Good morning. Welcome to Axios today. It's Tuesday, April 12th. I'm Nailibutu. Here's what you need to know today, the six dates that could be key in the midterm elections.

But first, today's one big thing. China's extreme COVID lockdowns cause suffering and Shanghai.

China's largest COVID outbreak in two years continues to spread across the country. In Shanghai, daily cases surpassed 26,000 over the weekend, despite weeks of lockdown.

And now the 26 million residents there are increasingly struggling to get access to food and medical care.

Here to explain the latest is Bethany Allen Ibrahimian, China reporter at Axios. Hi, Bethany. Hey, Nailibutu. Bethany, what are you hearing about what it's like for people in Shanghai right now?

The scenes that are unfolding in Shanghai are very dramatic. In the US, you may remember from two years ago at the beginning of our lockdowns when it was so difficult to get toilet paper.

Now, imagine that exact scenario except instead of toilet paper, it's really hard for everyone to get food. That's what's happening in Shanghai.

And that's kind of incredible because you know, Shanghai has 26 million people. It's one of the most modern and prosperous cities in the world. There's people here, you know, lawyers, doctors, executives.

And many of them are struggling to find food on grocery sales, to be able to order food from delivery apps and everyone is trapped in their houses.

And so Shanghai is actually still reporting zero COVID deaths, despite some 130,000 cases. How accurate is that data?

There have been unofficial reports of deaths related to COVID, but those don't seem to be showing up in the official numbers right now.

There's also been unofficial reports of deaths related to the lockdowns. So for example, people being unable to get medical care or their conditions in nursing homes being so bad that people can't survive.

Bethany, what are vaccination rates like across China and Shanghai?

Vaccination rates in China are quite high, 89%. However, there's some important caveats here for one, the vaccination rate amongst elderly people in China is much lower around 51%.

In addition, the vaccinations have all been performed with Chinese made domestic vaccines and they have lower efficacy in stopping the spread of COVID and in reducing the severity of illness.

Bethany, why is the vaccination rate so low among older people? It's the opposite of most Western countries.

A disproportionate number of elderly people live in rural areas and it's harder for them to access vaccines. In addition, China's elderly population has tended to feel more hesitancy in receiving vaccines. They're more concerned about side effects.

What are the concerns for people outside of China watching this unfold?

Well, there's certainly humanitarian concerns beyond that. People are watching supply chains very closely watching for shortages, including in some cases higher end goods.

So for example, Tesla has one of its large factories there that has been shuttered now for a couple of weeks.

How are you thinking about the way China is trying to enforce this zero COVID policy?

I guess I would say China's response to COVID has also been affected by politics.

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