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45 cities in China are in some sort of COVID lockdown. Here's the toll that's taking

DANIEL ESTRIN, HOST:

The city of Shanghai in China remains under strict lockdown because of COVID, and it's not the only one. Forty-five Chinese cities have some sort of lockdown measure in place as the country struggles to contain the highly infectious omicron variant. NPR's Emily Feng reports on the costs these measures are having.

EMILY FENG, BYLINE: A blood-red sun is setting in Beijing over thousands of workers walking through checkpoints. They're headed back home to the city's satellite suburbs in Hubei, the province next door. Qi Ling, a tech worker, is among those who live in cheaper housing across the border than travels to Beijing each day for work. When lockdowns happened this year...

QI LING: (Through interpreter) The impact was huge. I was locked down in my home in the suburbs for 20 days. If I had stayed in Beijing, I would be required to quarantine for two weeks.

FENG: Now the border is technically open, but only people with special permits can walk across to get to work each day. Qi Ling, clad in leather, opts to ride his motorcycle.

QI: (Through interpreter) I'm trying to get around the traffic congestion, and Beijing blocks out city cars from driving in.

FENG: Cars like certain trucks, for example. That means trucking logistics could be blocked with no warning in China, shutting down critical regional transport hubs. And this is happening all across the country. One tally from Beijing research firm Gavekal Dragonomics calculates cities accounting for about 50% of China's total economic output have some sort of lockdown measure in place. Now, let's zoom out because this congestion is happening on a global scale, too, with China at the center of it.

EYTAN BUCHMAN: It's like super chaos theory. If you shut down, you know, one ship in one place, what happens three months later?

FENG: Eytan Buchman is chief marketing officer for the platform Freightos, which helps small businesses book shipping freight for their goods. The problem is major ports, like the one in Shanghai, are also snarled up due to Chinese lockdowns.

BUCHMAN: Then you also start to get the cascading dominos falling, and you see more congestion at their surrounding ports because now ships might not call at the Port of Shanghai. And you have 3 to 6 months of echoes in the system that just don't go away.

FENG: Ninety percent of their clients say they've been impacted by delays and higher shipping costs, even if their factories or logistics are not even directly in Shanghai - clients like Dan Otto, vice president at Code and Quill, a high-end stationery e-commerce company.

DAN OTTO: The Port of Shanghai is currently going through some pretty extreme congestion. Goods that would have otherwise gone out of Shanghai are now going through Ningbo. So even the ports that may be less affected by lockdowns are still seeing the spillover effects.

FENG: Including the Port of Ningbo, where he ships his custom notebooks and planners from.

For the last two years, China's zero tolerance approach to COVID-19 meant a relatively stable operating environment - long periods of normalcy punctuated by occasional mass testing or lockdowns across only a handful of cities. Michael Hart is president of the American Chamber of Commerce in China.

MICHAEL HART: When we did a survey at the end of last year, a lot of people admitted that COVID zero had been successful to that point.

FENG: But China is now at the point where the time in between lockdowns could be getting shorter than the lockdowns themselves.

HART: The situation has now changed. This is different because, finally, China is having to deal with COVID.

FENG: In that, more infectious variants are challenging this lockdown model, but the greatest cost is being borne by the most vulnerable in China. For them, the cost is not just financial - it's emotional and physical. One public health expert estimates about 2,000 excess diabetes deaths alone in Shanghai. In Wuhan, China's CDC estimated excess deaths from chronic disease were up more than 20% during its lockdown. China's zero tolerance COVID policy likely saved lives, even at great economic cost at first. But now, it could start to cost more than it saves.

Emily Feng, NPR News, Beijing. Transcript provided by NPR, Copyright NPR.