Both the United Nations (UN) and the World Health Organization (WHO) are calling on the Chinese government to be more transparent regarding the outbreak of COVID following Beijing’s abrupt halt of its Zero-COVID policy last month. The official Chinese reporting is that there has only been a slight increase in cases and relatively few COVID related deaths, zero to five per day according to the Chinese National Health Commission’s official daily briefing of December 23rd. The following day, December 24th, these daily briefings which have been going on since February 2020 were abruptly canceled. Meanwhile, unofficial reports are of hospitals struggling at capacity, drug store shelves empty of all cold remedies and morgues unable to accommodate more bodies. This picture appears to be true for large urban centers as well as rural areas in this country of 1.5 billion people.
An article in the prestigious British Medical Journal (BMJ), which was published this week, suggests a much more dire situation. The article is based on computer modeling by the British health data analyst company, Airfinity. The article reports that the current daily COVID death rate in China is probably somewhere between 9,000 and 11,000 deaths per day. This is in such stark contrast to the Chinese government’s claim of 5 per day as to leave one incredulous.
The BMJ article goes on to say, “Airfinity’s model predicts that China’s outbreak will reach a first peak on 13 January, at 3.7 million new cases a day. Covid deaths are expected to peak 10 days later at around 25,000 a day, which is roughly equivalent to China’s normal daily death toll from all other causes. A second peak, striking rural areas hard, will reach 4.2 million new cases a day on 3 March, the model predicts. It foresees 1.7 million deaths across China by the end of April 2023.” The article also references similar predictions made by a model carried out by the University of Hong Kong that predicts 964,000 new COVID deaths in China by the end of this month.
An article that appeared this week in Reuters suggests that as many as 250 million new Chinese cases may have occurred in the last 20 days of 2022. If so, this is about 18% of the Chinese population becoming newly infected in just 3 weeks.
Currently, the US is the only country to hold the unenviable record of breaking 1 million COVID deaths. India is second at just over half a million. Total worldwide deaths are estimated to be 6.7 million since the start of the pandemic in late 2019. Through its Zero-COVID policy, China was able to keep its total deaths at around 5,000 during the early years. However, in March of 2022 China began to see large outbreaks in some of its biggest cities like Shanghai. If the official reports are to be believed, the number of COVID deaths in China at the at the end of the summer totaled just over 30,000.
The reason that accurate information is so crucial to organizations like the WHO and the US Centers for Disease Control (CDC) is that when we have large scale outbreaks of COVID they carry with them a high chance of new variants developing. We saw this in India during its greatest outbreak in December of 2020, out of which came the Delta variant which was 75% more contagious than previous variants. Factors that came into play then included not only the overall numbers of new cases, but also how the Indian healthcare system became overwhelmed which contributed to the long duration of the outbreak. It is feared that a similar situation may now be developing in China.
The WHO has repeatedly requested viral genetic information regarding the current outbreak in China. Last week, the Chinese equivalent of our CDC released viral sequencing results from 2,000 samples taken on December 1st. These results show that 97% of the cases at that time were from two strains of Omicron with no new variants detected. However, the current surge began after December 8th, when China relaxed its stringent rules under its Zero-COVID policy which included massive lockdowns, travel restrictions and frequent mandatory testing of its population. The WHO is asking for real time data pertaining to the current surge so that if a new variant develops it can be detected early.
Not surprisingly, global politics are coming into play. Several major countries have now instituted either a total ban on travel from China or at least are requiring negative COVID tests for entry into their countries from China. These include the United States, France, Spain, Italy, India, Israel, Australia, Canada, Japan, and South Korea. While requiring negative tests upon entry may be somewhat beneficial in slowing spread and monitoring which variants are moving to and fro, they do not stop the spread of a new variant into the country. Further, travel bans have been repeatedly shown to not prevent spread of disease and merely tend to undermine cooperation efforts.
With the ending of Zero-COVID, China dropped its requirement that travelers entering the country be quarantined for ten days. China still requires travelers to test negative before entering. Now, the Chinese government is chafing at the restrictions being imposed on it by other countries and threatening to retaliate with similar travel bans. Underscoring these tensions are feelings of mistrust of what China is reporting on the one hand, with China feeling that such measures are political manipulation aimed at undermining its position as a global leader on the other.
Perhaps to both sooth tensions and assist China in gaining better control of the outbreak, the US State Department has offered to send American manufactured vaccines to China. This could have real impact upon curbing the current situation in China since the Pfizer and Moderna mRNA vaccines have been shown to be the most effective including against current strains of Omicron. China still has a relatively low vaccination rate compared with other developed countries, especially in its large elderly population. However, it seems unlikely that China will accept the offer as it has long touted its own two vaccines, SinoPharm and SinoVac, as a source of national pride despite their lower effectiveness.
It would seem that a threat like a pandemic, which does not recognize borders or divisions based on politics, religion and culture, would somehow bring us closer together against the common threat. However, it appears that we still have lessons to learn before that utopian outcome can occur.
Miller Report for the Week of January 2nd, 2023; by William Miller, MD
You can access all previous Miller Reports online at www.WMillerMD.com.
Dr. Miller is a practicing hospitalist and the Chief of Staff at Adventist Health Mendocino Coast hospital in Ft. Bragg, California. The views shared in this weekly column are those of the author and do not necessarily represent those of the publisher or of Adventist Health.
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