administration official who led the White House’s Covid-19 response, to be his next chief of staff, according to people familiar with the decision.
Ron Klain,
Mr. Biden’s current chief of staff, is expected to step down in the coming weeks after more than two years on the job. The Washington Post earlier reported that Mr. Zients was expected to replace him. Mr. Zients didn’t respond to requests for comment, and the White House declined to comment.
Mr. Zients helmed the White House efforts to increase distribution of the Covid-19 vaccine during the first year of Mr. Biden’s presidency, helping to cobble together a network to make the shots available nationally.
He left the administration in April last year, saying he had no specific job plans, and in recent months was tapped by Mr. Klain to prepare for staff departures and help identify potential replacements, according to people familiar with the matter. Mr. Zients co-chaired Mr. Biden’s presidential transition team in 2020.
The president is turning to Mr. Zients as his next chief of staff because of his reputation as a manager with a history of navigating government bureaucracy, the people familiar with the matter said.
Mr. Zients is expected to bring to the job a more decentralized approach than the one favored by Mr. Klain, who was involved in nearly every aspect of day-to-day operations at the White House, some of the people familiar with the matter said.
While Mr. Zients is expected to focus on policy and governing, other longtime aides to Mr. Biden are likely to be more involved in advising the president on political matters as he faces investigations from newly empowered House Republicans and prepares to announce his reelection bid.
White House Chief of Staff Ron Klain and President Biden greeting each other at a White House event.
Photo:
KEVIN LAMARQUE/REUTERS
In the coming year, White House officials expect to focus on implementing a slate of laws signed by the president since he took office, including measures to fix the country’s aging infrastructure, invest in renewable energy and boost semiconductor manufacturing. Options for major legislative breakthroughs will be limited now that Republicans have taken control of the House.
Mr. Zients was a top economic adviser to President
Barack Obama,
serving as the director of the National Economic Council and a senior official at the Office of Management and Budget. Mr. Zients joined the board of
Facebook Inc.
—now part of Meta Platforms Inc.—in 2018 after leaving the Obama administration. He was a top executive with the Cranemere Group, an investment holding company.
At the beginning of Mr. Obama’s presidency, Mr. Zients was appointed the administration’s chief performance officer, a newly created role that centered on making the government more efficient. He later led a mission aimed at fixing HealthCare.gov, the federal website for the Affordable Care Act, when it experienced technological difficulties in 2013. He brought in private companies and technology firms to undertake a rapid review of the platform’s problems.
Mr. Zients is known as a meticulous planner. In his beginning days handling the Covid-19 response, he scheduled hour-by-hour what needed to be done to execute his pandemic plan. He and Mr. Biden spoke three to four times a week while he was overseeing the coronavirus response.
While Mr. Zients’ selection to handle the pandemic was initially criticized by some progressives who said he lacked public health experience, he earned bipartisan praise in hearings for his efforts to rapidly disseminate vaccines after a bumpy rollout during the end of the Trump administration. About 65% of the population, or more than 200 million people, were fully vaccinated by the time he announced in March 2022 that he would be leaving his position.
He also won high marks for shifting the administration from a more reactive approach to the pandemic to responding to Covid-19 as an ongoing public health issue. He pledged a wartime response to the administration’s global response to Covid-19 but some donations to poor countries fell short of targets because of low demand and limited funding.
Mr. Biden was criticized in 2021 for holding a massive July Fourth party on the South Lawn and declaring “we’re closer than ever to declaring our independence from a deadly virus” just as the Delta variant began spreading in the U.S., causing another round of shutdowns.
Later that winter when the Omicron wave caused infections to spike, the lack of testing kits caused long lines and concerns across the country. The president acknowledged in a January 2022 speech that the situation was “frustrating.”
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Messrs. Biden and Zients developed a relationship during the Obama administration, and became closer when Mr. Zients was brought on as an adviser to Mr. Biden’s 2020 presidential campaign. Mr. Zients doesn’t have the kind of decadeslong relationship with Mr. Biden that some of the president’s closest aides have. But those advisers—including senior White House aides
Mike Donilon,
Steve Ricchetti
and
Bruce Reed
—are expected to continue working closely with Mr. Biden as he prepares to announce his reelection bid in the coming month.
“He has the utmost integrity and that’s why everyone trusts him,” said Andrew Slavitt, who was a senior adviser for the Biden administration Covid-19 response. “He over-communicates and seeks out everyone’s views but does it in a way to push the ball down the field every day.”
Mr. Zients’ experience and ties in the business world has engendered skepticism from some progressive groups, many of whom developed close relationships with Mr. Klain.
Matt Stoller, the director of Research at the American Economic Liberties Project, a nonprofit that advocates for strict antitrust enforcement, called Mr. Zients “an ugly choice” for the job, noting that he joined the board of Facebook in the wake of the Cambridge Analytica scandal.
Write to Andrew Restuccia at andrew.restuccia@wsj.com, Stephanie Armour at Stephanie.Armour@wsj.com and Annie Linskey at annie.linskey@wsj.com
When the virologist Kirsten St. George learned last summer that a paralyzed patient in New York’s Rockland County had tested positive for polio, she turned her attention to the state’s sewers.
Polio is particularly stealthy because most infected people never develop symptoms but can still spread the virus. A wastewater-surveillance network established during the Covid-19 pandemic helped officials at the New York State Department of Health’s Wadsworth Center track polio’s spread in several counties.
New York is now expanding wastewater monitoring and starting to look for flu, RSV, hepatitis A, norovirus and antibiotic-resistant genes in parts of the state, as health officials across the U.S. consider wastewater as a more permanent public-health tool for watching a variety of threats.
“Are we on the brink of another outbreak, if it’s rising? Is it just sort of holding steady?” asked Dr. St. George, Wadsworth’s director of virology. “These are all important public health questions.”
Dr. Kirsten St. George of the Wadsworth Center is looking for clues in the state’s sewage.
An analysis conducted at the Wadsworth Center indicates the presence of the hepatitis A virus.
Dr. Kirsten St. George of the Wadsworth Center, which is starting to track the spread of pathogens including the hepatitis A virus.
For decades, researchers around the world used wastewater primarily to track poliovirus, which spreads through contact with an infected person’s feces. At the onset of the pandemic, scientists found that the Covid-19 virus’s genetic material could be detected in sewage. That meant sewage might help trackother respiratory viruses, too.
Researchers built surveillance networks around the country to track Covid-19 and monitor for variants.
Now they are starting to leverage that system to search for other pathogens they had wanted to track through the sewers for years including norovirus and antibiotic-resistant microbes, said Amy Kirby, program lead of wastewater surveillance at the Centers for Disease Control and Prevention.
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“Once you have this system, it’s much easier to activate it for a new pathogen,” Dr. Kirby said.
Sewage samples from treatment plants are sent to labs, where genetic material that can come from hundreds of thousands of people is isolated. Researchers usually test samples for pathogens with the PCR technology used in a Covid-19 lab test administered at the doctor’s office.
Health officials use the data to track changing concentrations of a virus, which can help them monitor the spread of pathogens including flu and RSV for which many people might not be tested. The technique has yielded early evidence of Covid-19 outbreaks and helped officials tailor public messaging and decide where to opentesting sites.
Biobot Analytics Inc., which works with the CDC to monitor Covid-19 and the renamed mpox, started tracking opioids in wastewater before the pandemic. It has collected data on substances including fentanyl in more than 100 counties across 47 states. Officials in Cary, N.C., used that data to encourage people to dispose of drugs properly and to distribute more overdose-reversal drugs, Biobot said.
Not everything can be tracked through sewage, and there isn’t a standard national system for collecting data and comparing readings from site to site. Privacy can be a concern in smaller communities or when tracking illicit substances, researchers said, though wastewater data is processed as an anonymous group sample. And some communities that collect wastewater data aren’t using it to guide public-health policy, researchers said.
The wastewater treatment plant in Schenectady, N.Y., is participating in the study of sewage.
Workers at the Schenectady treatment plant collect samples and ship them for analysis.
Analysis of the wastewater samples is conducted at the Wadsworth Center in Albany, N.Y.
The wastewater treatment plant in Schenectady, N.Y., where workers collect samples and ship them for analysis at the Wadsworth Center in Albany, N.Y.
The National Academies of Sciences, Engineering, and Medicine said in a report Thursday that the U.S. should invest more in the CDC’s wastewater-surveillance network and expand its reach.The report recommended that the CDC should have an open process for picking which pathogens to track and establish an ethics committee, among other steps.
“We’re at a critical juncture where it has gone from being a grass-roots effort to a more nationally recognized tool,” said Megan Diamond, head of the Rockefeller Foundation’s wastewater-surveillance program, who wasn’t involved with the report.
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After a polio case was confirmed in New York in July, health officials reviewed stored wastewater samples and found poliovirus in wastewater from several counties, including as far back as spring. Health officials urged people who weren’t vaccinated against polio to get the shots and alerted doctors.
The CDC extended poliovirus wastewater testing to a handful of counties with low vaccination rates or potential connections to New York’s polio case.
“What you might expect a virus to do when it starts circulating is exactly what we saw in the wastewater,” said Dan Lang, deputy director of New York’s Center for Environmental Health and head of the state’s wastewater-monitoring program.
No samples tested positive for poliovirus by the end of November, but it was detected again in Orange County last month. Health officials are planning to analyze past samples from additional counties for traces of the virus before deciding whether to widen poliovirus wastewater monitoring when the weather warms and the virus can spread more readily.
“We’re worried about a big sort of roaring back,” said Dr. Eli Rosenberg, a lead epidemiologist who coordinates New York’s polio response. “We’re using this time now to prepare.”
Poliovirus was found in Orange County, N.Y., last month.
People who exercise regularly had lower rates of hospitalization and death from Covid-19 in a study published recently in the American Journal of Preventive Medicine.
Regular exercise improves overall health and healthier people generally have fewer serious complications with Covid-19 infections. Earlier research has shown an association between exercise and better Covid-19 outcomes. This latest study goes a step further and suggests that even people whose age or health conditions make them higher-risk have better outcomes if they are regular exercisers.
Higher amounts of physical activity were associated with lower rates of death and hospitalizations from Covid across nearly all demographics, says Jim Sallis, a public health professor at the University of California San Diego and co-author of the study. A very active 70-year-old still had a higher risk of Covid-related complications than did a similarly active 40-year-old, but the exercisers in both groups had hospitalization rates lower than those who didn’t work out.
The study used data from nearly 200,000 adult Covid-19 patients across the Kaiser Permanente network in Southern California. It asked patients to self-report the number of minutes of moderate exercise they did per week and analyzed the records of how many people in the study cohort were hospitalized, experienced deterioration, such as admission into an intensive-care unit, or died within 90 days of a Covid diagnosis.
The new bivalent vaccine might be the first step in developing annual Covid shots, which could follow a similar process to the one used to update flu vaccines every year. Here’s what that process looks like, and why applying it to Covid could be challenging. Illustration: Ryan Trefes
“You don’t have to run, you don’t have to sweat, you don’t have to do anything except get up and go out for a walk,” Dr. Sallis says. “That’s what most people do, and we see how much protection they’re getting from that.”
The findings add to a growing body of evidence that physical activity provides several types of protection from severe illness.
Exercise improves the body’s immune response by mobilizing and redistributing immune cells that can recognize and kill infected cells, says Richard Simpson, a professor at the University of Arizona whose research focuses on exercise immunology and who wasn’t involved with the Kaiser Permanente study. Without exercise, viruses have more time to replicate inside our bodies, which can result in more severe symptoms, he says.
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Physical activity can also help reduce inflammation, the body’s natural immune response to damage or pathogens. Chronic inflammation has been linked to more severe Covid-19 outcomes, especially in the lungs. Cytokines, small messenger proteins that help regulate inflammation, are released during exercise.
The study data were collected from the beginning of the pandemic to May 2021, when vaccines were just starting to become more available and before more recent waves of Covid. However, the researchers believe the results of the study are still broadly applicable.
“Exercise is as effective as many of the drugs that we use and has no side effects,” says Jordan Metzl, a sports medicine physician in New York City who wasn’t involved with the study. “We want to get people taking it every day.”
BEIJING—Chinese health authorities plan to lift Covid-19 quarantine requirements on international arrivals early next month, taking one of the country’s biggest steps to ease restrictions since the pandemic began even as case numbers remain high.
China has maintained among the world’s most restrictive coronavirus lockdown measures, slowing its economy significantly and sparking anger. Following waves of protests this fall, authorities abruptly abandoned the country’s stringent zero-Covid-19 strategy early this month.
From Jan. 8, China will scrap all quarantine measures for Covid-19, including requirements for inbound visitors, both foreigners and Chinese nationals, according to the National Health Commission.
The commission late Monday issued a plan to stop treating Covid-19 as a “Class A” infectious disease, which calls for stringent control measures, and downgrade the management of the virus to “Class B,” which requires more basic treatment and prevention. The Wall Street Journal reported last month that China was weighing such a move, which would give it room to further loosen public-health measures.
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The change means people traveling to China from abroad will need to have only a negative Covid-19 test within 48 hours to be allowed into the country, the NHC said. International arrivals will no longer be required to be tested on arrival or undergo quarantine—a major step toward opening up for a country that has been largely closed off to the outside world for three years.
The commission in its statement pledged to facilitate foreigners’ visits to China, including those for business, studying and family reunions, and to provide visa assistance.
The shift came as fever clinics and hospital emergency rooms in Beijing continued to overflow with patients on Monday and Chinese leader
Xi Jinping
called on local officials to take pains to save lives.
Before Monday’s loosening of Covid restrictions, Mr. Xi addressed his country’s new pandemic reality for the first time in comments marking the 70th anniversary of the Patriotic Health Movement, a campaign to wipe out flies and mosquitoes launched by
Mao Zedong
during the Korean War to fortify China against the possibility of American germ warfare.
“At present, our country’s Covid prevention and control efforts are facing new circumstances and a new mission,” Mr. Xi said. China should launch “a more targeted Patriotic Health Movement” to “effectively guarantee the lives and health of the people.”
Visits to three major hospitals in Beijing by the Journal on Monday showed the capital’s healthcare system still swamped with an influx of patients following the government’s about-face on Covid-19 controls, which has left many citizens, especially the elderly, scrambling to find treatment.
In the emergency room of eastern Beijing’s Chaoyang Hospital, known for treating respiratory diseases, hallways at the intensive-care unit were packed with dozens of elderly patients lying on portable beds. One nurse said all the ICU beds were full and only patients with the most life-threatening symptoms were being admitted. “Those patients with less severe symptoms can only get a temporary bed and stay in the hallway,” she said.
To cope with the surge in patients, Beijing’s Chaoyang Hospital opened a second fever clinic in a nearby sports stadium for some Covid-19 patients.
Photo:
Chen Zhonghao/Zuma Press
On Monday, the Chinese Center for Disease Control and Prevention issued a report showing fewer than 2,700 new infections and no new deaths on Christmas Day. Over the weekend, local officials presented a much grimmer picture.
A senior health official in the coastal province of Zhejiang, home to e-commerce giant
Alibaba Group Holding Ltd.
, said on Sunday that new daily infections had topped one million, with the wave expected to peak at around two million cases around New Year’s Day.
Roughly half a million people were being infected every day in the northeastern city of Qingdao, a local health official said in a since-removed interview with a state-owned broadcaster.
To minimize the impact of the infection surge on China’s already battered economy, some cities said people could return to work even if they had mild symptoms. Authorities in Shanghai said Saturday that the city’s 25 million residents wouldn’t need to be isolated at home for more than seven days, even if they are still testing positive.
Rapid transmission of Covid-19 in China raises the likelihood for fresh outbreaks beyond its borders and the emergence of risky virus variants, said
Michael Osterholm,
director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
“New variants are a huge possibility, and they could have a tremendous impact on the rest of the world,” Dr. Osterholm said.
In his own comments marking the anniversary of the Patriotic Health Campaign, which evolved over the years to target infectious diseases such as malaria, China’s Premier
Li Keqiang
said adjustments to the country’s Covid-19 policies were being implemented in an orderly manner, but urged officials at every level of government to address public demands for medical care and supplies.
Covid-19 cases in China have surged after authorities scrapped most of its restrictions, prompting residents to self-isolate and stockpile medication. WSJ’s Jonathan Cheng reports from Beijing on the risks that come with the country’s rapid reopening. Photo: Xiaoyu Yin/Reuters
China’s health system, thinly resourced even before the pandemic, has struggled to contend with the fast-spreading Omicron variant. The growth in infections has sent people scrambling to buy up home test kits along with ibuprofen and other medications.
At Chaoyang Hospital’s emergency room on Monday, digital screens showed a long wait list for people seeking treatment at the internal-medicine department. In an interview last week with China’s state broadcaster, Mei Xue, deputy director of the hospital’s emergency department, said around 400 patients were coming seeking internal medicine treatment every day—roughly four times the normal number.
“These patients are all elderly people with underlying diseases. After the combination of fever and respiratory infection, they are all very seriously ill,” he said.
A staffer with Beijing’s emergency medical center, which coordinates requests for urgent medical care in the city, said he and his colleagues had been working nonstop to transfer patients to Chaoyang Hospital in recent weeks and he expected the current situation to last for a few more weeks.
To cope with the surge in patients, the hospital has opened a second fever clinic in a nearby sports stadium for Covid-19 patients with mild symptoms.
Peking Union Medical College Hospital and Peking University First Hospital, both located in the center of Beijing, were similarly overwhelmed.
A sign outside the Peking Union emergency room warned patients it could take more than four hours to see a doctor. A nurse at Peking Union’s fever clinic said that for weeks patients had been forced to wait in the hallways for beds to open up. One elderly patient, unable to secure a bed, was lying on a metal bench just inside the entrance of the fever clinic.
A nurse at Peking University First Hospital’s emergency room said beds there were all full and the wait time at the internal medicine department was roughly six hours. The hospital public address system announced that nearly 50 patients were waiting to be seen.
In recent weeks, doctors and nurses from around China have been dispatched to Beijing to support the capital. Shandong province sent a team of medical staff to Beijing, according to state media reports.
In the U.S., the State Department on Friday updated its travel advisory and is asking that people reconsider travel to China due to the surge in Covid-19 cases, arbitrary enforcement of local laws and Covid-19-related restrictions.
—Xiao Xiao and Dominique Mosbergen contributed to this article.
The nose knows why some people still can’t smell long after recovering from Covid-19.
A haywire immune response in the olfactory system was found to explain why some people still can’t smell long after symptoms of the disease have abated, according to a small, peer-reviewed study published Wednesday in the journal Science Translational Medicine. In some cases, the immune or inflammatory response was detected in patients with smell loss up to 16 months after recovery from Covid-19.
Compared with people who can smell normally, patients with long-term smell loss had fewer olfactory sensory neurons, cells in the nose responsible for detecting smells and sending that information to the brain. Patients with lingering loss of smell had an average of 75% fewer of the neurons compared with healthy people, said
Brad Goldstein,
a study co-author and sinus surgeon at Duke University.
“We think the reduction of sensory neurons is almost definitely related to the inflammation,” Dr. Goldstein said.
Loss of smell is a common Covid-19 symptom, though its prevalence varies widely depending on factors including which variant caused the infection, head and neck specialists said.
Most Covid-19 patients who experience smell loss regain the sense within weeks of infection. But the symptom can stick around for a year or longerfor up to 7% of patients, a February analysis said.
Dr. Goldstein said he and his colleagues sought to identify what was damaged or altered in people with long-term smell loss. “If we don’t know what’s broken, it’s hard to tell how to fix it,” he said.
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They took samples from the nose tissue of nine patients who couldn’t smell long after Covid-19 infections and compared them with cells from healthy people. Patients with persistent smell loss had more T-cells, a type of white blood cell that plays a critical part in immune response, in their noses, the study said. The T-cells were making interferon-gamma, a substance linked to inflammation, Dr. Goldstein said, and support cells appeared to be reacting to it.
The support cells protect and nourish olfactory sensory neurons. Without them, the olfactory sensory neurons can’t survive. Research has shown that the virus that causes Covid-19 doesn’t infect olfactory sensory neurons directly, but that it can attack such support cells.
Patients with smell loss also had fewer of a certain type of anti-inflammatory cell and more of a particular inflammatory cell than healthy people, said the study of 24 patients. The healthy group included two people who had recovered from Covid-19 but didn’t have long-term smell loss.
Covid-19 researchers said the study bolstered evidence that inflammation could be a culprit in long-Covid symptoms. An April study in the journal JAMA Neurology found inflammation among deceased Covid-19 patients in the olfactory bulb, the part of the brain responsible for receiving and processing information from olfactory sensory neurons in the nose.
Neuroinflammation could be a contributor to loss of smell and other neurological symptoms related to long-Covid such as brain fog, said
Cheng-Ying Ho,
a co-author of the April study and an associate professor of pathology at Johns Hopkins University School of Medicine.
Dr. Ho, who wasn’t involved in the new study, said inflammation that starts in the nasal cavity could extend to the brain. She said that the new study was compelling but that its small sample size necessitated further work in more patients. Because the vaccination status of participants wasn’t collected, she said it wasn’t clear whether getting the shots played a role in the olfactory system’s inflammatory response.
In a survey published last year of more than 400 patients with smell loss, more than 40% reported depressive symptoms and almost 90% reported enjoying food less.
“People might think smell loss is not really an important Covid symptom compared with severe symptoms such as pneumonia, but it can really bother some patients,” Dr. Ho said.
Researchers said regions of the brain linked to the sense of smell are closely associated with brain regions that control memory and emotion.
Sandeep Robert Datta,
a co-author of the new study and a professor of neurobiology at Harvard Medical School, said he and others are conducting more research into the reasons for smell loss following Covid-19 infection smell loss. The research could lead to potential targets for treatment. There are no effective treatments for long-term smell loss, Dr. Datta said.
“Smell gives you a sense of place. It can be very disorienting without it,” Dr. Datta said.
Write to Dominique Mosbergen at dominique.mosbergen@wsj.com
has accelerated plans to shift some of its production outside China, long the dominant country in the supply chain that built the world’s most valuable company, say people involved in the discussions. It is telling suppliers to plan more actively for assembling Apple products elsewhere in Asia, particularly India and Vietnam, they say, and looking to reduce dependence on Taiwanese assemblers led by
Foxconn
2354 4.05%
Technology Group.
Turmoil at a place called iPhone City helped propel Apple’s shift. At the giant city-within-a-city in Zhengzhou, China, as many as 300,000 workers work at a factory run by Foxconn to make iPhones and other Apple products. At one point, it alone made about 85% of the Pro lineup of iPhones, according to market-research firm Counterpoint Research.
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The Zhengzhou factory was convulsed in late November by violent protests. In videos posted online, workers upset about wages and Covid-19 restrictions could be seen throwing items and shouting “Stand up for your rights!” Riot police were present, the videos show. The location of one of the videos was verified by the news agency and video-verification service Storyful. The Wall Street Journal corroborated events shown in the videos with workers at the site.
Coming after a year of events that weakened China’s status as a stable manufacturing center, the upheaval means Apple no longer feels comfortable having so much of its business tied up in one place, according to analysts and people in the Apple supply chain.
“In the past, people didn’t pay attention to concentration risks,” said Alan Yeung, a former U.S. executive for Foxconn. “Free trade was the norm and things were very predictable. Now we’ve entered a new world.”
Footage shows police beating workers at Foxconn’s facility in Zhengzhou, China. The world’s biggest site making Apple smartphones had been under Covid-19 lockdowns in recent weeks. Screenshot: Associated Press
One response, say the people involved in Apple’s supply chain, is to draw from a bigger pool of assemblers—even if those companies are themselves based in China. Two Chinese companies that are in line to get more Apple business, they say, are Luxshare Precision Industry Co. and
Wingtech Technology Co.
On calls with investors earlier this year, Luxshare executives said some consumer-electronics clients, which they didn’t name, were worried about Chinese supply-chain snafus caused by Covid-19 prevention measures, power shortages and other issues. They said these clients wanted Luxshare to help them do more work outside China.
The executives referred to what is known as new product introduction, or NPI, when Apple assigns teams to work with contractors in translating its product blueprints and prototypes into a detailed manufacturing plan.
It is the guts of what it takes to actually build hundreds of millions of gadgets, and an area where China, with its concentration of production engineers and suppliers, has excelled.
Apple has told its manufacturing partners that it wants them to start trying to do more of this work outside of China, according to people involved in the discussions. Unless places such as India and Vietnam can do NPI too, they will remain stuck playing second fiddle, say supply-chain specialists. However, the slowing global economy and slowing hiring at Apple have made it hard for the tech giant to allocate personnel for NPI work with new suppliers and new countries, said some of the people in the discussions.
Apple and China have spent decades tying themselves together in a relationship that, until now, has mostly been mutually beneficial. Change won’t come overnight. Apple still puts out new iPhone models every year, alongside steady updates of its iPads, laptops and other products. It must keep flying the plane while replacing an engine.
“Finding all the pieces to build at the scale Apple needs is not easy,” said Kate Whitehead, a former Apple operations manager who now owns her own supply-chain consulting firm.
Yet the transition is under way, driven by two causes that are feeding on each other to threaten China’s historic economic strength. Some Chinese youth are no longer eager to work for modest wages assembling electronics for the affluent. They are seething in part because of Beijing’s heavy-handed Covid-19 approach, itself a concern for Apple and many other Western companies. Three years after Covid-19 started circulating, China is still trying to crush outbreaks with measures such as quarantines, as many other countries have returned to prepandemic norms.
Zhengzhou, China, is home to a giant Foxconn facility known as iPhone City.Shang Ji/Future Publishing/Getty Images
A worker is shown disinfecting equipment at iPhone City in Zhengzhou, China.VCG/Getty Images
Zhengzhou, left, is home to a giant Foxconn facility known as iPhone City, where a worker is shown at right disinfecting equipment.Shang Ji/Future Publishing/Getty Images; VCG/Getty Images
Protests in Chinese cities over the past week, during which some demonstrators called for the ouster of President
Xi Jinping,
suggested criticism over Covid-19 restrictions could build into a larger movement against the government.
All this comes on top of more than five years of heightened U.S.-China military and economic tensions under the Trump and Biden administrations over China’s rapidly expanding military footprint and U.S. tariffs on Chinese goods, among other disputes.
Apple’s longer-term goal is to ship 40% to 45% of iPhones from India, compared with a single-digit percentage currently, according to Ming-chi Kuo, an analyst at TF International Securities who follows the supply chain. Suppliers say Vietnam is expected to shoulder more of the manufacturing for other Apple products such as AirPods, smartwatches and laptops.
For now, consumers doing Christmas shopping are stuck with some of the longest wait timesfor high-end iPhones in the product’s 15-year history, stretching until after Christmas. Apple issued a rare midquarter warning in November that shipments of the Pro models would be hurt by Covid-19 restrictions at the Zhengzhou facility.
In November, as the worker protests in the facility grew, Apple issued a statement assuring it was on the ground looking to resolve the issue. “We are reviewing the situation and working closely with Foxconn to ensure their employees’ concerns are addressed,” a spokesman said at the time.
The risk of too much concentration in China has long been known to Apple executives, yet for years they did little to lessen it. China supplied a literate and diligent workforce, political stability and a huge local market for Apple’s products.
Taiwan-based Foxconn, under founder
Terry Gou,
became an essential link between Apple in California and the Chinese assembly plants where iPhones get put together. Foxconn managers share a language and cultural background with mainlandworkers.
Pegatron Corp.
, another Taiwan-based contractor, has played a smaller but similar role.
Apple is looking to manufacture more in Vietnam, where a facility of China-based Luxshare, an Apple supplier, is located.
Photo:
Linh Pham/Bloomberg News
And both the government in Beijing and local governments in places such as Henan province, home to the Zhengzhou plant, have enthusiastically supported Apple’s business, seeing it as an engine of jobs and growth.
Even now, when ever-harsher anti-American rhetoric flows each day from Beijing over issues such as Taiwan and human rights, that backing remains strong.
People’s Daily, the mouthpiece of the Chinese Communist Party, hailed the Apple production site in a Nov. 20 video, saying it accounted directly or indirectly for more than a million local jobs. Foxconn shipped about $32 billion in products overseas from Zhengzhou in 2019, according to a Chinese government-linked think tank. All told, the Foxconn group accounted for 3.9% of China’s exports in 2021, according to the company.
“The government’s timely assistance…continuously provides a sense of certainty for multinational companies like Apple, as well as for the world’s supply chain,” the People’s Daily video said.
Yet such words ring hollow to many U.S. businesses in light of stringent anti-Covid measures by the government that have hampered production and roused worker unrest. A survey by the U.S.-China Business Council this year found American companies’ confidence in China has fallen to a record low, with about a quarter of respondents saying they have at least temporarily moved parts of their supply chain out of China over the past year.
To keep operating during government Covid-19 measures, the Zhengzhou factory is among those compelled to adopt a system in which workers stay on-site and contact with the outside world is limited to the bare minimum to keep the goods flowing. Foxconn has sealed smoking areas, switched off vending machines and closed dining halls in favor of carryout meals that workers bring back to their dormitories, often a half-hour walk away, workers said.
Many have escaped, jumping fences and walking along empty highways to get back to their hometowns. In November, the pandemic policies and pay disputes further fueled workers’ grievances. Some clashed with police at the site and left smashed glass doors.
Many of those abandoning the factory were young people who said on social media that they decided wages equivalent to $5 or less an hour weren’t enough to compensate for tedious production work, exacerbated by Covid-19 restrictions.
People protested throughout China this past week against the country’s strict anti-Covid protocols.Kevin Frayer/Getty Images
Beijing residents waited in line last month to be tested for Covid-19.Kevin Frayer/Getty Images
People protested throughout China this past week, left, against the country’s strict anti-Covid protocols. Beijing residents, right, waited in line to be tested for the disease.Kevin Frayer/Getty Images (2)
“It’s better for us to skate by at home than to be sucked dry by capitalists,” one person who identified herself as a departed Foxconn worker posted on her social-media account after the protests.
Asked for comment, a Foxconn spokesman referred to earlier statements in which the company blamed a computer error for some of the pay issues raised by new hires. It said it guaranteed recruits would be paid what was promised in recruitment ads. The spokesman declined to comment further.
China’s Covid-19 policy “has been an absolute gut punch to Apple’s supply chain,” said Wedbush Securities analyst
Daniel Ives.
“This last month in China has been the straw that broke the camel’s back for Apple in China.”
Mr. Kuo, the supply-chain analyst, said iPhone shipments in the fourth quarter of this year were likely to reach around 70 million to 75 million units, which he said was around 10 million fewer than market projections before the Zhengzhou turmoil. The top-of-the-line iPhone 14 Pro and Pro Max models have been particularly hard-hit, he said.
Accounts vary about how many workers are missing from the Zhengzhou factory, with estimates ranging from the thousands to the tens of thousands. Mr. Kuo said it was running at about 20% capacity in November, a figure expected to improve to 30% to 40% in December. One positive sign came Wednesday, when the local government in Zhengzhou lifted lockdown restrictions.
One Foxconn manager said hundreds of workers were mobilized to move machinery and components by truck and plane nearly 1,000 miles from Zhengzhou in central China to Shenzhen in the south, where Foxconn has its other main factories in China. The Shenzhen factories have made up some, but not all, of the production gap.
Meanwhile, Foxconn is offering money to get workers to come back and stay for a while. One of its offers is a bonus of up to $1,800 for January to full-time workers in Zhengzhou who joined at the start of November or earlier. Those who wanted to quit have gotten $1,400.
India and Vietnam have their own challenges.
People in Beijing protested this past week against stringent anti-Covid measures.
Photo:
Kevin Frayer/Getty Images
Dan Panzica, a former Foxconn executive who now advises companies on supply-chain issues, said Vietnam’s manufacturing was growing quickly but was short of workers. The country has just under 100 million people, less than a 10th of China’s population. It can handle 60,000-person manufacturing sites but not places such as Zhengzhou that reach into the hundreds of thousands, he said.
“They’re not doing high-end phones in India and Vietnam,” said Mr. Panzica. “No other places can do them.”
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India has a population nearly the size of China’s but not the same level of governmental coordination. Apple has found it hard to navigate India because each state is run differently and regional governments saddle the company with obligations before letting it build products there.
“India is the Wild West in terms of consistent rules and getting stuff in and out,” said Mr. Panzica.
The U.S. embassies of India and Vietnam didn’t respond to requests for comment.
Nonetheless, “Apple is going to have to find multiple places to replace iPhone City,” Mr. Panzica said. “They’re going to have to spread it around and make more villages instead of big cities.”
—Selina Cheng contributed to this article.
Write to Yang Jie at jie.yang@wsj.com and Aaron Tilley at aaron.tilley@wsj.com
As smoke crept through the 21-story apartment building in far western China, panicked messages filled the residents’ chat group. “On the 16th floor, we don’t have enough oxygen,” a woman gasped in an audio message. “Soon our children won’t be OK.”
Another person added a plea about the people in apartment 1901: “They wouldn’t be able to open the door. Can you break into it and take a look? There are many children inside.”
Many who heard the reports were shocked, not by a tragedy in the remote city of Urumqi, but because it had taken firefighters three hours to control the fire. People across the country believed the delays happened in part because of the pandemic restrictions that have been a running source of discontent throughout the country. The impact has reached into the heart of Chinese politics.
Excerpts of residents’ panicked conversation began to circulate on social media, along with videos of the emergency response. They showed fire crews struggling to get around barriers to approach the building. Videos showed fire crews’ water streams falling short of the fire as its flames slithered toward the top of the apartment tower.
Pandemic controls imposed by Chinese authorities around, and possibly inside, the apartment building had delayed the fire response, neighbors and family members of those killed have said. That would mean that the death toll, which many believed was much higher than the official tally of 10, was ultimately in part a product of China’s strict, already widely detested zero-tolerance Covid policy. The government denies all that.
Outrage spilled onto the streets of Urumqi, the capital of the heavily Muslim Chinese region of Xinjiang, where residents had been locked down for more than 100 days. Footage of the fire and the protest in Urumqi spread on Chinese social media and on the popular do-everything app
WeChat.
Firefighters sprayed water on a residential-building fire in the city of Urumqi that killed 10 and triggered protests against Covid-19 lockdowns.
Photo:
Associated Press
To large numbers of Chinese people who have had the experience of being locked inside their own apartments because of Covid controls, the words and images flowing out of Xinjiang conjured a scenario that seemed terrifyingly plausible.
“The 100-plus day lockdown is real. The many deaths from Covid controls are real. Discontent has accumulated and is destined to erupt,” said a user on the Twitter-like
Weibo
platform in one widely endorsed comment about the fire.
Within days, the protest would spread throughout China, growing into the largest show of public defiance the Communist Party has faced since the 1989 pro-democracy protests at Tiananmen Square. The demonstrations have posed a rare challenge to the recently extended rule of Chinese leader
Xi Jinping,
compounding the government’s challenges over how to ease its Covid restrictions.
Large protests erupted across China as crowds voiced their frustration at nearly three years of Covid-19 controls. Here’s how a deadly fire in Xinjiang sparked domestic upheaval and a political dilemma for Xi Jinping’s leadership. Photo: Thomas Peter/Reuters
China has experienced public outrage over its strict Covid-19 restrictions before, most of which the authorities had managed to contain online. Going back nearly three years, the death from the coronavirus of Li Wenliang, a doctor who was punished for warning others about the initial outbreak in Wuhan, unleashed a flood of grief and anger.
This September, a bus crash in Guizhou province that killed 27 people who were being sent to quarantine in the middle of the night raised an outcry about steps taken to control the coronavirus.
Mourners in Hong Kong paid their respects in February 2020 to Chinese physician Li Wenliang. Dr. Li raised early alarms about the coronavirus outbreak in Wuhan but was silenced by police, only to die of the disease himself.
Photo:
jerome favre/EPA/Shutterstock
More recently, after an announcement that Covid restrictions would be eased led to little actual change, public frustration spilled out onto the streets. Workers at
Foxconn Technology Group’s
main plant in the city of Zhengzhou, the world’s largest iPhone factory, clashed with police while protesting a contract dispute with roots in pandemic lockdowns. In some Beijing neighborhoods, people argued with officials over the legality of controls.
In maintaining the lockdowns in Xinjiang, local authorities have been able to rely on the country’s most advanced and suffocating security apparatus, originally built to carry out a campaign of ethnic re-engineering against the region’s 14 million Uyghurs and other Turkic Muslims.
Most if not all of the fire’s victims belonged to these groups, according to relatives and overseas Uyghur activists. Discrimination by China’s Han majority against Turkic minorities has long fueled ethnic tensions in the region, which exploded into deadly race riots in Urumqi in 2009.
Yet in the past week, the sides found common cause, at least temporarily, in anger over the fire.
According to an official account published in the state-run Xinjiang Daily newspaper, the blaze began on the 15th floor, in the apartment of a Uyghur woman who was having a bath in a home spa when a circuit breaker flipped. She flipped it back, then was alerted by her daughter to the smell of smoke. When she re-emerged from the bathroom, flames had risen to the wooden ceiling from the bed.
A community worker arrived just as they were fleeing the flames, according to Xinjiang Daily. He called the fire service at 7:49 p.m. last Thursday, then helped rush the pair and their neighbors downstairs.
A still taken from a social media video shows a fire truck shooting water at the burning residential building in Urumqi. The fire and delays in fighting it proved a catalyst for nationwide protests against Covid-19 lockdowns.
Photo:
REUTERS
At the ground level, burning debris had begun falling over the doorway. Those who couldn’t leave through the front gate in time had to climb out of a window from an apartment, the newspaper reported.
Firefighters didn’t reach some of the apartments until around 90 minutes after they were called, according to posts on the chat group.
Video footage showed that traffic-control structures had to be removed as a line of fire trucks waited, causing delays. The government denied the structures had been installed for pandemic-control reasons.
At a press briefing convened late Friday night as protests unfolded, officials said that three fire trucks from a nearby station arrived at the scene five minutes after the fire was reported, but they were blocked by cars that had to be moved.
On social media, residents said those cars had been parked there for months during the fall Covid lockdown, and the engines couldn’t start.
Li Wensheng, Urumqi’s fire chief, said at the press briefing that some residents’ “self-rescue abilities were weak,” a comment that added to the simmering anger.
The Xinjiang and Urumqi governments didn’t respond to requests for comment.
Han residents of Urumqi led the protests that unfolded in the freezing night air the day following the fire. Uyghur residents have faced the strictest lockdowns and largely stayed home out of fear they would bear the brunt of any reprisals, overseas activists said.
Demonstrations were fueled by the group chat conversations and footage of obstructed fire trucks, as well as by videos circulating online that appeared to capture the screams of people from the smoldering building. “Open the gate!” one woman could be heard shouting in horror in one video.
On Saturday night, several female students stood for hours on the campus of Communication University of China in Nanjing, holding blank sheets of paper in silence, widely taken to be a reference to Chinese censorship. A male student from Xinjiang offered a tribute to the victims in Urumqi and to “all other victims nationwide,” saying he had been a coward for too long.
A man was arrested on a Shanghai street when protests erupted following a deadly apartment-building fire in China’s Xinjiang region.
Photo:
hector retamal/AFP/Getty Images
That same night, dozens of people in Shanghai gathered for a vigil with flowers and candles near a street named after Urumqi. Passersby joined in, and the crowd grew into the hundreds. Just past midnight, some demonstrators began chanting for Mr. Xi to step down.
Similar protests emerged in half a dozen Chinese cities and more than a dozen university campuses in the following days. In several instances, demonstrators chanted “We are all Xinjiang people.” Others called for democracy and free speech.
Chinese authorities have devoted enormous resources to building domestic security and surveillance systems specifically designed to prevent such wide and unified outbreaks of dissent. While protests aren’t uncommon, scholars who study China say they are almost always local events with little capacity to spread.
The Cyberspace Administration of China issued guidance to companies on Tuesday, including Tencent Holdings Ltd. and ByteDance Ltd., the Chinese owner of short video apps TikTok and Douyin, asking them to add more staff to internet censorship teams, according to people familiar with the matter. The companies were also asked to pay more attention to content related to the protests, particularly any information being shared about demonstrations at Chinese universities and the fire.
In imposing its stringent Covid controls, human-rights activists and other observers say, the Communist Party created an issue that China’s citizens only have to look out their front door to understand. Some Uyghurs affected by the fire said the fear and frustration stemming from pandemic controls crossed deep-seated ethnic divides.
Marhaba Muhammad, now a resident of Turkey, said she read news of the fire with a sense of horror. She recognized the building as the home of her aunt, whom she last visited in 2016, shortly before leaving China. The family lived in apartment 1901, the subject of one of the desperate messages left in the residents’ chat group.
Ms. Muhammad said she and her family abroad learned that the aunt, Qemernisahan Abdurahman, 48, had died in the apartment, along with four children age 5 to 13.
Ms. Abdurahman’s husband wasn’t there. He and an elder son were detained as part of the crackdown in Xinjiang in 2017 and now are imprisoned, said Ms. Muhammad and her brother, Abdulhafiz Maiamaitimin, who lives in Switzerland.
“This news is so painful. No one imagined,” she said.
Qemernisahan Abdurahman, 48, with 3 of her four children who died in the fire in Urumqi.
Photo:
Marhaba Muhammad
In apartment 1801, directly below where Ms. Muhammad’s aunt and children died, a woman also died along with her children, according to Abduweli Ayup, a Uyghur activist in Norway who spoke with relatives and neighbors of the fire victims.
Han Chinese don’t have to fear the level of oppression faced by Uyghurs, Ms. Muhammad said, referring to the Chinese government’s detention of upwards of a million Uyghurs and other Turkic Muslims in internment camps and prisons—a practice the United Nations has said may constitute a crime against humanity.
Yet “after the fire, they realized that Uyghurs today would be the Chinese tomorrow,” she said.
Police have targeted protest participants by using some of the surveillance techniques honed in Xinjiang to target Uyghurs. In chat rooms used to organize demonstrations, protesters have reported police scanning the smartphones of pedestrians for overseas apps such as Twitter and Telegram, a common experience on the streets of Urumqi.
A lawyer representing more than a dozen protesters taken by police said she believes many of her clients were tracked through mobile-phone data, another echo of the Uyghur experience in Xinjiang.
On Tuesday, Chinese-Australian activist and cartoonist Badiucao, who goes by one name, reposted a widely shared video of police on the Shanghai subway checking the phones of passengers on Twitter. He appended a single phrase: “Xinjiang-ization.”
Protesters in Beijing lighted candles during a protest against China’s strict zero-Covid measures.
Photo:
Kevin Frayer/Getty Images
Write to Austin Ramzy at austin.ramzy@wsj.com and to Wenxin Fan at Wenxin.Fan@wsj.com
faces a difficult choice between loosening China’s zero-tolerance Covid-19 policy or doubling down on restrictions that have locked down neighborhoods and stifled the country’s economy over the past three years.
Neither option is a good one for a regime focused on stability. Stock markets around the globe declined Monday as protests in China fueled worries among investors about the outlook for the world’s second-largest economy.
“Xi’s leadership is in a bind,” said
Yuen Yuen Ang,
a political scientist focused on China at the University of Michigan. “If they compromise and relax zero-Covid, they fear it will encourage mass protests. If they repress more, it will create wider and deeper grievances.”
Protesters across China have directly challenged the authority of the Chinese leader and the Communist Party in scenes unthinkable just a month ago, when Mr. Xi secured a third term in power.
In Shanghai over the weekend, protesters used call-and-response chanting to demand political change. In Beijing, crowds shouted “Freedom.” In other large cities, demonstrators marched holding blank sheets of paper—a swipe at government censorship.
China experts say the protests are unlikely to translate into a leadership change, in the near term at least. But Beijing’s dilemma is a tough one. It could lift restrictions and risk a large and potentially deadly wave of Covid infections that could undermine its credibility. Or it could crack down on the demonstrators and stick with a strict pandemic strategy that large parts of the population are clearly fed up with.
All three benchmark U.S. stock indexes closed more than 1% lower on Monday as investors worried that the protests would lead to more market volatility.
Widespread and public outpourings of political grievance have been extremely rare in a country where people have long consented to obey party authorities—as long as they deliver prosperity and allow citizens relative freedom in their personal lives.
People sang slogans and chanted for political change on a street in Shanghai on Sunday.
Photo:
hector retamal/Agence France-Presse/Getty Images
Police cars were parked on a Shanghai street on Monday, a day after rare demonstrations were held.
Photo:
hector retamal/Agence France-Presse/Getty Images
The protests put in stark relief the fraying of that social contract, showing that the climbing economic and social costs of China’s zero-Covid policies—coupled with an increasingly authoritarian regime’s zero-tolerance for dissent—have driven many to a kind of breaking point.
Demonstrations aren’t unusual in China, but they are largely over local grievances such as unpaid wages, land disputes or pollution. Since the Tiananmen Square protests in 1989, the party has made it a priority to prevent nationwide protests of a political nature.
The current wave of unrest started last week in the remote northwestern region of Xinjiang after 10 people died in a fire. Residents contended that Covid restrictions were partly to blame for delaying rescuers and contributing to the death toll. Officials said some barriers had to be moved but attributed the delay to parked cars in the way.
In the days since, the anger has spread across China. On Monday, authorities moved broadly to prevent any new protests, including dozens of uniformed and undercover police swarming the area around a highway bridge in Beijing where a lone protester hung a banner denouncing Mr. Xi in October. On Sunday, protesters had chanted lines from the banners.
In a rare show of defiance, crowds in China gathered for the third night as protests against Covid restrictions spread to Beijing, Shanghai and other cities. People held blank sheets of paper, symbolizing censorship, and demanded the Chinese president step down. Photo: Kevin Frayer/Getty Images
The unrest also underlined how anger about the Covid restrictions has united people from a range of social backgrounds—from migrant workers assembling iPhones in central China and residents of the remote region of Xinjiang to college students and middle-class urbanites in the nation’s biggest cities.
“The mass protests represent the biggest political crisis for Xi,” said
Minxin Pei,
editor of quarterly academic journal China Leadership Monitor. “It’s the first time in recent decades that protesters from a broad coalition of social groups have mounted a direct challenge to both the top leader himself and the party.”
Students staged a small protest Sunday at Tsinghua University in Beijing.
Photo:
Associated Press
Sudden reopening could lead to millions of intensive-care admissions in a country with fewer than four ICU beds per 100,000 people, and where many elderly still haven’t been fully vaccinated, according to public-health experts and official data. In addition, such a compromise would send a signal to the general public that mass protests are an effective means to win change, not something the government would want to encourage.
On the other hand, sticking to the zero-Covid policy could stir up even greater public resentment toward the leadership, with hard-to-gauge consequences.
The University of Michigan’s Ms. Ang and others say that the protests are unlikely to lead to any radical policy shift. Rather, one likely outcome is a mixture of selective relaxation of controls and harsh retaliation against select protesters.
Protesters and police stood on a street in Beijing on Monday.
Photo:
Kevin Frayer/Getty Images
“The danger is that if the leadership responds with repression, that could take China down a vicious cycle of control, leading to more grievances, to more control,” Ms. Ang said.
China’s Covid struggle underscores the limits of a political system where a lack of public debate has made it hard to adjust policies as other countries have done.
Many public-health experts say Beijing has missed the window to put in place a gradual exit plan out of zero-Covid. For the past three years, the government has spent significant resources on building ever more quarantine facilities and expanding mass-testing capabilities, while China’s progress on developing more effective vaccines has been slow.
Partly thanks to Beijing’s early successes at stemming infections, the Chinese population has developed little natural immunity. It only has access to homegrown vaccines that are less effective than some of the global alternatives.
A neighborhood in Beijing where access is restricted because of Covid regulations.
Photo:
Ng Han Guan/Associated Press
Notably, negotiations between China and the European Union over mRNA vaccine imports from the bloc fell through nearly two years ago, according to people familiar with the matter, after Beijing insisted that Europe recognize Chinese vaccines.
Beijing has also resisted approving any large-scale adoption of the mRNA vaccine co-developed by
Pfizer Inc.
and
BioNTech SE,
a decision healthcare and foreign-policy experts attribute partly to China’s strained relations with the U.S.
Mr. Xi and the party have faced public anger before, most notably during the early days of the pandemic when emotions swelled with the death from the virus of
Li Wenliang,
a young doctor in the city of Wuhan who was punished for trying to raise an early alarm. Ultimately, much of the nation’s anger then was directed at local authorities.
In the years since, Mr. Xi has identified himself closely with the zero-Covid strategy. That is now turning him into the natural target of protesters’ fury and has also made it nearly impossible to shift course without diminishing his standing. Notably, a People’s Daily article on Sunday continued to stress the importance of unwaveringly sticking to the existing Covid-control policy.
A Covid testing station in Shanghai on Monday. The government has built quarantine facilities and expanded mass-testing capabilities, while its development of more-effective Covid vaccines has been slow.
Photo:
Bloomberg News
As repeated lockdowns kept businesses closed and pushed up unemployment, some hoped there would be a shift away from the zero-Covid strategy once an October party conclave that handed Mr. Xi another five-year term was over.
As long as the top leader felt politically secure enough, those people argued, he would want to adjust the policy to help the economy—which still matters to the leadership despite its increased emphasis on ideology and party control.
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Businesses and investors alike cheered when Beijing earlier this month unveiled plans to “optimize and adjust” the Covid policy, including shortened quarantine restrictions. Many market analysts viewed the step as the beginning of a gradual exit from zero-Covid.
However, as Covid cases surged again along with the colder season, local officials across the country reimposed strict restrictions for fear of putting their jobs in jeopardy. Keeping Covid under control has remained the overarching political priority for localities that are also struggling to reboot economic activity.
The contrast of China’s continued Covid lockdowns as the rest of the world has moved on became more obvious over the past week as many Chinese soccer fans have seen TV images of thousands of maskless spectators cheering in stadiums during the World Cup in Qatar.
Then came the deadly fire in Urumqi, the capital of Xinjiang, where residents had struggled with lockdowns of more than 100 days, prompting protesters across the country to defy the risks of expressing dissent to seek change.
People lighted candles on Sunday in Beijing for victims of a deadly fire in the northwestern city of Urumqi, the capital of Xinjiang.
Flu activity continued to rise across the U.S. in the past week, adding to a crunch on emergency departments and pediatric hospitals from an early surge in respiratory viruses.
Flu has caused an estimated 4.4 million illnesses, 38,000 hospitalizations and 2,100 deaths so far this season including seven pediatric deaths, the Centers for Disease Control and Prevention said Friday. The highest flu hospitalization rates are among adults ages 65 and older, followed by children under the age of 5, the CDC said.
Pediatric hospitals across the U.S. have been under strain for weeks from a rush of patients with RSV and other respiratory viruses. RSV amounts to a cold in most people, but the virus can be dangerous for younger children and older adults, especially those with other healthconcerns.
“You have flu that is starting to surge in other areas where they’re trying to deal with the RSV surge, and you also have Covid,” said Tina Tan, vice president of the Infectious Diseases Society of America. “It’s one after the other after the other.”
RSV cases appear to be plateauing or declining in parts of the U.S., doctors said. Within the CDC’s RSV-surveillance network of 12 states, the hospitalization rate for RSV remains higher than the most recent prepandemic peak.
Some 76% of pediatric inpatient beds are occupied across the U.S. and occupancy of pediatric intensive-care beds is just above 80%, according to the Department of Health and Human Services. That’s up from 65% of pediatric beds and 70% pediatric ICU beds occupied in early August.
States including Massachusetts, Nevada, Pennsylvania and Texas have more than 90% of their pediatric intensive-care beds occupied, the data show. The data doesn’t specify why patients are in the hospital.
Researchers say the coronavirus is having a persistent effect, keeping millions out of work and reducing the productivity and hours of millions more.
Photo:
Neeta Satam for The Wall Street Journal
“We really maxed out all the space we have,” said Kristina Deeter, physician-in-chief at Renown Children’s Hospital in Reno, Nev., and specialty medical officer for pediatric critical care at
Pediatrix Medical Group.
Pediatric patients at Renown Children’s are backed up into the waiting room, some teenagers have been sent to the adult floor and a list of kids from nearby emergency departments are waiting for a bed, she said.
Other respiratory viruses, including Covid-19, and high demand from pediatric mental-health patients are contributing to the strain at pediatric hospitals, doctors said. Nursing shortages and a decrease in pediatric beds have compounded the crunch.
From 2008 to 2018, the number of pediatric inpatient beds in the U.S. decreased by 12%, according to a 2021 study in the journal Pediatrics. Declines in rural areas were steeper than average, and pediatric specialty care has been increasingly concentrated at large children’s hospitals. The pandemic exacerbated those trends, doctors said.
“When we combine that decrease in beds with a surge in the need for those beds, I certainly think we feel it,” said Anna Cushing, lead author on the study and a pediatric emergency medicine physician at Children’s Hospital Los Angeles. Children’s Hospital Los Angeles hasn’t had space to accept all the transfer patients looking for a bed, said chief medical officer James Stein.
At Rady Children’s Hospital-San Diego, emergency department wait times have fluctuated between two and six hours. In October, the hospital started sending administrative staffto volunteer there, freeing up the regular workers to focus on the sickest patients.
The staffers give kids blankets and alert a triage nurse if patients get sicker, said Nicholas Holmes, chief operating officer at Rady Children’s. A trained pediatric urologist, Dr. Holmes said he worked in the emergency room several times last week.
“Handing out a coloring book and giving a kid a Popsicle, it helps them feel a little bit better,” Dr. Holmes said.
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People should wash their hands, stay home if they’re sick, consider wearing masks indoors and while traveling and get vaccinated against Covid-19 and the flu, doctors and health officials said. They said people should be particularly conscious of risks to infants and older adults during Thanksgiving gatherings.
There are no specific treatments for RSV, but over-the-counter medication can help with fever and patients should stay hydrated. Parents should consult pediatricians if a child is having trouble breathing, having trouble staying hydrated or appears lethargic, doctors said.
The American Academy of Pediatrics said eligible high-risk infants could receive more than the standard five consecutive doses of the monoclonal antibody palivizumab to protect them during this unusually early and long RSV season. Hospital referrals should be reserved for children who need a higher level of care, to avoid overcrowding and extended wait times, the academy said.
Marijuana might do more damage to smokers than cigarettes alone.
A study published Tuesday in the journal Radiology demonstrated higher rates of conditions including emphysema and airway inflammation among people who smoke marijuana than among nonsmokers and people who smoked only tobacco. Nearly half of the 56 marijuana smokers whose chest scans were reviewed for the study had mucus plugging their airways, a condition that was less common among the other 90 participants who didn’t smoke marijuana.
“There is a public perception that marijuana is safe and people think that it’s safer than cigarettes,” said Giselle Revah, a radiologist who helped conduct the study at the Ottawa Hospital in Ontario. “This study raises concerns that might not be true.”
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One-fifth of Canadians over 15 years old reported using marijuana in the past three months, according to a 2020 survey of some 16,000 people conducted by Canada’s national statistical office. About 18% of Americans reported using marijuana at least once in 2020 in the U.S. Substance Abuse and Mental Health Services Administration’s National Survey of Drug Use and Health, including about one in three young adults age 18 to 25. The surveys didn’t ask how marijuana was consumed. About one-fourth of people over 12 years old believed there was great harm from smoking marijuana once or twice a week, according to the survey.
Previous studies have found that marijuana is more likely than tobacco to be smoked unfiltered and that smokers tend to inhale more smoke and hold it in their lungs longer. Bong smoke contains tiny pollutants that can linger indoors for up to 12 hours, a study published in March in JAMA Network Open showed.
Among the 56 marijuana smokers in the Ottawa study, 50 also smoked tobacco. The tobacco-only smokers were patients whose chest scans were performed as part of a high-risk lung-cancer screening program that included people age 50 and above who had smoked for several years.
Marijuana’s illicit status long discouraged substantial research into the long-term effects of its use, said Albert Rizzo, chief medical officer for the American Lung Association, who wasn’t involved in the study. Inhaling any heated substance can irritate airways, among other health dangers, he said.
“There could be an additive effect if you smoke cigarettes as well as marijuana,” Dr. Rizzo said.
The study authors found bronchial thickening in 64% of marijuana smokers versus 42% of tobacco-only smokers and a condition that leads to excess mucus buildup in 23% of marijuana smokers versus 6% of tobacco-only smokers.
Age-matched marijuana smokers had higher rates of emphysema (93%) than tobacco-only smokers (67%), and the emphysema, which appears in imaging as small holes in lung tissue, was more prevalent in the marijuana smokers, the study found.
