SHANGHAI (BLOOMBERG) - For much of the Covid-19 pandemic, a group of places in the Asia-Pacific brought infections to zero, becoming virus-free havens in a world ravaged by the pathogen.
Now with the rise of the Delta variant and the proliferation of vaccines, only one is still holding fast to that goal of eliminating Covid-19: China.
With New Zealand preparing to shift away from the zero-tolerance strategy, China's isolation is complete, raising the stakes on how long it can stick to a playbook that requires closed borders, abrupt lockdowns, and repeated disruption of social and economic activity.
One by one, formerly Covid-zero places like Singapore and Australia have decided that the approach is unsustainable, pivoting instead to vaccination to protect people from serious illness and death while easing off on attempts to control the number of infections. In contrast, China's resolve to stamp out every infection has appeared to only grow stronger, though 75 per cent of its vast population is fully vaccinated.
The country is now grappling with its fourth Delta-driven flareup in two months and this week locked down a prefecture in Xinjiang province over two asymptomatic infections amid a peak tourism period. The Chinese territory of Hong Kong, which has so far avoided local transmission of the Delta variant, has also made clear that its status as a global financial hub is less important than links to the mainland and the joint goal of elimination.
The task is likely to get even harder as cold weather, the conditions in which the virus spreads best, descends. In three months, Beijing will host the Winter Olympics, welcoming thousands of athletes from around the world.
"Covid-zero in the medium- to long-term is unsustainable," said Peter Collignon, an infectious disease physician and professor at the Australian National University Medical School. "Delta shows the almost impossibility of that. It's hard to see how China will be able to get to zero Covid-19 this winter."
Still, the status has become a political point of pride for China, with authorities trumpeting their success in containing the virus as an ideological and moral victory over the US and other nations now treating the virus as endemic.
New Zealand's planned shift underscores the mounting futility of the elimination strategy. In mid-August, the country went into the highest level of restrictions when a single person was diagnosed with Covid-19 in Auckland. No working in the office. No going out to dinner or the gym or church. In most cases, no leaving the house.
Seven weeks later, it's still reporting more than two dozen infections daily, prompting Prime Minister Jacinda Ardern to acknowledge on Monday that "long periods of heavy restrictions have not gotten us to zero cases."
"But that is OK," she said. "Elimination was important because we didn't have vaccines. Now we do, so we can begin to change the way we do things."
It's an adjustment already made by Singapore and Australia, two other lauded examples of containment. In both places, fatigue among the population had grown over stop-start cycles of lockdown and travel curbs that imposed weeks of mandatory quarantine on new arrivals.
In Taiwan, officials said that elimination was too difficult to achieve earlier this year after a large outbreak, though it's now reported no cases for several days straight. The abandonment of the zero-tolerance goal now does not mean the strategy was wrong-headed from the start.
The approach allowed these economies to suppress Covid-19 fatalities to a very low level, getting through the pre-vaccine period of the pandemic with little damage - unlike the US and Europe. New Zealand has suffered 27 Covid-related deaths while Singapore has seen 130.
"If New Zealand can vaccinate widely, get access to new treatments and open cautiously, they'll have escaped the pandemic with little economic or health loss," wrote Devi Sridhar, chair of global public health at Edinburgh University Medical School, in Scotland. "They managed to press pause and wait for scientific solutions towards a sustainable exit."
The question is now what China's exit strategy will look like. In the latest flareup in Xinjiang province, tens of thousands of residents are being tested, while Yining city has halted all trains and flights and closed the local highways, The Paper reported.
Two people were found to be infected in the city of Horgos on Oct 3, which borders Kazakhstan. Though all 38,376 residents were tested and found negative for the virus, and the two original cases were asymptomatic, all tourists in the prefecture Horgos is located in - Yili - have been stopped from returning home and told to stay indoors until further notice.
Local governments were arranging food and lodging for them, the Beijing Youth Daily reported.
The latest flareup followed the contours of earlier ones. Officials shut down the city of Harbin after a single patient was hospitalized in September. The port of Ningbo, one of the world's busiest, was closed in August, while manufacturing took a hit because of the restrictions. The sporadic resurgences are unlikely to stop, public health experts said. But China's authoritarian government has always been capable of feats beyond the imagination of most other countries.
"The kind of capacity and degree of control they can exert is remarkable," said Michael Baker, a professor at the University of Otago's Department of Public Health in Wellington, who sits on the New Zealand government's Covid-19 Technical Advisory Group. "It's way beyond what we can do, not just from a point of view of resources but the social license that governments have. We wouldn't be able to exert the kind of control that China is able to exert, even in achieving a good end, which is managing an outbreak."
Officials in China have said they won't stick to Covid-zero forever, though it will only consider a change when the approach no longer works or the costs are too high - parameters of which have not been made public. City governments are being asked to create specialized quarantine facilities that could house thousands of overseas arrivals by the end of October, signaling that onerous travel curbs are unlikely to be eased in the near term.
Achieving elimination allowed life in China to be largely normal through most of 2020 and 2021, powering its economy even as most others were sapped by mitigation measures of various efficacy. But as its snap lockdowns and restrictions on movement continue through this year - and western economies resume full operations after vaccination - the impact is starting to show more deeply. Retail sales growth slowed to 2.5 per cent in August from a year earlier, falling far short of the 7 per cent expansion estimated by analysts.
Regardless of China's tolerance for the approach, some experts say that Covid-free havens may yet return. Governments like New Zealand could resurrect the goal if and when new medical options become available.
"Maybe we are reaching the limits of what we can do with our current tools to eliminate transmission," said Baker, who believes a Covid-zero strategy is still on the table. "We could find that the next generation of Covid-19 vaccines or anti-virals are so effective that they can eliminate the virus quite effectively."