More than 1.3 million people in China were under medical observation this week as close contacts of Covid-19 cases, the highest level since the pandemic broke out in Wuhan, and an increase of more than 300,000 in just a few days.
The skyrocketing number of close contacts, driven by an increase in cases to near-record levels, is putting immense pressure on a Covid-19 policy which, unlike the rest of the world, aims to eliminate rather than live with the virus.
China’s strategy has evolved since the start of the pandemic. While authorities have often relied on citywide lockdowns, including in Wuhan in early 2020 and in Shanghai in 2022they also use a sophisticated track-and-trace system that quickly quarantines close contacts of infections for “medical observation.”
The total number of close contacts is an important indicator of the authorities’ ability to control the virus in China. Meanwhile, evidence from Guangzhou, the center of the latest outbreak, points to a discrepancy between official guidance and reality.
How are close contacts traced?
In major Chinese cities, residents must take a PCR test every few days at kiosks set up on street corners to get a “green code” on their smartphones. Their phone must also be scanned on most public transport and at the entrance to buildings.
If a person tests positive, authorities can scan places the person has visited to track who else has scanned there. Close contacts can also be determined based on a person’s residence or place of work.
What happens to close contacts?
This month, amid rising cases, the government tweaked the approach it set out in June when it published the ninth edition of its Covid-19 strategy.
Under the revised guidelines, close contacts must be taken to a “centralized isolation location”, often a hotel, where they must stay for five days, instead of the previous seven. This should be followed by three more days of home observation.
Local governments have invested in building temporary isolation facilities. In October, Shanghai confirmed it would build a 3,000-person facility on Fuxing Island at a cost of around $220 million, designed for both close contacts and positive cases.
A construction bidding website reveals dozens of other similar projects across China in recent months.
However, government guidelines also say ‘special’ cases may be allowed to self-isolate at home. It does not clearly define a particular case, although each province has its own interpretation. In Hebei, children 14 and under are treated as special cases.
What is the reality on the ground?
When asked how many close contacts of more than a million people under medical observation had been quarantined at central facilities compared to their homes, China’s National Health Commission directed the survey to the Center for Disease Control and Prevention, which could not be contacted.
Central guidelines may be applied differently in different provinces. The example of Guangzhou, where daily cases number in the thousands, indicates that authorities are struggling to find the capacity to meet the central quarantine requirement. A resident, who asked to be called Victor, said his family had been named as close contacts after dining at a restaurant where there was a confirmed positive case.
He said his family had been told to prepare for a quarantine hotel, but were later told there was not enough space there and new quarantine sites were yet to come. been built. Instead, his door was sealed and he and his family isolated at home.
Elsewhere, there is flexibility in defining close contact. If there is a positive case in a building in Beijing, authorities designate the three floors above and below the case as close contacts and send those residents to central quarantine. Other floors are required to quarantine at home.
When a single positive case has been detected in Disneyland Shanghai this month, authorities locked down the park and tested tens of thousands of people, but did not define guests as close contacts. However, some Disneyland staff have been designated as close contacts and sent to central isolation facilities.
What happens next?
The requirement to quarantine close contacts of close contacts was relaxed this month. But expectations of a reopening were downplayed after the city of Shijiazhuangwhich had relaxed testing during its outbreak, reinstated stricter measures.
If the number of close contacts spirals even further out of control, the government could impose much tougher lockdowns, like in Shanghai this spring. Such a decision could be taken at the central level, but it would still have to be applied by several local governments and cities.
Even if the virus can no longer be controlled, any shift from an elimination model to a deletion-based model is unlikely to be straightforward. Instead, there are signs that elements of the former would likely persist.
A person who works in labor contracting in Guangzhou, which recorded nearly 8,000 cases on Wednesday, said the city was hiring dozens of drivers to transfer close contacts to quarantine hotels in order to cope with the growing number of contacts.
Additional reporting by Ryan McMorrow in Beijing and Gloria Li in Hong Kong