The World Tries to Move Beyond Covid. China May Stand in the Way.

As the rest of the world learns to live with Covid-19, China’s top leader, Xi Jinping, wants his country to keep striving to live without it — no matter the cost.

China won a battle against its first outbreak in Wuhan, Mr. Xi said last week, and “we will certainly be able to win the battle to defend Shanghai,” he added, referring to the epicenter of the current outbreak in China.

But pressure is mounting for a change to the zero-Covid strategy that has left Shanghai at a standstill since March, kept hundreds of millions of Chinese citizens under lockdown nationwide and is now threatening to bring Beijing to a halt.

This week, the World Health Organization called China’s current pandemic strategy “unsustainable.” An economist summarized it as “zero movement, zero G.D.P.” Multinational companies have grown wary of further investments in the country.

For more than two years, China kept its Covid numbers enviably low by doggedly reacting to signs of an outbreak with testing and snap lockdowns. The success allowed the Communist Party to boast that it had prioritized life over death in the pandemic, unlike Western democracies where deaths from the virus soared.

More transmissible variants like Omicron threaten to dent that success, posing a dilemma for Mr. Xi and the Chinese Communist Party. Harsher lockdowns have been imposed to keep infections from spreading, stifling economic activity and threatening millions of jobs. Chinese citizens have grown restless, pushing back against being forced to stay home or to move into grim, government-run isolation facilities.

Yet abandoning the strategy risks a surge in deaths, especially among the country’s tens of millions of unvaccinated older people. Researchers this week warned of a “tsunami” of deaths if the virus surged unchecked, leaving China’s fragile national hospital system overwhelmed and raising the possibility of social unrest.

Fearing any dissent during a politically important year for Mr. Xi, China’s censors have moved quickly to muffle calls for a change in course on Covid-19. The head of the World Health Organization, whose recommendations China once held up as a model, was silenced this week when he called on the country to rethink its strategy.

Photographs and references to Tedros Adhanom Ghebreyesus, the director general of the W.H.O., were promptly scrubbed from the Chinese internet after the statement. The foreign ministry responded by calling Mr. Tedros’s remarks “irresponsible,” and accusing the W.H.O. of not having a “proper understanding of the facts.”

China’s state-controlled media has also glossed over the draconian measures officials have deployed to deal with outbreaks. This week, as some authorities in Shanghai erected new fences around quarantine zones, boarded up more homes and asked residents not to leave their apartments, state media painted a picture of a city slowly returning to normal.

One article described the “hustle and bustle of city life” returning, while another focused on statistics for how many stores had reopened.

But rosy state media reports cannot hide a looming challenge facing Mr. Xi.

To date, the coronavirus has claimed 569 lives and infected about 777,565 people since March 1, according to official statistics. If unchecked, the outbreak could lead to 112 million infections and nearly 1.6 million deaths between now and July, according to a study from researchers at Fudan University in Shanghai and Indiana University in the United States.

“The situation is pretty grim, and the study shows clearly the huge importance in vaccinating and boosting the elderly,” said Marco Ajelli, an infectious disease modeler at Indiana University’s School of Public Health, who contributed to the study.

Less than half of people aged 70 or older in Shanghai have received two jabs, according to the study. Across China, the number is 72 percent, a figure that health experts say should be 95 percent or higher. In dozens of cities where there have been outbreaks or partial lockdowns in anticipation of rising cases, resources have been devoted to stamping out the virus rather than to vaccinations.

Currently the vaccines available in China are also not as potent as foreign ones available in other countries. Chinese vaccines use traditional technology that has been shown to be less effective than breakthrough mRNA technology. China said last year that it was close to approving BioNTech, a German mRNA shot made in partnership with Pfizer, but that has not happened. Several Chinese companies are in the testing phase of a homegrown mRNA option, and China also recently approved for emergency use a Covid-19 antiviral pill made by Pfizer called Paxlovid.

Administering three vaccine shots, using antiviral therapies and offering more effective vaccines could help China find a path out of zero Covid, Mr. Ajelli said.

Investors and business leaders worry that China’s rigid adherence to its zero-Covid policy could send the economy into free fall. “It is high time for the government to change its strategy,” said Fred Hu, a prominent Chinese investor. The benefits of zero Covid no longer outweigh the economic costs, he added. “Sticking to the zero-Covid strategy would decimate its economy and undermine public confidence.”

By one estimate, nearly 400 million people in 45 cities have been under some form of lockdown in China in the past month, accounting for $7.2 trillion in annual gross domestic product. Economists are concerned that the lockdowns will have a major impact on growth; one economist has warned that if lockdown measures remain in place for another month, China could enter into a recession.

European and American multinational companies have said they are discussing ways to shift some of their operations out of China. Big companies that increasingly depend on China’s consumer market for growth are also sounding the alarm. Apple said it could see a $4 billion to $8 billion hit to its sales because of the lockdowns.

Howard Schultz, the interim chief executive of Starbucks, said the company has “virtually no ability to predict our performance in China.”

Foreign investments have nearly dried up, and some projects have been on hold for more than two years because pandemic restrictions have made it essentially impossible for foreign executives to visit China. When executives at multinational companies appeal to senior Chinese officials, their calls are met with silence, said Michael Hart, the president of the American Chamber of Commerce in China.

“China has been very steadfast in its views that it has the right strategy and it doesn’t want people to criticize it,” Mr. Hart said.

Some of China’s top leaders have also started to share concerns about the economy. China’s premier, Li Keqiang, described the employment situation as “complicated and grave” as migrant workers and college students struggle to find and keep jobs during lockdowns.

Even as daily virus cases in Shanghai are steadily dropping, authorities have tightened measures in recent days following Mr. Xi’s call last week to double down. Officials also began to force entire residential buildings into government isolation if just one resident tested positive.

The new measures are harsher than those early on in the pandemic and have been met with pockets of unrest, previously rare in China where citizens have mostly supported the country’s pandemic policies.

In one video widely circulated online before it was taken down by censors, an exasperated woman shouts as officials in white hazmat suits smash her door down to take her away to an isolation facility. She protests and asks them to give her evidence that she has tested positive. Eventually she takes her phone to call the police.

“If you called the police,” one of the men replies, “I’d still be the one coming.”

Isabelle Qian contributed reporting, and Claire Fu contributed research.