Jilin, Hebei and Shanghai fight against largest Covid outbreaks since Wuhan in early 2020; international flights to Shanghai diverted

China is fighting against several Covid outbreaks with the largest ones in Jilin and Hebei provinces and Shanghai municipality. Between March 15 and 21, China reported 14,741 confirmed Covid-19 cases with several thousands more asymptomatic ones, putting considerable strain on its dynamic zero-Covid policy. Two people who tested positive have died in Jilin province, but health authorities said they died from underlying causes, not from Covid-19. The last deaths from Covid in China were reported in January 2021.

To reduce the risk of spreading Covid-19, all residents of Jilin province have been prohibited from traveling to other provinces or other parts of Jilin. Those who have to travel for special reasons must register at their local police station and undergo quarantine after returning. Those who do not report their journeys truthfully will face punishment. Jilin has purchased 12 million Covid-19 rapid antigen test kits and distributing them to the worst-hit regions. “The combination of nucleic acid and antigen testing will greatly beef up detection capabilities,” Song Xiaohui, Deputy Director of the Jilin Provincial Department of Industry and Information Technology, told a news conference. Rapid antigen testing will serve as a supplementary diagnostic tool to regular nucleic acid testing. Jilin's capital Changchun and neighboring Jilin city are accelerating the construction of makeshift hospitals. Three makeshift hospitals with 1,200 beds were previously set up and another three with around 10,000 beds are under construction. Liaoning province is now requiring a 28-day hotel quarantine and another 28 days of health monitoring at home for arrivals from abroad. The capital city, Shenyang, has shut down its airport, banned indoor dining and ordered citywide mass testing.

In Hebei province's Langfang city – 60 km from downtown Beijing – more than 500 asymptomatic cases were reported. Travel from Langfang to Beijing is restricted. Residents of Hebei who work in Beijing are encouraged to work from home. If they really need to go to Beijing, certificates from their work units and residential communities, and nucleic acid tests taken within 24 hours are required.

Shanghai authorities asked citizens not to leave the city unless absolutely necessary. Those leaving or entering the city must have a negative nucleic acid test taken within the past 48 hours. Departing travelers without a negative test will not be allowed to board planes or trains. Arriving passengers without a report must pay to receive tests at the airport or railway station. All large exhibitions, art performances and other gatherings have been banned. International flights involving 22 routes scheduled to arrive in Shanghai are redirected to 12 other airports across the country. The changes will be in effect from March 21 to May 1. Shanghai is one of China’s busiest international transport hubs, handling nearly 40% of international arrivals since 2020. Shanghai’s nucleic acid testing capacity has tripled over the past two weeks and now exceeds 3 million samples a day. The ongoing Covid-19 outbreak in Shanghai has resulted in more than 1,200 infections.

Production resumed and people’s lives began to get back to normal in Shenzhen after parts of the city effectively achieved zero new cases. Stricter control and prevention measures had been introduced, metro and bus services suspended and people told to work from home. Three rounds of citywide testing were also conducted last week. The neighboring industrial city of Dongguan also eased restrictions and began to resume public transport. Shenzhen implemented a seven-day lockdown from March 13 to 20.

The peak of the latest outbreak in Hong Kong was registered on March 2 and 3 with 76,000 and 77,000 new cases respectively. The basic reproductive number (R0) has recently dropped below one. The death toll in Hong Kong has already exceeded the one for the whole of mainland China. Hong Kong's Covid-19 tally since the pandemic began is 1,047,690 cases with 5,896 related deaths. Hong Kong plans to lift Covid-related flight bans on nine countries and shorten quarantine to seven days on April 1.

China is pushing Covid-19 vaccination for the elderly, especially for people aged 80 and above, as clinical data showed 65% of severe cases in China are people aged 60 and above, and 65% of the severely ill seniors are not vaccinated, the National Health Commission (NHC) said. Chinese President Xi Jinping stressed science-based and accurate measures and the adherence to the dynamic zero-Covid policy to curb the spread of the epidemic soonest.

The Geneva-based Medicines Patent Pool (MPP) has offered a non-exclusive sub-license to five Chinese enterprises to produce the generic version of Pfizer’s oral Covid-19 drug. Pfizer will not receive royalties from sales of nirmatrelvir from the MPP sub-licensees while Covid-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization (WHO). Zhejiang Jiuzhou Pharmaceutical is sub-licensed to produce the active pharmaceutical ingredient (API) nirmatrelvir, while the other four firms, including Apeloa Pharmaceutical, will produce both the ingredients and the finished drugs.

China is battling the worst outbreak of Covid-19 in two years, while slowly adapting its zero-Covid policy although not abandoning it. Antigen tests are becoming available in pharmacies so people can test at home instead of at nucleic acid test points. China jas approved 11 antigen test kits made by local companies, including Beijing Savant Biotechnology, Nanjing Vazyme Biotech, Guangzhou Wondfo Biotech, Beijing Jinwofu Bioengineering Technology and Shenzhen-based BGI PathoGenesis Pharmaceutical Technology. But nucleic acid tests will still be used for diagnosis.

People who test positive but are asymptomatic will no longer be admitted to hospitals, but will be isolated in designated quarantine centers where their health will be monitored. The Global Times said that China will only relax the current policy when strong immunity is built, effective medicines are available, hospitals have well prepared for a surge in cases, society no longer fears the virus, and a consensus in reached on opening up again, which apparently has not happened yet. Since the beginning of March, a total of 28 provincial-level localities reported Covid-19 cases. Epidemiologists expect the current outbreaks to be under control by early April, with possibly 35,000 people infected.

The fact that many countries are dropping or have already dropped their Covid-19 measures and are ready to "coexist with the virus" also poses a great challenge for China to fend off the virus, especially in border cities, a CDC Expert said. Zhang Wenhong, an infectious disease expert in Shanghai, described it as “the most difficult period in the two years Covid-19 battle." He admitted that the virus is not as powerful as it was before, and there are very few severe cases. But many elderly people are not or only partially vaccinated.

This overview is based on reports by the China Daily, Global Times and South China Morning Post.