The affluent city of Shanghai is going through a staggered lockdown this week as it battles its biggest surge of COVID cases in two years. – more than 5,000 new case a daily, a relatively huge amount for a city which had enjoyed near-zero cases for the last two years.

The stringent quarantine measures include home isolation for all residents and cancellation of all public transport while authorities test all 25 million residents – first in the city's eastern Pudong district, then in western Puxi district starting Friday.

The speed at which the lockdown was announced left the city's residents scrambling to secure food and supplies. Stay-at-home orders are also limiting residents from seeking medical care unrelated to COVID.

"There is one hospital which takes patients with fevers but we are worried about cross-infection, and other hospitals will not take patients from neighborhoods that have been locked down," says Grace Wang, whose mother, a cancer patient, came down with a fever this week.

Social workers have arranged special transport to take her mother to a designated hospital, on the condition that they would first test negative for COVID. "But we could not guarantee that we could get a COVID test in time, since we can only attend massive tests arranged by the community," Wang told NPR by phone.

Her mother's fever has gone down since, but Wang is worried about her mom's next medical issue: Will the lockdown be lifted in time before her mother's next chemotherapy appointment in two weeks?

The cost of Shanghai's lockdown has raised some serious grumbles of discontent. China's zero-COVID policies still enjoy widespread support, but frustration is mounting at China's repetitive use of lockdowns to control the virus.

By contrast, nearby South Korea and Taiwan are opening up using a careful mixture of widespread vaccination and flexible isolation policies. Singapore said starting this week, it was opening borders, nixing quarantines and restarting international flights after a four month pause.

Shanghai residents have crashed government and health commission hotlines with both COVID and general health inquiries, so hundreds of people are turning to social media each hour as a way to secure urgent medical help.

"It has been five days since my father has received his blood dialysis treatments. He is now staying alone in a hotel room near the hospital, waiting for further information," said one man surnamed Cao, who has been asking for help on Chinese social media site Weibo this week. He declined to give his full name because it is politically sensitive to criticize COVID prevention policies.

The lockdowns are also laying bare Shanghai's social inequalities. Affluent residential compounds have been able to organize private food deliveries, yet the city's migrant workers and homeless population struggle to find shelter or testing.

"A lot of them don't even have an ID card, so they cannot register themselves for the PCR test which is connected to cell phones." said Jimmy McWhinney, the co-founder of Renewal, a project to help homeless people in Shanghai.

"Sometimes the cure is worse than the disease," said Ooi Eng Eong, an infectious diseases professor and research director at Duke NUS medical school in Singapore. "Lockdowns come with a price. The health of the population is more than just the absence of COVID."

Prominent health experts are calling for a clearer roadmap in China for eventually easing restrictions and living with an endemic COVID through higher vaccination rates among the elderly, with more efficacious mRNA vaccines.

Gabriel Leung, a Hong Kong epidemiologist and public health adviser, urged the city to embrace a more flexible approach to containing the virus. "That we move toward an endemic disease using the safest way, or we do so by cutting all and every transmission [chain], it is a matter of time," he said at a press conference last week.

In an essay widely-circulated in China, Zuo-Feng Zhang, a professor of epidemiology of University of California at Los Angeles (UCLA), suggested China put mild COVID cases into home isolation rather than centralized quarantine at a government facility that sends people to stay in, for example, storage containers or stadiums. and to import foreign-made COVID vaccines and treatments. Currently, China has only approved domestically-made vaccines which do not perform as well in preventing infection.

This week, Shanghai's government said it supported importing vaccines and COVID treatment drugs. The northern province of Jilin, which remains sealed off because of an Omicron outbreak, says it has secured 10,000 doses of Pfizer's Paxlovid pill to treat cases.

The ongoing outbreaks in Shanghai, as well as far larger outbreaks in Hong Kong and Jilin, are also giving experts the richest source of China-specific COVID data so far in the pandemic.

Two people with direct knowledge told NPR that Chinese health officials are closely paying attention to Shanghai and Hong Kong's outbreaks. They're providing valuable data about how well vaccines work, how fast infections have spread and perhaps could shape a gradual opening up strategy, someday, in China.

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