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What the U.S. can learn from China's response to COVID infections


In China, a single COVID case shut down Shanghai Disneyland the other day. Health workers in hazmat suits tested park guests for the virus as part of a contact tracing effort that ensnared tens of thousands of people. The country as a whole is reporting well below 100 COVID cases a day on average.


Contrast that to this country, where we're logging more than 70,000 new COVID cases a day. And most restrictions have been lifted. The U.S. and China present two diverging visions on where the pandemic is headed and what we plan to do about it as the coronavirus, like the flu, becomes a regular part of life in the years to come.

KELLY: So what's the game plan from here? And what can we learn from the way countries like China are approaching this? Well, here to talk about that are NPR health reporter Pien Huang and NPR China correspondent John Ruwitch.

Hi, you two.

PIEN HUANG, BYLINE: Hey, Mary Louise.

JOHN RUWITCH, BYLINE: Good afternoon.

KELLY: John, you start with what I gather China is calling a zero tolerance policy. What does that actually mean on the ground?

RUWITCH: Well, this is the approach that China's been using since the earliest days of the pandemic when Wuhan was locked down, if you recall, about two years ago. So basically, the borders of China have been closed with very strict quarantines for people entering. And where there are flare-ups, they've imposed tough lockdowns, and they're doing mass testing. So what'll happen is the numbers are disproportionate. You'll have a suspected case or two, or a few, and the consequences - the inconvenience - will be felt quite widely.

KELLY: And allow me to be just mildly skeptical for a moment about the numbers.


KELLY: Fewer than a hundred cases a day in a country the size of China. Do we think that there's any underreporting going on?

RUWITCH: There may well be underreporting. I spoke with two public health experts, though, who follow China quite closely, and they're confident that the Chinese statistics are broadly correct. I mean, as one put it to me, the Chinese government isn't really giving the virus much of a chance to spread very widely.

KELLY: As, I guess, was demonstrated at Disneyland in Shanghai. Tell us more about what happened.

RUWITCH: Exactly. Yeah, somebody who visited the park was identified as a close contact, and then shortly after that, tested positive. This is after they left Disneyland. And the government closed the park - 33,863 visitors and staff were locked in. They were all given tests and let out the next day after...


RUWITCH: ...There were negative results. Broadly speaking, though, you know, this approach has had impressive results for China. They've reported well under 200,000 cases and around 5,000 deaths. There's been almost no deaths since that outbreak in Wuhan was brought under control.

KELLY: Pien, hop in here and contrast this with, clearly, a very different approach that that is unfolding here in the U.S. We are at nothing like zero tolerance.

HUANG: Absolutely. Yeah. I mean, you know, contrast China's under 200,000 cases with what's happening here in the U.S., where we've had more than 46 million cases. And even now, COVID community transmission is either substantial or high in every U.S. state. But bars and restaurants are open. People are heading back to work and school. And the U.S. goal right now is really focused on getting a lot of the population vaccinated. At a Senate committee hearing last week, Dr. Anthony Fauci sketched out a vision for where this all leads.


ANTHONY FAUCI: So if we get more people vaccinated globally, hopefully within a reasonable period of time, we will get to that point where it might occasionally be up and down in the background, but it won't dominate us the way it's doing right now.

KELLY: Dr. Fauci testifying there last week. And I know - when we had him on the show last week - I interviewed him on Friday and asked, is there a number that he keeps the closest eye on to gauge where we are in all of this? Is it reducing case numbers? Is it reducing deaths? Is it getting more shots into arms? He said all of the above, that you can't do any of it in isolation. Does that square, Pien, with what others tell you as you're reporting?

HUANG: It is a little bit of everything, but the emphasis on each of these things changes depending on the phase of the pandemic we're in. So health officials say that they've been thinking a lot about what an endemic phase looks like, and they say that they're modeling it on flu. So in terms of what that means, that means less of a focus on case numbers, more of a focus on severe illness, hospital capacity and deaths. Some health experts say we should also be tracking long COVID cases, especially the severe ones. But we are still not in that endemic phase yet. There are more than 70,000 cases a day in the U.S., and health officials have said that getting that number below 10,000 a day would mean that the virus is under control. By those metrics, China has the virus under control. But U.S. officials mean sustaining that low level of cases with people going to school, to work, enjoying travel and leisure, so the U.S. is still a ways off from that.

KELLY: John, what is the downside to the approach China has taken? - because fewer than a hundred cases a day sounds pretty great.

RUWITCH: Yeah. Well, look, initially this worked for China. Economically, China was able to bounce back quicker than any other country. You'll recall it was the only major economy to grow last year. Politically, the Chinese Communist Party has gotten some mileage out of it, claiming that its approach is working. It's more complicated now, though, and there are diminishing returns with the spread of the delta variant in China. There are more flare-ups and more lockdowns, and particularly since the summer, it's been more widespread. And it's clearly taking a toll on domestic consumption, which is a key part of the economy. You know, when things close, like movie theaters, shopping malls and when travel is restricted, it has an effect. The government's kind of in a tight spot. I mean, there are signs of lockdown fatigue in some pockets of the country. But for those that aren't locked down, you know, they've broadly come to expect zero cases.

KELLY: So is the Chinese approach sustainable?

RUWITCH: Other countries that have taken this approach, like Australia and New Zealand, Singapore, are shifting away, and China's sort of out there on its own. For now, though, the leadership appears to think that this is all worth it. The price might be higher if they were to change tacks, you know. In three months, Beijing is hosting the Winter Olympics, and outbreak ahead of time or during the Olympics would be a disaster from their perspective. Once winter's done, China goes into this politically sensitive time ahead of a leadership reshuffle. Scientifically, too, there are big question marks. I spoke with Xi Chen about this. He's a public health expert at Yale University.

XI CHEN: China, unfortunately, doesn't have data to make the decisions. They really need the data about the virus transmission and the vaccine efficacy to reopen. Otherwise, the policymaking is very difficult.

RUWITCH: His point here is that China has done so well at snuffing out the virus, they don't have data on how fast it spreads in the country. They don't have data on how well Chinese vaccines actually work against it out in the real world. And a final point on top of all that - China's health care system is understaffed and ill-prepared for a spike, which would be inevitable if they were to relax their policy. And China's leaders know this, and they're worried about hospitals being overwhelmed.

KELLY: Pien, I'm going to give you the last word here. Is part of this just that there is a very different tolerance of risk in China and the U.S., that Americans are willing to put up with a certain level of sickness, even a certain level of death from COVID if we're able to go about with something resembling our old normal lives?

HUANG: Well, there's definitely a difference in risk, but also in terms of what people are willing to tolerate between our societies. You know, here in the U.S., health officials have been trying to strike a balance between public health and individual rights, which is something that people can interpret very differently. Here's Dr. Jose Romero, health secretary for Arkansas.

JOSE ROMERO: First of all, we could never do what's done in China, right? People would not tolerate it. And so we have to work within the liberties of our system.

KELLY: But does it have to be either-or, Pien? Is there some kind of middle ground between the Chinese approach and the U.S. approach?

HUANG: Well, Romero says that the U.S. is actually holding the middle ground between China's approach and one like the U.K.'s, which has removed almost all mandated restrictions in favor of vaccines and people's good sense. Remember - the pandemic threat doesn't end until the virus is under control everywhere. It started in one Chinese city and has now affected every corner of the world.

KELLY: NPR health reporter Pien Huang and China correspondent John Ruwitch talking about two really different approaches to where the pandemic goes now.

Thanks to you both.

HUANG: Thanks for having us.

RUWITCH: Thanks, Mary Louise.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

Pien Huang is a health reporter on the Science desk. She was NPR's first Reflect America Fellow, working with shows, desks and podcasts to bring more diverse voices to air and online.
John Ruwitch is a correspondent with NPR's international desk. He covers Chinese affairs.