Confusion and falsehoods spread as China reverses its 'zero-COVID' policy

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After nearly three years of strict "zero-COVID" policies, in recent days Chinese officials have rolled back most of them following rare protests across the country. Mass testing and mass quarantining are now things of the past.

Just as dramatic as the policy shifts is the shift in messaging coming from the public health experts the Chinese government has relied on since the virus was first identified in China in late 2019, risking their credibility ahead of what is likely to be a giant wave of infections.

Two months ago, Dr. Liang Wannian, the architect of zero-COVID policy, said China "cannot tolerate" a wave of mass infections. This month, he said, "The virus is much more mild now."

If Liang was shifting focus to less stringent protocols, another prominent public health expert, Dr. Zhong Nanshan, a pulmonologist who made his name fighting the SARS outbreak, made outright misleading claims about the virus. He went from touting China's mass quarantine strategy in May to telling a state media outlet that he hasn't seen cases of COVID-19 causing obvious long-term organ damage.

Many studies have shown that COVID can cause chronic health issues, including heart problems and brain damage.

Zhong also said that 78% of patients infected with the Omnicron variant won't be reinfected for quite a long time. Studies suggest protection against reinfection declines dramatically over time and most people will be reinfected every one to two years.

"Did Omicron mutate, or did the experts?"

The about-face did not go unnoticed on the Chinese internet. Posts juxtaposing several experts' TV appearances before and after state policy change - including Zhong and Liang - have garnered more than 100,000 views.

"Did Omicron mutate, or did the experts?" one poster wrote.

Not all public health and medical experts have changed their views. Zhang Wenhong, the infectious disease director of a Shanghai hospital affiliated with Fudan University, said the zero-COVID policy should be relaxed even before an outbreak in Shanghai shut the city down for weeks. That position had initially attracted some attacks online though now he's being praised for speaking truth to power.

Wu Fan, a member of Shanghai's disease outbreak containment expert commission famous for insisting that Shanghai could not shut down is now receiving apologies online.

Whiplash aside, much of the online discussion has moved to how to deal with the aftermath of the policy change, including what preventative measures and treatments are available.

Untested remedies flourished

Untested remedies to fight COVID have again flourished in recent days. An internal medicine doctor who's a member of China's prestigious Academy of Engineering recommended the unproven method of rinsing out your mouth using iced salt water daily. Commenters online were baffled. "Wasn't salt water rinse debunked two years ago? Does an iced version make a difference?" one wrote in a blog post.

A local government in southwest China suggested making tea out of orange peels and monk fruit - both common ingredients in traditional Chinese medicine - to prevent infection. Dr. Zhong said weeks ago that he hasn't found any medication that is effective at preventing a COVID infection.

The chaos and uncertainty right now reminds Chen Wenhong, an associate professor of media studies and sociology at University of Texas, of the atmosphere in early 2020 when COVID was first spreading. "It's kind of flying in the dark."

Information gap

For most people in China, state media and health professionals are the most-trusted sources for information about COVID-19, according to surveys conducted in 2020. And with access to the global internet cut off for most, there are few alternatives to state media and its constellation of aligned social media accounts, says Huang Yanzhong, a senior fellow for global health at the Council on Foreign Relations in New York.

Private outlets could provide better information though they do not have the same reach, he says.

Additionally, non-state media outlets are vulnerable to government crackdowns. Ding Xiangyuan was a well-read online health information outlet that debunked health myths and criticized the government's promotion of traditional Chinese medicine as well as the zero-COVID policy before it was suspended from popular social media platforms in August. Its accounts on the popular Chinese social media site, Weibo, remain silent today.

Another challenge is that Chinese news outlets often translate COVID misinformation from English-language sources and share it with their audience. "It doesn't matter whether [the sources] are reputable or not," says Huang. "They find anything that they thought would be useful to them, they start to translate that into Chinese, and start to spread it, and it becomes viral."

A recent example was how the Communist Party-controlled newspaper, The Global Times, cited a misleading report in the British tabloid, Daily Mail, that suggested without evidence that vaccine maker Moderna manufactured the virus. The Global Times extensively cited the coverage, using it to attack other unsupported theories about the virus's origin, including the one that suggested it leaked from a government research lab in Wuhan. Other smaller social media accounts made videos of the report, putting "British Media" in the headlines.

Information from overseas doesn't just come from newspapers, but also from the millions of Chinese nationals living abroad.

"The Chinese diaspora has played a very useful role here to share with people back in China about their personal COVID experience," Chen says, "knowing that in most cases it will not be that serious."

She points out that while researchers and journalists often pay attention to social media discourse, many rural, often elderly residents rely on television and family members in larger cities to stay informed. Many are vulnerable to the disease, live in places where healthcare resources are scarce, and aren't adept at finding information on social media.

With the disease rapidly cascading from large cities to towns and villages, the Chinese government needs to act fast to get medically-sound public health messages out to the most vulnerable people, says Chen.

So far, both Chen and Huang say it's too early to tell what effect the health messaging whiplash will have.

Implications for the next pandemic

Abrupt changes in public health messaging is not a new or uniquely Chinese challenge. At various stages in the pandemic, many countries have changed course around what healthcare messages to send. Early on, there was a lot of back-and-forth about whether masks and facial coverings would lessen the spread of the virus, including in the United States.

As NPR reported, public health authorities don't base their messages for the public entirely on science - many considerations are also pragmatic and culturally-based.

Chen says that scientists have some soul searching to do in the next couple of years. "If we know that politics is going to play a role in public health and also in science, how do we conduct ourselves? What [are] our ethics?"

"When the next pandemic comes, what would be the best message?"

Michaeleen Doucleff and John Ruwitch contributed reporting.