For three years, China has followed a strict “zero-Covid” policy, based on stringent protocols of mass testing, quarantine, and isolation of even asymptomatic cases. However, following a wave of protests by thousands of citizens weary of draconian lockdowns, the government has now started to relax Covid restrictions, which is coming as a relief for many Chinese residents who have been clamoring for change.
Nevertheless, according to many Chinese and international experts, these changes are likely to bring about an unprecedented flood of infections in a largely immunologically-naïve population, possibly followed by a massive wave of severe disease and death among the most vulnerable parts of the population. This is what happened in Hong Kong several months ago.
“There is still the possibility that they may muddle through it without a mass die-off,” said Yanzhong Huang, an expert in Global Health at the Council on Foreign Relations. “But even the most smooth and orderly transition will not prevent a surge of cases.”
Sadly, with its under-vaccinated residents and sparse infection history, China harbors “a more susceptible population than really any other large population [we] can think of,” according to Sarah Cobey, a computational epidemiologist at the University of Chicago.
“Eventually, just like everyone else on Earth, everyone in China should expect to be infected,” added Michael Worobey, an internationally renowned evolutionary virologist from the University of Arizona.
Currently, one of China’s weakest spots is its lack of immunity to Covid-19. Although over 90 percent of the population is doubly vaccinated, those over 80 were not prioritized in the nation’s initial rollout, and their rate of vaccination is just about 66 percent, with an even smaller percentage having received a booster.
Moreover, the vaccines that have been used are based on chemically inactivated particles of the Wuhan coronavirus variant, and seem to be less efficient than the mRNA-based western vaccines. In addition, the stringent zero-Covid policies have left the majority of citizens with no infection-induced immunity. Finally, the country’s healthcare system – with about 3.6 ICU beds for 100,000 citizens – is largely unequipped to handle a massive surge in infections.
Thus, many experts warn that not only will a massive Covid outbreak possibly kill from one to five million of China’s population over the following months, but will most likely have unpredictable effects on the virus.
Since the world’s most populous country is home to a vast number of immunocompromised people, who can harbor the virus for months during chronic infections, this will give it the chance to mutate. The world may be about to witness “a billion or more opportunities for the virus to evolve,” as Ben Cowling, an epidemiologist at the University of Hong Kong, put it.
Furthermore, the virus could exploit the Chinese residents’ close interactions with farmed animals and thus become enmeshed in local fauna, where it can find myriad opportunities to further mutate, possibly giving rise to variants more virulent than Omicron.
In its current situation, China would most likely benefit from an intensive campaign of vaccination with the updated mRNA boosters (which offer a degree of protection also against several Omicron sub-variants), together with a gradual rather than sudden relaxation of all restrictions, as well as massive investments in new healthcare centers and medical personnel. Otherwise, the entire world is at risk from what could potentially become the largest outbreak we have witnessed during this pandemic.
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