More than 1.3 million people in China were under medical observation this week as close contacts of cases of Covid-19, the highest level since the pandemic broke out in Wuhan, and an increase of more than 300,000 in a few days.
The rising number of close contacts, driven by an increase in cases to near-record levels, is putting enormous pressure on a Covid-19 policy that, unlike the rest of the world, aims to eliminate rather than live with the virus.
China’s strategy has evolved since the beginning of the pandemic. While authorities have often relied on city-wide lockdowns, particularly in Wuhan in early 2020 and in Shanghai in 2022they also use a sophisticated track and trace system that rapidly quarantines close contacts of infections for “medical observation”.
The total number of close contacts is an important measure of whether the authorities are still able to control the virus China. Meanwhile, evidence from Guangzhou, the center of the latest outbreak, indicates a gap between official guidance and reality.
How to track close contacts?
In major Chinese cities, residents must take a PCR test every few days at booths set up on street corners to get a “green code” on their smartphones. Your phone must also be scanned on most public transport and when entering buildings.
If a person tests positive, authorities can analyze the places the person has visited to track who else has scanned there. Close contacts can also be determined based on a person’s place of residence or workplace.
What happens to close contacts?
This month, amid rising cases, the government tweaked the approach it set out in June when it published the ninth edition of its Covid-19 strategy.
Under the revised guidance, close contacts should be taken to a “centralized isolation site”, often a hotel, where they must stay for five days, down from the previous seven. This must be followed by a further three days of observation at home.
Local authorities have invested in building temporary isolation facilities. In October, Shanghai confirmed it would build a 3,000-person facility on Fuxing Island at a cost of about $220 million, designed for both close contacts and positive cases.
A construction tender website reveals dozens of other similar projects across China in recent months.
But the government’s guidance also says that “special” cases can be allowed to isolate at home. It does not clearly define a special case, although individual provinces have their own interpretations. In Hebei, children aged 14 and under are treated as special cases.
What is the reality on the ground?
Asked how many of the more than 1 million close contacts under medical observation were quarantined in central facilities compared to at home, China’s National Health Commission referred the inquiry to the Center for Disease Control and Prevention, which could not be reached.
The central guidance can be applied differently in different provinces. The example of Guangzhou, where daily cases are in the thousands, indicates that the authorities are struggling to find capacity to meet the central quarantine requirement. A resident, who asked to be referred to as Victor, said his family was designated as close contacts after eating at a restaurant where there was a confirmed positive case.
He said his family was told to prepare for a quarantine hotel, but was later informed that there was not enough space there and that new quarantine places had not been built yet. Instead, his door was closed and he and his family isolated at home.
Elsewhere, there is flexibility in the definition of a close contact. If there is a positive case in a building in Beijing, authorities designate the three floors above and below the case as close contacts and send those residents into central quarantine. Other floors are required to quarantine at home.
When a single positive case was discovered at Disneyland Shanghai this month, authorities locked down the park and tested tens of thousands of people, but did not define guests as close contacts. However, some Disneyland employees were designated as close contacts and sent to central isolation facilities.
What happens next?
A requirement to quarantine close contacts was eased this month. But expectations of a reopening have been toned down after the city’s Shijiazhuangwhich had eased testing during its outbreak, reinstated stricter measures.
If the number of close contacts gets further out of control, the government may enforce much tighter lockdowns, as in Shanghai this spring. Such a decision can be made centrally, but it still needs to be enforced by several local governments and cities.
Even if the virus can no longer be controlled, any shift from an elimination model to one based on suppression is unlikely to be straightforward. Instead, there are indications that elements of the former would likely persist.
A person who works in labor outsourcing in Guangzhou, which recorded nearly 8,000 cases on Wednesday, said the city hired dozens of drivers to transfer close contacts to quarantine hotels to handle the rising number of contacts.
Additional reporting by Ryan McMorrow in Beijing and Gloria Li in Hong Kong