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US expert: Only God knows when the “epidemic” in China will end

Covid patients in the emergency room of a hospital in Shanghai (January 4, 2023)
Covid patients in the emergency room of a hospital in Shanghai (January 4, 2023)

NEW YORK — The Chinese government will not change its practice of covering up the truth about the outbreak because of the flood of negative coverage of its handling by the global news media, the head of a research institute dedicated to global health statistics and impact assessment. He believes that due to the uncertainty of the epidemic data from China, there is “no confidence at all” in predicting when the epidemic in China will end.

However, he believes that this wave of Chinese outbreaks is still an Omicron subvariant, and from an immunological point of view, the probability of new variants in China is not high, because “new variants are unlikely to arise in immunologically naïve (uninfected) people.” ”

On Tuesday (Jan. 3), the Chinese Center for Disease Control and Prevention told the World Health Organization that the main infectious viruses in China’s latest wave of outbreaks were two subvariants of the Omicron lineage, and no new variants of the new coronavirus were found.

Several countries, including the United States, have made rules to test for coronavirus for tourists from China after it opened up to travel, and reports suggest that the main concern for these countries is a possible new variant of the virus from China.

The new variant is unlikely to come from immune naïve populations

Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME), believes the risk is small.

From an immunological standpoint, Murray said, new variants are unlikely to arise in immunonaïve (uninfected) people, who are “generally unlikely — of course, there is always chance — to have pressure to select new variants, which is a very small risk.” Murray said.

“Because where you really expect to see new variants emerge is where immunity is high.” The only way the new coronavirus spreads is through breakthrough immunity (immune escape). Dr. Murray said. The new variant “is more likely to occur in people with higher levels of immune exposure or protection than in people who are not immune-exposed.” ”

Still, the Chinese government has not met all the requirements from the World Health Organization, especially data on the impact of the coronavirus outbreak on the population, including hospitalizations, intensive care unit admissions, and deaths.

Mike Ryan, executive director of WHO’s Health Emergencies Programme, told the media on Wednesday, “We believe that the latest figures released by China grossly underestimate the true impact of the new coronavirus disease in terms of hospitalizations, intensive care rates, and especially deaths.” ”

China intentionally does not report hospitalizations and deaths

Dr. Murray said that since the outbreak began in December, China has “largely not reported cases of infection at all”; “They never reported hospitalization data, and although the Chinese Center for Disease Control and Prevention has an online report that they can get a report on this, they never did, so it may be a conscious choice not to report hospitalizations.”

As for the number of deaths, the Chinese government’s daily reporting of single-digit deaths under strict restrictions on the definition of coronavirus deaths is completely inconsistent with the reality that hospitals and funeral homes are overwhelmed.

“Fundamentally, the most important indicator is how many people have died from the coronavirus,” Murray said. “They have systems in China that can track deaths in some hospitals across the country,” Dr. Murray said.

Murray argues that the Chinese government’s concealment of the death toll “may be partly due to (deliberate) choice, and partly because the data systems for death reports are not as sophisticated or advanced as in many countries such as Europe, the United States or Canada.” ”

The Institute for Health Metrics and Evaluation, led by Dr. Murray, is a research institute dedicated to global health statistics and impact assessment at the University of Washington in Seattle. In 2020, at the beginning of the pandemic, the institute developed a model of the number of coronavirus deaths that has been widely cited by governments and businesses.

The outbreak could result in 160 or 1.7 million deaths

The late last year, when the Omicron pandemic broke out in China, the institute’s independent predictive modeling team used data from Chinese provinces and information from the recent outbreak of Mysterious Keron in Hong Kong to release projections that more than 1 million people will die in China by 2023.

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“If there is some kind of verification of this, if Hong Kong and the mainland are roughly very similar in terms of vaccination levels, with the same vaccines, with the same age structure, based on what happened in Hong Kong and what happened in the mainland, we can expect that 10,000 deaths in Hong Kong translate to the whole Chinese mainland which is 160 or 1.7 million deaths.”

According to Johns Hopkins University, as of Jan. 4, Hong Kong had 2.7 million infections and 12,081 deaths.

Dr. Murray believes that ensuring WHO has access to transparent and accurate data on the outbreak in China has been a “very big challenge”. “I don’t think we’re going to see any changes. I doubt that international discussions and media coverage of the crematorium will change China’s official position. ”

Due to the uncertainty of China’s epidemic data, Dr. Murray believes there is a “complete lack of confidence” in predicting when the outbreak in China will end.

In the future, he argued, as the Chinese government still fails to provide transparent and accurate data on the pandemic, the international community needs to encourage the establishment of “various types of reporting systems” independent of the government, and give us some signs of a major crisis through “the use of satellite imagery and mobile phone data.”

Here’s an interview with Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME):

Reporter: On Tuesday (January 2), the Chinese Center for Disease Control and Prevention reported data on the new crown pneumonia epidemic to WHO, showing that the Omicron lineage predominates in locally acquired infections, and no new variants have been reported. Do you think the world can breathe a sigh of relief?

Murray: I think the findings in the report from the Chinese Center for Disease Control and Prevention, which are confirmed by sequencing of tourists leaving China, are indeed what we expect to see, which is that the rapid spread of COVID in China is driven by the Omicron subvariant as expected. People who have relatively and largely inexperienced with the coronavirus from an immunological point of view are generally unlikely – although there is always a possibility – that there will be pressure to select new variants, which is a very small risk. So that’s very much in line with what we expect to see today.

Question: Reuters reported that the WHO believes that China’s data does not adequately reflect the surge in COVID infections and deaths in China, and the WHO has asked China to regularly share specific and real-time data on the impact of the disease, including hospitalizations, the emergency room stays and deaths. Do you think China will meet these requirements from the WHO?

China has tracking systems to obtain accurate data

Murray: If we look at the whole pandemic, there are basically three sources of information we get about Covid (not just China): case reports, hospitalizations, and death reports, which depend on different types of data systems in each country. I think the challenge for China is that until recently they had very good case reports, but when the outbreak started in December, they basically didn’t report infections at all, which could be because of a lack of testing or a lack of reporting, and we don’t really know [why]. They never reported hospitalization data, and although the Chinese Center for Disease Control and Prevention has online access to reports and they can get reports on this, they never did, so this may be a conscious choice not to report hospitalizations. Regarding daily deaths, they have a system in China that can track deaths in some hospitals across the country, but the number of deaths in the community, given the current information system, cannot be reported in a short period of time. So part of the reason may be (intentional) choice, and part of the reason may be that the data systems for death reporting are not as complex or advanced as many countries such as Europe, the United States, or Canada.

Reporter: Why is disease impact data as important as genetic sequencing data?

Murray: The most important thing for us is the impact of Covid. Fundamentally, the most important indicator is how many people have died from Covid. As we’ve learned in three or nearly three years of the pandemic, there are challenges to accurately obtaining the number of deaths, even in well-resourced settings. But it’s extremely important to understand that we are far from getting this kind of information from China to get a good idea of how many people have died and Covid. The closest analogy we have is the experience of Hong Kong, where in late January, February and March, their data systems were much better, with nearly 10,000 deaths in Omicron out of a population of less than 8 million, which is a huge number if you project it to the national level of the Chinese mainland.

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Reporter: At the same time, the International Air Transport Association (IATA) has criticized countries for restricting passengers from China on the grounds that the Omicron virus has spread within their borders. What do you think of this criticism?

Murray: I think the argument put forward by governments that set testing requirements, such as the United States, is that there may be some new variants in China, and now based on the data available, there is no indication of that. Therefore, perhaps this will lead to a re-evaluation of these testing requirements. But you know, not a long time ago, that is, seven or eight months ago, many countries in the world still had testing requirements for air travel. So I’m not sure how these governments will act. But from the point of view that we are spreading major new variants around the world, this does not appear to be a serious risk at the moment.

Reporter: Since the beginning of the pandemic, China has not fully shared important coronavirus data with WHO. Given the huge gap between the reality of the epidemic in China and the single-digit coronavirus deaths reported by the government, how should the international community ensure the transparency and accuracy of China’s coronavirus data in the future?

China will not change its practice of concealing hospitalizations and deaths

Murray: It’s a very big challenge because we’ve seen a surge in Omicron, and we’ve seen that China used to have pretty good case reports, but there was no hospitalization and no death data. I don’t think we’re going to see any changes. I doubt that international discussions and news media coverage of crematoriums will change China’s official position. So I think we’re going to have this huge Omicron wave, where there could be a million deaths in China, and we can’t be sure of the real consequences. As for the future, it’s really about WHO and other organizations in the UN system to convince the Chinese leadership that it’s in everyone’s interest to report data openly and transparently, whether it’s your own country or others, to make us more vigilant about this pandemic and possible future pandemics.

Reporter: When China cannot provide complete data on the new crown epidemic, what can the United States and the international community do to protect people from the outbreak of the epidemic in China?

You cannot rely on data reported by the government

One of the reasons we think about the future is that we need both to encourage government reporting, to strengthen oversight systems where funding is inadequate, especially in low-resource settings, and to establish various types of reporting systems that do not require governments to be carriers of data. Therefore, we already knew at the beginning of the coronavirus that voluntary reporting organizations like the Emerging Disease Surveillance Program (ProMED) began monitoring the outbreak in Wuhan in late December. But we need more. We have monitoring data systems, detecting social media, using satellite imagery, and cell phone data, which can give us some signs that a major crisis is taking place, which is somehow independent or completely independent of the government. We need both, we need to strengthen legal tools and government reporting systems, and we need to see these independent data sources widely used so that we can all track what’s happening around the world.

The Institute for Health Metrics and Evaluation (IHME), which you lead, predicts that a new wave of outbreaks in China will lead to a surge in infections and more than a million deaths in China in 2023. What is the basis for this prediction? Do you have any corrections to this prediction now?

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Murray: We base our predictions on the fact that we have epidemic models for each country. The Chinese model takes into account past infection rates, which were very low in China until December; vaccination rates, as the protective effect of vaccines diminishes over time; There is also access to the antiviral drug Paxlovid, which is the basis for our predictions this year, which we expect to kill more than 1 million people in this wave of the epidemic that swept through China. If there is some verification of this, depending on what happens in Hong Kong and what happens in the mainland, Hong Kong and the mainland are roughly very similar in terms of vaccination levels, the same vaccines, the same age structure, etc., we can expect that the 10,000 deaths in Hong Kong translate to the entire Chinese mainland which is 160 or 1.7 million deaths. So both our formal model and the rough analogy with Hong Kong suggest that the death toll will be very high. It’s hard to imagine how you can avoid this, because in the first wave of the outbreak when you see the highest number of deaths, it shows that the population does not have a lot of immunity.

Reporter: When do you predict the epidemic in China will end?

There is no confidence at all in predicting the peak of the epidemic

You know it’s very difficult. We are more confident in the overall level of damage than in predicting time because timing depends critically on when outbreaks start and stop, as different cities and provinces have different peaks. Since the data from China is difficult to determine right now, we have no confidence in the peak timing (forecast) at all. In our publicly available model, we expect a peak at the end of March, but if, as the Chinese Center for Disease Control and Prevention hints at some unpublished data, the outbreak of Covid infections began in late November, then the peak could be much earlier. So we’re pushing the whole outbreak back a month or two, depending on the situation, and maybe even peaking sometime this month. But we’re pretty sure that there will be different peaks by city and province.

Reporter: Do you believe that the Chinese Center for Disease Control and Prevention said that no new variants of the new coronavirus were found in this wave of outbreaks?

Murray: Yes, I’m inclined to believe it, because genome sequencing of Chinese tourists going abroad shows that the profile of the Omicron Jonya variant is almost exactly the same as reported by the Chinese CDC. This is also in line with our general view that in people who have not seen a lot of new coronary pneumonia before, have medium or relatively low vaccine performance, and most of them were vaccinated more than a year ago, there will be many people who are easily infected, and Omicron should spread quickly in such people, but there should not be what we call pressure to choose new variants. Because where you really expect to see new variants emerge is where immunity is high. Of course, there may be a chance, but it is more likely to occur in people who are immune exposed or have a higher degree of immune protection than in people who are not immunely exposed. And the only way for covid to spread is through breaking immunity (immune escape), and then it may become heavier or less heavy.

Reporter: If you had the opportunity to make your proposal to the Chinese government, what would it be?

Murray: Our general advice is to wear masks and practice social distancing to slow the rapid spread of the Omicron variant so that hospitals are not overwhelmed. Second, rapidly use more effective vaccines, such as mRNA-based vaccines such as Pfizer and Moderna, in high-risk older populations. Then third, ensure greater access to Paxlovid or effective antivirals, especially for the elderly and high-risk groups. The latter two steps seek to reduce or potentially significantly reduce the number of deaths; Wearing masks and social distancing slows transmission, allowing more time to get vaccinated and expanding the use of antivirals.

Interviewer: Thank you, Dr. Murray.

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