How it all began
On December 31, 2019, China informed the WHO that a new virus causing severe pneumonia was spreading throughout the country. In early January 2020, Chinese scientists announced that it was a pathogen from the group of coronaviruses – the same one that included SARS, SARS and the virus that causes the Middle East respiratory syndrome, MERS. The lethality of SARS was 10%, MERS – about 30%. Despite this, the Chinese authorities at first did not want to introduce emergency measures, although, as it turned out later, they knew back in December that it was a relative of SARS that caused the strange disease.
At the end of January, a multi-day celebration of the Chinese New Year, also known as the Spring Festival, begins in China, when hundreds of millions move around the country to spend time with their families. By that time, it was already clear that the borders between the regions were about to be closed, so many people hurried off and went to their relatives. This contributed to the rapid spread of the virus throughout the country, and since air traffic was not blocked, then around the world.
At the same time, in China itself, already in early March, the number of new cases began to fall significantly. The reason is the unprecedented tough measures that have replaced the initial hesitation. On January 23, the authorities completely quarantined the eight millionth city of Wuhan, where the epidemic began, and also significantly complicated entry and exit from Hubei province, of which Wuhan is the capital. In total, restrictive measures affected 50 million people. Schools did not open after the holidays, all mass events were canceled, and the authorities began to introduce a system of health codes. When a positive test was found in a person (at first it was PCR testing, then China introduced rapid antigen tests), not only him and everyone who had contact with him, but the entire condominium or even the area were quarantined. “Volunteer helpers,” a distant analogue of Soviet vigilantes, took people out of locked houses for testing and helped with groceries. Often, doors were welded in quarantined houses.
In China itself, already in early March 2020, the number of new cases began to fall significantly.
Thanks to all these unprecedented measures, by the summer of 2020, not a single case of infection was recorded in China. To prevent the introduction of the virus from other countries, where the epidemic, on the contrary, only accelerated, China closed the borders, and if a person had good reasons to enter the country, he had to spend two weeks at his own expense in special quarantine hotels. The Western media and even the WHO commission admired the success of the PRC and lamented that in Western democracies neither politicians nor residents would allow the introduction of measures that could just as quickly stifle the virus.
First doubts
Serious epidemiologists had no doubt that China would not be able to maintain zero cases, as it managed to do with SARS. SARS did not really go beyond the redistribution of the PRC, in addition, that virus was much less contagious. In the case of SARS-CoV-2, already in mid-2020 it was clear that it would not disappear and would sooner or later become endemic. In such a situation, the question of opening the country arose: it was impossible to keep the borders closed forever, and the virus entering the 1.5 billion non-immune population would mean a new epidemic.
In the case of SARS-CoV-2, it was already clear in mid-2020 that it would not disappear.
Moreover, it has become clear that the strict entry control measures that were effective for early strains of SARS-CoV-2 will no longer work with newer, more infectious versions. When the alpha variant began to spread around the world, cases of infection began to be registered again in China. To prevent these cases from developing into new foci of infection, the authorities severely isolated everyone who, at least in theory, could contact the person who tested positive. Widespread masks returned to the country (which, however, did not completely disappear), regular testing became mandatory. With the advent of the even more contagious Delta, and later the Omicron, these measures also began to falter. New infected people were found in the country every now and then, in Shanghai there was an outbreak that affected at least 627 thousand people. And each such case led to the introduction of city-wide lockdowns, quarantines for entire houses, road closures and forced isolation in “kovidaria”.
Complete change of course
By the end of the autumn of 2022, an incredible thing happened for China: Chinese citizens, tired of the ever-increasing restrictions, came out to protest . The trigger was the tragedy in Urumqi, where at least 10 people died as a result of a fire in a high-rise building (although rumors persistently circulate in Chinese social media that the real figure is much higher). Residents were unable to leave the burning building, as the house was closed for quarantine and the entrance doors were blocked . On the other hand, the firefighters could not get close enough, because Urumqi had been under lockdown for more than 100 days by that time and part of the roads had been blocked.
Contrary to expectations, the Chinese authorities did not disperse the protesters, but instead announced the upcoming easing of coronavirus measures. On December 7, the zero-tolerance policy was suddenly replaced by the same radical lifting of all measures. Covidarias were closed, those infected were allowed to get sick at home, or even go to work if the symptoms are mild and the profession is important, mandatory tests were canceled.
On December 7, the zero tolerance policy was suddenly replaced by the same radical lifting of all measures
The Chinese authorities, through official media, happily informed citizens that the virus had weakened and in 95% of cases causes an asymptomatic course, that the country was ready to meet it, that, unlike the West, which had been floundering in a pandemic for three years, the Celestial Empire would survive a new outbreak in a few weeks and back to pre-Covid lifestyle. At the same time, a sharp reversal in the strategy of coexistence with covid caused great concern among epidemiologists – and there are more than enough reasons for concern.
Real situation
Let's start with the virus. If assurances about 95% of the asymptomatic course simply do not have any evidence, then the assertion that the virus is weakening has some basis. Compared to earlier versions or, say, "delta", "omicron" is really less likely to cause a severe course. However, we cannot say with certainty how much this is due to the characteristics of the virus itself, but how much to the fact that the vast majority of people outside of China have some form of acquired immunity to SARS-CoV-2, which protects them from developing serious symptoms. In addition, more than a third of infections in China are with the BA.5.2 variety, which in animal studies shows a tendency to cause severe lung pathogenesis.
Chinese authorities and media emphasize that the population is not afraid of the virus, since almost 90% of the inhabitants are vaccinated against SARS-CoV-2. Even if we accept the hypothesis that this figure is true (which is at least not self-evident), 90% is an insufficient vaccination rate to stop the spread of a respiratory virus as contagious as Omicron. Even for the less transmissible delta, experts estimated the minimum vaccination threshold needed to spontaneously stop transmission of the virus at 98%. In the case of the omicron, the concept of herd immunity, which can prevent a pathogen from constantly circulating in society, does not seem to apply in principle. Moreover, the vast majority of those vaccinated were vaccinated a very long time ago – at least a year ago. And since there was no widespread circulation of the virus in the country all this time, their immunity did not receive an “update” and protection fell.
Chinese authorities and media emphasize that the population is not afraid of the virus, since almost 90% of the inhabitants are vaccinated
And even the most effective anti-coronavirus vaccines in use, created on the basis of mRNA technology, although they protect very well against the severe consequences of covid, the risk of infection and further transmission of the virus is not reduced so significantly. Although a study of American prisoners showed that sick vaccinated people transmitted the pathogen to their cellmates 20% to 40% worse than unvaccinated ones, depending on the number of doses, but the more time passed from the moment of vaccination, the weaker the protection became.
In China, mRNA vaccines were not used: the vast majority of Chinese residents were vaccinated with one of two inactivated Chinese vaccines – CoronaVac or SinoPharm. When compared with other types of vaccines, these drugs show markedly less protection against both infection and severe disease, especially if a person has received less than three doses . At the same time, in China, no more than 40% of those vaccinated have the third dose of the vaccine, and 8%, that is, 120 million people, are not vaccinated at all, even according to official statistics. According to Western journalists living in China, a significant proportion of the unvaccinated are elderly, often discouraged by doctors from getting vaccinated. It is the elderly who constitute the main risk group for the development of a severe course and death from covid.
Additionally, the risks of a large number of deaths increase due to the total overload of hospitals and the lack of the only effective antiviral agent against SARS-CoV-2, Paxlovid, in the country. This drug, if taken in the first days after diagnosis, reduces the risk of severe disease and death from covid from 46% to 88% . Theoretically, China has monoclonal antibodies, but how effectively they reduce the risks of omicron infection is unknown, especially given that we are talking about inhaled antibodies , which are not used anywhere in the world. In addition, it is not clear whether the Chinese population has access to these antibodies, given that even non-specific drugs are not available in pharmacies and hospitals are overwhelmed.
Similarly, it is not known how many people have already died from covid since the zero tolerance policy was abandoned. China's National Health Commission has stopped publishing daily summary reports on new cases and deaths since December 24. Officially, 22 deaths have been reported since December 7, when restrictions were lifted. What's more, on Dec. 20, an infectious disease expert working for the Chinese government said the country would only count deaths caused directly by damage to the respiratory system. People who died due to the fact that a coronavirus infection provoked, say, kidney failure or thrombosis (common causes of death with covid) will not be included in the total count of deaths from SARS-CoV-2.
It is not known how many people have already died from covid since the zero tolerance policy was abandoned.
At the same time, Chinese social networks are full of videos from the corridors of hospitals overcrowded and clogged with patients, as well as videos in which relatives burn the bodies of those who died from coronavirus infection right in the yard, because it is impossible to organize the procedure in crematoria overloaded with requests. One British health analytics company calculated based on its models that since the lifting of restrictions in China, about 176 thousand people could have died, and the average rate is about 14.7 thousand deaths per day. According to the company's forecasts, by the end of April 2023, covid in China will claim about 1.7 million lives.
More conservative estimates from Hong Kong experts suggest that the current wave of covid will kill about 964,000 people. On the other hand, if we extrapolate the data on deaths during the outbreak of “omicron” in the same Hong Kong in the spring of 2022 to the entire population of China, the figure will be twice as high – and this is without taking into account the fact that part of the inhabitants of Hong Kong was vaccinated with mRNA vaccines.
As measures that could mitigate the consequences for China, experts suggest mass vaccination, primarily of risk groups, the use of a heterologous booster – that is, sequential immunization with different types of vaccines, the return of partial restrictive measures in society and the widespread use of antiviral drugs. All these measures have many weaknesses, the main of which is time. It takes about 2-3 weeks for the formation of full protection after the introduction of each dose of the vaccine. During this time, given how widely the virus has spread, a huge number of people will become infected before their bodies produce enough effective antibodies and T cells against SARS-CoV-2.
As measures that could mitigate the consequences for China, experts suggest mass vaccination
Also, purely logistical problems cannot be discounted: it is impossible to vaccinate 1.5 billion people with one, let alone several doses of a vaccine in a short time – not to mention the fact that these vaccines must first be produced. Europe offered to urgently supply EU-approved vaccines to China, but Beijing rejected this proposal. Prior to this, China backed out of a deal with mRNA vaccine manufacturer Moderna in November, as the agreement did not provide China with the rights to manufacture the drug in the country and disclose technological secrets.
Consequences for the world
Health officials traditionally express concern and urge the PRC to provide at least some data that would allow us to assess what is happening in the country. In the meantime, the authorities of some Western countries are introducing mandatory testing for visitors from China, provoking angry speeches by representatives of the Chinese government.
For their part, epidemiologists doubt the appropriateness of such measures while the same varieties of coronavirus circulate in China as in the rest of the world. There is no reason to expect the emergence of new variants that can evade the immune response and cause a significant surge in the incidence in the West in the near future. In China, globally there is no immunity against "omicron" and its many versions, which means that selection in the direction of avoiding existing antibodies should not occur.
There is no reason to expect the emergence of new variants that can evade the immune response
But as more and more people in China become acquainted with the coronavirus and acquire immune protection against it, it will be more difficult for the pathogen to find new victims. This will contribute to the preferential survival of variants that are different from those that are common now – because they will be unfamiliar to the immune system, they will be able to multiply in the organisms of those who have already been ill and be transmitted further. Such varieties may well cause off-season waves of covid outside of China.
In addition, the emergence of new dangerous variants can be accelerated by an inadequate response to the spread of the virus. For example, with the uncontrolled use of specific antiviral drugs. Their active substances are directed to some important process for the virus, and if they are used in insufficient dose and / or for too short a period of time, viral variants will predominantly survive, which by chance will be more resistant to the damaging effects of the drug. Repeated misuse of the drug is very likely to lead to the formation of such varieties of SARS-CoV-2.
As already noted, there is no Paxlovid in China, but local scientists are actively developing their own drugs and even claim the effectiveness of some of them. True or not, it is difficult to verify, but the indiscriminate use of even not very effective drugs, however, can accelerate the changes in the virus, which is always bad. In addition, at the end of December, China still approved Paxlovid, so it cannot be ruled out that it will appear in the country in the foreseeable future. It is unlikely that the manufacturer will be able to provide China with many doses at once, but if this happens and the Chinese authorities cannot ensure strict adherence to the rules of administration, resistance to the drug can be expected. In this case, the burden of coronavirus for the West, which has just entered a relatively acceptable mode of coexistence with the pathogen, will increase significantly, since without Paxlovid for many people from risk groups, the likelihood of an unfavorable outcome will increase significantly.
