The first wave of the disease manifested as the 2019–2020 COVID-19 outbreak in mainland China, beginning with a cluster of mysterious pneumonia cases, mostly related to the Huanan Seafood Market, in Wuhan, the capital of Hubei province.

[15] As of October 2020 China's economy continued to broaden recovery from the recession during the pandemic, with stable job creation and record international trade growth, although retail consumption was still slower than predicted.

[21][22] The outbreak went unnoticed until 26 December 2019, when Zhang Jixian, director of the Department of Respiratory Medicine at Hubei Xinhua Hospital, noticed a cluster of patients with pneumonia of unknown origin, several of whom had connections to the Huanan Seafood Market.

[26][27] Around 23 January 2020, stringent measures such as lockdown of Wuhan and the wider Hubei province and face mask mandates were introduced,[28] which lowered and delayed the epidemic peak according to epidemiology modelling.

[48]: 170 E-commerce contributed substantially to China's COVID-19 pandemic response by facilitating fast delivery of personal protective equipment, food, and daily use consumer goods during lockdowns.

[49]: 67 Nationwide protests broke out in November 2022 amid growing discontent among residents over the zero-COVID policy and the resulting economic costs.

[51][52] It was reported that restaurants and food delivery services had closed due to staff infections, and pharmacies had been emptied of medicine and disinfectant solution.

[53] On 22 December, a report by UK research firm Airfinity modelling based on regional Chinese data estimated that more than 5,000 people were dying each day from COVID-19 in China, with cases rising fastest in Beijing and Guangdong province.

[59] Hong Kong was relatively unscathed by the first wave of the COVID-19 outbreak and had a flatter epidemic curve than most other places, which observers consider remarkable given its status as an international transport hub.

[60] Some experts now believe the habit of wearing masks in public since the SARS epidemic of 2003 may have helped keep its confirmed infections at 845, with four deaths, by the beginning of April.

[60] In a study published in April 2020 in the Lancet, the authors expressed their belief that border restrictions, quarantine and isolation, social distancing, and behavioural changes such as wearing masks likely all played a part in the containment of the disease up to the end of March.

[61] Others attributed the success to critical thinking of citizens who have become accustomed to distrusting the competence and political motivations of the government, the World Health Organization, and the Chinese Communist Party.

[65] Measures taken in response included a suspension of school classroom teaching until the end of the year, and an order for restaurants to seat only two persons per table and close at 10:00 p.m. taking effect on 2 December;[66] a further tightening of restrictions saw, among other measures, a 6 pm closing time of restaurants starting from 10 December, and a mandate for authorities to order partial lockdowns in locations with multiple cases of COVID-19 until all residents were tested.

[68] Hong Kong is one of few countries and territories to pursue a "zero-COVID" elimination strategy, by essentially closing all its borders and, until February 2022, subjecting even mild and asymptomatic cases to hospitalisation, and sometimes isolation extending over several weeks.

The fifth, Omicron variant driven wave of the pandemic emerging in late December 2021[69] caused the health system to be stretched to its limits, the mandatory hospitalization to be abandoned,[70] and led several experts to question the zero-COVID strategy.

[72] At a press conference in February 2020, Ho Iat Seng welcomed mainland Chinese people to make use of Macau's free medical service.

Afterwards, Secretary for Administration and Justice Cheong Weng Chon (張永春) said that any patients from outside Macau who had COVID-19 would need to pay their own medical bills; they would be able to apply for a fee waiver, and the government would make a decision based on their financial situation and effects on the public.

[76] The Taiwanese government integrated data from the national health care system, immigration, and customs authorities to aid in the identification and response to the virus.

[77][78] The Journal of the American Medical Association says Taiwan engaged in 124 discrete action items to prevent the spread of the disease, including early screening of flights from Mainland China and the tracking of individual cases.

[79][80] Starting 19 March 2020, foreign nationals were barred from entering Taiwan with some exceptions such as those carrying out the remainder of business contracts and those holding valid Alien Resident Certificates, diplomatic credentials, or other official documentation and special permits.

[80][94] However, an outbreak among Taiwanese crew members of the state-owned China Airlines in late April 2021 led to a sharp surge in cases, mainly in the Greater Taipei area, from mid May.

[95] In addition to a low testing rate and the recent shortening of the quarantine period for pilots to just three days,[96] Taiwanese medical experts said that they had expected the flare-up due to the emergence of more transmissible variants of the coronavirus (the Alpha variant was found in many of those linked to the China Airlines cluster[96]), combined with the slow progress of Taiwan's vaccination campaign.