Now it’s China’s turn. COVID-19, lockdown and older people in Shanghai.

On 3 April 2022 a strict lockdown was introduced in the Chinese city of Shanghai, in response to rapid increases in reported COVID-19 cases. This follows a surge in cases and deaths in Hong Kong. There are many parallels between the situations facing the two cities and their experiences foreshadow what lies in store for other cities in China and the wider region.

First, as in Hong Kong, rates of COVID-19 vaccination among older people remain quite low. Around 75 and 40 per cent of the more than two million elderly residents in Hong Kong have received two and three jabs respectively. In Shanghai, around 60 per cent of people aged 60 or more have received two doses and less than 40 per cent have received three. In most cases, the vaccine has been either Sinovac or Sinopharm, which has been shown to be significantly less effective than most other vaccines in reducing case fatality after two doses, but relatively effective after three. It is claimed that vaccine hesitancy has been widespread among older people in Shanghai, as elsewhere in China. Past success in containing the virus through lockdown has encouraged a false sense of security and some older people place more faith in traditional remedies.

After less than three weeks, it is too early to say whether the lockdown will be effective. Official data indicate that it has been. By 17 April, no COVID-19 deaths had been reported in the city. There are, however, a number of reasons to doubt this impressive statistic. Those people most at risk of dying of COVID-19 almost always have other health conditions, and it is claimed that these are often recorded as the prime cause of death, regardless of the role played by COVID-19. There are media reports and anecdotal claims of COVID-19 deaths among older people, including unverified reports of at least 27 deaths in a single long-term care facility.

There are also widespread reports of social tensions and the economic impacts of the city’s strict lockdown. This includes claims of growing tensions between older and younger residents of apartment blocks, whereby the former insist that positive cases move out, while the latter view this as unnecessary. There are also claims that the lockdown has interfered with older people’s access to essential health services for conditions unrelated to COVID-19.

What are the implications for other parts of China? Less information is available for many areas than it is for cities like Shanghai, but there are few grounds for expecting the virus will remain localised. It is claimed that vaccine coverage of older people in rural is lower than in the cities. All of these issues -limited vaccine coverage of older people, unreliable data and inter-generational tensions- have been reported in Global Platform blogs for other countries. Tragically, it would seem that it is now China’s turn.