For an hour every day, Xu Xinhua waits in line for a health worker to push a swab down his throat and swirl it around. Each time, he hopes his Covid test will be negative so that he may continue delivering food, medicine and flowers to residents across Shanghai.
Mr. Xu, 49, is paid hourly by Shansong Express, an intercity courier service, but only when he is fulfilling orders. “That means you work an hour for no gain,” Mr. Xu said in an interview.
The routine is familiar to hundreds of millions of people as China makes lab tests for Covid a permanent feature of daily life. In major cities across the country, even where there are no reported cases, residents are being required to present a negative P.C.R. test to go shopping, ride the subway or bus, or participate in public activities.
China is the last country in the world that is trying to eliminate Covid, and the spread of the highly contagious Omicron variant is challenging its strategy of mass lockdowns and quarantines. The country already uses health code apps to surveil its citizens and track infections, and it imposes stringent lockdowns and centralized quarantines for confirmed cases and close contacts.
Officials hope the regular mass testing will help isolate cases in the community before they spiral into bigger outbreaks. But the policy can be expensive and time-consuming, undercutting the central government’s efforts to fire up the economy.
In Shanghai, barely two weeks after the city lifted its two-month lockdown, the authorities have placed millions under new lockdowns to conduct mass testing, setting off protests in some areas. In Beijing, days after the city said it had brought an outbreak under control, cases hit a three-week high on Tuesday. In the eastern district of Chaoyang where an outbreak was tied to one bar, authorities began testing residents for three days and shut businesses.
Workers say the time required to get tested is cutting into their pay. Local governments are taking money from poverty alleviation projects to pay for testing. Businesses are concerned that the requirement will hurt productivity, and economists worry people will stay home to avoid the bother.
Some local officials have tried to scale back testing. Others have acknowledged the huge burden that routine testing has imposed on citizens. But China’s top leader, Xi Jinping, has ordered the country to “unswervingly” stick to the strategy of stamping out infections, and dozens of officials have been fired for mishandling outbreaks, making any effort to loosen restrictions politically risky.
“When you are a local government official and you are facing these competing demands, you are going to rank them,” said Yanzhong Huang, a global health expert at the Council on Foreign Relations. “I think any rational local government official will still have more incentives to enthusiastically pursue zero Covid than to take a more flexible approach.”
After a vice premier, Sun Chunlan, ordered cities to ensure that residents can get tested within a 15-minute walk from where they live, tiny testing booths, with holes for gloved hands to stick out and swab throats, appeared in town squares, shopping plazas and parks.
Health officials in 57 cities and five of China’s 31 provinces — covering nearly half of the country’s 1.4 billion people — have started some sort of normalized testing system, according to a report by the Suzhou-based financial firm Soochow Securities.
The approach has fed public anger in some places. In Shanghai, the authorities have forced residential compounds or even city blocks back into lockdown for testing in recent days, sometimes because just one resident happened to be in the same store or subway car as someone who later tested positive.
On Monday night, frustrated residents in the city’s northeastern district of Yangpu banged on pots and shouted “End the lockdown!” after their compound was locked down over the weekend, said Jaap Grolleman, a Dutch expatriate who lives in the neighborhood. More than a dozen police officers stood watch outside a giant wrought iron gate that was locked shut, he said.
“People are worried about taking the subway or going to the shopping mall,” said Mr. Grolleman, who saw his neighbors protesting. “You don’t know if someone before you or after you tests positive, meaning that you would be dragged into quarantine or your whole compound would go into lockdown.”
In Beijing’s Chaoyang district, some residents are bristling at more testing and lockdowns. Zoey Zhou, a journalist who lives in the district, said she worried that if she missed a test, her health code app would prevent her from being able to enter her neighborhood.
“I don’t think it is acceptable for the government to then put more burden on the public and increase surveillance in the name of epidemic prevention,” Ms. Zhou said. “Why am I being deprived of the freedom I should have?”
There are signs of how China’s pandemic policies are rippling through the economy. Fewer people are shopping, pushing retail sales down. People are less interested in buying property; real estate sales plunged by 39 percent in April compared with a year earlier.
Local governments are struggling to pay for all the testing. In Yangquan, a city in northern China, officials said they would build a mass testing system despite the city’s “severe financial restraints.” In Kaifeng, to the south, officials said that they had scraped together $3 million for testing “under very difficult financial circumstances.”
Estimates of the total cost of the new testing policy vary, but are in the tens of billions of dollars. If testing is extended to small cities, capturing as much 70 percent of the population, it could cost as much as 1.8 percent of annual economic growth, according to the Japanese bank Nomura.
Shanghai has said that in August it will start charging residents for every test. A single test will cost Mr. Xu, the delivery worker, roughly half of what he makes in an hour. His income had already taken a hit during Shanghai’s two-month lockdown when he had to live in a hotel that would allow him to come and go.
Parts of the government are sounding the alarm about the need to limit the impact the measures are having. A Beijing health official on Thursday warned that P.C.R. testing “should not become the norm.” And some cities have eased the requirements for how frequently tests must be taken.
In the southern province of Jiangxi, where civil servants have faced pay cuts and a squeeze on bonuses for months because the budget is so tight, officials last week decided to stop mass testing in areas with low cases, citing it as an obstacle to economic development.
Testing can break a transmission chain before it escalates into a broader outbreak, experts say, but it is unsustainable in the long term. Other measures, such as increasing vaccinations and securing antiviral drugs, could help a country develop a broader immunity and be better prepared for future outbreaks.
But of China’s 264 million people aged 60 or older, just 64 percent have received a booster, a figure that experts say is too low. A third dose of China’s main Sinovac vaccine is needed to significantly increase protection against severe disease and death, according to a recent study.
Some business leaders have pointed out what they see as the shortsightedness of the government’s approach. In a recent meeting with Li Keqiang, China’s premier, and other foreign business leaders, Jörg Wuttke, China’s chief representative for BASF, the German chemical giant, said he urged the leader to focus on vaccinations instead of testing. It was unfathomable, Mr. Wuttke said he told Mr. Li, how failing to vaccinate the elderly “can hold the economy hostage.”
Li You, Liu Yi and Joy Dong contributed research.
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