Explainer | How bad is China’s Covid crisis and should the rest of the world be worried?
- With millions of people on the move for the Lunar New Year holiday, the virus is expected to reach even the most remote parts of the country
- Amid questions over the death toll and demands for more data transparency, many places have imposed restrictions on Chinese travellers
With the borders reopened, many countries are concerned about how China’s Covid-19 crisis could affect their populations and have imposed restrictions on Chinese travellers. Beijing has retaliated, clashing with the US, South Korea and Japan over the curbs.
There are also questions about the death toll since China scrapped its tough pandemic controls; other countries have seen a jump in deaths when cases have surged because of the more transmissible variants.
This is what we know so far.
How severe has the situation been?
Just two weeks after the zero-Covid policy was scrapped, Chinese health authorities estimated that infections had reached 248 million people by December 20.
A Peking University study released last weekend estimated some 900 million people had been infected with the virus up to January 11 – or 64 per cent of the population. Reports on the study were taken down from mainland Chinese websites.
Jiao Yahui, director of the National Health Commission’s medical affairs department, said there had been 128,000 patients with severe Covid-19 on January 5, but the number had dropped to 105,000 by January 12.
International scientists have viewed the numbers – which are much lower than estimates made by overseas universities and institutes – with scepticism, especially since Beijing has said it only counts deaths caused by respiratory failure in its tally. The amount of testing being done in hospitals would also affect the tally, according to experts.
Is the worst really over?
Beijing is sending the message that the worst has passed.
However, the mass migration of people during the Lunar New Year – with many Chinese keen to travel after three years of restrictions – means the virus is likely to reach even the most remote parts of the country.
According to Ben Cowling, chair professor of epidemiology at the University of Hong Kong’s School of Public Health, the holiday migration “will ensure that any remaining unaffected areas will be seeded with infections, prolonging this current epidemic wave”.
British analytics firm Airfinity has updated its cases and deaths forecasts because of the holiday travel taking place.
“Our analytics indicators suggest that the virus has spread more quickly to rural areas, partly driven by people travelling for the Chinese New Year celebrations,” it said.
The company revised its death toll estimate from 25,000 a day to 36,000 a day on January 26 due to the travel.
“In our updated model, cases could peak at 4.8 million a day with 62 million infections predicted across a fortnight [from January 13-27] before beginning to fall.”
But while the Lunar New Year travel could prolong the peak, Mark Jit, a professor of vaccine epidemiology at the London School of Hygiene and Tropical Medicine, said the impact would likely be short term.
“Chunyun [the holiday travel rush] may indeed cause the virus to spread further, particularly to more remote and rural areas, similar to what happened at the start of the epidemic in 2020,” Jit said. “However, by late January it is likely that the virus will already have spread quite far, so the effect of chunyun will probably be short-term only.”
Why are other countries concerned?
Many nations – including the United States, Canada, United Kingdom, France, Italy, Spain, Australia, Malaysia, Japan and South Korea – have imposed testing requirements on travellers from China.
While new strains could emerge when a large population is infected, so far the newer strains detected around the world have been sublineages of Omicron – and they have not been found to be more pathogenic, though some have higher transmissibility.
But other countries are worried, especially given the lack of transparency.
“Whether these concerns are valid is difficult to fully tell because of the limited official data coming out of China,” said Kelley Lee, a professor of public health at Simon Fraser University in Canada.
“The key information to know about these subvariants in China is whether they are more transmissible, are they capable of immune escape, and are they capable of causing severe disease, which appears to be the case among Chinese nationals although it is unclear whether increased severity extends to people fully vaccinated and people vaccinated with non-Chinese vaccines,” she said.
“A change in how Covid-19 deaths are defined, footage suggesting a surge in hospitalisations and deaths, and insufficient data sharing make it difficult to achieve an accurate picture and thus are fuelling international concerns.”
Lee said Beijing should allay those concerns by increasing transparency on testing data, trends in infections and deaths, and genomic sequencing data.
“Limiting data sharing creates misinformation and suspicions which are not in anyone’s interests,” she said. “The targeted testing of travellers from China, despite their proven ineffectiveness, is a direct reaction to these unaddressed concerns.”
How are other nations faring this winter?
Some countries have seen a surge in Covid deaths fuelled by the highly transmissible Omicron variants, coupled by waning immunity and the lifting of social distancing measures.
For example, Japan reported a record number of Covid-related deaths on January 11, when more than 500 people died in a single day.
The deaths were driven by a spike in cases because of the highly transmissible BA.5 strain, which is now circulating in many countries. Japan’s daily cases stood at 96,392 on Thursday, but the number was down by 28,716 from the previous day.
In the United States, Covid deaths rose by 44 per cent – to 3,907 – in the week ending January 11 from the previous week. But the toll was still lower than the more than 17,000 weekly deaths being recorded in January last year.
The fast-spreading Omicron subvariant XBB.1.5 was estimated to have accounted for 43 per cent of the cases in the United States for the week ending January 14, according to data from the Centres for Disease Control and Prevention.
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Lee said she was concerned about the rising number of deaths caused by XBB subvariants.
“More importantly, we should equally be concerned, and perhaps more so, about what is happening with the surge in hospitalisations in recent weeks from the XBB and XBB.1.5 subvariant.
“For example, in the US and UK, it appears that these subvariants are quickly overtaking others. According to US CDC data, XBB was accounting for 40 per cent of new cases and is driving hospitalisations, especially among the elderly, in New York. It represents 1/25 or 4 per cent of cases in the UK. The reason for the surge is waning immunity, increased social gatherings, lack of mitigations – notably mask wearing,” she said.
“We are now relying on wastewater and some limited sentinel PCR testing (hospitals, healthcare settings) and really do not have sufficient data in many parts of the world to understand ongoing changes to the pandemic. So we should be paying more attention to what is happening in a lot of places in the world right now. It is all concerning.”