[ It’s clear that the ever-stricter measures in China are
failing to keep up with more-transmissible variants while becoming
increasingly costly to society. This has caused country-wide protests
sparked by frustration, anger, discontent, and despair. ]
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COVID-19 IN CHINA AND GLOBAL CONCERN  
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Katelyn Jetelina
November 29, 2022
Your Local Epidemiologist
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_ It’s clear that the ever-stricter measures in China are failing
to keep up with more-transmissible variants while becoming
increasingly costly to society. This has caused country-wide protests
sparked by frustration, anger, discontent, and despair. _

People line up for coronavirus tests outside a hospital in Shanghai
on Friday. , AP

 

After Omicron emerged as a highly contagious variant of concern, the
majority of the world accepted a harm reduction strategy: get vaccines
in as many arms as possible, then slowly open up. In many countries,
this turned out to be a good public health strategy to reduce death,
minimize stress on healthcare systems, improve quality of life,
improve the economy, etc. However, China continues to attempt a
zero-COVID strategy—very, very tight restrictions—in an attempt to
stop _all _transmission.

While China’s strategy has an upside, like reduced deaths, reduced
long COVID rates and decreased chances of mutations, it has massive
downsides. It’s clear that the ever-stricter measures fail to keep
up with more-transmissible variants while becoming increasingly costly
to society. This has caused country-wide protests sparked by
frustration, anger, discontent, and despair.

COVID-19 seems to be on the verge of exploding in China. They are
reporting record-high numbers—nearly 40,000 new infections per day.
The biggest concern is China’s incomplete immunity wall when faced
with infections:

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China _does _have a highly vaccinated population—about 90%
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vaccinated with the primary series. This is _higher _than the United
States. However, quality (not just quantity) of the vaccine is
important. China rolled out Sinopharm and SinoVac—inactivated
vaccines that are just not very effective against Omicron.

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Their booster rate, and specifically _who _is boosted, is abysmal.
Only 30% of 80+ year olds have one booster, for example. We have
plenty of evidence
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the importance of boosters among the most vulnerable.

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Infection-induced immunity is low. While preventing infections _is
_the safest route, we have more than 30 studies
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immunity (vaccine + infection) builds a more complex immunity wall for
the virus.

Last winter, we witnessed what Omicron could do in a population with
an incomplete immunity wall—death rates in Hong Kong went vertical.
It was simply disastrous.

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_What could happen across all of China?_ A scientific publication
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Medicine_ predicted a grim picture earlier this year. They ran a
number of models with varied infection rates, booster rates, vaccine
efficacy, the use of non-pharmaceutical interventions (like masks),
and more. In conclusion, over a 6 month period, China would
experience:

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112.2 million symptomatic cases

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2.7 million ICU admissions, exceeding their ICU capacity by 15.6
times

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1.55 million deaths, 75% of them among those aged 60 years and older

Solution?

From a public health perspective, I’m not sure how this ends well
for China, as there are very few ways out of this scenario.

The best option is to vaccinate as many people as possible, especially
older adults, through a very intense, massive public health campaign.
They are starting to do this, but too late. And, ideally, they would
use mRNA vaccines. China has ~10 mRNA vaccines in the development
pipeline, but to my knowledge, none are close to roll-out. My hope is
that they will pivot to American vaccines, soon, but I’m not holding
my breath. They could wait for second generation vaccines that stop
transmission, but this will take a lot of time.

A vaccine campaign has challenges, too—mainly lack of trust. A great
article
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covered why China has not implemented a vaccine mandate even though
they implement other very strict measures: dramatic social resistance.

Japan has released
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results of the first effective anti-viral for _non_-high risk people.
I would pair this with Paxlovid, better ventilation, and masks and
hope for the best.

In all, I think the situation in China is about more than public
health. It’s about politics, control, autonomy from the West, and so
much more, which makes solving the public health problem that much
more difficult.

Global implications

We should be very concerned for the people of China. But this
situation also has global implications.
If the flood gates open, there will be an impact on the economy.
We’ve seen throughout the pandemic that healthy people equals a
healthy economy. A massive outbreak in China would have a global
cascading impact on supply chains.

It could also impact viral evolution. If COVID-19 takes hold in China,
there will be little to stop the virus from jumping person-to-person
in a network of 1.4 billion people—about 20% of the global
population. Some mutations arise from persistent infection with
immunocompromised people (we think this is how Omicron developed), but
the more a virus jumps, the more opportunity it has to randomly
mutate. This is how we got Delta, for example.

To add fuel to the fire, global COVID-19 surveillance is down 90%. So
if we do get a mutated virus, we won’t have a lot of warning. In
fact, we don’t even know which Omicron subvariant is causing the
current wave in China.

_“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn
Jetelina, MPH PhD—an epidemiologist, data scientist, wife, and mom
of two little girls. During the day she works at a nonpartisan health
policy think tank and is a senior scientific consultant to a number of
organizations, including the CDC. At night she writes this newsletter.
Her main goal is to “translate” the ever-evolving public health
science so that people will be well equipped to make evidence-based
decisions. This newsletter is free thanks to the generous support of
fellow YLE community members. _

_You may subscribe by going to the publishing site of _Your Local
Epidemiologist.

 

 
 

* Covid; Covid in China;
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