Chinese government response to COVID-19
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During the COVID-19 pandemic in mainland China, the government of China took various actions to prevent the spread of COVID-19. China was the first country to experience what would become the COVID-19 pandemic. After discovery of a cluster of patients with pneumonia of unknown etiology in Wuhan, Hubei Province, a public notice on the outbreak was distributed on 31 December 2019. On 8 January 2020, a new coronavirus (SARS-CoV-2) was identified by Chinese scientists as the cause of the symptoms.
On 23 January 2020, the Chinese government banned travel to and from Wuhan, enforced strict quarantines in affected regions and initiated a national response. The epidemic in Hubei province peaked on 4 February 2020. Large temporary hospitals were built in Wuhan to isolate patients with mild-to-moderate symptoms, with the first opening on 5 February 2020. The epidemic was heavily concentrated within Hubei province and Wuhan. Through 22 March 2020, over 80% of the recorded cases in China were in Hubei province, with over 60% of cases nationwide occurring in Wuhan alone.
By the summer of 2020, China had largely brought the outbreak under control, ending widespread community transmission. After the initial outbreak, lockdowns and other restrictive measures were eased throughout China. The lockdown in Wuhan was lifted on 8 April 2020. The epidemic control measures in China held the death toll due to COVID-19 to under 5,000.
China is one of a small number of countries that have pursued an elimination strategy, sustaining zero or low case numbers over the long term. Most cases in China are imported from abroad, and several new outbreaks have been quickly controlled through intense short-term public health measures, including large-scale testing, contact tracking technology, and mandatory isolation of infected individuals. In the 18 months after the containment of the initial outbreak in Wuhan, two COVID-19 deaths were recorded.
In 2020 and 2021, China was the largest exporter of COVID-19 critical medical products. China was the world's largest exporter of face masks, increasing exports by around 600% in the first half of 2020. A number of COVID-19 vaccines have been developed in China. Through November 2021, China was the world's largest exporter of COVID-19 vaccines, with a cumulative share of around 40% of worldwide exports (totaling around 1.5 billion doses), according to the World Trade Organization.
China's response to the initial Wuhan coronavirus outbreak has been both praised and criticised. Some have criticised the censorship of information that might be unfavorable for local officials. Observers have attributed this to a culture of institutional censorship affecting the country's press and Internet. The government censored whistleblowers, journalists and social media posts about the outbreak. During the beginning of the pandemic, the Chinese government made efforts to clamp down on discussion and hide reporting about it. Efforts to fund and control research into the virus's origins and to promote fringe theories about the virus have continued up to the present. In October 2020, The Lancet Infectious Diseases reported: "While the world is struggling to control COVID-19, China has managed to control the pandemic rapidly and effectively."
Based on retrospective case analysis, the first person known to have fallen ill with COVID-19 in Wuhan first began experiencing symptoms on 1 December 2019. In mid December 2019, Wuhan doctors noticed a pattern of unusual white spots in patients' lung scans. On 24 December, a sample was sent to a Chinese lab called Vision Medicals. On the 26th, a tech at Vision Medicals obtained a partial DNA sequence and noticed it was similar to SARS. The alarmed tech forwarded the information to his boss, but the information was not made public at the time. Doctors in Wuhan noticed a cluster of patients with pneumonia of unknown etiology in late December 2019. A public notice on the outbreak was released by Wuhan health authority on 31 December; the initial notice informed Wuhan residents that there was no clear evidence of human-to-human transmission of the virus, that the disease is preventable and controllable, and that people can wear masks when going out. WHO picked up news reports of the outbreak on the same day. Warnings by doctors were at first ignored by local government officials. On 7 January 2020, the Politburo Standing Committee of the Chinese Communist Party discussed COVID-19 prevention and control.
Initially, the Chinese government was against the World Health Organization declaring a public health emergency, but eventually a public health emergency was declared on January 30.
2020 Chinese New Year
The Wuhan government, which announced a number of new measures such as cancelling the Chinese New Year celebrations, in addition to measures such as checking the temperature of passengers at transport terminals first introduced on 14 January.
Beginning on 23 January 2020, extensive lockdown measures were taken in Hubei province, and then in much of China. Travel in and out of Wuhan was halted on 23 January, and travel restrictions were implemented throughout China. A group tasked with the prevention and control of the COVID-19 pandemic was established on 26 January, led by Chinese Premier Li Keqiang. The leading group decided to extend the Spring Festival holiday to contain the outbreak.
China Customs started requiring that all passengers entering and exiting China fill in an extra health declaration form from 26 January. The health declaration form was mentioned in China's Frontier Health and Quarantine Law, granting the customs rights to require it if needed. On 27 January, the General Office of the State Council of China, declared a nationwide extension on the New Year holiday and the postponement of the coming spring semester. The office extended the previously scheduled public holiday from 30 January, to 2 February, while it said school openings for the spring semester would be announced in the future.
Declaration of emergency
Hong Kong's Chief Executive Carrie Lam declared an emergency at a press conference on 25 January, saying the government would close primary and secondary schools for two more weeks on top of the previously scheduled New Year holiday, pushing the date for school reopening to 17 February. Macau closed several museums and libraries, and prolonged the New Year holiday break to 11 February for higher education institutions and 10 February for others.
On 1 February 2020, Xinhua News reported that China's Supreme People's Procuratorate (SPP) had "asked procuratorates nationwide to fully play their role to create a favourable judicial environment in the fight against the COVID-19 pandemic." This included severe punishments for those found guilty of dereliction of duty and the withholding of information for officials. Tougher charges were proscribed for commercial criminal activities such as increasing prices, profiteering along with the "production and sale of fake and shoddy protective equipment and medicines." Prosecuting actions against patients who deliberately spread the infection or refuse examination or compulsory isolation along with threats of violence against medical personnel were also urged. The statement also included urging to prosecute those found fabricating and spreading COVID-19-related information and also stressed "harshly punishing the illegal hunting of wildlife under state protection, as well as improving inspection and quarantine measures for fresh food and meat products."
On 23 January 2020, a cordon sanitaire on travel in and out of Wuhan was imposed in an effort to stop the spread of the virus out of Wuhan. Flights, trains, public buses, the metro system, and long-distance coaches were suspended indefinitely. Large-scale gatherings and group tours were also suspended. By 24 January 2020, a total of 15 cities in Hubei, including Wuhan, were placed under similar quarantine measures.
Due to lockdown measures, Wuhan residents rushed to stockpile essential goods, food, and fuel; prices rose significantly. 5,000,000 people left Wuhan, with 9,000,000 left in the city. The city of Shantou in Guangdong declared a partial lockdown on 26 January, though this was reversed two hours later. Local authorities in Beijing and several other major cities, including Hangzhou, Guangzhou, Shanghai, and Shenzhen, announced on the same day that these cities will not impose a lockdown similar to those in Hubei province.
By 6 February 2020, a total of four Zhejiang cities—Wenzhou, Hangzhou, Ningbo, and Taizhou—were under the "passport" system, allowing only one person per household to leave their home every two days. These restrictions apply to over 30 million people.
A specialty hospital named Huoshenshan Hospital has been constructed as a countermeasure against the outbreak and to better quarantine the patients. Wuhan City government had demanded that a state-owned enterprise construct such a hospital "at the fastest speed" comparable to that of the SARS outbreak in 2003. Upon opening, the specialty hospital had 1,000 beds and took up 30,000 square metres. The hospital is modelled after the Xiaotangshan Hospital, which was fabricated for the SARS outbreak of 2003, itself built in only seven days.
On 24 January 2020, the authority announced that they would convert an empty building in Huangzhou District, Huanggang to a 1,000-bed hospital named Dabie Mountain Regional Medical Centre. Works began the next day by 500 personnel and the building began accepting patients on 28 January 2020 at 10:30 pm. In Wuhan, authorities seized dormitories, offices and hospitals to create more beds for patients. On 25 January authorities announced plans for Leishenshan Hospital, a second specialty hospital, with a capacity of 1,600 beds; operations are scheduled to start by 6 February. The hospital opened on 8 February.
By 16 February 2020, 217 teams of a total of 25,633 medical workers from across China went to Wuhan and other cities in Hubei to help open up more facilities and treat patients. A total of 14 temporary hospitals were constructed in China in total, but all were reported to have closed after the crisis was determined be under control on 10 March 2020. "On March 31, the Chinese government announced that large-scale domestic transmission of Covid-19 had been stopped."
End of the first outbreak
The public health measures put in place from 23 January 2020 onward suppressed transmission of the virus below the critical threshold, bringing the basic reproduction number of the virus to near zero. On 4 February 2020, around two weeks after the beginning of the lockdowns in Hubei province, case counts peaked in the province and began to decline thereafter. The outbreak remained largely concentrated within Hubei province, with over 80% of cases nationwide through 22 March 2020 occurring there.
As the epidemic receded, the focus shifted towards restarting economic activity and preventing a resurgence of the virus. Low- and medium-risk areas of the country began to ease social distancing measures on 17 February 2020. Reopening was accompanied by an increase in testing and the development of electronic "health codes" (using smartphone applications) to facilitate contact tracing. Health code applications contain personalized risk information, based on recent contacts and test results. Wuhan, the last major city to reopen, ended its lockdown on 8 April 2020.
China reported its first imported COVID-19 case from an incoming traveler on 30 January. As the number of imported cases rose and the number of domestic cases fell, China began imposing restrictions on entry into the country. Inbound flights were restricted, and all incoming passengers were required to undergo quarantine.
The death toll in China during the first outbreak was approximately 4,600 according to official figures, and has been estimated at under 5,000 by a scientific study of excess pneumonia mortality published in The BMJ.
Blood samples taken by the Chinese CDC from a random sampling of 34,000 citizens in Wuhan and other parts of China one month after the virus first wave was contained showed 4.43% of sampled community members in Wuhan had antibodies. In the wider Hubei area, 0.44% of those sampled were positive for antibodies, while of 12,000 nationally representative samples taken only two recorded positive results.
Early censorship and police responses
The early response by city authorities was criticised as prioritising a control of information that might be unfavorable for local officials over public safety, and China was also criticised for cover-ups and downplaying the initial discovery and severity of the outbreak. By the time China had informed the WHO of the new coronavirus on 31 December 2019, The New York Times reported that the government was still keeping "its own citizens in the dark". Observers have attributed this to the censorship institutional structure of the country's press and internet, exacerbated by China's paramount leader Xi Jinping's crackdown on independent oversight such as journalism and social media that left senior officials with inaccurate information on the outbreak and "contributed to a prolonged period of inaction that allowed the virus to spread".
A group of eight medical personnel, including Li Wenliang, an ophthalmologist from Wuhan Central Hospital who in late December posted warnings on a new coronavirus strain akin to SARS, were taken into custody by Wuhan police and threatened with prosecution for "spreading rumours" for likening it to SARS. Li Wenliang later died of the disease on 7 February, and was widely hailed as a whistleblower in China, but some of the trending hashtags on Weibo such as "Wuhan government owes Dr Li Wenliang an apology" and "We want freedom of speech" were blocked. His death widespread public anger in the aftermath, in what has been described as "one of the biggest outpourings of online criticism of the government in years," was not a topic that was permitted for coverage.
As part of the central government's "bifurcated approach to diffuse discontent", citizens were permitted to criticise local officials so long as they did not "question the basic legitimacy of the party". The Cyberspace Administration (CAC) declared its intent to foster a "good online atmosphere," with CAC notices sent to video platforms encouraging them to "not to push any negative story, and not to conduct non-official livestreaming on the virus." Censorship has been observed being applied on news articles and social media posts deemed to hold negative tones about COVID-19 and the governmental response, including posts mocking Xi Jinping for not visiting areas of the epidemic, an article that predicted negative effects of the epidemic on the economy, and calls to remove local government officials. While censorship had been briefly relaxed giving a "window of about two weeks in which Chinese journalists were able to publish hard-hitting stories exposing the mishandling of the novel coronavirus by officials", since then private news outlets were reportedly required to use "planned and controlled publicity" with the authorities' consent.
China and a small number of other countries have pursued an elimination strategy (also known as a "zero-COVID strategy"), which aims to completely eliminate local transmission of the virus.
The initial public health response was successful in reducing transmission to near zero within China. In the 18 months following the successful containment of the initial outbreak in China, the country suffered two COVID-19 deaths.
As lockdowns and other restrictions were eased in March and April 2020, attention shifted to preventing imported cases from abroad from causing a resurgence of the virus within China. International flights to China were heavily restricted, and incoming travelers were required to undergo PCR testing and quarantine. Through November 2020, these quarantine measures prevented nearly 4,000 infected international travelers from entering the wider community.
The China CDC COVID-19 Emergency Response Team described its elimination strategy in a paper in The Lancet in June 2020. The measures employed to contain new outbreaks include aggressive contact tracing, isolation of infected people, quarantine of their close contacts, large-scale nucleic acid testing and domestic travel restrictions from high-risk areas. Contact tracing is aided by the use of "health code" smartphone applications.
In order to detect new outbreaks early, routine PCR testing is carried out on all patients in China with fever or respiratory symptoms, medical staff and workers who handle imported goods. When an infected person is identified, all close contacts are required to undergo a 14-day centralized quarantine, with multiple rounds of PCR testing. During outbreaks, community-wide PCR testing is carried out in order to identify infected people, including those without symptoms. Community-wide screening is intended to rapidly isolate infected people from the general population, and to allow a quicker return to normal economic activity. Community-wide screening was first carried out from 14 May to 1 June 2020 in Wuhan, and has been used in subsequent outbreaks in China.
Response to subsequent outbreaks
Since the end of the initial outbreak in Hubei province, there have been additional, smaller outbreaks caused by imported cases, which have been controlled through short-term, localized intense public health measures.
Beijing experienced its second outbreak in June and July 2020. The first case was discovered on 11 June, after 56 days without any known local transmission in Beijing. The outbreak was centered on an agricultural wholesale market. Residents of the surrounding neighborhoods and close contacts of known cases were tested, and a total of 368 people infected with the virus were discovered. The outbreak was brought to a halt by 5 July 2020, less than a month after it began.
In October 2020, after a period of two months without any known domestically transmitted COVID-19 cases, three new cases were detected in the port city of Qingdao. Two dock workers with asymptomatic infections were subsequently identified as the probable source of the outbreak. The population of Qingdao was screened using pooled PCR testing, with total of 10.9 million people being tested within 5 days of the detection of the first cases. This lead to the identification of 9 additional cases. Travel restrictions were imposed on the city, requiring people leaving the city to present a negative PCR test and to quarantine for one week. The outbreak was brought to an end without a lockdown.
From July through August 2021, China experienced and contained 11 outbreaks of the Delta variant, with a total of 1,390 detected cases. The largest of these outbreaks, in both geographic extent and in the number of people infected, began in Nanjing. The index case of the outbreak, an airport worker, tested positive on 20 July 2021, and the outbreak was traced back to an infected passenger on a flight from Moscow that had arrived on 10 July. The outbreak spread to multiple provinces before it was contained. Through 26 August, 1,162 infections related to the Nanjing outbreak were reported.
China's later response to the pandemic has been praised by some foreign leaders and scientists. After the lockdown of Wuhan, it was reported in the journal Policy Design and Practice that "China has managed to contain this unprecedented public health crisis reasonably swiftly".
Case and death count statistics
Papers from academic journals and publishers such as Science, Nature, The Lancet, and Karger Publishers have regarded China's measures to domestically contain COVID-19 to be effective. A study in March published in Science Magazine concluded that the Wuhan travel ban and national emergency response may have prevented more than 700,000 COVID-19 cases outside the city. As of 31 December 2021, official statistics showed 102,083 cumulative cases and 4,636 cumulative deaths in mainland China. This corresponds to 3.2 deaths per million inhabitants.
A study published in The BMJ found that 4573 additional pneumonia deaths occurred in Wuhan from January to March 2020, compared with the same period in 2019. Outside of Wuhan, no measurable increase in pneumonia deaths was observed. Though there were confirmed COVID-19 deaths outside of Wuhan, the authors speculated that lockdowns suppressed influenza transmission sufficiently to offset these deaths.
A survey of seroprevalence conducted in April 2020 found that 4.4% of people in Wuhan had antibodies to SARS-CoV-2, indicating that they had been infected. Seroprevalence fell with distance from Wuhan, indicating that the initial outbreak had been largely contained to the city. Elsewhere in Hubei province, 0.4% of people had antibodies, while outside of Hubei province, less than 0.1% of people had antibodies. These results imply that in the first wave, approximately 500,000 people were infected in Wuhan, 210,000 people were infected in the rest of Hubei province, and 120,000 people were infected outside of Hubei province. A study conducted from March to April 2020 found that between 3.2% and 3.8% of people in Wuhan tested had antibodies to SARS-CoV-2. A study of Hong Kong residents evacuated from Hubei province in March 2020 found that 4% of them had antibodies to SARS-CoV-2.
According to British epidemiologist Ben Cowling, "due to the compulsory testing when there is an outbreak, the case numbers in China tend to include a lot of mild or asymptomatic infections that would never have been identified in other parts of the world", which explains China's relatively low case fatality rate. Peer-reviewed antibody studies have found a seropositivity rate of around 3.8% for Wuhan inhabitants.
In May 2020, a commentary article in Global Public Health researchers in Hong Kong examined the possible inaccuracy of China's death toll due to political censorship and manipulation, concluding with a hypothesis suggesting that although there was discrepancy in the death toll during the initial outbreak (due to insufficient testing capacity), the reported figures were probably close to the actual figures.
On 1 February, the People's Bank of China and other five departments jointly issued the notice on further strengthening financial support for the prevention and control of the epidemic of pneumonia caused by novel coronavirus infection, stating that relevant financial services will be further strengthened during the period affected by the epidemic. For those who are temporarily affected by the epidemic and facing difficulties, the document requires financial institutions to tilt their credit policies appropriately, flexibly adjust their loan repayment arrangements and reasonably postpone the repayment period. Those overdue due to inconvenient repayment during the epidemic period shall not be included in the record of credit investigation and breach of trust.
On 30 January, the Ministry of Finance and NHC issued a notice on the financial guarantee policy for the prevention and control of the new type of pneumonia. The Central Government shall grant a subsidy of 300 yuan per person per day to those who are in direct contact with the cases to be investigated or confirmed who are involved in the diagnosis, treatment, nursing, hospital infection control, case specimen collection, and pathogen detection. For other medical personnel and epidemic prevention workers who take part in epidemic prevention and control, the Central Financial Department shall subsidize them at a rate of 200 yuan per person per day.
The Ministry of Finance, the General Administration of Customs and the General Administration of Taxation issued a joint announcement that from 1 January to 31 March 2020, more preferential import tax policies will be implemented for imported materials used for epidemic prevention and control.
On 20 January, Chinese Communist Party general secretary Xi Jinping ordered that great attention should be paid to prevention and control of the epidemic. The CCP also vowed to guide people's opinions with intensive publicity strategies and interpretations of current policies to ensure social stability. Premier Li Keqiang urged relevant ministries and localities to take a highly responsible attitude towards the People's health and resolutely prevent the spread of the epidemic. Premier Li Keqiang also called a meeting of the State Council's Executive Meeting and deployed the work of epidemic prevention and control.
On 21 January, Premier Li urged protection and encouraged the health care workers. The National Healthcare Security Administration decided to adopt a special reimbursement policy for confirmed patients and temporarily bring relevant drugs and medical services into the reimbursement scope of medical insurance. On 22 January, Vice Premier Sun Chunlan went to Wuhan to inspect the prevention and control of the epidemic.
On 26 January, the first meeting of the Central Leading Group for the Response to the Epidemic of Pneumonia Caused by 2019-nCoV infection prioritized the provision of urgently needed medical and health forces, protective clothing and face masks for prevention and control in Hubei Province and Wuhan and attached importance to the transport of daily necessities for residents and relief supplies to Hubei. It urged the local governments to enhance epidemic control including cancelling meetings and events, strictly quarantining confirmed and suspected infection cases, extending the Chinese New Year holiday and supporting online office and teaching. The Central Government promised to crack down on hoarding and profiteering in materials for disease prevention and control. Public Finance at all levels should fully guarantee such funds as prevention and control of epidemic situations and treatment of the patients.
Xi Jinping's actions
On 27 January, Chinese Premier Li Keqiang, entrusted by Party general secretary Xi Jinping according to the state Xinhua News Agency arrived in Wuhan to inspect and guide the epidemic prevention and control work. According to The Wall Street Journal, the appointment of Li who is considered a technocrat surprised some observers, given that he had been sidelined in recent years as Xi concentrated power and cultivated a populist ideological image. Some suggest that Xi was more at risk to the political fallout of the COVID-19 while Li could be a convenient political scapegoat. Li's visit to Wuhan earned high popularity on Chinese social media. Xi Jinping said that he personally commanded the fight against the COVID-19 outbreak when meeting with WHO director general in Beijing on 28 January, but according to a report by The Guardian, he has not made any public presence since then,[when?] whilst social media posts mocking Xi's absence were promptly deleted by the censors.
Xi's first public appearance during the outbreak was at a residential community in Chaoyang, Beijing on 10 February. Xinhua posted photos of Xi wearing a mask and said that the aim of Xi's visit was to learn about the situation of epidemic prevision and control at the grassroots level. It was his first time to interact with the people since the outbreak after he paid a short visit to Yunnan during 19–21 January as a tradition that China's leaders observed to visit the smaller towns and villages before the Spring Festival. He was said to chair a meeting on 3 February by the state media, but no pictures or videos were released. Xi also met Cambodian Prime Minister Hun Sen, the first foreign leader to visit China since the COVID-19 outbreak on 5 February.
On 15 February, Qiushi, the CCP's main theoretical magazine, documented a 7 January order by Xi Jinping regarding the COVID-19 outbreak at a Politburo Standing Committee meeting, 13 days before the public was aware of the outbreak's severity. This appeared to reveal that Xi knew about and was directing the response to the virus on 7 January and raised important questions about whether it was the Central Government that dithered over the response, allowing the virus to spread across the country and eventually the world. However, Homare Endo, director of the Global Institute for China Studies, said a record of the same meeting released beforehand shows there was no mention of the epidemic. She said this indicated that Xi was forced to make "additions" retrospectively because of the public's anger over the death of Dr. Li Wenliang, who was arrested by the Wuhan police for early warning of an epidemic.
Since the outbreak of the epidemic, a number of government officials have been publicly held accountable for their dereliction of duty in the epidemic prevention in 6 provinces.
On 29 January, Director of Huanggang Health Commission Tang Zhihong did not answer questions from media regarding the capacity of the local hospitals, current hospital usage, and testing capacity. After the clip went viral, the Party Committee of Huanggang removed Tang from her post the next day. On 1 February, according to the Mayor of Huanggang named Qui Lixin, the city authority disciplined 337 of its officials and removed 6 principals who caused disadvantages to the epidemic prevention.
On 2 February, Zhang Cong, Party Secretary of Xuanhua, Hebei was admonished. Zhang Guoqing, Deputy Party Secretary of Xuanhua and Guo Xiaoyi, the political commissar of the local police were given disciplinary actions by the Party. On the same day, February, Xiangshui, Jiangsu reported three cases of misconduct. The cases were associated with illegal disclosure of personal data and dereliction of duty. Party secretary, Zhang Changyue and deputy director Gu Bing of the Zhangji Health Center and the director of the Xiangshui CDC were removed or disciplined.
Tang Hu, the director of the Health Bureau of the Nanhu New District in Yueyang, Hunan Province was suspended. Cai Junfeng, the deputy director of the Lengshuijiang Municipal Committee and Yang Wen, the deputy director of the municipal government office are suspended. He Yong, the deputy secretary of the Gutang Party Committee and township chief was suspended.
On 4 February, Zhang Qin, the vice president of the Hubei Red Cross, was removed from his post while Gao Qin and Chen Bo of the Hubei Red Cross were given a warning. The deputy director of the Wuhan Municipal Bureau of Statistics, Xia Guohua was also removed from his post. The Secretary and Director of the Leading Party Group of the Wuhan Municipal Development and Reform Commission, the Secretary and Director of the Leading Party Group of the Wuhan Municipal Bureau of Statistics, Meng Wukang and the deputy director of the General Office of the Wuhan Municipal Government, Huang Zhitong are admonished.
National day of mourning
On 3 April, the Chinese government declared 4 April, the Qingming Festival of 2020, a national day of mourning for those who lost their lives in the COVID-19 pandemic. At 10 a.m., people were asked to observe three minutes of silence while sirens and vehicle horns blasted out. Chinese flags were flown at half-mast across the country and at embassies overseas. All public entertainment were halted for the day.
On 18 January 2021, an interim report from the independent panel on the world's response to the pandemic led by Helen Clark and Ellen Johnson Sirleaf criticised the local and national health authorities in China for not applying public health measures more forcefully to control the initial outbreak in January 2020.
In July 2020, the Chinese government granted an emergency use authorization for COVID-19 vaccines developed by Sinovac Biotech and China National Biotech Group. The government also approved a vaccine developed by CanSino Biologics for use in the military. By mid-December, authorities said that over one million vaccine doses had been administered to over 650,000 people (the vaccines require two doses), with "no serious adverse reactions". By December, plans were in place to vaccinate more widely, beginning with high-risk groups. The vaccine rollout was delayed by limited supplies and vaccine hesitancy.
As of February 2021 China had provided vaccines to 53 developing countries and vaccine exports to 22 countries. Foreign Minister Wang Yi criticized developed countries for hoarding vaccines and urged the international community to "promote fair and equitable distribution of vaccines".
In June 2021, China reached one billion of domestically produced vaccine doses administered, representing more than one third of the global total at that point in time. This is about 74 doses per 100 population, a similar rate to many European countries. In June 2021, China was administrating nearly 60% of worldwide vaccinations.
In August 2020, an outbreak in the capital, Urumqi, caused officials to declare a state of "wartime" lockdown. Transportation including trains and buses were canceled, and residents started protests. Some online claims reported residents had been forced to use traditional Chinese medicine, handcuffed to buildings, and told to stay indoors for weeks.
In October 2020, it was reported that China's largest outbreak in months appeared to be occurring in a Xinjiang factory linked to "forced labour and the government’s controversial policies towards Uighur residents." The outbreak prompted officials in northwestern China’s Xinjiang region to implement a mandatory lockdown of residents in Ghulja.
Tight restrictions on information flowing out of Xinjiang have added to the confusion over the virus's spread in the province.
China has sent tests, equipment, experts, and vaccines to other countries to help fight the pandemic. European Commissioner for Crisis Management Janez Lenarčič expressed gratitude and praised collaboration between the EU and China. Chinese aid has also been well received in parts of Latin America and Africa. Chinese-Americans also marshalled networks in China to obtain medical supplies.
On 13 March, China sent medical supplies, including masks and respirators to Italy, together with a team of Chinese medical staff. While the head of the Italian Red Cross, Francesco Rocca said these medical supplies were donated by the Chinese Red Cross, there were other sources that said that these were paid products and services. Chinese billionaire and Alibaba co-founder Jack Ma also donated 500,000 masks and other medical supplies, which landed at Liege Airport in Belgium on 13 March and then sent to Italy. Italian Prime Minister Giuseppe Conte thanked China for its support and assistance. A former Mexican ambassador Jorge Guajardo said that masks sent to China in January and February were being sold back to Mexico at 20 to 30 times the price.
A U.S. congressional report released in April concluded that "the Chinese government may selectively release some medical supplies for overseas delivery, with designated countries selected, according to political calculations."
On 18 May 2020, the Chinese government pledged US$2 billion to help other countries fight COVID-19 and to aid economic and social development "especially [in] developing countries".
China has also provided vaccines to other countries. In November 2021, the Chinese government pledged to provide 1 billion vaccine doses to African countries, including 600 million donated doses and 400 million other doses, in addition to the 200 million doses it had already provided. In the same announcement, Xi pledged additional investment in Africa and promised to send 1,500 public health experts.
Virus origin investigations
The central government has restricted the publication of some COVID-19 origins academic research. A directive was issued by the Ministry of Education's science and technology department, stating "academic papers about tracing the origin of the virus must be strictly and tightly managed", requiring that such papers be vetted by a State Council task force. An anonymous Chinese researcher said "I think it is a coordinated effort from (the) Chinese government to control (the) narrative, and paint it as if the outbreak did not originate in China. And I don't think they will really tolerate any objective study to investigate the origination of this disease." The researcher said that such a move would obstruct important scientific research. Yanzhong Huang of the think tank Council on Foreign Relations said, "it is no surprise that the government seeks to control related scientific research so that the findings do not challenge its own narrative on the origin of the virus and the government response to the crisis".
The broad scientific consensus holds that SARS-CoV-2 originated in bats. The Chinese government's reluctance to participate in investigations has fueled speculation into the much less likely COVID-19 lab leak theory.
Reactions to government response
The exodus from Wuhan before the lockdown resulted in angry responses on Chinese microblogging website Sina Weibo from the residents in other cities, who were concerned that it could result in the spreading of the novel coronavirus to their cities. Some in Wuhan were concerned with the availability of provisions and especially medical supplies during the lockdown.
The World Health Organization called the Wuhan lockdown unprecedented and said that it showed how committed the authorities were to containing a viral breakout. Later, the WHO clarified that the move was not a recommendation that it made and that the authorities had to wait and see how effective it was. The WHO separately stated that the possibility of locking an entire city down, as happened in this case, was new to science.
The CSI 300 Index, an aggregate measure of the top 300 stocks in the Shanghai and Shenzhen stock exchanges, dropped almost 3% on 23 January 2020, the biggest single-day loss in almost 9 months after the Wuhan lockdown was announced as the investors that were spooked by the drastic measure sought a safe haven for their investments.
The lockdown caused panic in the city of Wuhan, and some expressed concern about the city's ability to cope with the outbreak. Medical historian Howard Markel argued that the Chinese government "may now be overreacting, imposing an unjustifiable burden on the population" and said that "incremental restrictions, enforced steadily and transparently tended to work far better than draconian measures." Others such as Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, defended the intent behind the lockdowns, citing that the lockdowns bought the world a "delay to essentially prepare better." A mathematical epidemiologist named Gerardo Chowell of Georgia State University stated that based on mathematical modelling, "containment strategies implemented in China are successfully reducing transmission."
Response from the scientific community
On 29 January, the Ministry of Science and Technology issued a notice, urging the scientists "to write their papers on the land of the motherland, to use the results to fight the epidemic" and the scientists should not focus on publishing their papers until the epidemic prevention and control task is completed. Duowei News believed this was aimed to respond to the academic conflict between Zhang Yongzhen's group from Fudan University which published the first genomic sequence of 2019-nCoV and the Gao Shan group from Nankai University which published an analysis on the sequence without authorization from Zhang. Before the notice, Nankai and Fudan, two of China's top universities had a fight over the alleged academic misconduct related to the analysis published by the Gao Shan group.
On 30 January, Wang Liming, a neuroscientist from Zhejiang University expressed anger on a Weibo post about George F. Gao's latest NEJM article. Wang believed that the article indicated that the Chinese CDC had clear evidence of human-to-human transmission in early January and kept it secret until three weeks later. Although the post was soon deleted, China CDC came under the spotlight. China CDC had to respond on the next day that the research was a retrospective analysis of the 425 cases reported to CDC on 23 January. Jennifer Zeis of NEJM's media Relations Department told The Paper, a Chinese newspaper that it took only two days to publish the article, but she refused to give further details.
The journal Nature reported at least 54 English-language papers about the new coronavirus in China were published by 30 January. Zuofeng Zhang, a public health expert from UCLA interviewed by the mainland China-based magazine Intellectual, asked why the published data were not used in epidemic control even before their publication.
The Chinese government has funded research on the origin of COVID-19, but has also restricted this research. In 2021, a WHO-led international mission traveled to China to investigate the origins of COVID-19; the Chinese government granted them permission to arrive after initially blocking them due to visa issues.
Reaction to proposed origin inquiry
After the Australian government called for an independent inquiry into the origins of COVID-19, Chinese ambassador Cheng Jingye said that Australia was treading a "dangerous path". Shortly afterwards, the Chinese government banned beef imports from Australia's four biggest abattoirs. It also put a tariff of over 80% on Australian barley and informally banned imports of Australian coal. Following a a motion supported by 122 members of the World Health Organization at the 2020 World Health Assembly, the Chinese government later agreed to conduct an inquiry. An article in The Economist speculated that an inquiry "might reveal China doing more to suppress information about early infections than to quash the outbreak itself".
UN Secretary General Antonio Guterres stated on February that it was clear "there is a massive effort that is made by China in order to contain the disease and avoid its propagation" and added the effort was "remarkable". Scientists interviewed by The Lancet Infectious Diseases attributed China's success in ending the initial outbreak in Wuhan to rapid measures to suppress viral transmission and the Chinese public's memory of the 2002–2004 SARS outbreak. According to Gregory Poland of the Mayo Clinic, "Other countries, even though they had much longer to prepare for the arrival of the virus, delayed their response and that meant they lost control."
U.S. President Trump thanked Chinese leader Xi Jinping "on behalf of the American People" on 24 January on Twitter, stating that "China has been working very hard to contain Coronavirus. The United States greatly appreciates their efforts and transparency." In March 2020, Trump said he was "a little upset with China", saying that the country was "very secretive and that's unfortunate". President Biden would later say Trump failed to hold China accountable on coronavirus.
Germany's health minister Jens Spahn, in an interview on Bloomberg TV, said with comparison to the Chinese response to SARS in 2003: "There's a big difference to SARS. We have a much more transparent China. The action of China is much more effective in the first days already." He also praised the international co-operation and communication in dealing with the virus.
In a letter to Xi, Singaporean president Halimah Yacob applauded China's "swift, decisive and comprehensive measures" in safeguarding the health of the Chinese people, while prime minister Lee Hsien Loong remarked of "China's firm and decisive response" in communities affected by the virus. Similar sentiments were expressed by Russian president Vladimir Putin.
During the first half of 2020, health experts, United States intelligence officials, British scientists, and British government officials expressed doubts about the accuracy of the figures provided by the Chinese government relating to the epidemic, raising concerns that the Beijing government has deliberately under-reported the extent of infections and deaths.
On 1 April 2020, two United States officials said that China had deliberately concealed its cases and deaths according to a report by US Intelligence Community. The officials asked not to be identified because the report is secret, and declined to detail its contents. The anonymous officials stated that the Chinese central government does not know the extent of the outbreak because lower-level officials reported falsified statistics to avoid losing their positions.
A mid-2020 study by the PEW Research Center found that in most of the 14 countries surveyed, majorities of respondents said China had handled the COVID-19 outbreak poorly, particularly among citizens in Japan, South Korea, Australia, Denmark, Sweden, the United States, and Canada.
In 2021, the United States, Britain, South Korea, Israel, Japan, and others issued a joint statement expressing concern with China's handling of the pandemic and requesting an independent evaluation.
According to law professor Lawrence Gostin, the virus was always going to be difficult to contain, but the world missed its chance to contain the virus due to not knowing that it was capable of human-to-human transmission until too late.[verification needed]
Censorship and propaganda
The Chinese government has actively engaged in disinformation to downplay the emergence of COVID-19 in China and manipulate information about its spread around the world. The government also detained whistleblowers and journalists claiming they were spreading rumors when they were publicly raising concerns about people being hospitalized for a "mysterious illness" resembling SARS.
The blame for the failure to report cases of COVID-19 at the onset is unclear because of the difficulty pinpointing it as a failure by either local or national officials. The Associated Press reported that, "increasing political repression has made officials more hesitant to report cases without a clear green light from the top." There are ongoing investigations in an effort to understand what happened, including an investigation by the World Health Organization (WHO) which will probe into what Wuhan officials knew at the time of the outbreak.A 14 February 2021 exposé by the Associated Press said that China took a "leading role" in spreading misinformation and conspiracy theories about COVID-19.
Censorship and police responses
A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December. The early response by city authorities was accused of prioritising a control of information on the outbreak. A group of eight medical personnel, including Li Wenliang, an ophthalmologist from Wuhan Central Hospital, who in late December posted warnings on a new coronavirus strain akin to SARS, were warned by Wuhan police for "spreading rumours" for likening it to SARS.
"Do not use 'incurable', 'fatal'[,] or similar headlines to avoid causing societal panic."
By the time China had informed the World Health Organization of the new coronavirus on 31 December 2019, Nicholas Kristof commented that the government was still keeping its own citizens in the dark in an opinion published on The New York Times. While by a number of measures, China's initial handling of the crisis was an improvement in relation to the SARS response in 2003, local officials in Wuhan covered up and downplayed the initial discovery and severity of this outbreak. This has been attributed to the censorship institutional structure of the country's press and Internet, with Jude Blanchette of the Center for Strategic and International Studies quoted stating "under Xi Jinping, the inclination to suppress has become endemic and, in this case, contributed to a prolonged period of inaction that allowed the virus to spread". William Summers, a Yale University professor of medicine, told Undark Magazine though that such silencing and downplaying tactics are not unique to China, and seems to be standard operating procedure worldwide.
On 20 January, Xi Jinping made his first public remark on the outbreak and spoke of the need for the timely release of information. Chinese premier Li Keqiang also urged efforts to prevent and control the epidemic. One day later, the CPC Central Political and Legal Affairs Commission, the most powerful political organ in China overseeing legal enforcement and the police, wrote "self-deception will only make the epidemic worse and turn a natural disaster that was controllable into a man-made disaster at great cost," and "only openness can minimise panic to the greatest extent." The commission then added, "anyone who deliberately delays and hides the reporting of cases out of self-interest will be nailed on a pillar of shame for eternity." Also on the same day, Xi Jinping instructed authorities to strengthen the guidance of public opinions, language which some view as a call for censorship after commentators on social media became increasingly pointedly critical and angry at the government due to the epidemic. Some view this as contradictory to the calls for openness that the central government had already declared.
As part of the central government's bifurcated approach to diffuse discontent, while the propaganda machinery was going into "overdrive...to protect [Xi Jinping's] reputation", citizens were permitted to criticise local officials so long as they did not question the basic legitimacy of the party. The Cyberspace Administration (CAC) declared its intent to foster a good online atmosphere, with CAC notices sent to video platforms encouraging them to not to push any negative story, and not to conduct non-official livestreaming on the virus. Censorship has been observed being applied on news articles and social media posts deemed to hold negative tones about the COVID-19 and the governmental response, including posts mocking Xi Jinping for not visiting areas of the epidemic, an article that predicted negative effects of the epidemic on the economy, and calls to remove local government officials. Chinese citizens have reportedly used innovative methods to avoid censorship to express anger about how government officials have handled the initial outbreak response, such as using the word 'Trump' to refer to Xi Jinping, or 'Chernobyl' to refer to the outbreak as a whole. Younger individuals have also been creating digital archives of media concerning the epidemic – which is prone to deletion by censors – and posting them on the exterior web. While censorship had been briefly relaxed giving a "window of about two weeks in which Chinese journalists were able to publish hard-hitting stories exposing the mishandling of the novel coronavirus by officials", since then private news outlets were reportedly required to use "planned and controlled publicity" with the authorities' consent.
On 30 January, China's Supreme Court delivered a rare rebuke against the country's police forces, calling the "unreasonably harsh crackdown on online rumours" as undermining public trust. In what has been called a "highly unusual criticism" by observers, supreme court judge Tang Xinghua said that if police had been lenient against rumours and allowed the public to have taken heed of them, an earlier adoption of "measures like wearing masks, strictly disinfecting and avoiding wildlife markets" might have been useful in countering the spread of the epidemic. Human Rights Watch reported that "there is considerable misinformation on Chinese social media and authorities have legitimate reasons to counter false information that can cause public panic," but also noted censorship by the authorities on social media posted by families of infected people who were potentially seeking help as well as by people living in cordoned cities who were documenting their daily lives amidst the lockdown.
Journalists in China have worked to publish information about the outbreak. The government initially allowed greater leeway than usual to reporters investigating the crisis, but then cracked down with greater censorship than usual. On 12 March, ten Tibetans were arrested for breaching control measures meant to prevent the spread of the virus. Dolma Kyab, a Tibetan writer and teacher, told Radio Free Asia that "the Chinese government is only using coronavirus as a convenient excuse to infringe on the human rights of Tibetans".
The New York Times later reported that "authorities issued strict commands on the content and tone of news coverage, directed paid trolls to inundate social media with party-line blather and deployed security forces to muzzle unsanctioned voices."
On 19 February 2020, the Chinese Foreign Ministry announced the revoking of the press credentials of three Wall Street Journal reporters based in Beijing, accusing the Wall Street Journal of failing to apologize for publishing articles which the Foreign Ministry said slandered the Chinese government's response to the COVID-19 outbreak, and failing to investigate and deal with those responsible.
In February 2020, Cheng Lei, an anchor for Chinese state broadcaster CGTN, posted on Facebook that she and her friend Haze Fan, a Bloomberg news assistant, had been trying report from Wuhan. Cheng was detained in August and later charged with “illegally supplying state secrets overseas”. Fan was detained later that year in in December, and both remain detention.
Response to whistleblowers
On 18 December 2019, Ai Fen, director of the emergency department of Central Hospital of Wuhan came into contact with an unusual pulmonary infection from a delivery person of Huanan Seafood Wholesale Market. On 27 December, she received a second patient with similar symptoms, but who had no link to the wet market. In the afternoon of 30 December, upon seeing the words "SARS coronavirus, pseudomonas aeruginosa", Ai immediately reported to the hospital's public health department and infection department. She circled the word "SARS", and took an image of it and forwarded it to another doctor in Wuhan. From there it spread throughout medical circles in Wuhan, and reached Li Wenliang, an ophthalmologist at the hospital. On the afternoon of the same day, Li sent a warning to former classmates over WeChat which was reposted widely. In an interview with Renwu magazine, Ai said she was reprimanded after alerting her superiors and colleagues of the SARS-like virus in December. Li Wenliang would later be canonised on the internet as a heroic whistleblower, and Ai would be lauded as the one who provided the whistle.
On 1 January, eight people were summoned for talks by Wuhan police for their claim that there were SARS cases in Wuhan. Li Wenliang said he didn't know whether he was one of them or not. According to Wang Gaofei, Weibo's CEO, the eight people are all doctors at Wuhan hospitals who "are still fighting at the frontline". The Supreme Court defended these doctors and pointed out in a WeChat article on 28 January, delay and opacity in public information are the root of fake news and the information that is mostly factual and not subjectively malicious and causes no objectively severe consequences should be tolerated. On 29 January, the eight doctors were also praised by Zeng Guang, Chief Scientist at China CDC. Hu Xijin, the editor of the Global Times, complained about the local governments' low tolerance of differing online opinions and believed this weakened checks-and-balances of government powers through news media.
Death of Li Wenliang
After Li Wenliang was warned by Wuhan police, the doctor was diagnosed with the COVID-19 infection and died from it on 7 February 2020. He was said to be dead on the evening of 6 February, although the hospital said that he was still under emergency treatment. People speculated that authorities were trying to censor the news. After his death, people mourned his death and criticized the government. some of the trending hashtags on Weibo such as "Wuhan government owes Dr. Li Wenliang an apology" and "We want freedom of speech" became trending topics on Weibo until the posts were deleted by censors. While media outlets were allowed to report his death, the nature of the doctor's censorship which produced widespread public anger in the aftermath, in what has been described as "one of the biggest outpourings of online criticism of the government in years," was not a topic that was permitted for coverage.
A group of Chinese academics including Xu Zhangrun of Tsinghua University signed an open letter calling for the central government to issue an apology to Dr. Li and to protect freedom of speech. Professor Zhou Lian of Renmin University has observed that the epidemic has "allowed more people to see the institutional factors behind the outbreak and the importance of freedom of speech". After attempts to discourage the discussion on Dr. Li's death further escalated online anger, the central government has been accused of reportedly attempting to co-opt the incident by "cast[ing] Dr. Li's death as the nation's sacrifice – meaning, the Chinese Communist Party's own".
In March 2020, Wuhan police apologised to Li Wenliang's family after National Supervisory Commission and Beijing Investigators announced that they found the conduct of local officials was inadequate and praised the whistleblower's effort on raising public awareness. Shortly after the official findings were published, Wuhan police announced that the two officers responsible for improperly reprimanding Li have been disciplined. 
Zhang Ouya's criticism
In January, Zhang Ouya, the Chief Journalist of Hubei Daily called for the removal of the current leaders of Hubei and Wuhan on Weibo. But, he was asked to remove his post and the newspaper that he worked for apologized to the Wuhan authorities, promising that they will publish only positive content from now on. Mayor Zhou of Wuhan said to the state media "As a local government, I could not disclose information until I get information and authorization which was not understood at the time." His argument which hinted at the Central Government's responsibility, was refuted by China CDC. Chief Scientist Zeng Guang said to Chinese tabloid The Global Times that what the scientists said was "often only part of their decision-making" and praised the eight whistleblowers who were warned by the Wuhan authorities before the epidemic.
Suppression of information about the initial Wuhan outbreak
As COVID-19 began spreading within China between December 2019 - February 2020, Chinese authorities prevented doctors and laboratories from sharing information about the outbreak, including admonishing frontline healthcare professionals and perceived whistleblowers, most notably, Li Wenliang.
Arrest or disappearance of citizen journalists
As of December 2020, around a year after the outbreak, at least 47 journalists were currently in detention in China for their reporting on the initial coronavirus outbreak.
Chinese citizen journalist Chen Qiushi started reporting on the outbreak from Wuhan on 23 January 2020. He disappeared on 6 February. On 24 September, a friend said he had been found. He was being supervised by "a certain government department", but would not face prosecution for the moment because he had not contacted opposition groups.
Fang Bin is a Chinese citizen journalist who broadcast images of Wuhan during the outbreak several times on social media. He was arrested several times during February 2020. The last arrest was on 9 February, and as of September 2020, he had not been seen in public since.
Li Zehua was reporting on the outbreak from Wuhan in February 2020. On 26 February, he was caught by the authorities after livestreaming part of the chase. On 22 April, he returned to social media with a brief statement in which he quoted a proverb that the human mind was "prone to err." A friend said he may have been told by authorities to make the statement.
Another citizen journalist, Zhang Zhan, stopped sharing information on social media in May 2020. On 28 December, she was sentenced to 4 years in prison. According to one of her attorneys, she was convicted of "picking quarrels and provoking trouble".
Restrictions on publishing COVID-19 data and research
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Currently, around 1.5 million Hong Kong and Taiwan citizens are long term residents working in China, which comprise slightly over 0.1% of China’s population. Meanwhile, COVID-19 death toll from China is 4641 (Johns Hopkins Coronavirus Resource Center, 2020; worldometer, 2020). This should theoretically translate into around five cases of COVID-19 death of such Hong Kong or Taiwan citizens. Should there be even one single case of COVID-19-related death for Hong Kong or Taiwan citizen living in China, it would be highly publicised because of political reasons. As a matter of fact, up to this date, there have been no such reports in Hong Kong or Taiwan. Therefore, while it is acknowledged that there was discrepancy in the COVID-19 death toll during the initial outbreak for reasons discussed in previous sections, our hypothesis herein suggests that the reported Chinese death toll would probably be not far from the actual number.
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