At least three Chinese cities put in place partial lockdowns and the gambling hub of Macao shut its casinos for the second time since the start of the pandemic, as authorities tried to stamp out the latest outbreaks.

In mainland China, the cities of Xi’an, Lanzhou and Haikou imposed partial lockdowns, closing nonessential businesses and enforcing mass testing, setting restrictions on several million residents.

In Macao, a semi-autonomous Chinese city, authorities also closed nonessential businesses, including its 42 casinos, which are the main drivers of the city’s economy, and asked residents to stay home except to buy food.

The latest measures follow lockdowns in Shanghai and in Beijing where millions of people were confined to their homes earlier this year as China’s dealt with its biggest outbreak of the virus. New cases have emerged in Shanghai barely a month after a citywide lockdown was lifted, prompting officials to order many residents to undergo testing as new cases emerged, a possible precursor to more severe restrictions.

China’s blunt strategy to eliminate the disease wherever it pops up comes with economic and social consequences. It means locking down apartment blocks, neighborhoods or even whole cities for days or weeks to stamp out even handfuls of cases. And it has led to a significant slowdown in economic growth, which has been felt globally with the disruption of supply chains.

Macao’s 680,000 residents have been relatively sheltered from the virus. It has reported two deaths and fewer than 2,000 confirmed cases since the start of the pandemic in 2020, according to government data.

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The government had already closed parts of the city in recent weeks, along with banks, government buildings, parks and swimming pools. All residents had to undergo rounds of mandatory testing.

But until now, Macao had avoided shutting down the casinos, which were last closed in February 2020, for 15 days, because of the economic impact. Shares in the companies that run the casinos tumbled Monday.

On Sunday, a health official in Shanghai said that the first case of an omicron sub-variant, BA.5.2.1, has been found in the financial hub. The news triggered more mandatory testing orders for residents of several neighborhoods in the city, which is still recovering from the psychological scars of strict lockdowns earlier in the year.

Unrelated to the coronavirus, a rare case of cholera was reported at Wuhan University. The patient, a graduate student, has been isolated in a hospital. Medical authorities have tested health workers who had come into contact with the patient for the bacterial disease, which is spread through water or food and causes severe diarrhea.

China reported five cases of cholera last year, according to government data.