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Comment by mrtksn | Hacker News Reader

Lockdowns certainly can stop geometric rise of an infection and it can make sense if you don't want to have people who might have been saved dying in hospital corridors due to lack of capacity but IMHO it doesn't make any sense whatsoever as a long term solution if the lockdown is not globally coordinated to eradicate the microbe at once. If the lockdown is not global, it will keep coming back.

That's why I wonder what China is trying to achieve here. Are they trying to get rid of any foreign dependence under the pretext of health concerns? Turkey's Erdogan did something like that with their stock exchange, i.e. pushing out foreign capital let Erdogan do economically ridiculous things without having international pushback.

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> I wonder what China is trying to achieve here.

From reading scientific papers about the occurrence of complications in people who've had Covid twice, it looks like the virus inflicts long-lasting damage to the body, even if it isn't readily apparent.

People how have Covid twice have a higher rate of complication the second time around (including post-Covid syndrome a.k.a. long covid). There are no reasons to think that people in places where "living with Covid" is a thing really are rotting with it. Vaccines do little to protect against this.

In Europe, the cumulative incidence of confirmed infections is nearing 50% of the population (and ~30% in the US). In China, that number is less than 1%.

Major caveat regarding the reasoning above, the studies were carried before omicron emerged. These variants have fewer complications, not sure how this will compound.

It is possible that the drop in productivity in the US that's been reported this week (https://news.ycombinator.com/item?id=33405389) is in part driven by lower mental acuity or immune system performance. The decline may not be large enough to be noticeable on a day to day basis, yet show up in aggregate measurements.

Xi may be playing the long game here. If the above holds, even if Covid ends up endemic in China after a while, its workers would have an edge on the rest of the world.

————

https://www.researchsquare.com/article/rs-1749502/v1 (it's only a preprint, but third party experts vouch for it: https://edition.cnn.com/2022/07/05/health/covid-reinfection-...)

I've read an earlier paper on the topic, but I can't find it right now.

> In China, that number is less than 1%.

If you can believe that number. If I had Covid in China I would do everything to keep that a secret.

The drop in productivity is a fake as it is still higher than in 2010 before Covid.

China already has an edge by numbers alone. Total productivity is the main factor here.

Point 1 is reasonable, point 3 arguable, but point 2 is way off..

> The drop in productivity is a fake as it is still higher than in 2010 before Covid.

Could it be that we made technological progress in the mean time?

The drop definitely isn't fake (https://www.bls.gov/charts/productivity-and-costs/nonfarm-bu..., look at the blue line), and a stark break from a consistent increase in productivity that's been ongoing for decades with few exceptions (https://ourworldindata.org/grapher/labor-productivity-per-ho...).

Well, if the noise of productivity seems to allow +10% year-to-year, it is the same in the other direction. I simply don't believe the prognosis.

https://www.washingtonpost.com/business/2022/10/31/productiv...

This is a typical media filler story. Textual bullshit. Reality was probably too boring again.

It's not year-to-year noise, it's quarter-to-quarter, and there's a seasonal pattern that vanishes if you do year-on-year quarter comparison (see the solid blue line in the bls.gov chart).

The WaPo article only shows the dotted line data from the BLS graph, which is far noisier, but shows two consecutive quarters of decline, which is unusual too.

I'll add that, since posting this, I've discovered this video (https://twitter.com/YanzhongHuang/status/1586537964267798530) that predates my post, where a Chinese businessman makes the same argument.

I had no idea this was openly discussed over there (though I suppose I should have guessed it was).

China's vaccine doesn't work. The zero-COVID policy works to control the spread of SARS-COV-2 and its variants. The policy does not work to control the spread of human misery, unemployment, and general disruption of lives. But the people in government have no ethical framework, and no political consequences requiring they attend to the actual needs of the people governed.

At this point, it is about the appearance of taking action so that the policy decisions of Xi Jinping's government seem correct, not about doing what's effective for the overall health of the system which includes all of the governed in all the variety of their activities and pursuits.

A couple of reasons. First, the strict measures were popular and people demanded them. It's been a while since I've spoken with people in China so I'm not sure how much this is still the case, but it was definitely true up to last year.

Second, the measures allowed most people to move relatively freely and go to discos when we still had blanket lockdowns in the west. The idea was to crackdown hard and quickly create green zones were life was possible almost as before. While that means millions of people on lockdown at a given time, it was likely a small fraction of the total population. (I'd like to see actual numbers here but find them hard to come by TBH).

Third, COVID is special as it is one of the few airborne / aerosol-transmitted diseases that you have a good chanche of supressing. The reason is that it shows overdispersion: most people are only slightly contagious, but few people are extremely contagious. (Caveat: I think that was the case with SARS, and with the early SARS-COV-2 variants, but I haven't seen data for Omicron.) This means that contact tracing is extremely effective. Most people will have had contact with the same few spreaders, and if you take them out, you can suppress the virus such that it will die out in a population. Western countries borked that up completely. When the incident numbers were really low, we dropped most measures, but that would have been the opportunity to eradicate it with just 1-2 more weeks of social distancing. Asian countries were much more successful with suppression.

Finally, China is a huge country. Most people move around inside, but rarely leave (its a bit like the US in that regard but much more so). To leave as a Chinese citizen you actually need an exit visa. So the majority of people are not bothered very much by travel restrictions. The comparatively little cross border traffic you can control by just giving everybody mandatory PCR tests. I could imagine the Borders to north Korea, as well as to Laos/Vietnam might be problematic to control, but AFAIK they are pretty closed up now.

So it makes totally sense to them to continue their strict course. I imagine as soon as a good vaccine becomes available there too (maybe a nasal vaccine that can prevent infection and not just severe cases), they will reevaluate.

“Third, COVID is special as it is one of the few airborne / aerosol-transmitted diseases that you have a good chanche of suppressing.”

The fatal flaw of this reasoning is that it lies dormant in animals.

Zoonotic spillovers are rare, this is why you probably never heard about corona viruses before 2002/2003 (SARS). The probability is increasing of course because we are detroying animals' habitats. And because we live in a densely interconnected world but can't agree on how to control diseases. We can either work on those problems, or throw the hands up in the air and blame the bats.

SARS-COV-2 combines aspects of HIV, the common cold, and Monsanto-engineered protein sequences, none of which had any chance of coming together in a single organism in the wild in order to combine like this.

I don't think bats are to blame, nor can this be a "simple matter" of zoonotic spillover.

Could it also be the vaccines that were administered in China being less effective? If I recall people were hesitant to get the ones they developed and they at some point admitted that the initial ones had too low of an efficacy. So it'd make sense (for the gov) to fall back to lockdowns, maybe?

Definitely. Unfortunately vaccination is political everywhere and there are also profit interests, so they can't just use the "better" vaccines.

With the mRNA vaccines and the weaker virus variants, we averted a lot of deaths and the "collapse" of the hospitals in many places. But we are still dealing with many dead, millions of work days lost per year, and many cases of long covid...

> First, the strict measures were popular and people demanded them.

How is this determined? A democratic vote....in China? At best, it's tyranny of the majority. The article quoted Xi as saying the people wanted it, but that's not the same thing.

"Videos posted on Chinese social media site Weibo showed people rushing to the park's gates following the announcement but finding them already locked."

It's a great policy to apply to other people. But it seems that they don't want any of it.

> That's why I wonder what China is trying to achieve here.

Most likely explanation: Population/unrest control. If you can randomly shut down parts of the country for the pretend reason of a plague, you can stop unrest from rising. Do shut down small areas randomly for maximum fear and effect.

Remember the Hong Kong protests?

> Remember the Hong Kong protests?

Perhaps the authority was concerned the unproductive unrest would go down like Libya, Syria, Egypt, Ukraine without and endstate better than how things were before the young and impressionable took to the street.

Sorry dude, one can't simply tell truth here. Your downvoters shall persist with their cognitive dissonance until they find themselves literally l̶o̶c̶k̶e̶d̶ self-isolated in t̶h̶e̶ ̶c̶e̶l̶l̶s̶ ̶o̶f̶ ̶t̶h̶e̶ ̶M̶a̶t̶r̶i̶x̶ their cosy appartments f̶e̶e̶d̶i̶n̶g̶ ̶t̶h̶e̶ ̶M̶a̶c̶h̶i̶n̶e̶ signalling their virtue, and even then they will pretend it's OK and everyone dissident is just nuts.

> I wonder what China is trying to achieve here.

Exactly the same as what the western world has tried for 2 years, give or take. It doesn’t work either way, but due to their authoritarian government they just have the ability to keep trying for longer.

The western world made a show of trying, but trying to balance political considerations with covid control is basically impossible. When cases are low, the political pressure to relax restrictions is irresistible, and then R goes above 1, but the political will to do anything about it comes too late to help much.

Frankly I'm surprised that China managed to control Omicron. It's certainly a social-technical feat.

In the end, only time will tell whether the Chinese strategy was a good one for China. Obviously China has paid extreme costs to maintain its policy. It's still unknown what the longer term results to the health of the population will be in other countries will be though.

Ah, clinging to the old fantasy of ‘low R values’, as if somehow that will cause the pandemic to disappear. In reality that outcome will online happen when there are exactly 0 cases left, both in humans and animals, in any country in the world. Spoiler: that’s never going to happen.

The fantasy is a reality in China. It's not necessary to get to zero cases to have a disease simply not be a major problem, similar to Measles in the U.S. In the general population for Measles R<1, so while it pops up from time to time in some poorly vaccinated communities, for the general population that's been vaccinated, it's really not an issue.

The fantasy with COVID was that you'd get R<1 for a period of time until there was a vaccine, and then the vaccine would do all of the work keeping R<1. Unfortunately the COVID vaccine doesn't do that. Hopefully some day we will have one that does that.

Well I don’t know what the mainstream theory was in the US but in the Netherlands it was ‘well if due to our lockdowns R is smaller than 1 the disease will just die down’. Which is obviously nonsensical in a pandemic.

If R is lower than 1, the disease will die down. If it's greater than 1 it will flare up (by definition). China has reached a stage where they have essentially eradicated it within China. They still import cases though into areas where R>1. When that happens, they get a flare up, and then they clamp down with massive testing and, if it gets bad enough, lockdowns, until they eradicate it from that area again.

Now at the beginning, one strategy could have been: get R much lower than 1, and push the disease to near eradication, and then dynamically change anti-covid measures so that R approximately equaled 1, which would entail substantial restrictions, but not a Wuhan or Shanghai style lockdown.

The problem is that riding along at exactly R=1 means any time the seasons change, or there's a new variant, or people's behavior changes, you have to constantly adjust restrictions. Generally it has been shown to be impossible in democracies to get enough people to agree to do this, and it's generally not politically possible to enforce this.

Once the vaccines came out, the hope was always that they would dramatically reduce transmission so that R was much less than 1 and we could treat it like measles, and for a while (mid-2021, pre-Delta) that seemed to be the case, but between waning immunity and Omicron, it turned out that the vaccines were not able to reduce transmission to a great enough degree to make this happen.

The vaccines were tested and approved so scientifically it should have been known before the rollout started that it wouldn’t work. So once the vaccines were approved (December 2020) either we knew all along it wasn’t going to work and the R values theory was just psuedoscientific fraud to get the population to comply, or we didn’t know and the approval process was faulty.

Either way the R values theory was never going to work because there was always going to be a big part of the population (animals, people abroad) that can’t be controlled with lockdowns or vaccine mandates. And that also should have been known.

And lastly, R values theories make for nice, easy to explain pop science, but it’s all statistics with all the downsides: the R value that’s on the news is just a number calculated from limited tests, and those tests can be manipulated. And it’s part of a random process; R>1 doesn’t ‘mean flare ups will occur’. It means the chance is higher that the numbers will go up. But they can also randomly go down.

All interesting for pop science and for making models and reports but a lot less useful for political decisionmaking in the real world.

The vaccines were not approved on the basis that they reduced transmission. This was a widely held hope, given that other vaccines do this, but that wasn't an endpoint of the studies. There was a little bit of data in the Moderna trial that was very encouraging, namely that everyone in the trial took a PCR test at the time of their second dose, and people in the active arm had a much lower positivity rate. There was also a lot of epidemiological evidence for the vaccines dramatically reducing transmission.

The problem is that this data was gathered with a different version of the virus than we have now, and it was gathered with relatively fresh vaccinations. Even pre-Delta, you could see immunity waning leading to increased transmission in Israel. With Omicron, the efficacy of the vaccines is also much less.

That said, from all the evidence we have, the existing vaccines still do reduce transmission, but not enough to prevent epidemic spread. There are a lot of numbers, because every study has a different population and different ways of measuring, but roughly speaking, being vaccinated cuts your risk of contracting and transmitting COVID by something on the order of 50%. That's a lot better than nothing, but COVID is so contagious that it's not enough.

The "R values theory" is perfectly reasonable and almost tautologically correct, and works regardless of an animal reservoir and imported cases from travel. We have the same issue with imported cases with Measles, but hardly anyone gets Measles, because almost everyone is vaccinated, and the R value in the population is much less than 1. If you import a case, that case infects less than 1 person on average, who infects less than 1 person on average, etc, until it dies out. R<<1 doesn't mean you have no cases, it just means that it's self limiting. If you import say, 100 cases a year, maybe that leads to 50 or 100 locally acquired cases total, but for the average person, you don't really have to worry about it. The exception is communities with low vaccination rates. You sometimes see Measles pop up still in the U.S. in religious communities, etc, because R for Measles in those communities is greater than 1 due to the lack of vaccination.

It would be great if COVID and COVID vaccines were like Measles, but unfortunately the vaccine isn't yet good enough.

The current strains are in between the severities of a cold and the flu. Lockdowns and so forth are ridiculous at this point and have been for at least a year, maybe even 18 months.

If a disease arises with a much higher fatality rate, lockdowns are still pretty much our only tool to deal with it. Eradication or not, we’re not going to survive a 35% IFR virus with business-as-usual plus hand washing and masks. China will locally eradicate it, and here in the US well… I dunno. It’s not looking great.

> China will locally eradicate it

You understand that with globalization, this makes no sense, right? It will return, again and again. Economic impact of always going into lockdown will be insane. Another reason for western companies to become less dependent on China in the long term, massive reduction in productivity in the short term.

With luck it means we’ll survive a high-IFR virus until vaccines are available, and won’t lose a huge chunk of our population and suffer collapse. China will even have a working economy. In the face of something truly deadly there aren’t good alternatives. China’s unwillingness/inability to switch to a post-vaccine strategy is the error here, not their very successful use of quarantine+lockdown pre-vaccine.

Particularly given the it is now endemic in so many countries.

If there ever was such a disease you’d actually have the opposite problem of convincing people to go out and keep society running.

The biggest casualty of covid is the trust in health authorities. Unnecessary lockdowns (assuming those even work which is really not clear given the absence of inflection point in cases when they were introduced in europe) will just lead to even more distrust.

Also high IFR viruses usually have high symptoms. Much easier to contain a disease when you can tell people are sick. People feeling sick will also travel and spread less. What made covid so widespread is that it was so mild to so many people. So there is a kind of bell curve of deadliness vs infectiousness. So not really convinced by those argument of what if covid was so much deadlier. You would need a virus with zero symptom while you are infectious, and then that kills you, like an airborne HIV. Anything is possible but with ifs...

Lockdowns didn't really do much in europe. Like washing hands it feels more like a placebo treatment to make people feel like the gvt is doing something useful.

It's simply zero covid working better than the best vaccines which will still lead to millions of deaths at PRC scale and with PRC's relatively lower per capita medical infra. Economically it sucks, but despite disruptions PRC exports booming and moving up the value chain until global slowdown due to UKR war, while being huge producer + cheap RU energy + reserves = slower growth + low inflation, and PRC is still doing relatively alright simply because most others are doing so shit. I imagine not even CCP knows how it ends long term except currently the cost benefit of waiting is worth it, especially with unknowns like long covid, or possibly useful excuse for impending global slow down that's going to impact PRC economy anyway. Might as well as weather it under guise of saving lives. TLDR is it's still sustainable status quo.

>It's simply zero covid working better than the best vaccines

Based on one metric. But ultimately it's self defeating. If you flush the economy down the toilet then there isn't the money for clean water, or hospitals etc.

Further zero flu works better than the vaccine. Do you want to stop the world until every disease is eradicated.

Lockdowns were never sustainable, in the context of a modern economy. It's a question of the least worst option. Vaccines mean it's no longer the least worst option.

> Vaccines mean it's no longer the least worst option.

Millions of dead, and 100s of millions taken out of workforce for ~2 weeks during infection, possibly multiple times, possibly with long covid effects for years after, or we're coming up on winter where immunity weakest. It's far from clear vaccines isn't the worst option short term (0-3 years).

>flush the economy down the toilet

I mean sure? Except with confluence of global factors PRC economy, while underperforming is still outperforming most of western countries, as stated above. Hence status quo is currently sustainable, there is less pressure to deliver economically when everyone else is sinking. Obviously sustainable not long term, but I can easily see another year or two, especially with global slow down. The broader point being, all the western MSM reporting on PRC wrecking itself economically is avoiding the fact that it's not wrecking itself as much as most developing countries with RU sanctions, or dealing with US dollar, and US dealing with end of cheap money. Zero covid + three red lines on real estate + tech crack down, etc all deliberate policy choices are not as devasting as 10% inflation or end of cheap credit causing housing sales + tech valuations to crash like in PRC. It's not world ending, PRC is collapsing stuff.

>Do you want to stop the world until every disease is eradicated

No I think PRC wants to stop this specific disease that has demonstrably kills many people with linger side effects even in wealthy countries with access to better health care.

E: posting rate limited so @benj111

>So I don't even know what figures you are working with

Studies conservatively extrapolating TW/SKR post living with covid + mRNA numbers to PRC with modifier for lower per capital med care access. I don't know what figures you are working with to conclude ~3M would get covid when it will be 100s of millions since no vaccine prevent spread and majority of pop have no natural immunity. Estimates from scientists who actually crunched the numbers: a few million dead, significant % of which due to overhelming hospital infra.

1. Millions of dead (conservative estimate is ~2+) is still factually a lot of dead to deal with. If that can be avoided with accepted costs (which I'm arguing, currently is) then why not.

2. It's worse in that it comes with millions of dead bodies and at least 10s of millions long covid. Maybe zero covid is sunk cost and those figures are inevitable, but still no compelling reason for lifting short term.

3. Covid = flu? Are linger side effects of flu as well understood as covid? Annual influenza deaths is fraction of covid deaths. Extrapolating from US annual flu deaths, in PRC, influenza would kill ~100,000 per year vs again millions of covid deaths in same period. Like if PRC can get away with only 500k hospitalizations, Xi could personally go smother each covid ICU patient and still spin it as a win.

>Millions of dead, and 100s of millions taken out of workforce for ~2 weeks during infection, possibly multiple times, possibly with long covid effects for years after

1. In a country of billions, 'millions' could mean fractions of a percent. 'millions' in this context is just emotive rather than factual.

2. What do you mean taken out of the workforce? From illness? That sound wrong. From isolating? How is that worse than it Chinese status quo?

>No I think PRC wants to stop this specific disease that has demonstrably kills many people with linger side effects even in wealthy countries with access to better health care.

Which is why I specifically gave the example of flu. A disease that kills and has lingering side effects. A disease that we live with currently. Millions of people in China probably due from flu every year. Which incidentally shows how flawed your use of the figure is.

From what I can work out ~3m people would be expected to get covid in China if they were all vaccinated. ~500k would be hospitalised. And ~70k would develop long covid lasting at least 6 months. So I don't even know what figures you are working with.

chinese population is ~1.4 billion

https://health-study.joinzoe.com/post/risk-covid-after-vacci...

>We saw that 2,394 and 187 people tested positive for COVID-19 more than two >weeks after their first and second jabs, respectively, with the chances of ?>becoming infected falling as time passed.

>That’s the equivalent of one in 500 (0.2%) and one in 3,333 (0.03%)

1,400,000,000 x 0.002 = 2,800,000

(Note I actually misinterpretted this as applying to 2 different vaccines, of which I chose the least effective, whereas this is after just 1 jab.)

based on double jab figures the figure would be around 0.5 million.

>Reassuringly, only 104 people in the vaccinated group who tested positive for COVID-19 ended up in hospital (one in 2,500 or 0.04%).

1,400,000,000 x 0.0004 = 560,000

https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/... >Estimates of the proportion of people who had COVID-19 that go on to >experience post-COVID conditions can vary:

>13.3% at one month or longer after infection >2.5% at three months or longer, based on self-reporting >More than 30% at 6 months among patients who were hospitalized

2,800,000 x 0.025 = 70,000 (although this is based on the single jabbed figure, fully jabbed the figure would be 1400.

>when it will be 100s of millions since no vaccine prevent spread

Are you saying the vaccine doesn't stop you getting covid? that is false. It doesn't stop it 100% but it is significant, significant enough that outbreaks can die off on their own. Further i'm not sure if thats even relevant, the issue is how many it kills. its easy to get a cold, you don't need to worry about getting a cold because that won't kill you. so the relevant factor is how good is the vaccine at preventing major illness and hospitalisation.

https://assets.publishing.service.gov.uk/government/uploads/...

vaccines lower risk of infection by 60% - 80% vaccines lower the risk of symptomatic disease by 65% - 90% vaccines lower risk of hospitalisation by 90% vaccines lower risk of death by over 90%

Rather than doing napkin math using sources like joinzoe, i.e. self report (app) on population with high natural immunity due to uncontrolled spread, with great health care infra, and low population density - many factors why that's a bad place to start your reason chain - here's earlier study by epidemologists who are familiar with PRC conditions.

https://www.nature.com/articles/s41591-022-01855-7

> lift such measures could see more than 112 million symptomatic cases of Covid-19, five million hospitalisations, and 1.55 million deaths.

There's also later analysis that extrapolates with TW/SKR numbers after they began living with covid with IIRC greater deaths. These are fellow East Asian examples with more simliar conditions than PRC except they have much better per capita health care infra.

>relevant factor is how good is the vaccine at preventing major illness and hospitalisation.

Yes and the relevant factor to that relevant factor is PRC doesn't have the ICU beds / hospital infra per capita to absorb even vaxed spread. Most of country is old and underdeveloped and "crushing the curve" is still the best path. Vax prevents severe cases but at PRC scale and infectiousness of omicron, in dense urban enviroments during colder seasons, that's still more symptomatic severe cases than the medical system can handle.

>We find that the level of immunity induced by the March 2022 vaccination campaign would be insufficient to prevent an Omicron wave that would result in exceeding critical care capacity with a projected intensive care unit peak demand of 15.6 times the existing capacity

https://www.theguardian.com/world/2022/may/11/lifting-zero-c...

That's the crux of the issue, PRC is a developing country with low hospital beds per capita that demographically skews old (and antivax). These factors means PRC is better off with no vaccines and zero covid than vaccines and living with covid until zero covid or some other factor makes zero covid unsustainble.

> It's simply zero covid working better than the best vaccines which will still lead to millions of deaths at PRC scale and with PRC's relatively lower per capita medical infra.

If China was able to logistically handle zero covid, I would be more inclined to agree with you. However, each time a city in China has been locked down, it has been a logistical disaster that almost always resulted in:

- extremely poor quarantine zones in unsanitary conditions (which defeats the purpose of being free of disease). This includes many people who were lucky enough to quarantine in their own homes as even their pets are not allowed to leave, they need to dedicate spaces in their home for their animals to defecate.

- lack of basic necessities; food, heating, water leakage, insect problems, or even lacking a proper indoor building in some cases.

- a lack of professionalism, discipline, or even respect of human decency among the staff. Attaching spikes to entrances to keep people from leaving by force, refusing to allow elderly access to medical care, threatening people with weapons, security bao'ans going on China social media laughing about all the new found power and control they have over the populace, beating people in a show of their power trips.

- questionable policies, such as requiring everyone in a community to come together, line up, for a covid test, which increases the likelihood of getting covid, rather than go door to door.

This has lead to more than just inconveniences, it's lead to death. Which is supposedly the very thing this is all supposed to avoid. The Chinese state has proven by experience, repeatedly, that it cannot logistically handle these strict policies. It is a failure of the zero covid policy and a failure of the Chinese Communist Party to administer its State in a competent manner.

> able to logistically handle zero covid

Seeing as we are almost 12+ months post delta/omicron and local outbreaks have consistently been contained to prevent uncontrolled geometric spread, yes PRC is logistically handling zero covid. Over many lock downs, of various sizes, across different regions, to keep spread at so-far managable levels.

> logistical disaster / always resulted in / it's lead to death

Of course, it's not a smooth 5star process, shutting down urban regions with millions fundmentally can't be. That's not a failure of policy, but acceptable baseline for competent epidemiologic management, competence being it contains spread and saves significantly more lives than it takes. Some pain/death is inevitable operating on the scale of hundreds of millions. The "very thing it's suppose to avoid" is millions of deaths due to uncontrolled spread and overwhelmed medical system, not a hundreds/thousands of incidental deaths because someone peoeple starved/suicided/bus crashed. Same with increasing chance of local spread to prevent higher order spread. Like these aren't exquistily managed bespoke interventions, they're coarse but by now tested methods that can be implemented in a snap. Of course it's not clean, but it's better than health system collapsing. The cost benefit analysis of maintaining zero covid, when one can, and PRC can, is obvious. So obvious that I'd argue they're politically trapped by repeated demonstrating ability to logistically execute zero covid.

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