Nearly three years after it was first identified in China, the coronavirus is now spreading across the vast country. Experts predict difficult months ahead for its 1.4 billion people. China’s adamant “zero-covid” approach, which aimed to isolate all infected people, took years to prepare for the disease.
But an abrupt reopening, which was announced without warning on December 7 in the wake of antiwar protests, has left the nation short on vaccinations and short of hospital capacity. Experts forecast one million to 2 million deaths next year.
Predicting deaths during the pandemic has proven difficult, as it is influenced by a variety of factors and China presents an extremely complex case due to opaque data sharing. It is unclear how large the current outbreak is, as China has reduced testing and stopped reporting most mild cases.
But in the cities and towns around Baoding and Langfang in Hebei province, an area that was one of the worst hit by the uncontrolled outbreak, Associated Press reporters saw hospital intensive care units overwhelmed with patients, and ambulances turned back Done.
Across the country, widespread reports of absences from work, shortages of fever-reducing drugs, and crematorium workers working overtime suggest the virus is widespread. China belongs to a small club of countries that managed to stop most domestic transmission of the virus in 2020, but it is the last country to end restrictions.
The termination experiences differ: Singapore and New Zealand achieved high vaccination rates and strengthened medical systems during restrictions, and have reopened relatively smoothly. Hong Kong, where Omicron oversaw immunization while many elderly people were not vaccinated, faces a disruptive COVID-19 wave in 2022.
According to Hong Kong’s Department of Health, the disease has killed nearly 11,000 people this year in the city of 7.4 million, of whom 95 per cent were over 60 years of age. Jin Dong-yan, a virology expert at the University of Hong Kong, said the city’s data showed a death rate of 15 percent for people over the age of 80 and non-vaccinated.
an under-vaccinated population
China has a higher vaccination rate than Hong Kong at the time of the Omicron outbreak, but many people are vulnerable to infection, especially the elderly. The country has exclusively used domestically produced vaccines, which rely on older technology than mRNA vaccines used elsewhere, which have shown the best protection against infection.
A study conducted in Hong Kong, in which both the mRNA vaccine and Sinovac’s CoronaVac were administered, suggested that CoronaVac needed a third shot to provide comparable protection, especially for the elderly. A typical course of the vaccine is two shots, followed by an optional booster.
Most of the people vaccinated in China have received either CoronaVac or a similar vaccine made by Sinopharm, but the country has administered at least five other vaccines. Comparable real-world data is not available for these vaccines.
While 90 percent of China’s population has been vaccinated, only 60 percent have received boosters. Older people are especially likely not to have a booster vaccine. According to China’s official Xinhua news agency, more than 9 million people over the age of 80 have not received the third vaccine.
Since the beginning of the month, the rate of vaccination has increased more than 10-fold, with more than one million doses administered a day. But Dr. Gagandeep Kang, who studies the virus at the Christian Medical College of India in Vellore, said prioritizing the elderly would be important.
Ray Yip, founding director of the US CDC office in China, said that unlike other countries, China prioritized vaccinating more mobile youth to prevent the virus from spreading. A campaign targeting those over the age of 60 began in December, but it is unclear how successful it has been.
“They haven’t paid enough attention to making sure everyone gets full vaccine protection,” Yip said. “How well they do this particular catch up effort could determine some of the outcome.”
overcrowded hospital
Around Baoding and Langfang, a surge in severe cases has left hospitals running short of intensive care beds and staff. Patients lay on the floor, while others went from hospital to hospital looking for beds for relatives on Wednesday.
The National Health Commission said China had 10 intensive care beds for every 100,000 people on 9 December, a total of 138,000 beds, up from 4 for every 100,000 people on 22 November.
This means that the number of beds has more than doubled within just three weeks. But that number “could be wrong,” said Yu Changping, a doctor with the department of respiratory medicine at the People’s Hospital of Wuhan University. “It is improbable that the numbers could have jumped that quickly in such a short period of time,” Yu said.
Even at face value, an increase in intensive care beds does not necessarily mean that the health system is prepared for a surge in cases because the pressure point, as seen globally, is often the availability of specialized doctors and nurses who can treat those patients. Can treat those who need it. intensive care, Chen said.
China only has 80,050 doctors and 220,000 nurses for its critical care facilities, and another 177,700 nurses that the National Health Commission says could potentially work in those units. “If you look at intensive care unit beds, China … is in a huge deficit,” he said.
Yu said they have seen an increasing number of COVID-19 patients in recent weeks, and nearly all the doctors in the department have been infected. “We are under pressure because we are receiving a large number of patients within a short period of time,” Yu said.
China has also not announced a clear triage plan, a system where hospitals prioritize treatment for the very sick with limited resources. In addition, China’s health system is focused on large hospitals, which usually treat even the mildly ill, Chen said.
Chen said the potential shortfall would depend on how fast cases rise, and ration resources for the very sick could still overwhelm hospitals if people with mild symptoms don’t stay home. “That could easily crash the system,” he said.
To try to protect its health system, Beijing has increased the number of fever clinics from 94 to 1,263 converted into makeshift hospitals and centralized quarantine facilities. But rural areas may suffer, as most of China’s ICU beds are in its cities.
The use of digital tools and telemedicine could provide hospitals with some breathing space: More than a third of hospitals use some form of telemedicine, and nearly 31 percent have used digital tools in their healthcare, As a nationwide survey of 120 public and private hospital executives found. in urban areas organized by LEK Consulting in Shanghai.
China earlier this year approved Pfizer’s drug Paxlovid for COVID-19 and two home remedies: An antiviral used for AIDS made by Genuine Biotech that has been repurposed for COVID-19 and a cocktail of virus-blocking antibodies made by BriiBio. But it’s not clear how widely available these drugs are.
How bad would it be?
Scientists are not certain, as the death rate depends on factors such as vaccination rates, people’s behavior and efforts to strengthen hospitals. The Institute for Health Metrics and Evaluation at the University of Washington in Seattle predicts the number of deaths could reach one million by the end of 2023 if the virus continues to spread unchecked.
But Ali Mokkad, a professor of health metrics sciences at the institute, said the government would be able to reduce this toll with renewed social distancing measures.
Another study from the University of Hong Kong also predicts nearly a million deaths as the virus spreads across the country and authorities cannot provide vaccine boosters and antiviral treatments.
Bill Hanage, co-director of the Center for Communicable Disease Dynamics at the Harvard TH Chan School of Public Health, estimated a death toll of 2 million in a December 14 call to reporters. “China has a very, very difficult road ahead in the months ahead,” Hannez said. “But in the absence of vaccination, it would be much, much worse.”
Will the boom in China spread to the rest of the world? Neighboring India has asked its state governments to be vigilant and not let down genome sequencing efforts.
Jeremy Luban of the University of Massachusetts Chan Medical School said that a large jump in infections increases the likelihood of more dangerous mutations arising. Luban sees “no particular reason to worry” about any dangerous variants already in China, “except for the fact that a lot of infections are bad.” Luban said: “The more the rate of transmission in China can be controlled, the better.”