As Officials Ease Restrictions, China Faces New Pandemic Risks

As country after country succumbed to outbreaks this year, China contained the coronavirus, taking valuable time to prepare for the inevitable: a change The body of the virus is so cunning and contagious that China will also struggle to contain it.

But instead of laying the groundwork for that scenario, China has stepped up its pledge to be “Covid-free”, implementing rapid lockdown measures and contact tracing.

Meanwhile, the number of daily vaccinations fell to a record low. Intensive care beds remain in short supply, even as workers build testing chambers and isolation facilities. Research on domestic mRNA vaccines has not kept pace with the rapidly mutating virus.

Now, the costs of that approach are piling up, the scientists said in interviews, putting China in a bind from which there seems to be no easy way out.

Even as new Covid cases hit an all-time high, people still took to the streets to protest the blockade order that has brought daily life to a halt in many cities. Alarmed, officials have begun easing restrictions.

The researchers worry that China may find it difficult to reopen the country and ease the strain on the economy without risking a wave of deaths. Such a catastrophic rise could pose a significant threat to the political leadership.

Dr Siddharth Sridhar, a virologist at the University of Hong Kong, said: “We often pretend that China has a choice between being ‘Covid-free’ or opening up. “There is never a choice. The simple fact is that China is not ready for a wave of that size.”

Nothing hinders China’s preparation more than the country’s difficulty in vaccinating its elderly. Two-thirds of people 80 years of age and older are vaccinated, but only 40% receive a booster dose, a serious shortcoming because the Chinese-made vaccine offers weaker protection than the vaccine. -please Pfizer-BioNTech and Moderna.

in one research during Hong Kong’s Omicron spike, China’s two main domestic doses of vaccine, Sinovac, are only 58% effective against severe or fatal Covid in people 80 years of age and older. In contrast, two doses of Pfizer-BioNTech were 87% effective in the same group. One previous study in Brazil The same also found that two doses of Sinovac were only 61% effective in preventing Covid deaths.

Those results bolstered scientists’ impressions that the Chinese shots, which rely on a killed virus to spur an immune response, are actually a three-dose vaccine, not two. .

Making matters more difficult, China’s last major vaccination campaign was in the spring, a period of 8 months or more since the last dose for many recipients.

That can create a dent in their immune defenses. One study abroad malaysia found that although the Pfizer-BioNTech vaccine confers relatively stable protection against intensive care admissions three to five months later, Sinovac’s efficacy on care admissions intensive care dropped from 56% to 29% in that time period.

Dr Paul Hunter, an infectious disease expert at the University of East Anglia in the UK, said Chinese vaccines were relatively good compared to other non-mRNA Covid vaccines in the world. But reopening the country too long after the last vaccination campaign could be damaging.

“I think it’s more of an issue than the quality” of the Chinese vaccine, says Dr. Hunter.

The vaccination gap in China’s older population is all the more pronounced as the country has achieved relatively strong coverage overall. Nearly 90 percent of the population has received a primary series of vaccines, which typically include two doses of Sinovac or Sinopharm, another Chinese-made vaccine.

Andy Chen, an analyst at Shanghai-based consulting firm Trivium, said the disparity stems in part from an outdated theory that as long as younger and more active Chinese are vaccinated. , this country can establish a kind of herd immunity and protect the elderly. .

Elderly people in China generally avoid health risks, and so the possibility of even minor side effects from vaccines seems to have threatened many, Chen said. Other experts say China’s reluctance to provide data on vaccine efficacy and side effects has created a vacuum for those worries to grow. Misinformation about side effects spread on Chinese social media.

And while health officials have encouraged older adults with chronic illnesses to get vaccinated, people who get vaccinated are often reluctant to get vaccinated when they don’t have access to the medical histories of vulnerable people. hurt more.

The “zero Covid” strategy only complicates the vaccination campaign. By limiting infection, it has saved many lives but also eroded many older people’s sense of urgency about the need to get vaccinated.

The emphasis on throat swabs rather than vaccinations has drawn additional attention from the vaccination campaign. After the outbreak in the spring, China erected tens of thousands of testing sites in cities like Shanghai and Beijing, and built huge facilities to isolate millions of people. Vaccination rates have stagnated.

“There has always been a shortage of staff in the health care system,” said Xi Chen, an associate professor of public health at Yale University. “People told me at the time they were asked to focus on mass testing.”

China said this week it would renew immunization efforts for its oldest citizens, announcing measures to use mobile vaccination stations, delivering vaccines to nursing homes and door-to-door to reach the most vulnerable, according to a report. statement from the country’s National Health Commission.

But some experts, such as Yanzhong Huang, a global health expert and senior fellow at the Council on Foreign Relations, expressed skepticism that the move was more than just words.

“It’s about tinkering with the current approach,” he said. “But that approach basically doesn’t make sense from a public health policy perspective anymore.”

Authorities did not provide a blueprint for new efforts and stop mandatory vaccinations. Experts say that no matter how powerful the country’s leadership is, forcing the elderly to vaccinate is considered a potentially outrageous act that carries the risk of public backlash.

“From a local government official’s point of view, if it only takes one person to die from a side effect of a vaccine, it’s bloodshed,” said Chen, an analyst at Trivium. “It was really hard to recover after that.”

If cases continue to rise, the gap in vaccine coverage could put additional pressure on hospitals, which may also face winter colds and flu. China has fewer intensive care beds per capita than many other Asian countries.

The country once addressed the shortage of doctors and nurses, especially in rural areas, by moving medical staff from one province to another during the outbreak of the virus. A series of nationwide Omicron infections would make that impossible.

One research from Shanghai’s Fudan University in May warned of a “tsunami” of Covid cases and about 1.6 million deaths if China abandoned its “no Covid” policy. Since then, China has gained more options for antiviral treatments. Ben Cowling, a professor of epidemiology at the University of Hong Kong, said hospital capacity is so limited that a sudden lifting of “Covid-free” restrictions would still create a health crisis.

Because it’s inevitable that cases will increase whenever China reopens, Yang Yang, an associate professor of biostatistics at the University of Florida, said the efforts “prepare the health system” economy” is the top priority. He added that there have been some signs that the leadership is shifting its focus from building isolation facilities to consolidating the best hospitals.

China’s awkward retreat from the emergency phase of the pandemic contrasts with the exits of places like New Zealand and Taiwan. There, the closure gives breathing space while people are vaccinated; when the measures were lifted, the number of deaths increased, but at a much lower rate than in countries like the United States.

China’s strategy so far has also limited the number of Covid-19 deaths, scientists say, but has not outlined a way out of the restrictions.

Jeremy Farrar, director of Wellcome, a global health organization, said: “Restrictions and lockdowns can buy time to take important public health measures and save lives, but they are not an exit strategy in and of themselves.

China, which has rejected the Pfizer and Moderna vaccines, seems to be counting on hopes for domestically produced mRNA alternatives. Government scientists have conducted head-to-head testing of more than a dozen new vaccine candidates, including several doses of mRNA, experts say.

Public data is scarce, but Indonesia recently authorized Chinese mRNA vaccines, and some vaccine manufacturers appear to be getting closer to getting permission from Chinese officials.

“The recipe for the correct mRNA vaccine may have achieved some of its goals, but early data suggests it is working,” said James Bellush, a medical science specialist at RTW Investments in New York. in the right direction”.

China’s top leadership has signaled that its comprehensive approach to virus control is causing growing social and economic damage, and called for measures to be taken. adopt a “one size fits all” approach. In recent days, several cities have eased some of the harshest restrictions following a wave of mass protests.

But there still seems to be some debate about whether retreating from Covid restrictions is the right approach. In the northeastern city of Jinzhou, in China’s Liaoning province, officials said they had begun easing some measures but still pushed back against abandoning the “Covid-free” strategy.

“We don’t need to give up our defenses when we can get to zero, avoiding large-scale infection,” the officials said.

David Pierson contribution report.