By Bill Birtles, ABC China correspondent
Analysis - China is bucking a global move towards "living with the virus" by doubling down on a "zero tolerance" approach that may see it remain isolated with closed borders well into 2023.
Local citizens line up while keeping social distance at a test centre in Gaoxin District of Yangzhou City, east China's Jiangsu Province. Photo: AFP
The fast-spreading Delta variant of coronavirus has forced a rethink on continuous lockdowns in countries such as Australia and Singapore.
But a similar suggestion last month from a well-respected Chinese infectious diseases specialist saw him both publicly rebuked and even trolled online.
Zhang Wenhong, the director of infectious diseases at a major Shanghai hospital, suggested in a social media post: "More and more people believe the pandemic won't end in a short period of time and perhaps won't end in the long term either".
"More infectious disease experts around the world believe this is now a resident virus and the world will have to learn how to coexist with it," he wrote.
His post came as China faced its most challenging flare-up since the initial outbreak in late 2019, with the Delta variant of coronavirus spreading out from Nanjing to 12 other cities in recent weeks.
The numbers are still low - roughly 100 cases per day across a country of 1.4 billion.
But the fresh outbreak prompted Zhang to suggest considering a loosening of the rigid border controls that, like Australia, stop most Chinese from travelling abroad.
"After the Nanjing outbreak, we will definitely learn more," he wrote.
"The way that China chooses in future must be to ensure a community with a shared future with the world … while at the same time protecting its citizens from fear of the virus."
Zhang has been a leading voice on containment measures throughout the pandemic.
But his new perspective, which would be widely accepted in many other countries, appeared to touch a nerve at home.
China wants to 'win the war' against virus
China's former health minister, most likely with the top leadership's blessing, used an official People's Daily editorial this month to firmly reject Zhang's suggestion.
Without naming him, former minister Gao Qiang wrote: "Some experts [in China] think that Britain, the US and other countries' approaches of 'coexisting with the virus' promotes 'openness', while China's approach with quarantine control is restrictive."
He said Western nations "blindly lifted or relaxed" containment measures to "demonstrate their dominance and influence".
Gao said those decisions were made without regard for people's health.
"This is a mistake in decision-making for epidemic prevention caused by the defects in the political systems of the United Kingdom, the United States and other countries," he wrote.
"It is also an inevitable result of advocating individualistic values."
Gao painted a picture of a zero-sum battle between the virus and humanity, firmly arguing China did not view vaccinations alone as being sufficient to "win" the war.
A medical worker takes a swab sample from a citizen at a Covid-19 nucleic acid testing site. Photo: Xinhua News Agency.
Zhang is not the only one facing blowback for suggesting China contemplate eventually opening up.
Former Chinese Centre for Disease Control expert Feng Zijian mentioned last week that the nation could return to a "normal" state of affairs once a higher level of vaccination was reached.
His comments were promptly scrubbed from the internet.
And police in Jiangxi province even arrested a man who commented online in support of loosening restrictions, according to a media report.
The apparent censorship of Feng's comments, combined with Gao's scathing editorial, is the clearest sign yet that Beijing will go its own way on coronavirus - even if the rest of the world is dissembling restrictions.
It makes for an intriguing lead-up to the Beijing Winter Olympics in six months' time.
Authorities are yet to outline how they plan to manage an influx of athletes and team officials from countries where the virus is widespread.
Can an isolated China survive and thrive?
Gao's reference to the weaknesses of Western political systems is a familiar theme in China, where Communist Party leader Xi Jinping has framed the nation's successful containment of the virus as proof of its superior system.
"They've created this image that having zero case counts is successful, so to move away from that takes some adjustment of public expectation," Ian Chong, a political scientist at the National University of Singapore, said.
"Now with the Delta variant and perhaps future variants, getting to zero cases becomes less possible, so there needs to be some new indicator of success for the party and leadership to play up."
While China's domestic political debate is tightly clamped, changing the government's messaging would involve a jolting shift from the all-encompassing, war-like language that authorities have used to describe the pandemic control effort.
And Gao's editorial shows little appetite for that.
"The history of human survival and reproduction is also a history of fighting viruses to the death," he wrote.
"Either humans have eliminated viruses or humans have been swallowed by viruses.
"Humans have never 'coexisted' with viruses for a long time."
While border closures have economically crippled countries largely dependent on tourism, China is not one of them.
Nor is there widespread discontent with restrictions on overseas travel, with only around 10 percent of Chinese citizens holding passports.
Although it is difficult to gauge genuine public opinion, prolonged isolation for China would not necessarily trigger domestic political pressure like it could in Australia.
As infections exploded overseas in early 2020 just as Wuhan's outbreak was coming under control, a popular perception took hold in China.
A perception that took hold last year was that the outside world became a more dangerous place due to coronavirus, a view that appears to largely remain in place today.
Is China worried about the strength of its vaccines?
Yanzhong Huang, a senior fellow for global health at the US-based Council on Foreign Relations, believes the zero-tolerance approach remains very popular among the Chinese public.
But he said another reason for sticking with the policy was China's leaders might be worried about the country's vaccines.
"I think they are not very confident in the effectiveness of their vaccines in preventing infections from the Delta strain," he told the ABC.
China has administered more than 1.7 billion doses of its two vaccines, Sinopharm and Sinovac, roughly equating to 60 per cent of its giant population being fully vaccinated.
"They are still effective, I think, for preventing severe cases, but for a country that pursues a zero-tolerance stance, any infection is intolerable," Huang said.
Speaking to the ABC in June, a representative of Sinovac said a clinical trial in Brazil showed efficacy of just above 50 per cent due to new variants and the participants of the trial being frontline medical workers who faced a higher risk of infection than the general community.
He pointed to much higher efficacy rates seen in trials conducted in Turkey and Indonesia.
All the trials though were conducted before the emergence of the Delta strain.
A state media reporter who asked an official in Nanjing a question about "breakthrough infections" among people already vaccinated was disciplined by her superiors last week, according to the Financial Times.
Health officials in China have flagged the possibility in future of mixing vaccines.
This week it approved a trial to mix the Sinovac vaccine and a DNA vaccine developed by American company Inovio.
Pulling up the drawbridge comes with risks
"This approach generates its own forces resistant to change, and it's a logic that can be applied to Australia as well," he said.
While it may give people inside the closed borders a sense of security, dangers could lay ahead, according to Huang.
"Eventually, when a country is isolated from the rest of the world and you don't have the epidemiological exchange, you're going to see a so-called immunity gap," he said.
"Unless you keep updating your vaccines, you can see that countries that are shielded become vulnerable to new virus variants, which could potentially have disastrous consequences."
Yanzhong Huang believes that, in the meantime, China will keep its firm restrictions in place.
- ABC