Over a million could die as China’s COVID wave crashes into huge holiday

With China's zero-COVID policy abruptly scrapped last month, the pandemic virus is now ripping through the country's population, and health experts are bracing for a wave of devastation as peak transmission shifts from urban centers to more vulnerable rural communities. The dire situation is expected to be "dramatically enhanced" by mass travel later this month for celebrations of the Lunar New Year on January 22.

 

Multiple modeling studies have suggested that China could see around 1 million deaths in the coming weeks as the country reopens amid a raging outbreak. Last month, modeling by The Economist estimated that 96 percent of China's 1.4 billion people could catch the virus within the next three months, resulting in 1.5 million deaths. Of those deaths, 90 percent would be among people aged 60 and over.  Another modeling study, partly funded by China's Centers for Disease Control and Prevention, also estimated that 957,600 would die in the coming weeks if the country doesn't swiftly roll out fourth-dose COVID-19 vaccines.

 

Because China was previously able to keep COVID-19 waves at bay with its zero-tolerance policies, most of the country's immune protection derives from vaccination rather than prior infection or hybrid protection. Around 90 percent of China's population has had two shots of COVID-19 vaccines, but fewer than 60 percent have received a third shot as a booster dose. And even for those who have gotten a third dose, many of those doses were taken months ago, and peak protection has passed. Vaccination coverage among the elderly is particularly worrying. About 30 percent of people aged 60 and over have not gotten a third dose, and for people aged 80 and over, a startling 60 percent have not gotten a third dose.

 

"The [World Health Organization] is concerned about the risk to life in China and has reiterated the importance of vaccination, including booster doses, to protect against hospitalization, severe disease, and death," said WHO Director-General Tedros Adhanom Ghebreyesus in a press briefing Wednesday. "This is especially important for older people, those with underlying medical conditions, and others who are at higher risk of severe outcomes."

Lack of data

Tedros and other WHO officials were critical of China for not sharing more data about the current situation—and questioned the validity of some of the data it has shared. Officially, China has only reported 5,259 deaths in the entire pandemic so far, with just one death report on the mainland on Wednesday. But WHO officials said China's definition of a COVID-19 death is "too narrow" because it only counts those who die from respiratory failure associated with COVID-19, ignoring the other myriad ways the disease can present and lead to death, such as via blood clots, heart attacks, and sepsis.

 

"We believe that the current numbers being published from China underrepresent the true impact of the disease in terms of hospital admissions, in terms of ICU admissions, and particularly in terms of deaths," WHO Executive Director for Health Emergencies Mike Ryan said in the press briefing Wednesday.

 

The country has largely stopped reporting case numbers, and mass testing was abandoned last month.

 

While experts fear for China's vulnerable populations, there's also some international anxiety over whether mass infection in China will brew new variants that could mushroom out from its borders. Infection on such a large scale offers the virus a plethora of opportunities to mutate further. But with China's population having relatively little prior immunity to newer variants, the virus faces less pressure than it would elsewhere to become more immune-evasive.

Variants of concern

This week, China did present some genomic data to a WHO technical advisory committee. The data described more than 2,000 SARS-CoV-2 genomes that officials in China had collected during December. Overall, the data indicated that the current wave of infection in China is driven almost entirely—97.5 percent—by known omicron subvariants BA.5.2 and BF.7 (another sublineage of BA.5). This data aligns with what is being seen from hundreds of genetic sequences submitted to a public database (GISAID EpiCoV database) from mainland China. It also matches the genomes found in travelers from China. Though other omicron subvariants were detected at low levels, no new variants or subvariants have been detected from China so far.

 

In a news release Tuesday, the European Centre for Disease Prevention and Control reported that current genetic data suggests China's explosive outbreak appears to be at low risk of changing the COVID-19 situations of its member states. "The variants circulating in China are already circulating in the EU, and as such are not challenging for the immune response of EU/EEA citizens. In addition, EU/EEA citizens have relatively high immunization and vaccination levels," the agency wrote.

 

The variants seen in China are also circulating at low levels in the US, which has rolled out a bivalent booster that partly targets BA.5.

 

But again, the WHO called on China to provide "more comprehensive, real-time viral sequencing" to monitor variants spreading in the country.

 

China is defending its data sharing amid the criticism. In a press briefing Thursday, China's foreign ministry spokesperson Mao Ning insisted it has been transparent and that the current "epidemic situation is controllable," according to Reuters.

"Facts have proved that China has always, in accordance with the principles of legality, timeliness, openness, and transparency, maintained close communication and shared relevant information and data with the WHO in a timely manner," Mao said.

“Never too late to vaccinate”

Meanwhile, reports of packed hospitals and overwhelmed funeral homes continue to stream out of China's cities. A Reuters source told reporters that a hospital in Shanghai's suburban Qingpu District had patients in beds lining the halls of the emergency treatment area. The hospital's notice board informed patients that the average wait to be seen was five hours. For one elderly patient who died, staff pinned a note to the body listing the cause of death as "respiratory failure."

 

Health experts fear that the situation will only get worse as transmission moves out from the cities into the more vulnerable rural communities. In a modeling study published December 29 in Frontiers of Medicine, which is sponsored by China’s Ministry of Education, researchers reported that transmission may have already peaked in some major cities. But middle and western provinces and rural areas—places with more fragile health care systems—could be hit with peaks later this month.

"The duration and magnitude of upcoming outbreaks could be dramatically enhanced by the extensive travels during the Spring Festival" for the Lunar New Year, the researchers wrote. The celebration is the country's biggest, and tens of millions of people often travel around the country to spend the holiday with their families.

 

While the modeled outcomes look bleak, WHO's Maria Van Kerkhove, the agency's technical lead for the COVID-19 response, emphasized that they're not foregone conclusions. "These models are quite helpful for a scenario base—to plan. But the models are not predictions of what has to happen," she said Wednesday, urging China officials to act and take efforts to save lives. She highlighted the importance of early diagnosis, access to clinical care, antivirals, and vaccination.

 

"It is never too late to vaccinate," she said. "That additional boost will save lives… Those predictions do not need to become a reality."

 

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