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| Beijing residents stand in long lines in front of a fever clinic at a hospital. (AP December 11, 2022 photo) |
The novel coronavirus, first detected in China nearly three years ago, is once again spreading rapidly in this vast country. Experts predict that China’s 1.4 billion people will face difficult conditions in the coming months.
China once insisted on not abandoning the “zero” strategy, which was aimed at isolating all infected people and buying time to deal with the disease. However, after anti-lockdown protests, China announced its abrupt reopening on December 7 without warning, resulting in insufficient vaccination of the population in China and a run on hospital resources.
Experts predict that between 1 million and 2 million people will die from the coronavirus next year. Predicting death figures throughout the global pandemic has proven to be a tricky job, as it is influenced by a variety of factors; The opaque sharing of information in China makes this work particularly complex.
It needs to be clarified exactly how large the outbreak is now, as China has reduced testing and has stopped reporting most mild cases.
But in towns around Baoding and Langfang in Hebei Province, which experienced the first wave of the epidemic, AP reporters saw that the hospital’s intensive care unit was overcrowded and many ambulances were turned away. Across the country, widespread reports of employee absences, shortages of fever-reducing medications, and overtime work by crematorium workers suggest that the coronavirus is currently spreading everywhere.
China is one of the few countries in the world that managed to largely stop the spread of the virus within its borders in 2020, but it was the last country to end restrictions. Experiences from ending lockdowns vary: Singapore and New Zealand reopened relatively smoothly by achieving high vaccination rates and strengthening healthcare systems during lockdowns.
In Hong Kong, the Omicron strain broke through the epidemic defenses, and many elderly people were not vaccinated, so Hong Kong suffered a devastating COVID-19 outbreak in 2022. According to Hong Kong’s Department of Health, nearly 11,000 people in this city of 7.4 million people died from the disease this year, 95% of them over the age of 60. Jin Dong-yan, a virology expert at the University of Hong Kong, said data from coming to Hong Kong showed that the death rate for people over 80 and unvaccinated was 15 percent.
China has a higher vaccination rate than Hong Kong at the time of the Omicron outbreak, but many people are vulnerable to the virus, especially the elderly.
China uses all domestic vaccines, which are based on relatively old inactivated virus technology; Instead of messenger ribonucleic acid (mRNA) technology, other countries have adopted mRNA vaccines, which have shown optimal levels of protection against infection.
Hong Kong has received both mRNA vaccines and China’s CoronaVac inactivated vaccines. A study conducted in Hong Kong showed that people who received Sinovac’s inactivated vaccine needed a third shot to provide similar protection, especially for the elderly. The general course of the vaccine is two shots, followed by a booster shot.
Most of those vaccinated in China were vaccinated with similar inactivated vaccines made by Sinopharm or Sinopharm, but China has administered at least five other vaccines. There is no comparable real-world data for these vaccines.
While 90% of China’s population has been vaccinated, only about 60% has received a booster shot. Those who have not received a booster shot are especially the elderly. According to China’s official Xinhua news agency, more than 9 million people over the age of 80 have not received a third dose of the vaccine.
Since the beginning of the month, China’s vaccination rate has increased more than tenfold, reaching a rate of more than 1 million doses per day. But Dr. Gagandeep Kang, who studies the virus at the Vellore Christian Medical College in India, said prioritizing the vaccination of older adults is key.
Ray Yip, founding director of the CDC’s office in China, said that, unlike other countries, China is prioritizing vaccinating more mobile young people to prevent the spread of the virus. A vaccination campaign for people over 60 was launched in December, but it is unclear how successful the campaign was.
They “don’t pay enough attention to making sure everyone is fully protected by the vaccine,” Yere said. “How they accomplish this particular catch-up effort could yield some decisive results.”
Hospitals under heavy load
Around Baoding and Langfang, hospital intensive care beds and staff have become overwhelmed as severe cases have surged. On Wednesday, AP reporters saw many patients lying on the ground, while others drove from hospital to hospital to find beds for their relatives.
China had 10 intensive care beds per 100,000 people on Dec. 9, for a total of 138,000, up from just four ICU beds per 100,000 people on Nov. 22, China’s National Health Commission said. This means that the number of reported beds has more than doubled in less than three weeks. But that number “could be wrong,” said Yu Changping, a respiratory physician at Wuhan University People’s Hospital. “This number cannot have risen dramatically in such a short period of time,” he said.
Even to believe these numbers, the increase in intensive care beds in itself does not mean that the healthcare system is prepared for a surge in cases, because from global experience, the pressure point is whether there are enough healthcare professionals to care for those who need intensive care.
The National Health Commission says there are only 80,050 doctors and 220,000 nurses working in intensive care facilities in China; Another 177,700 nurses are likely to work in these units.
Yu Changping said he has seen an increasing number of COVID-19 patients in recent weeks, and nearly all doctors in his department have been infected. “We’re also under pressure because we’re taking in a lot of patients in a short period of time,” he said.
To protect its health system, Beijing has rebuilt temporary hospitals and centralized isolation facilities, increasing the number of fever clinics from 94 to 1,263. But rural areas could run into trouble, as the vast majority of intensive care beds in China are in cities.
The use of digital tools and telemedicine may provide some breathing room for hospitals: In a national survey of 120 public and private hospital executives in urban areas conducted by LEK Consulting in Shanghai, more than one-third of hospitals used some form of telemedicine, and about 31 percent used digital tools in their medical care.
Earlier this year, China approved Pfizer’s drug Paxlovid for COVID-19, as well as two domestic treatments: an antiviral drug for AIDS made by Genuine Biotech that has been used to treat COVID-19. The other is a virus-blocking antibody mixture produced by BriiBio. But it’s unclear how widely accessible these drugs are.
How will the situation get worse?
Scientific experts aren’t sure how bad the situation is going to get, because the death rate depends on a variety of factors, including vaccination rates, how people behave, and efforts to strengthen hospital capacity.
The Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle predicts that if the virus spreads uncontrollably, the death toll could reach 1 million by the end of 2023. But Ali Mokdad, a professor of health indicators science at the institute, said the government might be able to reduce the death toll by resuming social distancing measures.
Another study by the University of Hong Kong also predicted that nearly a million people would die if the virus circulates across China and authorities are unable to provide vaccine boosters and antiviral treatment. Bill Hanage, co-director of the Center for Infectious Disease Dynamics at the Harvard T.H. Chan School of Public Health, estimated 2 million deaths in a December 14 conference call with reporters.
“The road ahead for China in the coming months is very, very difficult,” Mr. Hanaki said. “But without vaccination, things get even worse, even worse.”
Will China’s surge in infections spread to the rest of the world?
Neighboring India has asked its state governments to remain vigilant and not to let genome sequencing efforts stop. Jeremy Luban of the University of Massachusetts School of Medicine said the large increase in infections raises the likelihood of more dangerous variants. Luban believes that “there is no concrete reason to worry” that any alarming variants have been bred in China, “of course, a lot of infections is always a bad thing.”
Luban added: “The more the speed of virus transmission in China can be controlled, the better.” ”
(This article is based on an Associated Press report.)