There’s no shortage of issues to keep Chinese premier Xi Jinping from sleeping at night: the threat of a real estate market collapse, Chinese provinces adjusting growth targets downward because of COVID, his decision to align closely with Vladimir Putin and Russia’s barbaric attack on Ukraine, a birth rate that’s hit a 61-year low

But perhaps the greatest concern for Xi is COVID-19’s threat to his reappointment for a third term as Communist Party chairman at the 20th Party Congress expected later this year.

Natural disasters have often led to political change in China. The July 1976 Tangshan earthquake, which killed more than half a million people by some estimates, was seen by many as an indication that Mao Zedong had lost legitimacy — or the “Mandate of Heaven” — as the ruler of China. His death a few weeks later only affirmed these superstitions.

Whether by superstition or simple discontent, Xi is worried that dissatisfaction with his government’s handling of COVID might weaken him in the run-up to the Party Congress. That’s why he and the Chinese Communist Party (CCP) are working furiously to ensure the success of his “Zero COVID” policy, especially until the Party meets in the fall.

China is not a democracy and dissent is not tolerated, but public opinion nevertheless matters. Xi is in a tough spot as the spread of the Omicron variant strains efforts to maintain the Zero COVID policy. The Shanghai government’s heavy-handed response to an outbreak has generated condemnation from citizens who are angry about empty store shelves, a lack of access to health services, shoddy isolation facilities, and — most draconian of all — policies that separate infected children from their parents.

At a certain point, this discontent may spill over into questions about Xi’s handling of the country.

China’s top disease experts are starting to admit privately that the Omicron variant threatens the viability of the Zero COVID policy. Can the Communist Party shut down cities and provinces for weeks and months at a time following every outbreak? Can it keep borders closed indefinitely? The looming social and economic costs of the Zero COVID strategy are becoming clearer, and Xi has no long term plan beyond keeping the virus at bay until the Party Congress.

After the initial outbreak of COVID-19 in Wuhan in December 2019, Chinese citizens were willing to endure significant limits on personal freedom and movement to maintain low to non-existent COVID levels in the country. The Wuhan lockdown in early 2020 forced 11 million people into their homes on the brink of China’s most celebrated holiday, the Lunar New Year.

Deprivation was significant, and signs of popular dissatisfaction began to appear on social media. But these were quickly silenced, and the Chinese people heralded victory over COVID in the spring of 2020 just before the rest of the world plunged into the seemingly endless winter of the pandemic.

In the nearly two years since, China has implemented some of the strictest international and travel restrictions in the world, all aimed at keeping COVID from entering the country. It has deployed high tech methods (like tracking and symptom checkers) as well as low tech methods (like work units and neighborhood committees) to ensure compliance with virus protocols and routinely locked down neighborhoods, and even whole cities, when cases emerge.

This strategy had largely worked — until recently.

In February, China had 136,000 cases and 5,700 deaths, with much of that registered during the crisis in Wuhan. Less than two months later that number had grown to just shy of 1 million cases and over 13,000 deaths.

While China’s numbers are still far fewer than the United States, as well as neighbors Japan and Korea — all of which have smaller populations and stronger health care systems than the PRC — the increases are causing alarm for many in the country. Hong Kong witnessed an alarmingly high death rate per capita in March, killing mainly the city’s elderly. And China is still refusing to make available more effective mRNA vaccines to its population because of what many see as “vaccine nationalism” on the part of the authorities, who continue to favor the country’s homegrown vaccine.

Until recently, many Chinese citizens accepted the government’s strict public health measures as a price they have been willing to pay for their health. But the spread of the Omicron variant threatens to outmatch China’s prevention strategies — and that’s keeping Xi Jinping awake at night.

Xi knows that he and the Party are responsible for China’s experience with COVID-19. As the rest of the world moves to COVID endemicity, the prospects of maintaining a “Zero COVID” state in China are dimming. While an uncontrollable national outbreak would surely pose a threat to Xi’s leadership, maintaining this strategy may prove just as menacing.

Amy Gadsden is the University of Pennsylvania’s Associate Vice Provost for Global Initiatives and Executive Director of Penn China Initiatives.