How China’s close contacts are putting pressure on Beijing’s zero-Covid policy

More than 1.3 million people in China were under medical observation this week as close contacts of cases of Covid-19, the highest level since the pandemic erupted from Wuhan, and an increase of more than 300,000 in just a few days.

The rising number of close contacts, driven by a rise in cases to near-record levels, is putting tremendous strain on a Covid-19 policy that, unlike the rest of the world, aims to eliminate the virus rather than to live with it.

China’s strategy has evolved since the start of the pandemic. While authorities have often relied on city-wide lockdowns, particularly in Wuhan in early 2020 and Shanghai in 2022, they are also using a sophisticated tracking and tracing system that quickly quarantines close contacts of infections for “medical observation”.

The total number of close contacts is an important indicator of whether authorities are still able to get the virus under control in China. Meanwhile, evidence from Guangzhou, the center of the latest outbreak, points to a gap between official guidance and reality.

How are close contacts traced?

In major Chinese cities, residents must take a PCR test every few days at street corner booths to get a “green code” on their smartphone. Their phone must also be scanned on most public transport and when entering buildings.

If a person tests positive, authorities can analyze the locations the person has visited to track who else scanned there. Close contacts can also be determined based on a person’s place of residence or place of work.

What happens with close contacts?

This month, amid rising cases, the government has revised the approach it outlined in June when it published the ninth edition of its Covid-19 strategy.

Under the revised guidelines, close contacts must be transferred to a “centralized place of isolation,” often a hotel, where they must stay for five days, instead of the previous seven. This is followed by three more days of home observation.

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Local governments have invested in building temporary isolation facilities. In October, Shanghai confirmed it would build a 3,000-person facility on Fuxing Island at a cost of approximately $220 million, designed for both close contacts and positive cases.

A construction bidding website has revealed dozens of other similar projects across China in recent months.

However, government guidelines also state that “special” cases may be allowed to self-isolate at home. It does not clearly define a special case, although individual provinces have their own interpretations. In Hebei, children 14 and under are treated as special cases.

What is the reality on the ground?

When asked how many of the more than 1 million close contacts under medical observation were quarantined in central facilities compared to at home, China’s National Health Commission referred the investigation to the Center for Disease Control and Prevention, which could not be contacted.

The central control can be applied differently in different provinces. The example in Guangzhou, where daily cases number in the thousands, indicates that authorities are struggling to find capacity to meet the central quarantine requirement. One resident, who asked to be called Victor, said his family was identified as close contacts after a dinner at a restaurant where there was a confirmed positive case.

A makeshift Covid quarantine facility follows in Guangzhou

A makeshift Covid quarantine facility in Guangzhou. The city is struggling with capacity to meet central quarantine requirements © cnsphoto/Reuters

He said his family had been told to prepare for a quarantine hotel, but was later told there was not enough space and no new quarantine sites had been built yet. Instead, his door was sealed and he and his family were isolated at home.

Elsewhere there is flexibility in the definition of a close contact. If there is a positive case in a Beijing building, authorities designate the three floors above and below the case as close contacts and send those residents to central quarantine. Other floors are required to self-quarantine at home.

When a single positive case was discovered at Disneyland Shanghai this month, authorities closed down the park and tested tens of thousands of people, but did not define guests as close contacts. However, some Disneyland employees were designated as close contacts and sent to central isolation facilities.

What happens now?

A requirement to quarantine close contacts of close contacts was relaxed this month. But expectations of a reopening have been downplayed after the city of Shijiazhuang, which had relaxed testing during the outbreak, reintroduced stricter measures.

If the number of close contacts spirals further out of control, the government could enforce much stricter lockdowns, as they did in Shanghai this spring. Such a decision can be made centrally, but still needs to be enforced by multiple local governments and cities.

Even if the virus can no longer be controlled, a shift from a model of elimination to one based on suppression is unlikely to be easy. Instead, there are signs that elements of the former are likely to persist.

A person who works at labor outsourcing in Guangzhou, which recorded nearly 8,000 cases on Wednesday, said the city is hiring dozens of drivers to transfer close contacts to quarantine hotels to accommodate the rising number of contacts.

Additional reporting by Ryan McMorrow in Beijing and Gloria Li in Hong Kong

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