As the number of COVID infections remains high worldwide, epidemic prevention and control work in Shanghai has entered a critical stage due to a new round surge in infected cases. During his recent inspection of Hainan Province, General Secretary Xi Jining once again stressed the need for adhering to the dynamic zero-COVID policy with scientific and targeted measures, which points to the striving direction and provides key guidance for Shanghai to carry out effective epidemic prevention and control. With a population of nearly 25 million, Shanghai has all the inherent characteristics of a megacity: high population density, an aging population, and large networks. These characteristics naturally require us to adhere to the principle of putting the people and their safety first, and firmly implement the dynamic zero-COVID policy with scientific and targeted measures. This is a policy that is in line with China's national conditions and can minimize the impact of the pandemic on the city and the country as a whole. 



The “dynamic zero-COVID” policy is the only way to prevent a run on medical resources for Shanghai as a megacity with high population density, high mobility and easy virus transmission 

Since the first case was detected in South Africa in November 2021, Omicron has rapidly swept across the world to become the prevalent coronavirus variant in many countries. As high population density is a key factor aggravating the COVID-19 pandemic, densely populated communities have become the hardest hit areas. Data from the United States, Japan, South Korea and other countries show that Omicron is much more contagious and stealthier than any of the previous coronavirus variants. As a result, the number of confirmed cases in many regions has soared, reaching new record highs over a very short period of time. Naturally, megacities like New York, Tokyo and Seoul that have the highest population densities have also become the most seriously affected places in their respective countries. For example, it took only five weeks for Omicron to become the dominant virus strain in New York City, while 20 weeks were needed for the Delta strain to do the same. New York Post reported on April 19 that the average 7-day positive test rate of Omicron was 4.46% in New York City, but it well topped 15% in densely populated areas such as Manhattan's financial district and Lincoln Square. Since Seoul reported its first Omicron case on December 1, 2021, almost all the new infected cases in the city have been Omicron infections, with the capital region being the hardest hit in South Korea. The same pattern has also happened to Tokyo, which accounted for a quarter of Japan's all confirmed cases in the peak month of February this year. 

Despite the currently low proportion of severe cases among Omicron infections, the sheer large number of the cases in absolute terms may well cause an overrun on urban medical resources. Shanghai is one of the cities with the richest medical resources in China, but it is already under a heavy burden, which makes it difficult for the city to cope with the enormous impact of the Omicron virus. In 2021, medical institutions in Shanghai made diagnosis and treatment for 272 million people, the biggest of all cities in the country. The burden on local medical resources was extremely high, and the hospital bed utilization rate ran as high as 86.72%. After the current surge in COVID infections broke out, Shanghai has imposed city-wide lockdowns since April. However, as of April 19, 2022, more than 30,000 cases had already been diagnosed and 22,522 cases (including 52 severe cases) treated in hospitals in Shanghai, putting enormous pressure on local medical resources. Shanghai has only managed to cope with the soaring needs of epidemic prevention and control after it built more than 100 shelter hospitals and tens of thousands of medical staff nationwide were drafted from around the country to its help. It is clear that the megacity characteristics of high population density and high mobility have led to a relatively small proportion but a large absolute number of confirmed Omicron cases. As a megacity, Shanghai must adhere to the "dynamic zero-COVID" policy to prevent the large-scale spread of COVID-19 among communities and reduce the risk of an overrun on local medical resources. At the same time, it is also necessary to further ensure the supply of livelihood items and the provision of regular medical services for residents during “dynamic zero-COVID clearance” and lockdowns. 



The “dynamic zero-COVID” policy is the only way for Shanghai as a fast-aging metropolis to protect the safety of its residents 

Shanghai is a megacity with an aging population. The culprit of the current round of resurgence in infected COVID-19 cases in the city is the highly contagious Omicron, which poses a big threat to elderly people and does great harm to those unvaccinated. According to China’s seventh demographic census, there were 5,815,500 people aged 60 and above and 4,049,000 people aged 65 and above in Shanghai. As of April 20, 2022, 62% of the senior citizens aged 60 and above in the city had been vaccinated, while only 38% had taken a booster jab. The rate of vaccination is not high. There are approximately 2,200,000 elderly people, 600,000 infants aged between 0 and 3, and a certain number of pregnant women, lactating women and special people with basic diseases who are not suitable for vaccination. Together, the total number of unvaccinated residents in Shanghai is estimated to be around 3 million, which is a fairly large number. The elderly and the unvaccinated are the groups most vulnerable to the Omicron virus. According to Provisional Data Analysis on COVID-19 Reported Death Cases released by the Hong Kong government on April 14, 2022, most Omicron-induced deaths were elderly and unvaccinated people. As of April 13, the fifth wave of COVID-19 claimed a death toll of 8,735 in Hong Kong, with more than 95% of them being elderly people over 60 and 73% being unvaccinated. The latest data show that the case fatality rate of the fifth wave in Hong Kong reached 0.76% as of April 20, 2022. These figures show that the Omicron virus is far more dangerous than influenza and it is nothing from what some people call a "bad flu". According to the authoritative data in Global Mortality Associated with Seasonal Influenza Epidemics 2019, the influenza-related mortality rate was between 5/10,000 and 1/1,000 among people over the age of 65, but below 1/10,000 for people under 65. In China, the annual influenza-induced mortality rate (with influenza being the main cause of death) is 1/10,000 for the whole age group, but /10,000 for those over 65.

However, it has been convincingly show that COVID vaccination can significantly reduce severe cases and the mortality rate. This is proven by the case of Singapore, which has recently been listed as a "low-risk" country by the Ministry of Foreign Affairs. With the world's highest vaccination rate at 96%, Singapore has achieved a 0.03% mortality rate, the lowest in the world. Therefore, the only way for Shanghai as a megacity to minimize the risk of COVID infections and protect people's lives and health is to put the people and their safety first, adhere to the “dynamic zero-COVID” policy with scientific and targeted measures, and further increase the vaccination rate.  



Adhering to the “dynamic zero-COVID” policy is the only way for Shanghai to prevent local outbreaks from impacting the rest of the country

As the largest economic central city in the country, Shanghai plays a vital role in China’s national industrial networks in numerous sectors, including transportation, finance, trade, shipping, science and technology, and professional services. The resultant exchanges of people, goods and services form well-developed connecting networks between Shanghai and other cities in all directions. Because of its core position in these networks, Shanghai has also become a core node in China’s city network. In addition, as a major consumption center city and a tourism destination in China, Shanghai is bound to have huge flows of people with other cities. According to the 2021 Annual Report on Comprehensive Transportation Development in Shanghai, affected by the epidemic, tourist arrivals and departures in Shanghai reached 220 million person-times in 2020, including 27.7% by air, 12% by highway, 60% by rail and 0.1% by ship. The total number of tourists in the whole year reached 237 million. As can be seen from the Civil Aviation Flight Operation Chart 2021, the top three most connected airports in mainland China are all related to Shanghai (Shanghai-Shenzhen, Shanghai-Beijing and Shanghai-Guangzhou). Before the pandemic broke out, Shanghai’s Hongqiao transport hub had a passenger throughput of 420 million person-times in 2019, while the daily average railway passenger arrival and departure volume between Shanghai and the Yangtze River Delta region reached 446,000 person-times. 

Besides being an important aviation and railway hub in China, Shanghai also has huge inbound and outbound personnel flows through its highway transport system. Before the outbreak of the COVID-19 pandemic, 606,000 vehicles and 87,000 passengers departed for other provinces from Shanghai on average each day. In particular, inter-city commuter corridors have long formed between Shanghai and neighboring Kunshan, Taicang and other cities. In 2019, the passenger flow in and out of the Huaqiao Section of Rail Transit Line 11 surpassed 60,000 person-times on working days, with a flow of 82,700 on peak days. The Omicron virus is already known for its high and stealthy transmission power. Because of the large and frequent personnel flows between Shanghai and other regions in China, if Shanghai is to give the pandemic a free run, it will be bound to cause outbreaks nationwide. Moreover, the great disparity in medical resources between regions is almost certain to result in an overrun on medical resources in the whole country. 

Given all the circumstances, Shanghai as a core node of various networks can only minimize the impact of local outbreaks on the rest of the country by adhering to the dynamic zero-COVID policy with scientific and targeted measures and quickly eliminating any infected case whenever it arises. At the same time, it also needs to consider its key position as a central economic city in various industrial networks and optimize the digital application and verification procedures for various access permits, so as to ensure essential production and logistics flows under the premise of effective epidemic control. 



Source: Deng Zhituan, Research professor, Institute of Urban and Demographic Studies of Shanghai Academy of Social Sciences, Wenhui Daily