Three years into the pandemic, China’s zero-COVID policy has not presented the country with easy choices.
The reversal of its infamous lockdown policy, as signaled this week, could trigger a wave of hospitalizations and deaths similar to what much of the rest of the world saw in the early days of the pandemic. And if it refuses to reopen, it risks a continuation of the anti-government protests that recently swept the country.
The problem with a zero-COVID approach, from an immunological perspective, is that it’s not a policy that can be “turned off” with little or no consequences, experts tell Fortune. Due to the widespread lack of contact — and thus the immune response — to COVID among its citizens, low vaccination rates among the elderly and use of subpar vaccines, China risks an explosion of COVID cases and hospitalizations if lockdown restrictions are eased.
“Due to the ongoing ‘zero tolerance’ policy, there is relatively little immunity to infection” in China, Dr. Daniel R. Kuritzkes — chief of the infectious diseases unit at Brigham and Women’s Hospital in Boston and professor of medicine at Harvard Medical School — told Fortune.
When Omicron hit the US late last year, things seemed relatively mild. But that’s not necessarily because the new variant is a tamer version of COVID, experts say. This was probably due, at least in part, to the fact that so-called hybrid immunity — through repeated vaccination and infection of the masses — mitigated the severity of the variant for most.
China, on the other hand, lacks population immunity, said Kuritzkes. Therefore, an Omicron surge in China could be more severe than an Omicron surge elsewhere.
For a country like China – “particularly with many vulnerable, under-vaccinated” elderly people – “a variant that’s relatively milder elsewhere could wreak havoc” so that it “feels like 2020 again there,” according to Ryan Gregory, Professor of Evolutionary Biology at the University of Guelph in Ontario, Canada, recently told Fortune.
The end result could be “hundreds of millions” of infected Chinese, said Dr. Ali Mokdad, Professor at the Institute for Health Metrics and Evaluation at the University of Washington.
“If you look at the numbers, only about 25% of people in China are immune to Omicron,” he told Fortune. “If they open, 75% of the population will be infected. They cannot handle the explosion of infections and hospitalizations.”
“This will spread like wildfire.”
A true time capsule
Since the pandemic’s early days in late 2019, time seems to have frozen in China, in a scenario eerily reminiscent of the country’s response to the deadly SARS pandemic in 2003. The mass tests – said to be “much more draconian and stringent than any response.” in Western countries,” they are “largely appropriate,” said Kuritzkes, who had spent a lot of time in China before the pandemic.
For the most part, anti-COVID efforts have been “clearly effective — at least as far as we know from the reported data,” Kuritzkes said.
China has seen nearly 10 million cases if its government’s data is to be believed. The total dwarfs the nearly 100 million registered cases in the US, which is widely considered an underestimate. And China’s official COVID death toll — 30,388 as of Saturday — is just a fraction of the United States’ 1.08 million.
Even before the recent anti-zero COVID demonstrations in China, new cases there were increasing rapidly every day. Almost 37,000 new infections were reported nationwide on Saturday, up from 2,481 the same day the month before, according to data from Johns Hopkins via Our World in Data — even as the country remains in a COVID-zero position.
In recent days, Chinese public health officials have signaled they may ease COVID restrictions due to the Omicron variant’s “declining toxicity,” CNN reported. However, Mokdad warns that the Chinese may only be making such statements to quell demonstrations and may not plan to go ahead with them.
Given that the country has already seen a sharp rise in the spread of diseases of late, it’s unclear what’s next for China – with or without a change in policy.
“Frankly, even if China starts reopening, “they will close as soon as they see an increase in mortality, and that would be justified,” Mokdad said.
An unstoppable inferno
The benefit of a zero-COVID approach is obvious: limited infections if all goes well. The downside: The virus will never be eradicated, experts say, and nobody will become immune – “unless a program has been implemented in parallel to offer a large majority of the population highly effective vaccines,” said Kuritzkes.
China has vaccines that it has manufactured domestically, but data on their effectiveness is lacking. Still, experts consider them inferior to vaccines like Moderna and Pfizer, which are used in the US, UK and many other countries.
In an interview with the Washington Post on Thursday, Dr. Anthony Fauci, presidential physician and outgoing director of the National Institute of Allergy and Infectious Diseases, referring to China that restricting the movement of citizens can be beneficial “until you can get your population in vaccinated entirety — particularly the high-risk elderly.”
“That didn’t happen,” he said. “Vaccinating the elderly was not well done and the vaccine they had was not a particularly effective vaccine. So it kind of goes against the principle… that if you do something that draconian [the lockdowns]do it for a purpose – an endgame.”
The Sinopharm vaccine – one of the main COVID vaccines offered in China – is approved by the World Health Organization. But one study found it was only 79% effective against hospitalization — and it only looked at people under the age of 60 with no underlying medical conditions, mostly men, according to the International Health Organization. Both Pfizer and Moderna mRNA vaccines were originally reported to be more than 90% effective in preventing symptomatic infections.
“Many people are prone to serious illnesses [in China]and that’s mainly a function of the Chinese government not allowing mRNA vaccines,” said Dr. Amesh Adalja, an infectious disease specialist and principal investigator at the Johns Hopkins Center for Health Security, told Fortune.
Mokdad argued that whatever its wealth, the West should supply mRNA vaccines and antivirals like Paxlovid to China at this crucial time of increased COVID traffic in the country. This could help prevent the development and spread of a new variant outside of China and hurt the global economy, he said.
“If we help China face a COVID wave, we are helping ourselves,” he said. “The World Health Organization and all rich countries should now turn to China and say, ‘If you decide to open up, what are the scenarios? How can we help you the most?’”
Asked about the country’s statements that it would relax its zero-COVID policy following recent public protests, Dr. Michael Ryan, WHO’s director of emergencies, told Fortune Friday that the organization was “pleased that the Chinese authorities are adjusting their current strategy.”
“It’s really important that governments listen to their citizens when they’re in pain,” he said.
The WHO hopes for a new Chinese approach that “balances control of the virus with the lives, livelihoods and well-being of the people of China,” he added.
“If you can’t put out a fire, you’re putting vulnerable people out of the way. And in this case, that’s what we’re doing with the vaccine.”