Where Do We Go from Here in the Post-Pandemic Era

Around 11 o'clock this morning, I sent out a questionnaire. The results show that some students' understanding of COVID-19 is still stuck in the Delta era, which is perhaps regrettable.

In today's post-pandemic era, most cities should, in principle, have improved their medical systems for dealing with COVID-19 to some degree. So why do major cities such as Changchun and Shanghai seem to have levels of prevention and control that are even worse than two years ago?

China's Achievements in Fighting the Pandemic

First, in order to draw a line between ourselves and certain Western media, we may as well review China's achievements in fighting the pandemic over the past two years.

Since the outbreak of the Wuhan virus, the measures China quickly adopted have included, but have not been limited to:

1. Locking down cities.

2. Controlling transportation, such as banning trains from leaving Wuhan during the outbreak there.

3. Free nucleic-acid testing for all residents.

4. Building makeshift hospitals.

5. Nationwide deployment of human resources, including medical workers, soldiers, administrators, and volunteers who went to affected areas.

6. Comprehensive public-health publicity.

Through the joint efforts of the state and the people, the results were remarkable: Wuhan went from lockdown to reopening in only two and a half months; in less than half a year, China successfully brought the pandemic down to the level of sporadic local infections. The institutional advantages displayed during that period were obvious and need no excessive emphasis; China's successful anti-pandemic measures were also recognized by many overseas scholars.

By comparison, Western countries across the ocean were somewhat caught off guard during the same period. Of course, the high infection rates in Europe and America were not caused by one single factor, but by multiple overlapping factors such as cultural differences, insufficient attention to public messaging, inadequate government administrative power, and anti-intellectual groups each going their own way.

Later variants, such as Delta, came fiercely, but were all controlled in time by strict prevention measures. If the period up to and including Delta, roughly from January 1, 2020 to December 31, 2021, is called the pre-pandemic era, then most rational students would sincerely admit:

China's prevention and control measures in the pre-pandemic era were, overall, efficient, reasonable, and successful. One could even say they were the most efficient and successful.

But in the post-pandemic era, China has begun to look somewhat strained.

Let me stress here that I do not mean to smear my country. By strained, I do not mean the original measures have lost their effect; I mean the cost paid for them has become too high.

Pandemic-Related Concepts

Above, I said that China's pandemic response was efficient, reasonable, and successful. The first two words have clear definitions: efficient means high execution efficiency, and reasonable means conforming to common sense and proceeding from reality. Only success is hard to define. You might say, "Reducing infections as quickly as possible is success." But everyone knows perfectly well what the fastest way to eliminate infections would be. That method not only cannot be called success; it should be consigned to the cold palace of anti-humanitarianism.

So what kind of pandemic response counts as successful? Here is my definition:

1. What Counts as a Successful Pandemic Response?

Weight all pandemic-control costs to obtain a "weighted cost amount" (abbreviated as "cost amount"). The lower the cost amount of a prevention measure, the more successful it is. Note that cost here does not refer only to economic losses; economic losses are also weighted and included in the cost amount.

Some people challenge this by asking: when human lives are at stake, can life really be measured by an index? I will answer this question later.

2. Viruses Do Not Stay the Same

(1) The characteristics of Omicron: high transmissibility, low mortality, and a main infected population of young people. This is what we know well.

(2) Hong Kong outbreak data: in the Hong Kong outbreak at the beginning of this year, data from the Centre for Health Protection showed that the median age of deaths in the first three weeks was 86, and 96% were over 60. Listing this data is not to suggest that "elderly lives are not lives," but to show that the Omicron variant is not highly lethal. We can see that the case fatality rate among people under forty was 0.

Some people worry that if the mainland adopted a policy like Hong Kong's, infections would rise sharply; although the fatality rate would not be high, the number of deaths would soar. This concern is reasonable. We do not pursue a purely Western model of freedom. But we should also note that among Hong Kong elderly people who died of illness, 88% had not received a second dose of COVID-19 vaccine. Is this common on the mainland? I think everyone has an answer in mind. Therefore, moderate opening might indeed slightly raise deaths, but the impact would not necessarily be as large as in Hong Kong.

3. Herd Immunity

Since Britain announced a "herd immunity" policy, the term has been heard constantly. Herd immunity refers to the resistance of a population, or a group of livestock, to infection. For most infectious diseases, if 70% to 80% of the group has resistance, a large-scale outbreak will not occur.

There are two main ways to achieve herd immunity. The first is that many individuals become infected, recover, and acquire resistance. The second is to achieve herd immunity through large-scale vaccination.

Needless to say, for diseases with a 0% mortality rate, taking economic impact into account, we would choose the first path without hesitation; for diseases with a 100% mortality rate, the first path would lead to human extinction, so we must choose the second.

The key question now is: for diseases with a mortality rate between 0% and 100%, how should we choose?

In reality, no country chooses only one of the two. All countries move along both routes at the same time. Even if the state does not subjectively encourage citizens to become infected, there will objectively be citizens who become infected and recover. The question again returns to the distribution of weights: to what degree should we execute path one and path two?

Clearly, in China, we strictly implement path two; in Britain, path one is implemented in an extreme way. At present, COVID-19 patients in Britain are not forcibly isolated either; that is coexistence in the true sense. Singapore can at most be called "not very strict prevention."

It is worth mentioning that in the questionnaire, I found some students believed "herd immunity" itself was unreasonable. This may be because they confused "herd immunity" with "coexistence and lying flat," and may also be related to the online stigmatization of the term when Britain announced herd immunity back then.

4. mRNA Vaccines and Inactivated Vaccines

There are currently two main types of COVID-19 vaccines on the market: the inactivated vaccines developed by China, and the mRNA vaccines led by Pfizer in the United States. Inactivated vaccines are relatively traditional, while mRNA vaccines are a relatively emerging technology. In terms of results, the development process and clinical effect of mRNA vaccines are superior to those of inactivated vaccines. But before COVID-19 vaccines entered the market, no mRNA vaccine had ever been approved anywhere in the world. The biggest issue is safety: no one knows whether mRNA has long-term side effects.

According to comments by Academician Gao Fu, mRNA vaccines had never really shown themselves before the pandemic; they are a very cutting-edge method, and no one knew how effective or safe they would be. Many people did not expect that through this pandemic, the technology would be pushed forward rapidly under pressure; even though many people had various adverse reactions, it still gained broad recognition internationally. Gao Fu pointed out that only societies such as Europe and America, with a cultural background of exploration, would dare to do this.

5. Lazy Governance and Overcorrection

Having lived in China for more than ten years, my positive feelings are certainly greater than my negative ones. In private and in public, I have expressed my position many times: there are shortcomings, but they can all be improved. This article mainly discusses the negative side, so let me first apologize to the leaders. The largest negative impression China's administrative system gives me is lazy governance and overcorrection.

Lazy governance does not mean being too lazy to manage; people too lazy to manage cannot become high officials (though of course that is hard to say). Lazy governance means implementing indicators rigidly and never handling matters flexibly. Its typical features include, but are not limited to: one-size-fits-all policymaking (for example, apart from political rights, protection of minors, and marriage law, minors and adults are barely differentiated in almost all laws and regulations; film and game rating systems are especially so, as I have discussed before), instruction-only execution (efficiently completing assigned tasks and ignoring everything outside them; using GDP, infection numbers, and similar figures as assessment indicators for officials), and passing orders down layer by layer so that the burden falls entirely on the grassroots. This improved somewhat after the 2019 "year of reducing burdens at the grassroots."

The problem of lazy governance can be solved through public polling. Although public opinion surveys in China are currently rare, and most of them are academic research rather than polls in the practical sense, I am optimistic about this. As the democratic process continues to develop, this problem will be solved sooner or later. Therefore, lazy governance is not a major problem. As long as the highest-level policymakers are sufficiently capable, the whole country can run efficiently. What is most annoying is the overcorrection indirectly caused by lazy governance.

Overcorrection means that when officials are criticized during policy execution, or when they hear that colleagues who adopted similar measures were criticized, their attitude makes a 180-degree turn and they move in the opposite direction. For example, at the beginning of the outbreak, some Wuhan officials concealed the facts and were dismissed. Later, Wuhan reported new cases strictly and transparently every day, built Huoshenshan and Leishenshan hospitals efficiently, and expanded screening. That was one turn. But normal living needs were neglected, causing many people to be unable to buy vegetables and food prices to soar. After public opinion fermented, since 2021 all localities have paid attention to people's livelihood while preventing the pandemic and have guaranteed basic living needs. Yet even in the post-pandemic period, Changchun's outbreak was still a counterexample. Then in Shanghai's outbreak, Shanghai decision-makers made another sharp turn: they opened vegetable markets at a specific time so residents could buy food. As a result, residents packed the markets so tightly that the scene became difficult to control, causing countless new infections.

From this you can see that Chinese city managers often swing repeatedly between the far left and the far right, from one extreme to another. Perhaps this has something to do with China's cultural tradition of sweeping reform since the New Culture Movement.

Of course, this problem has also been continuously improving in recent years with the trend toward younger cadres. Capable managers keep emerging, and officials in the new era of China have limitless prospects. But for now, the problem remains severe.

6. The Issue of Long-Term Effects

This concept came from a supplement by one student in the questionnaire, who reminded me in time of the issue of COVID-19 sequelae. I thank them here.

COVID-19 does have long-term effects, including but not limited to brain atrophy and decreased limb coordination; in severe cases, even slurred speech and inability to care for oneself. Although the group with long-term effects is a minority, it must not be ignored.

If pandemic management is to be relaxed, long-term effects must be considered. I know very little about this aspect; students who know more are welcome to add comments. Thank you.

7. National Scale and Conditions

In the questionnaire feedback, many students mentioned the issue of scale, and I realized that in many respects China cannot be compared with Singapore or Western countries such as Britain and the United States. In population alone, China's population is larger than that of all Europe and the United States combined. If an outbreak occurred, the impact on China might be more severe.

Answers to Two Questions

After clarifying the seven concepts above, we can return to the original question:

1. Why do major cities such as Changchun and Shanghai seem to have worse control capacity than two years ago?

In fact, the pandemic-control capacity of major cities is not worse than two years ago. On the contrary, the nucleic-acid testing capacity and emergency response ability of both cities have improved substantially. This is beyond doubt. The key issue lies in the direction of viral evolution.

If the earliest COVID-19 virus is regarded as having medium transmissibility and medium mortality, then Delta increased both infectiousness and mortality on that basis. But because its incubation period was short, China eliminated it quickly.

Omicron, however, has high transmissibility and low mortality. China's original policy therefore appears weak. Of course, this does not mean it is truly ineffective. Under the strict management of the pre-pandemic period, the outbreak could absolutely be controlled, but the price paid would be far, far too high.

2. When human lives are at stake, can life really be measured by an index?

True, human life cannot be measured by an index. The consensus in Chinese society is that life comes first, and this was well reflected in the Wuhan outbreak. But there is a very serious question: besides the danger to life caused by COVID-19, do other lives count as lives?

On January 1, 2022, New Year's Day, a pregnant woman in Xi'an who was eight months pregnant had abdominal pain. After struggling to reach the entrance of Gaoxin Hospital, she could not be admitted because of a nucleic-acid issue. She had to wait outside for more than two hours, during which she suffered massive bleeding. In the end, because rescue was not timely, her eight-month fetus was miscarried.

On March 11, 2022, a four-year-old girl in Changchun, Jilin, sought medical treatment for acute laryngitis at Changchun Anxian People's Hospital. Because her condition was serious and doctors did not open a green channel in time, the child died.

On March 25, Shanghai East Hospital responded on its official website to online reports of a nurse who died after an asthma attack: Zhou Shengni was a nurse at our hospital and had long worked in a related department. On March 23, she suffered an asthma attack at home and medication did not relieve it. Around 19:00, her family drove her for treatment. Our hospital's southern emergency department was temporarily closed due to pandemic-control needs for environmental sampling and disinfection, so her family took her to Renji Hospital East for treatment. Around 23:00, Comrade Zhou Shengni died after rescue failed.

Do these people's illnesses count as illnesses? Do these people's lives count as lives? Shanghai's current outbreak has recorded seven deaths, and every one has been clearly filed. But deaths caused by delayed treatment of other diseases because of pandemic control: do they count as deaths? How many cases are there? Has anyone counted them? Not many people can answer.

My Position

My position is to moderately lower the intensity of pandemic control, which I will call a "flexible policy" below. For Omicron prevention, the losses caused by prevention have already exceeded the losses caused by the pandemic itself, whether in life, economy, or livelihood. But I clearly oppose coexistence, at least "British-style" coexistence. We need to preserve the ability to return to emergency status at any time. If we abandon strong control capacity like Britain, we will be powerless if a highly lethal pandemic returns.

In my conception, a reasonable flexible policy must first adjust in real time according to the situation of the outbreak. It should respond according to the evolutionary characteristics of the virus. Put plainly, it means scientific prevention.

Combined with Omicron's characteristics, policies currently possible include:

Advising the elderly and children not to leave home unless necessary;

Restricting gatherings of more than ten people;

Allowing people who test positive to choose isolation at home or in hospital;

Allowing employees and students in non-severe outbreak areas (severe outbreak areas currently refer to cities such as Shanghai and Changchun) to work and attend school normally, while individual students infected at companies or schools go home for isolation. As an aside, when chickenpox broke out at Zhuoying back then, only two classes were isolated. Chickenpox can cause sepsis, though the probability is small, but it is extremely contagious; in a sense it happens to resemble Omicron.

Keeping large transport vehicles open normally and ensuring the normal operation of the aviation industry. Aviation has been extremely depressed over the past two years, including the three major airlines, which may indirectly increase the frequency of malfunctions.

Increasing investment in research and development for mRNA vaccines and COVID-19 treatment drugs. If we do not trust American drugs, we can develop our own vaccines, but inactivated vaccines and mRNA vaccines are not synonyms for China and America. Science has no political stance.

Most importantly, maintaining the government's credibility and control through strong publicity, so that if the outbreak becomes serious again, we can promptly restore the handling standards of the pre-pandemic era.

Qualitatively, flexible policy places restrictions on the people somewhere between strict prevention and coexistence.

Quantitatively, however, specific data are hard to provide. For example, how many infections make a city a severe outbreak area, how many people in a gathering should trigger a ban, and what weights each factor should hold in the cost amount: such decisions require national big data and analysis by professionals. One person certainly cannot do it.

Therefore, I suggest considering all factors with weights, rather than considering only infection and death numbers caused by the pandemic. An executor who prioritizes the weighted amount would not refuse to save a pregnant woman because of a nucleic-acid issue. Likewise, when the outbreak is serious, such an executor would not ignore residents' food supply, and would not choose to conceal reports, because the economic losses and public emotions caused by doing so would also carry weight. In plain words, we must consider the interests of all sides as much as possible, rather than fighting the pandemic to the bitter end alone.

Of course, I reiterate here: first, most of China's policies so far have been relatively successful; we are discussing how to make them more reasonable. Second, I am not an actual manager, so there are many difficulties facing managers that I have not considered, and there will be omissions. Third, Chairman Mao said that practice is the sole criterion for testing truth. The idea I offer has never been practiced in China and is currently only an empty shell detached from practice. Only after successful practice in China can it convince the public; such practice is partly taking place in Shanghai, but Shanghai's current situation is not optimistic. I hope the people of Shanghai can unite and fight the pandemic in a new way, proving to the whole country that this method is feasible.

Having said this, I believe everyone has gained a new understanding of the pandemic. The strict-prevention camp may no longer be so stubborn, and the coexistence camp may no longer be so firm. Everyone's thoughts should, more or less, be moving toward compromise.

Summary of Views

Let me summarize my views.

Facing Omicron now, our risk is this: the Omicron strain is evolving toward an influenza-like virus, with stronger transmissibility and lower mortality. The anti-pandemic measures of the pre-pandemic era consume manpower, material resources, and financial resources in the post-pandemic era. They need to be changed into a flexible policy.

Implementing flexible policy requires facing these risks:

1. The international political image established during the pre-pandemic era may no longer exist.

2. The issue of long-term effects.

3. Before fear of COVID-19 is completely dispelled, all confirmed cases will certainly have to be sent to hospitals, meaning all small clinics and residential communities cannot take in patients. With China's current medical capacity, especially in smaller cities, it would be difficult to withstand the shock of a soaring infection rate.

4. A large number of skeptical voices will appear, and these voices will not be without reason.

In this socially and politically sensitive period, the likelihood that China will change its pandemic policy in the short term is indeed not high. Although the general policy of dynamic zero-COVID will not change, the state is also gradually trying to reduce pressure on medical workers in specific small links, such as reducing isolation from 14 days to 7 days in the revision of Protocol Version 9.

For me personally, as long as the policy does not become stricter, the current measures are still acceptable. Whatever the policy is, we may argue endlessly during discussion, but once it is decided, whether or not it conforms to our own views, as citizens we must consciously accept and firmly uphold it. This can perhaps be considered a superiority of socialism: democratized decision-making, authoritarian execution.

Even if we may be dissatisfied with the policy in our hearts, we absolutely do not evade our obligation to cooperate with pandemic control. We all understand that even with a policy that is not very reasonable, the effect of working hard to cooperate is always better than everyone doing their own thing and ignoring one another.

I hope this article can help readers understand more clearly China's achievements and challenges in COVID-19 governance; at the same time, I use it to offer criticism and suggestions regarding China's current policy. Of course, one person's voice is not enough to stir waves. Only when everyone eliminates the special fear of COVID-19 in their hearts, and every person who turns pale at the mention of COVID-19 is awakened, will China's attitude have hope of changing.

———————————————————————————————————————

Survey Analysis

The following is a statistical summary of the questionnaire sent this morning, along with some excellent opinions.

As of 14:46 on March 30, 2022, a total of 40 responses had been received, with an average answering time of 9 minutes and 16 seconds. Nine students spent more than 10 minutes answering; thank you all here.

Q1: Describe the characteristics of the Omicron variant

There was a bit of a problem with how this question was designed. My original intention was for everyone to analyze it from objective data. Data from most countries in the world show that Omicron is highly transmissible, has a relatively low mortality rate, and mainly infects young people aged 18 to 50. But nearly half of the students chose elderly people and children as the main infected group.

From a virological perspective, however, you are right, because the vast majority of viruses infect people with weaker resistance more easily than those with stronger resistance.

The reason Omicron infections this time were mainly among young people may be that most people currently engaged in social activities are young people, allowing Omicron to spread through them, while elderly people and children mostly stay at home, have relatively fewer activities, encounter the virus less often, and therefore have lower infection rates. Both statements can be considered correct.

32.5% of students chose other options. Aside from random answers, the rest may have had a slightly insufficient understanding of the new variant, with their impression of the pandemic still stuck in the Delta era.

Q2: How large have the positive and negative impacts of pandemic control been for you?

The feedback was very interesting. From the score distribution chart, one can intuitively see that positive and negative impacts are negatively correlated: most people who gave the positive impact a score of 1 gave the negative impact a score of 7 or 8.

On average, the positive impact score was 4.42, while the negative impact score was 6.25. The negative impact was slightly higher than the positive, but the difference was not large. This shows that most people's lives were negatively affected during pandemic control, but compared with the results of prevention and control, these impacts were acceptable.

Q3: Your sense of identification with China's pandemic-control policy

Those who consistently agree account for 42.50%, those who partially agree account for 50.00%, and those who consistently disagree account for 7.50%. More than 90% of students recognize China's pandemic-control policy to some extent, showing that China's policy is widely recognized in its overall direction.

Q4: Among students who partially agree or consistently disagree, the most common reason for disagreement is lazy one-size-fits-all governance, insufficient attention to highly lethal strains, and excessive prevention against low-lethality strains.

Among other opinions, some mentioned that "some basic guarantees are not in place"; some mentioned that "some regions have concealed reports, with some prevention effective but still concealed so people still do not know, though the impact was small; some concealed reports led to the spread of the outbreak"; others proposed "smearing and suppressing scientific voices"; and some students mentioned that "various controls are too strict, especially for middle-school students, and greatly affect learning."

Q5: Material 1: Singapore's new pandemic policy - views on coexistence

Original question:

Recently, Singapore Prime Minister Lee Hsien Loong delivered a national televised address titled "Taking the Next Step," announcing that Singapore's anti-pandemic path had reached an important milestone: beginning next week, a series of pandemic-management measures would be substantially relaxed, officially moving toward coexistence with COVID-19.

"After considering all factors, we believe we are now ready to take a decisive step toward living with COVID-19," Lee said in the televised speech.

Singapore's coexistence policy includes: from March 29, allowing 75% of employees working from home to return to the workplace; allowing large events of more than 1,000 attendees to resume, with attendance capped at 75% of venue capacity; raising the social gathering limit from 5 people to 10; and allowing people to choose not to wear masks outdoors, while masks remain required indoors.

Share your view. For example: opinions on coexistence, whether Singapore's coexistence policy is truly coexistence, additional information you know, and the possibility, advantages, and disadvantages of implementing coexistence in China.

This question was placed first among the short-answer questions to introduce the concept of coexistence through a foreign pandemic-response approach and to seek interesting opinions.

I selected several excellent responses below.

Student No. 11:

Wu Zunyou emphasized that "COVID-19 is not a big flu." Whether China may coexist with it in the future remains unknown, but in the end, what the government needs to guarantee is that the outbreak remains controllable.

Student No. 21:

The implementation of coexistence is actually a last resort due to economic downturn. When discussing why coexistence is implemented, we must analyze it in connection with Singapore's national conditions.

As a capitalist country, Singapore's economic development naturally has deep significance for its capital. It is a country with an extremely developed tourism industry, and pandemic control during this period dealt a major blow to its economic development and choked its economic lifeline. Facing the frightening situation of negative economic growth, fiscal crisis, and economic pressure, its national leaders urgently need people to return to their posts and guarantee livelihood issues.

What does coexistence with COVID-19 mean? It is like treating COVID-19 as an ordinary flu, with no need for isolation, lockdown, or control. So what gives Singapore the confidence to implement coexistence for economic development? Data show that Singapore's COVID-19 vaccination rate is as high as 80%, and a large portion of people also have antibodies because they have had COVID-19. One could say Singapore's coexistence policy was obtained at a huge cost in human life.

Looking back at China, joint prevention and control during the pandemic suppressed the spread at the earliest stage. But China has a large population and different national conditions, so coexistence in China is inevitably impossible. First, China has a large population and a relatively low vaccination rate; implementing coexistence would inevitably endanger people's lives, health, and safety, making China's already difficult economic development even worse. China currently has the labor market as an advantage; if COVID-19 coexistence were implemented, it would greatly damage our economic development. Moreover, poverty alleviation is not yet stable, and poor households could easily fall back into poverty. This would seriously damage the path planned by our country, and China's development might become extremely difficult.

Therefore, coexistence is only a policy adopted by different countries according to their own situations. China still needs to consider its own national conditions and not blindly coexist.

Student No. 25:

Only coexistence is a long-term solution. It was so before, and it remains so now.

Human beings do not yet have the ability to completely eradicate viruses. The passing of every major flu can be traced back to "collective immunity." China's lockdown made it one of the first countries to suppress the first wave of the pandemic, and also made it one of the last major economies to emerge from the overall pandemic.

Student No. 28:

Singapore's coexistence theory is similar to the Western idea of herd immunity. At this stage, we cannot yet determine whether herd immunity is right or wrong; similarly, at the beginning of implementing coexistence, we cannot yet judge whether it is correct.

But we can see the effects of herd immunity in Western countries. In terms of infection numbers, it is clearly inferior to our country's prevention policy. Singapore's implementation of this policy may be a helpless response to economic pressure from pandemic control, criticism from the people regarding control restrictions, or confidence caused by the mortality rate of COVID-19 in Singapore. But relaxing measures so dramatically all at once, and relying on people's self-discipline for some measures, may be unreasonable. Still, different countries have different national conditions, and their decisions are optimal choices based on their own conditions. Perhaps they already regard COVID-19 as a minor illness similar to influenza.

The possibility of implementing coexistence in our country is very low. First, our country has always publicized the high danger of COVID-19, so opening policy may cause well-known maladaptation among the people and implementing agencies. Second, COVID-19 is highly contagious. As a populous country with high population mobility, once China implements coexistence, it would trigger a large wave of infections, and hospitals may not be able to handle so many patients. However, if China implemented coexistence, we might discover people naturally immune to COVID-19 and promote the discovery of new treatments.

Student No. 32:

Answering only based on impression; whether it is correct remains to be examined.

The overall direction of viral mutation should be toward continuously stronger transmissibility and continuously lower mortality, thereby achieving maximum spread: survival of the fittest. The virus probably will not be completely eliminated and will eventually move toward coexistence. There will be a period of confrontation in between. It will still take time to reach a state where coexistence is acceptable.

At present we still need treatment, and its sequelae are very serious. If coexistence is needed, it should be when it has already become similar to an ordinary cold: a considerable number of people can recover on their own or remain asymptomatic, while others need only simple treatment and do not suffer serious sequelae.

For now, China is still not suitable for a coexistence policy. China has a large population, a high possibility of concentrated outbreaks, and great risk from large gatherings. Although there are many asymptomatic infections this time, there are also many confirmed cases and asymptomatic re-positive cases. Moreover, although the mortality rate is decreasing, the severity of sequelae may not be decreasing. From this perspective, I do not support implementing a Singapore-style coexistence policy now or for quite a long time to come.

Student No. 33:

Singapore is a port city that mainly develops an export-oriented economy. It cannot withstand lockdown, so coexistence is necessary.

As COVID-19 naturally evolves, its danger is far less than before and it is no different from influenza. Coexistence has long been the consensus of most countries. In China, however, we are still stubbornly holding on to a zero-COVID policy. This itself is unscientific. The virus can almost never be cleared to zero. Coexistence is the natural law.

Although this country's propaganda machine keeps saying our economy is stable and improving, when I look across the country I see an economic slump around me, including in my own family. I see many big companies laying off workers on a large scale. I see cabbages in Shanghai costing more than 80 yuan each. I see people under pressure ending their lives. I see pregnant women forced to miscarry. I see elderly people with heart attacks unable to receive emergency treatment. I hear angry people on Shanghai's streets shouting, "We want food, we want work, we want freedom." All of this is not because of the pandemic, but because of a policy that devours people. I believe coexistence is the policy that truly seeks truth from facts and is truly responsible to the people. Yet the hope of realizing coexistence in our country is slim, because the vampires are making too much money.

Student No. 34:

I think the possibility of realizing coexistence is quite large. Looking at the current trend of viral evolution, transmissibility is getting stronger and toxicity weaker. Take Omicron: its transmissibility is several times higher than Delta's, but its fatality rate is under 7% even counting many unvaccinated people, elderly people with low immunity, and some other groups.

I once saw a prediction that COVID-19 will coexist with humans for a long time and become something like influenza. Judging from the current situation, healthy people who have received vaccines (proper vaccines) are basically asymptomatic after infection, meaning they have almost no symptoms during the illness, at most some physical discomfort, and almost no sequelae, while still being highly contagious. The current way of handling asymptomatic infections is home isolation, taking some medicine, and waiting to recover, which is really waiting for antibodies to eliminate the virus. It looks very similar to influenza. Even if there are symptoms, most are not serious, severe infections account for a very small share, and the share of people left with sequelae is also small. So rather than worrying and fearing infection or terrible sequelae, one might as well exercise more and strengthen one's body.

As for Singapore's policy, from a citizen's perspective I think there is not much problem with it. The only confusing part is that masks are required indoors but optional outdoors. Are they afraid that indoor contact is closer and therefore transmission is easier? But the virus does not appear out of nowhere. If it exists indoors, it must have been brought in from outdoors, so why not wear masks outdoors? In terms of comfort, people indoors are usually resting or doing other activities, and wearing a mask all the time is certainly uncomfortable. If I had to choose between wearing a mask outdoors or indoors, I would definitely choose outdoors. Of course, wearing masks both indoors and outdoors is safest, but that would also be uncomfortable.

For China, I think the probability of realization is also fairly high. After all, China's achievements in pandemic prevention are plain for all to see. But there are indeed some criticized areas, such as the frequency and speed of nucleic-acid testing, policies, and some lockdown methods and measures, which are also very unreasonable. For example, some universities "only lock down college students," and some people "rush for flights, but nucleic-acid results are abnormally slow and do not come out for days." These are clearly very unreasonable and need improvement. Different local governments also differ in their pandemic-control methods: some do well, and some... Overall, there is no need for forced smearing. Most people are just complaining for fun. Although the measures are a bit strict, the results are there; most people just hope to see the public's feedback reflected and policies better fit people's needs.

Student No. 37:

My personal view is that human beings should coexist with nature, but the idea of coexisting with a virus is simply unreasonable.

The new policy is absurd: on one hand it asks people to take protective measures in enclosed spaces, and on the other it raises the banner of harmonious coexistence. Such behavior is contemptible. This set of measures has no possibility of existing in our country. In the environment where human beings must survive, against viruses and diseases that kill people and may exterminate humanity, it must be "either you or me, life or death." Coexisting with such viruses and diseases?

Student No. 38:

I think coexistence theory has some correctness. Singapore's coexistence theory, however, is not true coexistence.

After all, the COVID-19 pandemic has lasted two years, variants keep appearing, and developing a vaccine immune to all variants remains extremely difficult. Under such circumstances, coexistence with the virus may be a solution. But Singapore's policy still includes pandemic control, so it is not true coexistence.

Coexistence is unlikely to be realized in China, because the harm caused by the pandemic would increase. Recent outbreaks have made the state invest enormous manpower, material resources, and financial resources, and these were still results under control. If coexistence were realized in China, several factors would need consideration. First, China has a large population, prosperous economic development, and developed foreign trade. Illness among people could trigger uncontrollable consequences, unlike Singapore, whose small population can be effectively controlled. Second, China is a socialist country. China will not let any resident be unable to seek medical treatment because of lack of money, especially lonely elderly people and poor families. This would have a great impact on Chinese society and increase fiscal burdens.

Student No. 40:

I think coexistence theory makes some sense. After all, in history some viruses lasted a long time, and to some extent COVID-19 may indeed "accompany us for life."

But I think the premise for relaxing restrictions and talking about coexistence is that people's lives are guaranteed. That is, you do not need to fear the disease and can continue to live happily, but once you are infected, I guarantee your safety and will not let your happy life end easily. We cannot eradicate the virus, but at least we can cure it. Only with sufficient security can people truly achieve coexistence. As for China, I think there will be no coexistence policy in the short term. Personal view.

Q6: Material 2. Data analysis of the current outbreaks in Hong Kong and Shanghai - compare the data and share your view.

Original question:

1. Hong Kong

As of March 24, Hong Kong's fifth-wave Omicron outbreak had caused 6,557 deaths in total, with a mortality rate (deaths / total population) of 0.08%, that is, 8 deaths per 10,000 people, and a case fatality rate (deaths / infections) of 0.6%, or 60 deaths per 10,000 infections.

Among them, the mortality rate for people over 80 was 1.2%, that is, 1.2 deaths per 100 people over 80, higher than in other age groups. In every age group, 60% to 70% of deaths had not been vaccinated, and about 20% had received only one dose and had not completed full vaccination; together, these two situations accounted for about 80% to 90% of deaths.

However, according to the 2021 life expectancy ranking released by UN-Habitat, Hong Kong ranked first in the world at 85.29 years. The conservative average age of death for the vast majority of Hong Kong deaths is very close to Hong Kong's own life expectancy. The implications behind this are hard to state, but obvious.

Furthermore, COVID-19 death statistics include three categories. The first is "die of" COVID-19, meaning clinically dying directly from the virus. The second is "die with" COVID-19, meaning the cause of death is unrelated to COVID-19 but the body tests positive, such as people who fell from buildings or had strokes and tested positive after admission without COVID symptoms. Of course, these two categories are sometimes hard to judge, so the third is temporarily unknown cause. Hong Kong government expert and Chinese University respiratory medicine chair Professor David Hui analyzed 120 deaths from the fifth wave, and the conclusion was very interesting: the proportions of dying of COVID-19 and dying with COVID-19 were 38% and 37% respectively, almost equal.

2. Shanghai

The Shanghai Municipal Health Commission reported this morning (the 29th): from 0:00 to 24:00 on March 28, 2022, Shanghai added 96 local confirmed COVID-19 cases and 4,381 asymptomatic infections, of which 21 confirmed cases were previously asymptomatic infections that converted; 7 confirmed cases and 3,824 asymptomatic infections were found under isolation control, while the rest were found in screening of relevant risk groups. So far, Shanghai's current outbreak has recorded 7 deaths.

Compare Shanghai and Hong Kong's data and share your view, from the perspectives of viral characteristics, mortality rate, vaccination, and scientific prevention.

From the material, Hong Kong's elderly vaccination rate is low, showing that they did not pay enough attention to the virus. Looking back at the mainland, vaccination rates are high and mortality is far lower than Hong Kong's. This question in fact provides evidence for the reasonableness of the flexible policy I want to argue for.

In the questionnaire feedback, some students questioned the scientific nature of our country's prevention measures, while others expressed dissatisfaction with the forced smearing of Chinese policy in online public opinion. Selected responses are below:

Student No. 28:

Hong Kong's outbreak situation shows that COVID-19's fatality rate is very low, and the later part also shows that COVID-19's impact on people is not as serious as imagined, or that we all think of COVID-19 as too serious, or that the country's publicity about COVID-19 may be somewhat exaggerated, though perhaps this was to make us pay more attention to it, or because the severe situation at the beginning of the outbreak frightened us. Clearly, after vaccination the fatality rate drops sharply, so universal vaccination is very important. In Shanghai's outbreak, the number of asymptomatic infections is obviously very large, and the number of deaths is also small...

Student No. 33:

Characteristics: highly contagious, not highly dangerous, extremely low fatality rate.

Vaccination: most people in our country received domestic vaccines such as Sinovac or Beijing Bio-Institute.

But according to some authoritative materials I have read, domestic vaccines seem to have very limited effectiveness against Omicron. Scientific prevention? I do not think our country's prevention is scientific. Take mass nucleic-acid testing. On one hand, people turn pale at the mention of COVID-19 and lock this and that down at every turn. On the other hand, nucleic-acid testing is indeed a large gathering site. Since people are so comfortable gathering for testing, either they do not take the potential virus seriously, or they assume everyone is healthy. Then what is the need for mass nucleic-acid testing? Formalism that exhausts people and wastes money.

Student No. 34:

Well, Hong Kong was affected by fake vaccines and some Western democratic brainwashing, so quite a number of people did not get vaccinated, and a high fatality rate is normal. Hong Kong also has a fairly high proportion of middle-aged and elderly people. Moreover, Hong Kong and Shanghai are both international cities with large population flows, high population density, and frequent overseas travel, so a sudden surge in infections is also normal.

As for measures, I actually think that rather than waiting until each outbreak is discovered and then managing it so strictly, it is better to control it at the source. Most cases discovered now are imported from abroad and then spread, so I think more attention should be paid to people returning to China from overseas. China's domestic prevention measures are already quite good. The same saying: viruses do not appear out of nowhere. No matter how well the inside is managed, we must prevent entry from outside, right?

Of course, I think the state should listen more to the opinions of the people. Personally, I do not have much opinion about whatever policy the state introduces, as long as it does not disrupt my life. I think most people feel this way. Those who have opinions about national policy just want to live more comfortably, which is understandable. But after all, meeting the needs of 1.4 billion people cannot cover every detail. What can be done well should be done well, and where perfection is impossible, compromise solutions can only be adopted. Mainly, seeing too much forced smearing online is somewhat speechless.

Q7. Material 3: Revision of the COVID-19 Diagnosis and Treatment Protocol - based on Protocol Version 9, suggest China's next measures.

Original question:

Material 3: Revision of the COVID-19 Diagnosis and Treatment Protocol

The National Health Commission and experts revised the eighth edition of the COVID-19 Diagnosis and Treatment Protocol, forming the ninth edition, which was issued nationwide on March 15, 2022. Key revisions are as follows (excerpt):

First: antigen testing is added in addition to nucleic-acid testing.

Second: cases are treated by category:

1. Mild cases are managed under centralized isolation. If the condition worsens, they should be transferred to designated hospitals for treatment.

2. Ordinary, severe, and critical cases are treated in designated hospitals. Severe and critical cases should be admitted to ICU as early as possible.

Third: two specific anti-COVID drugs are written into the treatment protocol: PF-07321332/ritonavir tablets (Paxlovid) and domestic monoclonal antibodies (ambavirumab/romlusevimab injection).

Fourth: traditional Chinese medicine treatment is improved.

Fifth: the original standard of "two consecutive negative respiratory specimen nucleic-acid tests, with sampling at least 24 hours apart" is revised to "two consecutive novel coronavirus nucleic-acid tests with N gene and ORF gene Ct values both >=35 (fluorescent quantitative PCR method, threshold value 40, sampling at least 24 hours apart), or two consecutive negative novel coronavirus nucleic-acid tests (fluorescent quantitative PCR method, threshold value below 35, sampling at least 24 hours apart)." "14 days of isolation after discharge" is revised to "7 days of home health monitoring after discharge."

The meaning of the fifth point is: previously, only negative patients could be discharged. Now patients with Ct values between 35 and 40, who may still be positive, can also be discharged because clinically they rarely infect close contacts.

Based on Protocol Version 9, share your suggestions for China's next pandemic-control measures.

This was the final question of the questionnaire, returning to our own country's latest policy. The original protocol is far too long, so I excerpted the content, but did not distort it. The goal was to ask students to seek inspiration from the concrete protocol and summarize their own opinions.

Student No. 5:

For important positions, such as schools and state-owned enterprises, appropriately loosen pandemic restrictions and grant a certain degree of autonomous management.

Student No. 33:

1. Seek truth from facts; too many social resources should not be occupied solely for pandemic prevention.

2. Traditional Chinese medicine? Is this a joke? This is a matter of public-health governance; why emphasize a special ideology? Absurd.

3. Introduce special medicines that have been proven feasible abroad and are widely recognized, set aside arrogance, and include them in medical insurance (this seems to be happening already).

4. Implement coexistence policy as soon as possible and strike pharmaceutical research oligarchs (impossible).

Student No. 34:

No suggestions. I cannot think of any.

Let me just talk about my view. Regarding the fifth point, I think this approach, on one hand, reduces the consumption of medical resources and saves medical workers' time and energy; on the other hand, it also reflects that the virus has become much less toxic. That is, even when the virus may not have been completely cleared, as long as another seven days pass, you can return to normal. If we continue thinking this way, after a few more generations of the virus, will the human immune system eliminate it even faster, perhaps to the point that no medical observation is needed and after infection you take some medicine and recover in four or five days? Well, it does sound quite like influenza. Of course, this is only a personal guess, but it is indeed quite interesting.

Student No. 38:

Restrictions can be moderately relaxed. The long incubation period of the pandemic should also be considered seriously, and the nucleic-acid testing process must be rigorous. Sometimes patients may not be detected because testing is conducted casually.

Free Comment Section

Student No. 15:

COVID-19 is a disaster for all humanity. I only hope it passes quickly. I have even somewhat forgotten what life before 2020 was like. I only know that now, through masks, we can still smell disinfectant every day; we must show travel codes in public places; travel has become a landmine that may explode at any time. We have lived anxiously like this for three years. I do not know how much longer we must wait, or even whether I can wait until then, but I am willing to wait: to wait for the day COVID-19 truly disappears.

Student No. 32:

First, the following is dream-talk output and may be triggering (?) Read carefully:

China's current semi-closed model (thank you, this term is my own invention) reminds me of the Qing dynasty's closed-door policy. To some extent it can resist external harm, but eventually it must open. Perhaps foreign countries have truly achieved coexistence, but that is not us. Coexistence achieved within one country and coexistence achieved worldwide are not quite the same. It is like biological invasion. From 2019 to now, three years have passed, and we have gone from being caught off guard to handling things with ease. What does not change is change. What changes will we encounter in the future? I cannot say.

In these three years, we have turned severe cases into mild ones, and moved from lives hanging by a thread to large-scale recovery and discharge. But there seem to be things we have not done. Loss of smell, organ decline, inability to do heavy work, and brain atrophy. These are also factors to consider before implementing coexistence policy. But at present, we clearly cannot overcome them.

Second, I cannot judge whether it is coincidence or necessity. Mortality and vaccination rate seem negatively correlated. Some strange words frighten me: life expectancy and carrying the virus. COVID-19 can cause failure of other organs, even the brain.

Third, it seems to be conveying a message to me: everything is loosening, widening, slowing, and lightening. More than three years of pandemic since 2019 seem to have made us long more for freedom. Once people have experience, they must be able to handle things calmly and unhurriedly, without caring too much. This seems inevitable in people's impressions.

Fourth, after I filled out all the questions, it prompted me to fill them out again. I really collapsed... (P.S. Sorry, I was wrong qwq.)

Student No. 33:

Quoting Zhihu:

China: You Americans are amazing. You really do not treat COVID-19 as an illness.

America: How can we compare with you? You do not treat anything except COVID-19 as an illness.

(End of full text. Thank you for reading.)