Workers put a mask on a 57 metre Buddhist goddess statue in Aizuwakamatsu, Fukushima prefecture, Japan. Photo: Reuters
Nancy S. Jecker
Nancy S. Jecker

Is the zero-Covid approach of China and Japan about saving face?

  • Two strategies have emerged to deal with the coronavirus: mitigation, favoured by the US and Europe, and elimination, which dominates in Asia
  • Mitigation leaves people free to decide on the risks they take, but in collectivist-leaning societies, one owes it to others not to become sickened
During the 1918 pandemic, influenza led to the loss of 50 million lives. Today, flu season returns each year, killing about 650,000 people world wide. If the novel coronavirus sticks around to become a background feature of our ordinary lives, as many scientists now predict, societies will be forced to accept some increase in the background level of death.

What level of risk should we accept? What freedoms should we give up to reduce the rate of death? Science alone cannot answer these questions because they are inherently value questions. The answers depend not just on the effects of different policies, but also on how we weigh values like saving lives and protecting health against competing values like avoiding economic hardship and supporting emotional and mental well-being.

As societies begin opening up, it will be helpful to clarify values about risk by speaking more directly about these values within families and communities. One way to go about this is by thinking about familiar risks to life and limb in our everyday lives.

We take risks every time we go for a swim, get in a car, or just cross the street. We also regularly assume risks by not doing certain things – exercising, sleeping enough, or eating right. These risks may seem worth it because of what they enable us to do, namely lead a fuller, more flourishing human life. What kinds of things is it important for people in our society to be able to do and be? What risk are we willing to accept to make this possible?

Medical workers inoculate students against Covid-19. Photo: Reuters
During the pandemic, two competing strategies have emerged. Mitigation, which dominates in the United States and most European nations, sets targets for community transmission and lifts restrictions once targets are met. This approach treats a certain amount of disease and death as acceptable. It strives to create the greatest good for the greatest number, weighing the loss of life and health to a few against the benefits of liberty, mental health, and happiness to the many.
By contrast, elimination or zero-Covid approaches, which dominate policies in New Zealand, Australia, Taiwan, South Korea, Vietnam, and China, seek to reduce community transmission to near zero through stringent, short-term lockdowns followed by strict find, test, trace, and isolate methods to tamp down reported cases. This strategy recognises a duty to protect lives at all costs and regards every death as one too many.

Both strategies can result in loss of life, since lockdowns can result in loss of life from domestic abuse and suicide due to depression, yet deaths caused by the novel coronavirus are more visible and seen as potentially affecting more people.

Zero-Covid? Hong Kong, Singapore have become trapped by their success

In some parts of the world, people are apt to weigh liberty and well-being above all else, and mitigation approaches make more sense, while in other societies, protecting life and health are more weighty values and aiming for elimination might be a better bet.

Aversion to risk is driven by many factors. One factor that influences risk-taking is face, which refers to having a favourable social self-worth in relation to a social network. Concerns about saving face, losing face, and maintaining face affect what people do and say and the risks they are willing to take.

In collectivist-leaning societies, people owe it to their friends and family to save face because losing face can potentially affect those in one’s close circle.

For example, Confucian-influenced societies, like mainland China, Vietnam, North Korea, and Taiwan, lean collectivist and tend to regard saving face as a duty to others. The appeal of zero-Covid strategies in these societies may reflect a sense that one owes it to others not to become sickened by Covid-19.
People queue to receive nucleic acid tests for Covid-19 in Shenzhen, China. Photo: AFP

Japanese society displays a similar concern with maintaining face for the benefit of others (referred to in Japanese as ‘seken-tei’) by avoiding the loss of face associated with becoming sick.

By contrast, individualist-leaning societies, such as the US and some European nations, show less face consciousness. They tend to regard people as independent and self-sufficient – free to “do their own thing”. This leads to making decisions based mostly on individual preferences, while deflecting efforts to restrict individual choice. The appeal of mitigation strategies is they appear to leave people freer to decide which risks they want to take.

Historical experiences also impact risk assessment. The 2003 severe acute respiratory syndrome (Sars) epidemic that spread to more than 24 Asian countries had an enduring impact on people’s behaviours, such as mask-wearing and hygiene.

How many deaths are acceptable in ‘zero-Covid-19’ economies?

Perhaps, behaviours like handshaking in the US and kissing on both cheeks in France will take a long-term hit from the Covid-19 pandemic. It would not be surprising if people’s post-pandemic behaviour includes more mask wearing and hand sanitising. Hopefully, we will not continue indefinitely to avoid public places like restaurants or gyms out of fear.

Of course, no strategy is fail-safe. For creatures like us, risk of harm is to some extent inevitable. Clarifying values surrounding risk can help us find ways to live our lives and help others live theirs.

Nancy S. Jecker is a Professor of Bioethics at the University of Washington School of Medicine and Visiting Professor at the Chinese University of Hong Kong Centre for Bioethics