The Lancet
The Chinese government has reacted to the wave of protests against the “zero-Covid” policy by ending most of the restrictions. The sudden turnaround caused the infection to rapidly spread to many millions of Chinese in December 2022. Rather than relying on hope that the pandemic is over, letting our guard down and thinking the problem lies elsewhere, we need to everyone stay alert. The pandemic is far from over (1).
3 years ago, it was January 5, 2020, the Department of Zoonoses of the National Institute for Communicable Disease Control and Prevention (Chinese Center for Disease Control and Prevention) announced the isolation of a new Coronavirus responsible for a wave of respiratory diseases. On January 30, WHO declared a public health emergency of international concern. Despite the many efforts of the last 3 years to try to learn from the pandemic and despite the discussions on international treaties to prepare for the pandemic, the global response remains inadequate and fragmented. In 2023, far from the end of the pandemic (as many have hoped for and as announced in the US by President Biden in September of last year), there is a new, dangerous phase that requires urgent attention.
On December 7, the Chinese government reacted to the wave of protests against its draconian so-called “zero-Covid” policy by ending most of the restrictions. Chinese with mild or asymptomatic disease were allowed to quarantine at home, travel was no longer restricted by electronic health cards, lockdowns severely reduced, no longer required for entire municipal areas or cities, and were eased after 5 days for new cases. Also, from January 8 onwards, people were able to travel abroad again. The sudden turnaround caused the infection to rapidly spread to many millions of Chinese people in December 2022. The health care system has run into enormous difficulties with high levels of mortality among elderly people, even though official data did not record these deaths as related to COVID 19 because the Chinese authorities applied a very narrow definition and blocked any information on the number of infections, hospital admissions and intensive care admissions. While infections may have peaked in Beijing, China and its people are entering an unstable and difficult phase for several reasons.
First, the vaccination rate, especially of the elderly, is insufficient. According to data from the National Health Commission of China, as of the end of November, 69% of over 60-year-olds and only 40% of over 80-year-olds completed a course of two vaccinations plus a booster with Chinese-licensed vaccines, which are not specifically targeted against the variants. prevailing omicrons. Now a vaccination campaign is underway, aimed above all at the elderly. Additionally, several Chinese companies are working on a bivalent mRNA vaccine, but it will take some time before these more effective vaccines are licensed.
Secondly, in addition to the winter season, the Chinese Lunar New Year on January 22 and the expected wave of travel across the country to see relatives they will mean the spread of infections in rural areas where the health system is weaker and where many elderly people with co-morbidities and poor health live, as a recent Peking University-Lancet Commission points out. Understandably, the Chinese want to return to normal lives and see friends and family after such a long period of restrictions, but the health consequences could be dire.
Third, the international community, far from showing sympathy, has reacted quickly by imposing or encouraging strong travel restrictions and requirements of a negative SARS-CoV-2 test before travel for the Chinese. This move was deemed unnecessary by the European Center for Disease Prevention and Control as the variants observed in China, the omicron subvariants BA.5.2 and BF.7, are those circulating in Europe and elsewhere, in populations that now have a high level of immunity. While the precaution is understandable and variant tracking and data sharing should be widely encouraged, targeting Chinese travelers is counterproductive and could have unintended consequences.
The most concerning and to watch omicron subvariant is XBB1.5, which has rapidly spread to the United States, where in late December 2022 it affected 40.5% of cases, with a doubling time of 1 week, according to the Centers for Disease Control and Prevention. Maria Van Kerkhove, WHO’s COVID-19 technical lead, called it the most transmissible, with mutations in the spike protein allowing for tighter binding to the ACE-2 receptor and hampering the immune response, although so far there is no are signs that it is due to a more serious disease. However, there are some early indications that hospital admissions are on the rise in the northeastern United States, where it is most prevalent.
Rather than relying on the hope that the pandemic is over, letting our guard down and thinking that the problem is somewhere else, everyone needs to remain vigilant; encourage maximum transparency in the reporting of cases, hospital admissions and deaths; and accelerate collaborative surveillance of variant testing and vaccinations. The pandemic is far from over.
- The COVID-19 pandemic in 2023- far from over. Editorial, Lancet 2023 January 14, 401; 79. The translation is ours as well as the subtitles and bolds.