China’s Epidemic of Mistrust

At the emergency department of a hospital in Chengdu, China, December 2022. Tingshu Wang / Reuters
At the emergency department of a hospital in Chengdu, China, December 2022. Tingshu Wang / Reuters

China experienced monumental upheaval at the end of 2022. For three years, Chinese President Xi Jinping waged what he termed a “people’s war against COVID-19”, an uncompromising campaign to prevent the spread of COVID-19 infections that became both a nationalistic rallying cry and a symbol of Chinese pride. In that time, his government subjected citizens to intense digital surveillance, frequent harsh lockdowns, and the constant threat of being consigned to quarantine facilities in the event of a positive test. These measures did have the effect of preventing outbreaks in China of the scale that occurred in other countries, such as neighboring India or the United States. But the policy proved unsustainable owing to the overzealousness of its implementation and the uncontainable infectiousness of the Omicron variant. In early December 2022, after a series of extraordinary public demonstrations and sustained financial pressure on local governments responsible for administering COVID-19 tests, Beijing suddenly ditched its “zero COVID” policy and let the virus run amok.

The public health costs of this decision are grim. Government statistics in China are notoriously untrustworthy, but the best unofficial estimates place the number of new infections at around one million per day. The virus is so uncontrolled that, according to the British newspaper The Guardian, nearly 90 percent of the residents of Henan Province (a sum larger than the total population of Germany) are now infected with COVID-19. Low vaccination rates among the elderly in particular are expected to contribute to high death tolls. Official death counts remain low, but videos on social media of overcrowded crematoriums in big cities offer glimpses of a darker truth. Worse still, hordes of migrant workers are expected to travel back to rural villages in late January for the Lunar New Year celebration, which will likely send infection rates skyrocketing in the countryside. Rural areas don’t have the same health-care resources as major cities, so an incoming COVID-19 wave will hit the rural population hard—experts have estimated that China will see 25,000 deaths per day in late January.

It could take some time for the political costs of Xi’s decision to become clear. In the years ahead, the Chinese economy may recover and Xi might even manage a rapprochement with the West, but the Chinese Communist Party could still pay for its mismanagement of the pandemic.

The drastic COVID-19 U-turn is highly uncharacteristic of the CCP. Although it could never be described as democratic, the party does care a great deal about how it is perceived by citizens. Chinese leaders seek to bolster the party’s ruling legitimacy by investing in propaganda, expounding the party’s ideology, and demonstrating how the state is responsive to the needs of the people. They do so because they rely on the tacit consent and even willing participation of society to maintain their grip on power and to enact their policies. The sweeping reversal of zero COVID may pacify some of the angry protesters who took to the streets to reject lockdown measures in November, but disquiet and dissent have grown. Public trust in the party is eroding. Three years of zero COVID—and no significant push to vaccinate the population—have left China grossly unprepared for what is to come, with millions of people vulnerable to the rampaging virus. Xi is taking China down an unknown path, one that may cost the party dearly in its ability to govern.


Authorities signaled the abandonment of zero COVID through a marked shift in state propaganda. The slogan “Be the first person responsible for your own health” is now ubiquitous. Chinese celebrities went on national TV to persuade the public that the Omicron variant of COVID-19, now rampant in China, is nothing to worry about. The authorities stripped the word “pneumonia” from the official description of COVID-19 infection, as if not mentioning a possible consequence of the virus would veil the threat posed by the virus. Under the strictures of zero COVID, authorities would round up anybody who tested positive and move them to faraway quarantine facilities. Now, authorities no longer classify people with asymptomatic cases as COVID-19 patients; instead, such patients are urged to quarantine at home. Before the lifting of zero COVID, Chinese citizens routinely had to line up at testing sites—sometimes late into the night and early mornings—to procure the negative test results required to enter public venues. Overnight, most testing stations were dismantled. The state has left people to fend for themselves.

Some are increasingly desperate. Severe shortages of medical resources are now evident throughout the country; people are struggling to find painkillers and common flu remedies in pharmacies. Many have resorted to traditional Chinese medicine as a substitute for conventional treatments. Others are luckier. The wealthy and those with connections in Hong Kong or Macau have been able to secure scarce medicines and the messenger RNA (mRNA) vaccines that remain out of reach for the general public in mainland China. In an ostensibly communist country, the current health crisis underscores the disparity between the haves and the have-nots.

The now jettisoned zero-COVID regime protected hospitals from the onslaught of the virus, almost to a fault; anyone who wanted to access hospital care had to produce a negative PCR test result, a hurdle that ended up denying many pregnant women and sick elderly people timely treatment. Instead of leaning on medical staff, China’s blunt approach to limiting the spread of COVID-19 depended on mobilizing resources outside the official hospital system to combat the virus in the most primitive way. The government’s vast grassroots apparatus mustered millions of people to shoulder the everyday responsibility of administering COVID-19 tests, locking people up by enforcing quarantines of residential blocks, and sending the infected to makeshift quarantine facilities. An official estimate suggests 4.9 million grassroots party organizations were involved in the effort, which had mobilized over four million community workers across 650,000 urban and rural communities nationwide in the fight against COVID-19. Since the abandonment of zero COVID, authorities have laid off many of the workers who were hired to enforce community lockdown measures.

In other countries, trained medical professionals usually performed the task of fighting the virus. This was not the case in China. The party-state’s capacity to mobilize grassroots workers and volunteers on such a massive scale demonstrated the prowess of what I have termed its “everyday state power”—its ability to penetrate society and muster people to implement quotidian state policies. This kind of power, with key responsibilities outsourced to a willing society, allowed China to impose zero COVID for so long.

Xi’s abrupt about-face has flooded the hospitals—which, unsurprisingly, were unprepared for the sudden surge in demand for medical care and have been forced to turn patients away. Doctors, nurses, and other medical staff are falling ill, leading to personnel shortages. ICU beds are in short supply, with the situation most acute in rural areas where medical resources are threadbare compared with what is available in metropolitan areas that are better funded by China’s decentralized health-care system.


Public anger and anxiety are palpable. Many Chinese citizens are still reeling from the mental exhaustion of three years of intermittent lockdowns. Some public intellectuals have even demanded an apology from the party for the collective trauma caused by zero-COVID policies. The sudden abandonment of restrictions has created further grievances, with the public angered by empty shelves at pharmacies, inaccessible hospital care, long waitlists at the crematoriums, a lack of reliable information from the state, and contradictory official rhetoric that insults their intelligence.

To be sure, the United States and other countries went through similar shocks to their health-care systems and saw rising social discontent at the peak of the pandemic. But the mounting stresses on the Chinese system follow the intense pressures of three long years of smothering restrictions. Many citizens have had enough. The first visible signs of dissent emerged during a badly handled lockdown in Shanghai in the early summer of 2022, when infuriated citizens went online to vent their anger. A few months later, in November, protests cropped up across major cities in support of the victims of a fire in a residential building in Urumqi housing mostly ethnic minority Uyghurs. Subsequently, students in numerous elite universities staged extraordinary demonstrations and chanted anti-regime slogans, a sight unseen since the pro-democracy protests at Tiananmen Square in 1989. The public is now frustrated with the abrupt policy reversal and the woefully unprepared health system that is unable to cope with the ballooning demand for care. Straws are piling on the camel’s back.

This growing discontent is bad news for Xi. Since coming to power over a decade ago, he has painstakingly tried to cultivate the image of a benevolent ruler who is not only close to his people but also of the people—a man who came from the masses and draws on the wisdom of the masses to inform his policies. He has evoked that image to imbue his rule with moral legitimacy, even as the Chinese state has increasingly infringed on civil liberties and repressed ethnic minorities.

It is hard to calculate the damage already done to Xi’s and the party’s standing. China lacks credible public opinion polls, but social media offers a portrait of a country that is fed up and disillusioned. Among the most popular Internet slang terms in 2022 were rùn (a word that both sounds like and is derived from the English word “run”, to mean “run away”) and bâi làn (“let it rot”), which together denote people’s dour view of the plight of the country and the resigned belief that little can be done to improve it. Emigration to greener pastures is no longer the exclusive desire of wealthy Chinese. Nor is exasperation only the province of the young. Both these sentiments have now permeated the general populace. In recent weeks, an increasing number of violent protests and riots have targeted the police and other representatives of the party-state.


The current debacle poses the sternest challenge yet to the party-state under Xi. The CCP has traditionally relied on intense political campaigns to deal with crises, a “whole of society” approach that mobilizes all available resources to the areas needing special assistance. Such campaigns require the collective fighting spirit of the country to overcome a crisis. That was how the regime handled the SARS epidemic in 2003 and the initial COVID-19 outbreak in Wuhan in late 2019 and early 2020. Through propaganda and the mobilization of resources, authorities motivated citizens to accede to government restrictions and public health measures. But three years of zero COVID has left the public beleaguered and jaded. Moreover, the spread of COVID-19 infections across the country means that the state cannot simply divert resources to deal with hotspots, as the virus is now everywhere.

More broadly, China’s system of daily governance, its everyday state power, hinges on public trust. The CCP relies on the willing participation of society at large to implement its policies. The erosion of trust in the wake of Xi’s handling of the COVID-19 crisis could shake the very foundation of this system, with wide implications beyond the battle with the virus.

In China’s decentralized system, Beijing often blames local government officials when things go wrong. Local authorities are often made the scapegoats for natural disasters, manmade accidents, and disease outbreaks. Leaders in Wuhan, for instance, were punished for “not reporting” the initial appearance of the virus in December 2019. This strategy has allowed the regime to evade responsibility for calamities that resulted in high casualties, such as the Wuhan outbreak, and to prevent any resulting erosion of its legitimacy. The COVID-19 crisis, however, may prove to be an exception. Xi clung to zero COVID not just as his signature policy but also as proof of the superiority of the Chinese system. Now that the entire edifice of the policy has come crashing down, it is hard to see how he can pick up the pieces. The full costs of this mistake are not yet clear—rising social discontent may eventually weaken the cohesion of the party’s elites—but it is hard to imagine the party escaping this crisis of its own making entirely unscathed.

Lynette H. Ong is Professor of Political Science at the University of Toronto and the author of  Outsourcing Repression: Everyday State Power in Contemporary China.

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