Tens of millions of Chinese confined at home, schools closed, businesses in limbo and whole cities at a standstill. Once again, China is locking down enormous parts of society, trying to completely eradicate COVID in a campaign that grows more anomalous by the day as the rest of the world learns to live with the coronavirus.

But even as the costs of China’s zero-COVID strategy are mounting, Beijing faces a stark reality: It has backed itself into a corner. Three years of its uncompromising, heavy-handed approach of imposing lockdowns, quarantines and mass testing to isolate infections have left it little room, at least in the short term, to change course.

China’s leader, Xi Jinping, has made clear that zero COVID is as much an ideological undertaking as a public health one. He has tied support for the policy to support for the Communist Party and hailed its execution as proof of China’s edge over Western democracies. He has prioritized nationalism over the guidance of scientists. Any reversal or adjustment would seem to undercut his vision, especially before a major Communist Party meeting next month where Xi is all but assured to extend his rule.

The emphasis on politics has created practical problems. Beijing has refused to approve foreign vaccines, opting instead to provide only less-effective, homegrown ones to its 1.4 billion people. The government has pushed propaganda depicting the virus as having devastated Western countries, feeding widespread stigma and a fear of infections even among the young and healthy. It has silenced voices seeking to offer a different approach, labeling them traitors.

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Buoyed by its early success at containment, the party was slow at first to encourage vaccination, leaving many older Chinese vulnerable. Since few Chinese have natural immunity from the virus, the risks of loosening controls are potentially even higher.

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“That sort of makes the zero-COVID policy self-sustaining,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.

At least 65 million Chinese are currently under some form of lockdown, according to a tally by Chinese media, including the southwestern city of Chengdu, home to 21 million people. In cities that are not battling outbreaks, quashing COVID still dictates the rhythms of daily life. Residents line up for mandatory, regular testing and obsessively monitor their health codes, digital markers that dictate whether they can move freely.

Many Chinese have found ways to cope, even if reluctantly: putting in longer hours to scrape up more money, cutting back on spending. Complaints about a shortage of medical care or food often emerge, but some residents say they support the overarching goal.

“Who can get used to this?” said Zhang Lang, a grocery store owner in the southwestern city of Guiyang, who has been under lockdown for three days. “But there’s no choice,” he said. “The epidemic is coming. Do you want what happened in America to happen here?”

Still, the question is how long China’s calculus will remain in favor of the current approach. Youth unemployment is soaring, small businesses are collapsing, and overseas companies are shifting their supply chains elsewhere. A sustained slowdown would undermine the promise of economic growth, long the central pillar of the party’s legitimacy.

“The social and economic cost will continue to increase. So I think ultimately, they’re going to reach a point where the cost exceeds the benefits,” Huang said. But, he added, “it just might be farther off.”

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For now, officials are sticking closely to the status quo, imposing the most extensive lockdowns in months to contain a series of new outbreaks.

Authorities in Guiyang, population 6 million, ordered a partial lockdown this week after detecting several hundred cases in recent days. In Shanghai, where one asymptomatic infection was announced Tuesday, officials imposed a one-week lockdown on a hotel where the patient had stayed and urged all residents not to leave the city during a public holiday this weekend.

Because of the high political stakes, local governments are likely to err on the side of overreaction to contain outbreaks, said Chen Xi, an associate professor of public health at Yale University. Scores of city officials have been fired or otherwise punished after cases emerged in their jurisdictions. The party meeting on Oct. 16 is adding to the pressure on officials.

“Given the sensitive timing before the party congress, local governments are afraid of making any mistakes, making the central government’s policies unnecessarily more stringent,” Chen said. China’s pursuit of zero COVID has often been single-minded, overriding all other concerns. Hospitals trying to avoid the risk of infection have turned away patients in dire need of care. Enforcers of lockdowns have barged into people’s homes or killed pets left behind by quarantined owners. When a 6.8-magnitude earthquake struck Luding County in Sichuan province Monday, residents in the locked-down city of Chengdu, the provincial capital, were blocked from leaving their homes even as buildings shook, according to widely circulated posts on social media.

After a public outcry, Chengdu health officials clarified that physical safety was the top priority in the case of natural disasters.

The challenge for China is that its own policies have made it harder to ease restrictions. While other countries prioritized vaccinating the elderly, China made older residents among the last to be eligible, citing concerns about side effects. And it never introduced vaccine passes, perhaps sensitive to public skepticism of its own vaccines.

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In late July, about 67% of people age 60 and older had received a third shot, compared to 72% of the entire population. Medical experts have warned that an uncontrolled outbreak could lead to high numbers of deaths among the elderly, as occurred during a wave this spring in Hong Kong, which also suffered from low vaccination rates.

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But those considerations are entangled with politics, too. China has refused to approve Western mRNA vaccines, though it has struggled to produce its own; its homegrown, inactivated vaccines have proved less clinically effective.

Cai Xia, a retired professor at the Communist Party’s top academy, attributed China’s inflexible approach to Xi’s desire for total control. In an essay published Wednesday in Foreign Affairs, Cai, who now lives in the United States, said Xi had overruled health experts throughout the pandemic.

“A leader more open to influence or subject to greater checks would not likely have implemented such a draconian policy, or at least would have corrected course once its costs and unpopularity became evident,” she wrote, in reference to this spring’s lockdown in Shanghai, which led many residents to report shortages of food and medical care. “But for Xi, backtracking would have been an unthinkable admission of error.” There may come a point at which the economic consequences of zero COVID force Beijing to consider a reset.

Youth unemployment has reached a record 20%, according to official statistics in August. The nearly three dozen Chinese cities under some form of lockdown represent one-third of China’s entire economic output, according to Hao Hong, the chief economist and a partner at Grow Investment Management in Hong Kong.

Survival is top of mind for business owners like Lu Wei, 50, who runs a restaurant in Daqing, in northeastern China. She and her husband have been sealed at home for three weeks, and she worries about how she will pay rent. She is relying on the government for deliveries of fresh vegetables and drawing from her store of pickled vegetables when they don’t arrive.

But Lu said she was used to measures such as daily testing and believed they could keep her safe. She said she did not have any specific changes she would like to see to COVID policies, other than perhaps the flexibility to order online food deliveries.

“I just hope we can achieve zero as soon as possible,” she said.