Zheng Ge, What Kind of Pandemic Policy Do We Need?

Zheng Ge, “’Do We Really Have No Other Choice This Time?’ Frank Words from a Shanghai Father”[1]
 
Introduction and Translation by David Ownby
 
Zheng Ge (b. 1972) is a Professor of Law at Jiaotong University’s Kaiyuan Faculty of Law in Shanghai.  His research focuses on the Chinese constitution and on legal theory, and he has also translated a number of important legal treatises from English and other languages (see here for more information on Zheng, in Chinese).  He has no formal training in epidemiology or public health, nor does he claim any.  He writes as a Shanghai resident—currently enduring the Omicron-inspired lockdown—and a Chinese (and world) citizen who is concerned about the pandemic and public health policy and who took the time and effort to write out his thoughts.
 
These thoughts were published in Beijing Cultural Review, a high-profile venue in China, in a new media initiative entitled “policy watch 政策观察.”  I cannot determine precisely what this initiative consists of or how new it is, but it is interesting that a venue like Beijing Cultural Review would give over this much space—some 15-20 pages/5000 words—to someone who is neither a journalist nor a specialist on the issue he is addressing.  “Letters to the editor” are one thing, but even if I had deep thoughts about, say, climate change, I am quite sure that no high-end venue in North America would publish a 15-page version of them. 
 
In their introduction to Zheng Ge’s piece, the editors of Beijing Cultural Review explain that the situation in Shanghai, and elsewhere in China, has provoked a great deal of debate about China’s management of the pandemic, and that they want to explore these different views.  I take them at their word.  It is possible that they gave Zheng as much space as they did because his arguments basically accord with those of the Party-State, but my impression is that these arguments are Zheng’s own, and that he is not simply repeating what everyone has heard on the news and read in the People’s Daily, and instead has done his own amateur research.  If publishing Zheng’s piece is part of a clever propaganda initiative, then it strikes me as quite effective, because Zheng’s arguments are logical and convincing on their own terms.
 
Zheng argues against those who say that Omicron is a game-changer, that China’s “dynamic zero” policy of eliminating the virus will have to change, because even if it might succeed, the costs of that success are too high, particularly because Omicron is usually closer to a bad cold or a flu and thus less dangerous than earlier variants of the coronavirus.  Zheng refutes such views by pointing to concrete situations around the world which suggest other perspectives.
 
First, Britain from the very outset suggested that there was “no choice” but to live with the virus and toyed with the idea of achieving “herd immunity.”  Zheng points out that this choice was conditioned by cuts of the National Health Service which deprived Great Britain of important weapons in their public health arsenal, and produced predictably dismal public health outcomes (as well as new variants which spread throughout the world). 

Second, Zheng turns to South Korea, which until quite recently had practiced what might be called a “China-lite” version of virus management based on contact tracing, social distancing, and isolation of confirmed cases, and which was quite effective.  Yet South Korea opted to “coexist” with the virus at the same time that Omicron hit, which produced a wave of cases, swamping hospitals and funeral homes.  Hong Kong’s situation is broadly similar. 

Finally, Zheng argues that genuine herd immunity will only be effective when vaccination rates approach one hundred percent—presumably worldwide—which means that the weakest among us will remain vulnerable.  Thus while it may be that China will eventually have no choice but to give up and learn to live with the virus, so far, China’s record in protecting its people from the harm wrought by the pandemic is outstanding in world terms.
 
China skeptics (or public health experts) may reject Zheng’s arguments for any number of reasons, and some discussion of the immense costs of China’s “dynamic zero” is obviously necessary (as well as a discussion of the costs of deciding to live with the virus), but Zheng’s arguments hold water on their own terms, at least in my reading.  China has succeeded—at a considerable price--in controlling covid better than virtually any other country .  Why stop now, as the sixth wave buffets Europe and North America? 

As a matter of purely personal choice, I prefer to live in Canada, where we talk a fairly good public health game, but lack both the political will and the discipline to enforce the rules, which leaves us freer, if sicker.  But I can readily understand Chinese people who think as Zheng does.  And if Zheng’s arguments are part of a clever propaganda campaign, I wonder if it is not more effective than having Dr. Fauci do the Sunday morning talk shows.
 
Translation
 
What kind of pandemic policy do we need?
 
To date, 48 million people have been diagnosed and 6.14 million have died the world over because of the coronavirus. In the United States, where the virus has hit the hardest, 80 million people have been diagnosed and 980,000 have died. 
 
In China, the country in which the coronavirus first appeared, due to the rapid adoption of scientifically effective and strictly enforced control measures, the majority of the population has enjoyed freedom from fear of infection and maintained a normal pace of life, work and study, except during the initial outbreak and the recent "fifth wave" of the outbreak caused by the Omicron variant. The second and third waves of the epidemic had minimal impacts on China, while the fourth wave (Delta) hit only localized areas of the country (Xi'an being the most severe). The current fifth wave of the epidemic has affected Jilin Province, Shanghai, and Hong Kong, but it has not reached the country as a whole and is still controllable.

Since this essay is about an urgent contemporary issue, I will set aside many theoretical dimensions to focus on my overall perspective, after which I will briefly and clearly make my case for my particular arguments one by one. 
 
First, the dynamic zero policy adopted by our country before the emergence of the Omicron variant was completely correct, as the results achieved have illustrated. If all other countries had adopted similar policies in 2020, the coronavirus might have been effectively brought under control long ago. It was precisely the inaction of countries such as the US and UK in the early stages of the epidemic that led the its massive spread of the virus, a man-made factor allowing for the emergence of various mutations.

Even if the current situation may lead us to discuss possible adjustments to our coronavirus policy, we must still acknowledge the success of China’s policy to date, and not argue that a “herd immunity” lying-flat[2] policy should have been adopted from the outset.  In fact, just a few days after proposing “herd immunity,” the British government itself completely denied that it intended to pursue such a policy, and the British Parliamentary Inquiry of 2021 was scathing in its criticism of the government's lax (but not "herd immunity") policy at the outset of the epidemic, describing it as "an abject failure of public health policy." Boris Johnson would be surprised to know that he has supporters in distant East Asia. 
 
Second, with the emergence of the more potent and insidious Omicron variant, should the dynamic zero policy eventually be modified, and replaced by a more flexible and lenient policy which will have less impact on people's normal work life and the society and economy in general? Those advocating changes to the present dynamic zero policy generally cite two reasons.  One is that there is no other choice, meaning that the super-transmissibility of Omicron makes precise prevention and control impossible, and the emergence of a large number of asymptomatic cases complicates the testing process.  Since not all cases will be detected, the argument is that we might as well lie flat.  The second reason is that dynamic zero is unnecessary, i.e., the idea that Omicron, while super-transmissible, has milder symptoms than either the original strain or previous variants, and is primarily an upper respiratory infection rather than pneumonia, much like the flu. It is clearly not a wise choice to employ such expensive measures to fight the flu.

There is also that supporting argument that other countries have opened up and nothing has happened, and we can read comments that "the UK has 200,000 new cases per day and life goes on as usual," or "Vietnam has joined the rest of the world and decided to live with the virus." It is worth noting that in the earlier rounds of outbreaks in China (e.g. in the Zhengzhou outburst and in Xi'an), mainstream opinion blamed local governments for poor epidemic prevention and failure to effectively implement the dynamic zero policy. They said that these government should have done what Shanghai was doing, because Shanghai’s policies were spot on. Yet when Shanghai has its own outbreak, we hear more and more people pushing to abandon dynamic zero. This in itself is an issue worth thinking about, but is not the focus of my essay. Instead, I will attempt to answer the following questions:  (1) Is there really no choice? (2) Is it really unnecessary? (3) Is it really okay to lie flat? 
 
Third, because of the global nature of the pandemic, different countries and regions have already responded differently based on their respective constitutional structures and political choices, the consequences of these choices are known, and analysis of this data can save us the cost of trial and error. We can no longer affirm choices that have been proven wrong by real world tests simply because we identify with a certain set of values. For those options that have been successful at some point in the epidemic, we can also see if they are still valid following the emergence of the Omicron variant. In the following section, I draw on these experiences and lessons from outside of China, as well as on Hong Kong SAR's response to the fifth wave of the pandemic, to answer the three questions above. 
 
Is there really no other choice?
 
In fact, the "there is no other choice" option was tried by one country early on in the epidemic:  the UK. This option was characterized in a 2021 House of Commons inquiry as "a policy approach of fatalism" characterized by "attempts to manage rather than contain the virus.” The report was very critical of this policy approach. This policy choice to seek "herd immunity" was harshly criticized in the report as a "complete public health policy failure" that led to the UK’s missing the best moment to control the epidemic. 
 
In fact, even the British government, which had itself proposed herd immunity, knew that a social Darwinist policy promoting the “survival of the fittest” as the virus ran its course would cause public outrage, so the policy was withdrawn soon after it was proposed, and the government has continued to deny that it ever attempted "herd immunity." However, the British Parliament was apparently not fooled by the rhetoric and believes that "herd immunity" was indeed the policy objective of Boris Johnson's cabinet in the early days of the epidemic. 
 
In a televised speech on March 12, 2020, Prime Minister Johnson called on every Briton to "be prepared to lose your loved ones.” The tone of the entire speech was that it would be impossible to completely eradicate the coronavirus and that the epidemic would be a long-term phenomenon. Instead of attempting to eradicate the virus, to no avail and at great cost, it would better to try to live with it from the outset. In a more systematic argument, Sir Patrick Vallance (b. 1960), chief scientific adviser to the British government, said that the epidemic would last a long time and that severe control measures could be effective for a few months.  But once these measures were lifted (and in his view they would be, because no country can bear the economic and social costs of implementing such measures over a long period), the epidemic would return. Premature and draconian measures would lead to "behavioral fatigue" and a loss of vigilance and the ability to respond to further outbreaks.

He discussed “behavioral fatigue” as if it were a scientific concept, by which he meant that if tough measures were imposed at the beginning, people would eventually become exhausted. Later, when outbreaks recurred, people would be significantly less responsive and less receptive to preventive measures, making control increasingly difficult. Given that the virus produced milder symptoms in for those who are young and healthy, the government should protect vulnerable populations (such as those over 70) and allow the rest to live as usual. Once some 60% of the population had been infected with the virus, herd immunity would develop. 
 
The plan drew almost unanimous criticism from the global medical community. Yale virologist Akiko Iwasaki (b. 1970) argued that normal people prefer to gain immunity through a vaccine, not by contracting a potentially deadly virus. Simple calculations tell us that if herd immunity requires that 60% of the population be infected, then the number infected in Britain would be 36.89 million.

Based on what was generally considered the covid mortality rate at the time (1.4%), this would have meant 520,000 deaths. In addition, more than 500 behavioral scientists signed a joint letter questioning the scientific validity of the concept of "behavioral fatigue" and demanding that the British government publish the basis for its decision. The British government quickly denied adopting a herd immunity strategy, with Health Secretary Matt Hancock (b. 1978) stating on March 15 that "herd immunity is not our policy objective.”
 
The British strategy is social Darwinist, based on notions of the survival of the fittest. The British epidemiologist Bill Hanage, who works at Harvard, asked:  “Who do you think are going to take care of the elderly who are being 'protected'? Well-trained gibbons? The very people who take care of them are the ones you think should be free to go out and catch the virus." The policy merely talked about protecting the elderly, and failed to consider the appropriate measures required to actually protect these vulnerable populations. 
 
It is basic common sense in public health that when an epidemic is on its way to becoming as pandemic, it is imperative to slow down the spread of the disease so that the new cases remain within the limits of health care resources and not cause a "bank run," a strategy that is often discussed in the epidemic prevention field in terms of "flattening the curve.”  All countries should take the standard measures recommended by public health, including universal quarantine, contact history tracing, isolation, closure of public gathering places, prohibition of mass gatherings, and guidelines for maintaining personal hygiene and social distance.

The hidden reason behind the sudden introduction (and swift denial) of the "herd immunization" strategy in the UK at a time when countries around the world were taking these measures is that the UK has been cutting NHS funding and staffing for years, resulting in a severe shortage of public health resources. Even for those who tested positive, most were required to isolate at home, and the critically ill were unable to receive emergency care and were often forced to abandon treatment.
 
Nonetheless, the British government, which had wanted to lie flat in the face of the social problems caused by the outbreak, was actually completely unable to do so, and had to react to the serious consequences produced by its inaction. The British government imposed three nationwide "lockdowns" on March 26, 2020, November 5, 2020 and January 6, 2021. On the day before the first lockdown, the Queen put the seal on the Coronavirus Act passed by Parliament, making the UK the first country in the world to pass legislation specifically aimed at the disease. 
 
However, this strategy—lying flat as overall goal and passive response as occasional exception—failed miserably and pleased no one, leading to very serious consequences. To date, the cumulative number of cases in the UK has reached 21.3 million (32% of the UK population) and the number of deaths has reached 166,000, with a daily average of 224 deaths over the course of the past week. Clearly, the goal of "herd immunity" is unattainable, and many people who have been infected with the virus have come down with it again, including Prince Charles. The UK's recent strategy of lifting all restrictions on vaccination is just one more example of "resigning themselves to fate" in the face of the fifth wave of the epidemic. But the situation clearly is not “good.” 

Moreover, given that a massively infected population is a "petri dish" for the virus, mutations and recombinant variants continue to thrive, posing a danger to people in other parts of the world. For example, the earliest coronavirus variant, Alpha, was produced in the UK, as was the more recent recombinant variant, XE.  Recombinant variant strains occur when a person is infected with two or more variants at the same time, and the genetic material of these variants is mixed in the infected person.  XE is a mixture of Omicron BA.1 and BA.2. This recombinant strain is far more infectious than the current Omicron and has been classified by the WHO as a new variant worthy of close attention. 
 
A path defined by fatalism is a path of no return. The helplessness of the present builds on the helplessness of the past. Once you lie flat, it is difficult to stand up again. Moreover, in a community of shared human destiny, one country lying flat in the face of a virus not only puts its own citizens at risk, but also poses a danger to other countries (including those that are doing a better job fighting the epidemic). 
 
Is it really completely unnecessary?
 
Before the emergence of the Omicron variant, South Korea's epidemic prevention policy was based on a three-step process of "detect, trace, and treat." i.e. contact tracing, social distance measures, and isolation of confirmed cases, which was quite effective before the Omicron variant became prevalent. However, to follow in the steps of Europe and the United States, the South Korean government relaxed the restrictions at the beginning of this year, and with the added impact of Omicron, the number of new cases in Korea has remained above 100,000 every day since February, even exceeding 300,000 in recent weeks, with the highest number reaching 620,000 on one day (March 17). The total number of confirmed cases in Korea reached 1,274,956 by March 30, which is close to a quarter of the country's population. The cumulative number of deaths from the coronavirus reached 15,855, with the majority of deaths occurring during the latest Omicron outbreak. The average daily number of deaths in the past week was 330. 
 
Lessons we can learn from the South Korean case include: (1) South Korea all along adopted control policies that combined prudence and leniency, and has the highest rate of complete vaccination (two or more doses) in the world, but things got out of control with the arrival of Omicron. This does not mean that vaccination is useless, but instead that relaxing epidemic controls before vaccine coverage approaches 100% can lead to widespread propagation of the virus.  Omicron "seeks out" vulnerable people who have not been vaccinated, just like an enemy seeks out weak links in a defense line, thus leading to a large number of deaths in the short term.

Moreover, the large number of serious illnesses and deaths in a short period of time is not only putting a squeeze on medical resources, but on funeral services as well. Recently, the South Korean government has asked the nation's crematoriums and funeral homes to "expand" their capacity from about 1,000 to 1,400 cremations per day, and funeral homes have been asked to store more bodies. 

The main reason for this situation is that, “inspired” by the policies of Europe and the United States, South Korea prematurely relaxed the behavioral restrictions that had been controlling the epidemic, such as limits on the number of people in gatherings, and has abandoned measures such as mass testing, active follow-up, and strict isolation of confirmed cases and asymptomatic infections. According to domestic epidemic prevention experts in South Korea, premature relaxation of epidemic prevention measures is sending the wrong signal to the nation, leading to a slackening of self-regulatory epidemic prevention measures and placing medical institutions in a dangerous situation. 
 
The situation in the Hong Kong Special Administrative Region is similar. During the current fifth wave of the epidemic, Hong Kong's medical resources are overwhelmed. However, with the help of the central government's unified deployment and with assistance from other parts of the mainland, Hong Kong has survived the most dangerous phase. During the worst phase of the epidemic, Hong Kong saw the tragedy of 76,341 new confirmed cases in a single day (March 2) and 294 deaths in a single day (March 11), alarming numbers for a city with a total population of 7.59 million.
 
A wealth of available data all point to a clear negative correlation between vaccination rates and the mortality rate of the coronavirus, meaning the higher the vaccination rate the lower the mortality rate. This is further supported by the data from Hong Kong, and this data is particularly instructive for us, because the vaccines used are Kexing, which is also commonly used in China, and Fubitai, which is produced by a Chinese company, Shanghai Fosun, in cooperation with the German company BNT. 

The former is an inactivated vaccine with fewer adverse reactions and side effects, and the latter is an mRNA vaccine with more side effects. According to a study conducted by the Li Ka Shing Faculty of Medicine of the University of Hong Kong, three doses of either the Kexing or the Fubitai vaccine were 97% effective in eliminating serious symptoms or death.  Statistics from the Hong Kong Special Administrative Region government also show that 70% of the fatal cases were people who had not been vaccinated.  
 
But vaccines are not a panacea. A study in Massachusetts showed that for the US as a whole, the states with the highest mortality rates are mostly those with the lowest vaccination rates, but the reverse is not necessarily true.  For example, North Dakota has one of the lowest vaccination rates in the country (54.6%) and one of the lowest mortality rates (0.24% of all confirmed Omicron infections). Maine has one of the highest vaccination rates (78.6%), but also one of the highest mortality rates (0.75%). The study states that "Omicron is more dangerous 要命 than Delta."

There are many reasons for this, including differences in the vaccines, as in the CDC finding that people who received the Johnson & Johnson vaccine (an inactivated vaccine similar to Kexing's) had a higher mortality rate than those who received the Pfizer vaccine (an mRNA vaccine). However, regardless of the vaccine administered, the severe illness and mortality rates were much lower than those who were not vaccinated. Therefore, I am afraid that a more convincing explanation has to be found in socioeconomic conditions such as demographic considerations, how old a particular group is, and the distribution of medical resources. 
 
Based on the above analysis, we can draw several preliminary conclusions. (1) Increasing vaccine coverage, including booster shots, is an effective means to reduce the rate of severe illness and mortality in the event of a major outbreak. (2) However, even with high vaccine prevalence, the virus cannot be allowed to spread, because a very high infection rate will put those very few unvaccinated people,  as well as a few who are completely vaccinated, at severe risk. 

The reasoning is simple: if only 1% of the population is infected, the virus will likely not find those extremely vulnerable people whose immune systems are still not strong enough to fight the virus even after vaccination. But if 10% of the population is infected, those extremely vulnerable people are much more likely to be infected. The fact that there has not been a single serious case in the Shanghai outbreak so far is due not only to the vaccine, but also to the fact that the number of infected people has been kept under control by strict preventive measures.
 
Is it really okay to lie flat?
 
The two arguments advanced so far illustrate that, objectively speaking, lying flat is not okay, but instead a big deal. However, due to different values, different countries and regions have different subjective judgments about what is okay and what isn’t.
 
The calculation of costs and benefits actually depends on values, especially when it concerns something like constitutional rights, which has no market price, which means that the kind of constitutional rights we value depends on the values of society. I once translated a book called The Future of Law and Economics written by Guido Calabresi (b. 1932), a Yale Law School professor who is also a U.S. federal appeals court judge. In this book, he points out that it is completely obvious why a society is willing to invest more in saving one person in an extremely dangerous situation, such as a crazy person trying to cross the Atlantic in a small sailboat, than in avoiding weekly disasters that kill many more people.

This is because the first case is highly visible, and superficially supports the proposition that "life is priceless," and when the government saves the crazy person it gets applause and votes.   The second case has no such visibility; if prevention works and the disaster does not happen, people will complain about the government’s spending the taxpayers' money, and if prevention fails and the disaster happens, the consequences will be the same as if you had not spent money on prevention.  So it's not in the politicians' best interest to do this kind of thing. 
 
In his 1968 essay "The Life You Save May Be Your Own", the Nobel laureate in economics, Thomas Schelling (1921-2016), introduced the concepts of “identified lives” and “statistical lives.” This set of concepts is common in the field of public health, where there is a clear preference for interventions that save the life of someone with a face and a story without consideration of the cost incurred, and a hesitation to improve public health and medical services for a statistically faceless population at a much smaller cost. This is known as the "identifiability bias.” A clear example of this is the Ipilimumab monoclonal antibody used to treat melanoma, an NHS-covered prescription drug that costs £42,200 per patient in the UK to extend their life by one year. At the same time, however, the UK, under the influence of conservative neoliberal ideology, has drastically cut the NHS budget, resulting in an inability to provide universal testing and prevention and control in the wake of the epidemic. 
 
The values embodied in China’s constitution differ markedly from those of capitalist countries, in that the objective well-being of the people, rather than their subjective rights, is the primary goal for which the Party and government strive (although this does not mean that the subjective rights of citizens are not protected). The positive obligations and powers of the state to prevent and control epidemics are important elements of our socialist constitution, as "protecting the health of the people" is one of the fundamental tasks of the state established in Article 21 of that document.

For this reason, China has taken active and decisive measures to prevent and control the epidemic from the very beginning, always adhering to dynamic zero and trying to avoid the spread of the virus in order to protect the life and health of every citizen. Such policies have achieved clear results, keeping the number of confirmed cases of the coronavirus below 100,000 for a long time after the first wave of the epidemic. Even though there has been a significant increase in cases during the fifth wave, the cumulative number of confirmed cases in mainland China (more than 230,000) is lower than the number of confirmed cases on a single day during the peak of the epidemic in the United States, India, Brazil, Germany, and even South Korea.  For example, the United States had 1.01 million cases on January 3, 2022, India more than 410,000 on May 6, 2021, and Brazil more than 280,000 on February 3, 2022. The cumulative number of deaths from the coronavirus in China is more than 4,600, only slightly higher than the single-day death toll in the United States on January 27, 2021 (4,102).

China's economy also maintained its growth during the epidemic, with GDP growth of 8.1% in 2021 and significant growth in inbound trade. While macroeconomic data cannot mask the impact on many small and medium-sized enterprises (SMEs) and individual entrepreneurs, central and local governments have begun to put in place various policies to help these hard-hit businesses and individuals, including rent reductions, preferential interest rates on loans, tax breaks, and more. 
 
The different impact on the average person of a “life with a story” versus a “statistically significant life” has been skillfully exploited by the media, as demonstrated in three stories on the New York Times Chinese website, which published a commentary on December 30, 2020, entitled "25 Days That Changed the World: How Covid-19 Slipped China’s Grasp," in which it was noted that, "China ultimately got control, both of the virus and of the narrative surrounding it. Today, the Chinese economy is roaring and some experts are asking whether the pandemic has tipped the global balance of power toward Beijing." At a time when countries in Europe and the United States were in the throes of both the epidemic and the economy, China not only managed to contain the epidemic but also achieved sustained economic growth. This commentary expressed disbelief and confusion in the face of unquestionable statistical data. 
 
On January 7, 2022, as the Delta variant ravaged Xi'an, the Times published another article titled "Life Stops, Access to Health Care Difficult: The Heavy Cost Behind Dynamic Zero in Xi'an,"[3] which questioned whether China's measures to combat the epidemic were "too costly" by telling the stories of particular, everyday people “with faces.” Several of the stories mentioned are ones that we have seen in other media and that created a huge public outcry at the time.

For example, "the vast health code system used to track people and enforce quarantines and lockdowns crashed because it couldn’t handle the traffic, making it hard for residents to access public hospitals or complete daily routines like regular Covid testing;" "Many were incensed when a woman in the city, eight months pregnant, lost her baby after she was made to wait for hours at a hospital because she was unable to prove she did not have Covid-19." These incidents do point out things to be improved in the measures our system employs,  but are not the inevitable results of dynamic zero, and instead are entirely compatible with it.  

By describing such incidents as the price of dynamic zero, the article is clearly intended to set the tone and turn readers against dynamic zero. However, the article had no choice but to acknowledge that the local government responded quickly to public opinion: "Amid the outcry, the government this week created special ‘green channels’ for pregnant women and patients with ‘acute and critical illnesses’ to get medical care more easily."  
 
On March 30, 2022, the Times published another yet commentary titled "Shanghai’s Lockdown Tests Covid-Zero Policy, and People’s Limits." The tragedies related in the story are ones we are already familiar with: "Last week, a nurse suffered an asthma attack but couldn’t get help from the emergency department at the hospital where she worked because it was closed for Covid disinfection. Her family rushed her to another hospital but she died, according to a statement from Shanghai East Hospital, her employer. On Friday, officials from Shanghai’s health commission expressed condolences to the nurse’s family. They urged hospitals to speed up infection screening, contact tracing and disinfection protocols to minimize disruptions to normal medical services." 
 
This incident does sound a wake-up call to policymakers in epidemic prevention: dynamic zero was intended to avoid the squeezing of medical resources caused by mass infections, but some man-made factors in the implementation of this policy goal have led to the exclusive use of medical resources by the coronavirus, leaving other critical emergencies without timely and effective treatment, which is contrary to the original policy intent. But to blame yet again the “zero policy” is clearly to exploit the cognitive bias of people's inability to empathize with "statistical lives."

Such narratives can easily appeal to the mindset of people who are already filled with resentment for the inconvenience caused by the epidemic prevention measures to their own lives, and thus may become self-fulfilling prophecies. Whether the people will unite behind the policy or public discontent will grow depends on how the government guides public opinion. Of course, if we want to continue to practice dynamic zero, adjustments at the policy implementation level will be necessary. In particular, we need to rectify the target responsibility system which takes dynamic zero as the sole assessment standard, so as to avoid the bureaucratic tendency of ignoring people's livelihood needs and basic rights outside the context of the epidemic.
 
Conclusion
 
Problems in our world contain no perfect solutions, and we all make decisions while dealing with risk and uncertainty. For our epidemic policy makers, abandoning the current dynamic zero policy can only be the final option, when there is truly no other choice. Because lying flat is the easiest thing to do,  but once we’ve done that, we’re at God’s mercy.

If that day comes, policy-makers should be able to say, "We did our best. Our efforts to date have prevented hundreds of thousands, if not millions, of our fellow citizens from dying of infection. These millions will not be the heroes of sensationalist stories, because they have survived; they will not know that they dodged a bullet, because policy kept them out of range; they will not show up in epidemic statistics, because the statistics do not reflect the number of deaths successfully avoided. But they are living, breathing people who could be your or my parents, siblings or children. Now that the situation has changed, we need to change our epidemic prevention policies and let's turn a new page together."
 
But that day has not yet come!

Notes

[1]郑戈, “’这一次, 我们真的别无选择吗?’ 一位上海父亲的秉笔直言,” published on the site of  文化纵横/Beijing Cultural Review on April 3, 2022. 

[2]Translator's note:  “Lying flat” is a common expression in China, generally referring to young people who “give up” in the face of the pressures of urban life.  See here for further discussion.

[3]Translator's note:  The title is in Chinese different, but this looks to be the article.