Covid in China: A Twitter Thread and Article

I wrote a twitter thread and an article about Covid in China before authorities abandoned their zerocovid policy in early Dec 2022. The thread/article often get criticised. Alex Berenson had a go at them but they also attracted more informed criticisms. Long thread ahead.
1/ https://t.co/gwUS2exjSl

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

The original thread in question.
2/https://t.co/KGgXljUGAs

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

The article in 'The Conversation'.
3/https://t.co/pu1CTdpwYc

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

Following one of those many discussions, I prompted @DanielHadas2 to come up with a series of criticisms, which I would address one by one. @DanielHadas2's manichaeistic worldview is very far apart from mine, but I consider he argues in good faith.
4/

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

Before I engage with his questions, I wish to state that I have virulently opposed 'zerocovid' policies since March 2020, as I believe they are epidemiologically idiotic and incompatible with my moral and ethical values.
5/https://t.co/xCQ3qd4VzP

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

On a more technical level, I believe that SARS-CoV-2 transmission can be suppressed with extreme 'social distancing' measures, and I am actually baffled that some seem to disagree with that, to me, evident statement.
6/

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

There was hardly any virus in circulation in Europe in summer 2020. Several countries in Asia and Oceania kept Covid in check for nearly two years and New Zealand even (somewhat accidentally) eliminated Covid from its territory.
7/

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

I don't particularly trust Chinese authorities but the idea that they had a lot of 'hidden Covid' in 2020-22 strikes me as pretty fanciful, given their closed borders and the brutal quashing of any emerging outbreak.
8/

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

Now, the questions and answers:
1- "A major surge seems largely inevitable in the short term".

Every single country that relaxed 'social distancing' measures experienced a major Covid wave, in particular when the re-opening was during the 'Omicron era'.
9/

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

That is true for countries with pandemic policies as diverse as Sweden, Denmark, Singapore, Australia, the UK ... A big wave in China with ~60-80% of the population getting infected in a short time interval was inevitable once restrictions were lifted.
10/

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

Official Chinese Covid case numbers are fanciful, but Chinese authorities don't even deny they had a major peak of cases in the winter 2022/23.
11/ pic.twitter.com/pHuwyqoyZH

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

2 - "A major Covid-19 surge in China would lead to a dramatic death toll"

In the Conversation article, my guesstimate for the number of deaths was ~1M. This was pretty conservative, and I believe it has been exceeded.
12/https://t.co/mGmBzWZ9eG

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

The official Covid death toll communicated by China is 83k. China has a unique and 'interesting' approach to counting Covid death, in variance with any other country, and with WHO's guidance. Even so, this number feels implausible.
13/https://t.co/J6tJ2jTALc

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

Extrapolation to China from the Omicron wave in Hong Kong, which faced a largely similar situation, with far better healthcare but worse vaccination rates of the elderly points to ≥~1M deaths.
14/ pic.twitter.com/xD5Q9EIeae

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

China tightly controlled the narrative around the death toll, and a lot of the evidence is anecdotal, and/or will take time to emerge. One unusual source of evidence for the death toll among the elderly is the peak in obituaries of 'academicians'.
15/https://t.co/uaD5km2c9t

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

3 - "[China's] healthcare system is fragile, in particular outside major cities. It would be easily overwhelmed by any significant surge in Covid-19 cases.

China's healthcare system is fragile overall, and it got overwhelmed, at least locally and transiently.
15/

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

Overall the health care system coped better than I worried, but there are grim videos of overwhelmed hospitals, which I won't link to, but are easy to find on the internet. The situation in some hospitals was largely reminiscent of Northern Italy in March 2020.
16/

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

4 - "the failure of a zerocovid strategy would be difficult to handle by Chinese authorities, given the immense political capital they invested into it since early 2020".

I appreciate this is difficult to quantify and it may take time to fully materialise.
17/

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

Though, I stand by this prediction. There are two aspects to it.
1. The cost in terms of China geopolitical soft power
2. The cost in terms of trust by the Chinese population in political authorities.
18/

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

Until fairly recently, 'zerocovid' was far from a fringe movement internationally, for a sizeable proportion of the population, including politicians, journalists and prominent academics ... and tankies
19/

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

There was a time not that long ago, when this hell site was full of tropes along the lines of "China knows something we don't", They care about their people", or "Thanks to zerocovid, they'll rule the world, when we will all be dead". Those are gone...
20/https://t.co/JZ6I6FlbLR

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

The effect of the brutal, lengthy enforcement of zerocovid, followed by its lifting essentially overnight, with a message shifting from one day to the next, from "Covid is the plague" to "Covid is a mild cold", must have rattled a large section of the Chinese population.
21/

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023

I know China a little bit but appreciate that public opinion is largely inscrutable from the outside. That said, I very much doubt that this extraordinary volte face won't come back to bite the government in the long-term.
22/

— Prof Francois Balloux (@BallouxFrancois) March 24, 2023