An article by a Chinese-American public health expert calling for Beijing to change its zero-Covid policies has been circulating widely on Chinese social media Zhang Zuofeng, a professor at the Fielding School of Public Health at the University of California Los Angeles, published an article in late March on the social media platform Meipian saying the city should allow home quarantine and rapid antigen tests, rather than conducting rounds of mass PCR testing, which increase the risk of cross-infection. He also recommended the city step up inoculation of the elderly using the mRNA vaccine developed by BioNtech, which is yet to be approved by the Chinese regulator even though Shanghai-based Fosun Pharma has already signed an agreement to distribute and produce the jabs. He also said the city should stock up on Pfizer’s pill Paxlovid to treat patients, especially the elderly. The Chinese authorities have carried out repeated mass testing and sent all positive cases to makeshift hospitals even though some were half finished or hastily built. People in Shanghai are also banned from leaving home, resulting in food shortages in China’s richest city. Beijing doubles down on Covid-19 curbs to keep a lid on ‘still challenging’ outbreak Government officials have repeatedly defended the strict zero-tolerance approach, saying they wanted to protect the vulnerable and avoid a spike in deaths. But after more than a month of lockdown, Shanghai was still reporting thousands of cases daily, though around 95 per cent were asymptomatic cases. Calls by mainland scientists and economists to reconsider the zero-tolerance approach have been censored by the authorities . The social media accounts of some economists who expressed concerns over the economic impact of the lockdown were closed. However, Zhang’s article and a second one blaming mass testing for Shanghai’s high case load, appear to have avoided that fate so far. Recently the censors have also targeted a widely shared video – called the “voices of April” that detailed the suffering of people under lockdown – and a WeChat post by Miao Xiaohui, the former chief physician at Shanghai Changzheng Hospital, challenging top government advisers over Covid policies. In the post, Miao said he would “slit his wrist” if China managed to eliminate all Covid cases because even if it could miraculously weed out Omicron there would still be other variants. Zhang wrote a second article in late April, which is structured as a conversation between him and the 89-year-old epidemiologist Yu Shunzhang, who taught him at Fudan University in Shanghai. In the second article, Zhang said the high caseload in Shanghai despite the lockdown was due to the mass tests and the order for all to stay home. “Since the virus can be spread by aerosol, if a person in the line is a positive case, the one who [was swabbed] afterwards would likely be infected. “The most important are the volunteers who helped to keep order. They have contacted many people and they have not undergone serious disinfection training. Therefore, the infections among volunteers can be high and they can become a source of infection,” Zhang wrote, adding that the workers that take samples might not change their gloves after each swab. Another intriguing phenomenon is the continuous high number of positive cases even after one cycle of the incubation period of the virus, which is usually only a few days for Omicron Zhang suggested that the virus was likely spread by courier and food delivery who residents rely on during lockdown. “Residents buy food via online platforms and the food is distributed by neighborhood committees, volunteers and deliverers. These people have not undergone serious disinfection training and many of them were infected. They became the main source of infection and further spread the virus,” he wrote. He also queried if Shanghai has changed its count of deaths and included “deaths with Omicron” in the calculation of mortality. Claim Covid-19 has ‘shattered the American myth’ stirs debate in China In the early days of the lockdown, the number of deaths in Shanghai was low, but as there are growing doubts about why the draconian measures were needed if the death rate was so low, the authorities began to include those who died with Covid to the count, in addition to those whose death was directly caused by Covid. Zhang also said the death rate in Hong Kong could have been inflated because it included those who died of underlying diseases. Zhang said China could keep its dynamic zero-Covid approach, but it should be modified to target zero hospitalisaton, severe cases and case mortality rate, instead of zero infections or symtomatic cases. He said countries like France had seen recorded similar Omicron mortality rates to flu and argued that if is the case in China, the governemnt should downgrade Covid-19 to the same category of infectious disease.