The COVID-19 pandemic in mainland China is part of the worldwide pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). China was where the first COVID outbreak occurred, the first where authorities imposed drastic measures in response (including lockdowns and face mask mandates), and was one of the first countries to bring the outbreak under control, at least temporarily.
The 2019–2020 COVID-19 outbreak in mainland China was the first wave of the disease, and was first manifested as a cluster of mysterious pneumonia cases, mostly related to the Huanan Seafood Market in Wuhan, the capital of Hubei province. It was first reported to the local government on 27 December 2019 and published on 31 December. On 8 January 2020, a new coronavirus (SARS-CoV-2) was identified as the cause of the pneumonia by Chinese scientists. By 29 January, the virus was found to have spread to all provinces of mainland China.
By late February, the pandemic had been brought under control in most Chinese provinces. On 25 February, the reported number of newly confirmed cases outside mainland China exceeded those reported from within for the first time. By mid-2020, widespread community transmission in China had ended and restrictions were significantly eased.
Until late 2022, the Chinese government response included a zero-COVID strategy, which aims to eliminate transmission of the virus within the country and allow resumption of normal economic and social activity, making it one of few countries to pursue this approach. By late 2020, China's economy continued to broaden recovery from the recession during the pandemic, with stable job creation and record international trade growth, although retail consumption was still slower than predicted.
Infection rates increased in 2022, and on 3 April of that year, China reported 13,146 new cases of COVID-19 in the past 24 hours, which was the highest single-day total of new cases since the height of the 2020 outbreak. Following nationwide protests in November and December of that year, the Chinese government relaxed many of its previous restrictions, effectively ending the zero-COVID policy and leading to a massive surge in cases.
Context
New infectious diseases impose a serious threat to the health of the general public. Their origins are often mysterious despite intensive research efforts. Although human coronaviruses (CoVs) had been known as major pathogens to cause the common cold, a new species of coronavirus, namely SARS-CoV caused an epidemic involving 29 countries during 2002–03 which infected 8098 persons and killed 774 of them. The evidence shows that the virus might have originated from an animal coronavirus, but somehow entered the human population. Its outbreak also implies that animal coronaviruses could be a potential danger to humans.
Since the 2003 SARS outbreak, the general public and the scientific community in China have been worried about the potential return of the deadly virus which motivated the Chinese government to reform its public health system to handle the next public health crisis. As part of the reform, China expanded the laboratory networks to handle the pathogens of the infectious diseases which included a newly built BSL-4 laboratory in Wuhan and a national key laboratory to investigate into pneumonia with unclear causes. Zeng Guang, the chief scientist at China CDC believed that a quicker publication of the epidemic information was a lesson that China learned from the SARS outbreak as the lack of information release worsened the outbreak.
With the improved public health system, China managed to handle several public health emergencies. In coping with the 2009 H1N1 flu outbreak starting from Mexico, China developed and distributed vaccines to 100 million people within months as an active prevention. During the 2013 H7N9 outbreak in East China, the country's health system identified the pathogen 5 days after the outbreak. Test kits for diagnosis were designed and distributed to all mainland provinces 3 days after the identification. Within months, effective vaccines were developed. Chinese academic Li Lanjuan and her group were the first to reveal the virus's transmission methods, molecular mechanisms and effective treatment.
However, Southern Metropolis Daily stated that although people paid more attention to public health, the government's funding to the health system was far from enough as CDCs in smaller municipalities had to reduce their staff. Ten years after the SARS outbreak, few people wore a face mask when they had respiratory symptoms and the hospitals were cutting the fever clinics off. Despite confidence in winning the next battle against SARS, Zhong Nanshan who earned fame in fighting the SARS outbreak in 2003 still held a conservative attitude to whether the Chinese officials would lie to the people about a disease outbreak. As of 2017, mainland China had only 36 critical care beds per million people; in comparison, South Korea had 106, and Taiwan 285, beds per million people.
Early cases surrounding the animal market suggested potential animal-to-human transmission while later the virus was found to be able to transmit from ill people to others. There have been cases where asymptomatic patients transmitted the virus to others. According to China NHC, the virus transmits by droplets or close contact while some proposed that feces could also be where the virus hides and transmits from. The typical symptoms of the viral infection included fever, dry cough, dyspnea, headache and pneumonia which are usually developed after an incubation time lasting as long as 2 weeks. The existence of mild but infectious cases complicated the epidemic control efforts. It is also noticed that patients might be able to transmit the virus even during the incubation period.
Financial Times described the outbreak as China's Chernobyl moment, increasing the pressure on its leader, Xi Jinping. A trade war with the US, the Hong Kong protests, and an African swine fever outbreak that led to a pork shortage already placed pressure on the current government.
At the end of December 2019, Henan announced the suspension of passenger trains to and from Wuhan. In early January 2020, the local government of Henan Province with its complete disinfection measures, effective and intensive publicity, a strong awareness of epidemic prevention and quarantine among the people, the setting up of return spots at the village entrance and even the use of garbage trucks, the digging of trenches to block roads connecting Hubei and the hanging of slogans such as "returning home with sickness is to dishonor your parents." #抄河南的作业 (lit. 'copy Henan's homework') became a trending hashtag on Weibo.
However, cutting the roads off without authorization is illegal in mainland China as Xinhua and the Public Security Ministry pointed out. The Ministry of Transport asked the local governments to take the principle of "block one, not three" (Chinese: 一断三不断), that is, to block the virus from spreading, but not to block roads, traffic and Internet access, the transportation of emergency supplies and the transportation of essential goods.
First outbreak
Based on retrospective analysis published in The Lancet in late January, the first confirmed patient started experiencing symptoms on 1 December 2019, though the South China Morning Post later reported that a retrospective analysis showed the first case may have been a 55-year-old patient from Hubei province as early as 17 November.
The outbreak went unnoticed until 26 December 2019, when Zhang Jixian, director of the Department of Respiratory Medicine at Hubei Xinhua Hospital, noticed a cluster of patients with pneumonia of unknown origin, several of whom had connections to the Huanan Seafood Market in Wuhan. She subsequently alerted the hospital, as well as municipal and provincial health authorities, which issued an alert on 30 December. Results from patient samples obtained on 29–30 December indicated the presence of a novel coronavirus, related to SARS.
Semi-log graph of 3-day rolling average of new cases and deaths in China during COVID-19 epidemic showing the lockdown on 23 January and partial lifting on 19 March.
Within three weeks of the first known cases, the government built sixteen large mobile hospitals in Wuhan and sent 40,000 medical staff to the city.
Spread beyond Wuhan
On 22 January, Hubei launched a Class 2 Response to Public Health Emergency. Ahead of the Hubei authorities, a Class 1 Response to Public Health Emergency, the highest response level was announced by the mainland province of Zhejiang on 23 January. Stringent measures such as lockdown of Wuhan and the wider Hubei province and face mask mandates were introduced around 23 January, which significantly lowered and delayed the epidemic peak according to epidemiology modelling. Guangdong and Hunan followed suit later on the day. On the following day, Hubei and other 13 mainland provinces also launched a Class 1 Response. By 29 January, all parts of mainland initiated a Class 1 Response after Tibet upgraded its response level on that day.
Yet, by 29 January, the virus was found to have spread to all provinces of mainland China. Hubei party secretary Jiao Chaoliang was removed from office for failure to contain the outbreak. On 31 January, the World Health Organization declared the outbreak a Public Health Emergency of International Concern. A severe shortage of face masks and other protective gear led several countries to send international aid, including medical supplies, to China.
On 25 March, authorities began to lift travel restrictions in Hubei outside of Wuhan and people need to confirm their "Green Code" health classification to travel.
On 8 April, Wuhan lifts its lockdown and all transportation in the city resumed operations.
April 2020–December 2021
2020
On 2 April 2020, the government ordered a Hubei-like lockdown in Jia County, Henan, after a woman tested positive for the COVID-19. It is suspected that she may have been infected when she visited a hospital where three doctors tested positive for the virus, despite showing no symptoms.
On 9 April, a COVID-19 cluster was detected in Heilongjiang Province, which started with an asymptomatic patient returning from the United States and quarantining at home. The US CDC reported that the infections were initially spread through a shared elevator used at different times, and led to at least 71 cases by 22 April.
In early May, restrictions were tightened in Harbin.
In June, an outbreak with 45 people testing positive at Xinfadi Market in Beijing caused some alarm. Authorities closed the market and nearby schools; eleven neighborhoods in the Fengtai District started requiring temperature checks and were closed to visitors. By this time, public health technology included special leaf blower backpacks designed to vent hot air onto outdoor surfaces. By the evening of 23 June, Chinese Vice Premier Sun Chunlan declared that the situation had been brought under control. China's traffic authorities vowed to strictly guard traffic out of Beijing: those with abnormal health QR codes or without recently-taken negative PCR test proof would not be allowed to take public transportation or drive out of the capital.
On 26 July, China saw its highest number of daily cases since March, mostly from outbreaks in Xinjiang and Liaoning, with 61 new cases, up from 46 cases a day earlier. This increased to 127 daily COVID cases on 30 July. The daily reported cases subsequently went down, to 16 on 23 August.
In July, Xinjiang province and its capital Ürümqi were locked down in the wake of the discovery of new cases in the city.
On 11 October, officials in Qingdao urged to carry out contact tracing and mass testing after 12 new cases were found connected to the Qingdao Chest Hospital. On 12 October, it was announced that Qingdao would test all 9 million of its residents.
In October, 137 asymptomatic cases were detected in Kashgar, Xinjiang and were linked to a garment factory.
On 18 December, a local case was reported in Beijing. It was the first local infection in 152 days in Beijing. As of 27 December, thirteen more cases have been detected. Another outbreak linked to a traveler from South Korea was reported in Liaoning late December.
2021
In January 2021, many cities and districts in the province of Hebei, Jilin and Heilongjiang were put into lockdown to contain a new outbreak in the region.
On 7 January, Dalian authorities reported 51 confirmed COVID-19 cases and 31 asymptomatic carriers.
On 6 January, after reporting 63 new cases in the northern province of Hebei, of which 20 were infections and 43 asymptomatic cases locally transmitted, the local Government decided to lockdown the provincial capital city of Shijiazhuang, as most of the cases were detected there. On 9 January, the cities of Shijiazhuang and Xingtai with total population of 19 million, were placed under lockdown measures, with passenger trains suspended, as well as flights and coach service to Beijing at 300 km distance in north east direction.
On 14 January, Wangkui County of Suihua City, Heilongjiang Province moved into lockdown after reporting 40 confirmed COVID-19 cases. The virus sample taken from the cases in Suihua is reported to be similar to the strain identified in Dalian.
Also on 14 January, China reported the first death from the virus after eight months, a patient from Hebei. A team of experts from the WHO visited Wuhan to conduct investigations into the origin of the pandemic. They were also supposed to quarantine for two weeks prior to starting their inquiry. On 15 January, the city of Langfang of Hebei was put into lockdown.
By 18 January 11 regions in China were under de facto lockdown, including five districts in Heilongjiang and the cities of Gongzhuling and Tonghua in Jilin province. On 20 January, residents of Daxing District of Beijing were banned from leaving the capital region.