Nearly three years after it was first identified in China, the coronavirus is now spreading through the vast country. Experts predict difficult months ahead for its 1.4 billion people.
China’s unyielding “zero-COVID” approach, which aimed to
isolate all infected people, bought it years to prepare for the disease. But an
abrupt reopening, which was announced without warning on Dec. 7 in the wake of
anti-lockdown protests, has caught the nation under-vaccinated and short on
hospital capacity.
Experts have forecast between a million and 2 million deaths
next year. Predicting deaths has proven tricky throughout the pandemic, since
it is influenced by varied factors and China presents an especially complicated
case because of opaque information sharing.
It’s not clear exactly how large the current outbreak is, as
China has reduced testing and stopped reporting most mild cases. But in cities
and towns around Baoding and Langfang, in Hebei province, an area that was
among the first to face an unchecked outbreak, Associated Press reporters saw
hospital intensive care units overwhelmed by patients, and ambulances being
turned away. Across the country, widespread reports of absences from work, shortages
of fever-reducing medicine, and staff working overtime at crematoria 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’s the last to end
restrictions. Experiences of ending vary: Singapore and New Zealand achieved
high vaccination rates and bolstered medical systems during restrictions, and
reopened relatively smoothly. Hong Kong, where omicron overcame defenses while
many elderly people were unvaccinated, suffered a disruptive COVID-19 wave in
2022. Nearly 11,000 people died of the illness this year in the city of 7.4
million, with 95% of them older than 60, according to Hong Kong’s department of
health. Data from the city showed a 15% fatality rate for those older than 80
and unvaccinated, said Jin Dong-yan, a virology expert at Hong Kong University.
AN UNDER-VACCINATED POPULATION
China has higher vaccination rates than Hong Kong did at the
time of its omicron outbreak, but many people are vulnerable to infection,
especially the elderly.
The country has exclusively used domestically made vaccines,
which rely on older technology than the mRNA vaccines used elsewhere that have
shown the best protection against infection.
A study conducted in Hong Kong, which has administered both
an mRNA vaccine and Sinovac’s CoronaVac, suggested that CoronaVac requires a
third shot to provide comparable protection, especially for the elderly. An
ordinary course of the vaccine is two shots, with an optional booster later.
Most people vaccinated in China have received either
CoronaVac or a similar vaccine produced by SinoPharm, but the country has
administered at least five other vaccines. Comparable real-world data isn’t
available for these vaccines.
While China counts 90% of its population vaccinated, only
around 60% have received a booster. Older people are especially likely to have
not had a booster vaccine. Over 9 million people older than 80 have not had the
third vaccine, according to China’s official Xinhua News Agency.
Vaccination rates have increased over 10-fold, to over a
million doses administered a day, since the start of the month. But Dr.
Gagandeep Kang, who studies viruses at India’s Christian Medical College in
Vellore said prioritizing the elderly would be key. Unlike other countries,
China prioritized vaccinating the more mobile young to prevent the virus from
spreading, said Ray Yip, the founding director of the U.S. CDC office in China.
A campaign targeting those older than 60 started in December, but it is unclear
how successful it has been.
They “did not pay enough attention to assure everyone gets
full vaccine protection,” Yip said. “How well do they perform this particular
catch up effort might determine some of the outcome.”
OVERWHELMED HOSPITALS
Around Baoding and Langfang, hospitals have run out of
intensive care beds and staff as severe cases surge. Patients lay on the floor,
while others drove from hospital to hospital searching for beds for relatives
Wednesday.
The National Health Commission said China had 10 intensive
care beds for every 100,000 people on Dec. 9, a total of 138,000 beds, up from
4 for every 100,000 people on Nov. 22. That means the reported number of beds
more than doubled in just under three weeks. But this number “might be wrong,”
said Yu Changping, a doctor at the Department of Respiratory Medicine of
People’s Hospital of Wuhan University. “It is impossible that the number could
have jumped sharply within such a short time,” Yu said.
Even taken at face value, the increase in intensive care
beds doesn’t mean the health system is prepared for a surge in cases since the
pressure point, as seen globally, is often the availability of specialized
doctors and nurses who can treat patients who need intensive care, said Chen.
China only has 80,050 doctors and 220,000 nurses for its critical care
facilities, and another 177,700 nurses who the National Health Commission says
could potentially work in those units.
“If you look at intensive care unit beds, China is... in a
great shortage,” he said.
Yu said he’s seen growing numbers of COVID-19 patients in
recent weeks, and that almost all the doctors in the department have been
infected. “We’re under pressure because we are receiving a large number of
patients within a short time,” said Yu.
China has also not announced a clear triage plan, a system
where hospitals prioritize giving treatments to the very sick to ration limited
resources. Moreover, China’s health system is focused on large hospitals, which
typically treat even the mildly ill, said Chen.
Potential shortages would depend on how quickly cases
increase, and if those with mild symptoms don’t stay at home to ration
resources for the very sick hospitals could still get overwhelmed, said Chen.
“That could easily crash the system,” he said.
To try to protect its health system, Beijing has converted
temporary hospitals and centralized quarantine facilities to increase the
number of fever clinics from 94 to 1,263. But rural areas may suffer, as the
vast majority of China’s ICU beds are in its cities.
The use of digital tools and telemedicine may offer some
breathing room to hospitals: Over a third of hospitals use some form of
telemedicine, and around 31% used digital tools in their health care, found a
nationwide survey of 120 public and private hospital executives in urban areas
conducted by LEK Consulting in Shanghai.
China approved Pfizer’s drug Paxlovid for COVID-19 earlier
this year, and two domestic therapies: 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 is unclear how widely
available these drugs are.
HOW BAD WILL IT GET?
Scientists aren’t sure, since mortality depends on factors
like vaccination rates, how people behave and efforts to bolster hospitals.
The Institute for Health Metrics and Evaluation at the
University of Washington in Seattle predicts deaths could reach a million by
the end of 2023 if the virus spreads unchecked. But Ali Mokdad, a professor of
health metrics sciences at the institute, said the government would likely be
able to reduce this toll with renewed social distancing measures.
Another study, from Hong Kong University, also predicts
nearly a million deaths in a scenario in which the virus spreads throughout the
country and authorities can’t provide vaccine boosters and antiviral
treatments. Bill Hanage, co-director of the Center for Communicable Disease
Dynamics at Harvard T.H. Chan School of Public Health estimated 2 million
deaths in a Dec. 14 call with reporters.
“China has got a very, very hard road ahead of it in the
coming months,” Hanage said. “But in the absence of vaccination, it would be
much, much worse.”
Will a surge in China spill over into the rest of the world?
Neighboring India has asked its state governments to remain alert, and not let
genomic sequencing efforts wane. Jeremy Luban of University of Massachusetts
Chan Medical School said large surges in infections increase the potential for
a more dangerous mutation to arise. Luban has seen “no specific reason to be
concerned” about any alarming variants already simmering in China, “except for
the fact that a lot of infections are bad.”
Luban added: “The more the rate of transmission could be
controlled in China the better.” -AP
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