A string of deaths at a hospital for elderly patients in Shanghai underscores the dangerous consequences of China’s stubborn quest for a zero coronavirus outbreak amid an escalating outbreak in the city of 26 million.

Relatives of the patients told The Associated Press that several patients have died at the Shanghai Donghai Nursing Home. They said loved ones who came into contact with the virus were taken away from quarantine, under strict pandemic rules, without proper care and depleted hospital staff.

Family members took to social media for help and answers, and asked to see surveillance video from inside the facility after getting little or no information from the hospital.

The state of the hospital and the death toll are a scathing rebuke of China’s adherence to a zero-coronavirus policy strategy in response to an outbreak in Shanghai where most infected people are asymptomatic. The focus is on forcing positive cases and close contacts into designated collective isolation facilities, where the cost of zero Covid-19 may outweigh the risk of getting sick.

On Saturday, Shanghai Vice Mayor Zong Ming said lockdowns in communities that had not reported positive cases in 14 days could soon be lifted or eased after another round of COVID-19 testing across the city.

Shen Peiming, 71, was a victim of such a draconian measure. She died in hospital on Sunday morning without any relatives. A family member said they had been calling the hospital non-stop to find out the cause of Shen’s death, but had never received a clear answer. “How many times have they been locked down since 2020? Have they not had experience managing this yet?” the family said.

All they knew was that her doctors and nurses had not come to care for Shen, who was semi-paralyzed after a stroke. Her last nursing assistant was quarantined because of a close contact with the positive case, the relative said, speaking on condition of anonymity for fear of retaliation. A strange worker called to inform them of her death. Later, the hospital said it was a chest infection.

There was a COVID-19 outbreak at the hospital, and the family learned from medical staff, but as of last week, Shen had tested negative.

Authorities in Shanghai have not reported deaths from the outbreak, but questions have been raised about the reliability of the data. Due to the sensitivity of the topic, a city health official said on condition of anonymity that the criteria for confirmed cases and deaths are very strict and vulnerable to political interference.

It is unclear how many patients died in the hospital and if anyone died from COVID-19. The family said they were talking to other families whose loved ones had also passed away. An article by Chinese news outlet Caixin describing the deaths and infections was taken down shortly after it was published, apparently targeted by censors. Calls to the Tokai Pension Company went unanswered. The Shanghai government did not respond to a faxed request for comment.

Most experts agree that China’s zero-coronavirus approach has been very successful in keeping the death toll to a minimum when drugs or vaccines are limited. But injections are now widely available in China, and with the omicron variant, many say the government should abandon the policy and focus medical resources on the elderly and vulnerable.

Instead, Shanghai has locked down 26 million people and conducted repeated mass testing in response to an outbreak caused by a highly contagious variant of omicron BA.2. On Saturday, the city reported more than 23,000 new local cases, with only 1,015 people showing symptoms.

“If you don’t have symptoms, what can hurt you?” said Ye Rui, founding director of the U.S. Centers for Disease Control’s China office, who is in close contact with Chinese health officials. “The only people who will get sick are those with diabetes, obesity, chronic diseases and older people. Protect those people. You can protect them.”

However, low vaccination rates among older adults remain a problem. According to the latest data available, only 62% of Shanghai residents over the age of 60 are vaccinated. Some experts support the strict approach, saying China needs to raise the rate to safely coexist with the virus.

Like the UK, the US guideline for asymptomatic cases is for individuals to isolate at home for five days. In Shanghai, workers scrambled to build a slew of makeshift facilities in showrooms and elsewhere in an attempt to house everyone who had tested positive.

The city-wide lockdown disrupted daily life and the economy. Many residents trapped in apartment buildings are scrambling to buy food through apps and place bulk orders with neighbors. Some people in quarantine have posted videos showing chaotic scenes of people scrambling for food and a lack of clean toilets. Others posted pleading for relatives in desperate need of medication.

The U.S. said on Friday that in light of the situation, it allowed non-essential personnel and family members to voluntarily leave its consulate in Shanghai.

The government has touted its success in containing COVID-19, touting it as evidence of the superiority of China’s governance system — especially when compared to Western democracies, which have suffered far more deaths than China. That argument makes it difficult for Beijing to change tack, experts say.

“They boasted to their people how great they were, and now they have drawn themselves into a corner,” Ye said. “The only way they can control Shanghai now is to repeat what they did in Wuhan.”

When the 2020 pandemic began, Wuhan’s 11 million residents were locked down for more than two months.

The lockdown in Shanghai is a sudden and dramatic change from a month ago, when some Chinese health experts publicly recommended easing epidemic control measures.

The city’s economic importance and advanced health care system have made officials reluctant to adopt draconian measures and confident in fighting any outbreak. In addition, Chinese leader Xi Jinping in mid-March ordered China’s ongoing outbreak to be contained at “minimum cost”, emphasizing Beijing’s desire to protect the economy while containing the virus.

Shanghai took targeted measures, locking down individual office buildings, shopping malls and neighborhoods for 48 hours at a time, but otherwise allowed life to go on as usual.

With the soft measures, the number of cases in the city has risen. The outbreak has spread to at least 71 other cities, according to a notice issued in southern China’s Guangxi province, and pressure is mounting for tougher measures.

On March 28, the city began an eight-day lockdown in two phases, which has since evolved into a city-wide lockdown with no end in sight.

“There is no time to waste,” Chinese Vice Premier Sun Chunlan said during a visit to the city over the weekend, according to a government statement. “We need to move forward faster and harder to provide strong support for society to eliminate cases. “

These actions led to the isolation of nurses and doctors, which worsened the situation at Tokai Pension.

Chen Jielei said the hospital outbreak infected her unvaccinated, partially paralyzed mother, 81. With the staff also sick, her mother didn’t eat on time and her sheets were not changed for days. A few days later, a replacement worker began to care for her.

A university professor who asked not to be named for fear of retaliation said his family was not notified for more than a day after his 82-year-old father died on March 31. His last contact was on March 28, when the nursing assistant called to warn that there were positive cases and that they could no longer care for his father.

“What happened to my father for those three days? What kind of abuse did he suffer?” he asked. When he spoke to the nursing assistant on March 28, his father’s condition was stable.

After the stroke, Shen lived in the hospital on and off for three years. Family visits every week. But the relative said that visits were banned in early March due to the spread of the COVID-19 epidemic in Shanghai.

They were not worried at first because the hospital was always responsive and they were in touch with the nursing assistant who cared for Shen. But an ordering officer warned on March 26 that there were positive cases and many employees at Tokai were being quarantined.

Hospitals employ temporary nursing assistants, but many have no health care experience, one nursing assistant said.

The woman, who gave her surname only Zhang, said an employment agency told her it was a cleaning job.

“They say your job is to clean and you don’t even have to wear protective clothing. But what they say is completely different from what I have to do,” she said.

Shen needs to help her eat through the tube by mixing her food into a liquid. She also has a tube in her throat that must be disinfected daily.

“In the past, if there was a problem, they would always call me. This time there was no voice. She died so suddenly,” the relative said. The hospital now asks the family of the deceased to sign a form to cremate the deceased. Shen’s relatives said the family would refuse until a clear answer was given.

The hospital issued letters of apology to some families on Wednesday. The Associated Press reviewed a copy.

“Due to the urgency of the outbreak, many elderly people are not vaccinated, resulting in the death of people with severe and frail underlying medical conditions,” it said.

While Chinese government researchers have begun to explore ways to end zero COVID, the government continues to punish officials for large outbreaks on its turf.

“The space for discussion has now been eliminated, and the message is loud and clear: Zero coronavirus, no exceptions,” said Yanzhong Huang, a public health expert at the Council on Foreign Relations.