China can prepare to end its zero-COVID policy

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The greatest challenge of moving away from the zero-COVID approach in populous mainland China is that SARS-CoV-2 cases could surge rapidly, with high case numbers for months after stringent control measures are lifted. The rising cases could overwhelm healthcare systems (Table 1), which could greatly increase the COVID-19 CFR.

SARS-CoV-2 is currently circulating in Japan, South Korea and Hong Kong at high levels, which should be observed closely as natural pilot experiments to evaluate the risk of the change in mainland China. It should be noted that the COVID-19 vaccination rate is low in Hong Kong, particularly in elderly people, which may render the COVID-19 outbreak there more severe than in mainland China.

Mainland China should also stockpile antivirals, personal protective equipment, N95 masks and ventilators, particularly at community hospitals. Traditional Chinese medications should also be considered, as they have a profound role in Chinese society and may help relieve mild respiratory symptoms.

It is our view that mainland China should consider changing stepwise from the zero-COVID approach in April or May 2022. By this time, vaccination immunity will not have declined much and most parts of the country will be warm. There is some evidence that SARS-CoV-2 is less transmissable in warmer months, when co-infection with other respiratory pathogens will also be less frequent.

Regardless of when the zero-COVID policy changes, preparations should be implemented in advance to confront the challenges.

J.-M.C. and Y.-Q.C. conceived and conducted this analysis and drafted the manuscript. J.-M.C. supported this work.