Project and is a proud part of the Sinica Network. Our show is produced and edited by me, Kaiser Kuo. We would be delighted if you would drop us an email at sinica@thechinaproject.com or just give us a rating and a review on Apple Podcast as this really does help people discover the show. Meanwhile, follow us on Twitter or on Facebook at @thechinaproj, and be sure to check out all the shows in the Sinica Network. Thanks for listening, and we’ll see you next week. Take care.