BAZHOU – Almost three years after it was first identified in China, the coronavirus is now spreading across the vast country. Experts predict difficult months for the 1.4 billion people.
China’s relentless “zero-COVID” approach, aimed at isolating all those infected, bought it years to prepare for the disease. But one abrupt reopeningAnnounced without warning on December 7 after anti-lockdown protests, the nation has been undervaccinated and caught with tight hospital capacity.
Experts are forecasting between one and two million deaths over the next year. Predicting deaths has proven difficult throughout the pandemic as it is influenced by various factors and China presents a particularly complicated case due to opaque information sharing.
It’s not clear how big the current outbreak is, as China has scaled back testing and stopped reporting most mild cases. But in cities and towns around Baoding and Langfang in Hebei province, an area that was among the first to face an uncontrolled outbreak, Associated Press reporters saw hospital intensive care units overwhelmed by patients and ambulances turned away. Across the country, widespread reports of absenteeism from work, shortages of antipyretic drugs and overtime by crematoria staff suggest the virus is widespread.
China is among a small club of countries that managed to halt most of the domestic transmissions of the virus in 2020, but it is the latest to end restrictions. Experiences of the end are mixed: Singapore and New Zealand achieved high vaccination rates and strengthened medical systems during restrictions, and reopened relatively smoothly. Hong Kong, where omicron overcame defenses while many elderly were unvaccinated, suffered a disruptive wave of COVID-19 in 2022. Nearly 11,000 people died from the disease this year in the city of 7.4 million people, 95% of whom were over 60, according to the Hong Kong Ministry of Health. City data showed a 15% mortality rate among those over 80 and unvaccinated, said Jin Dong-yan, a virology expert at the University of Hong Kong.
___
AN UNDERVACCINATED POPULATION
China has higher vaccination rates than Hong Kong at the time of the Omicron outbreak, but many people are vulnerable to infection, particularly the elderly.
The country has only used domestically produced vaccines, which are based on older technology than the mRNA vaccines used elsewhere, which have shown the best protection against infection.
A Study conducted in Hong Kong, which has administered both an mRNA vaccine and Sinovac’s CoronaVac, suggested that CoronaVac needs a third vaccination to provide comparable protection, particularly for the elderly. A normal vaccination cycle consists of two vaccinations, with an optional booster vaccination later.
Most people vaccinated in China have received either CoronaVac or a similar vaccine made by SinoPharm, but the country has administered at least five other vaccines. Comparable real-world data are not available for these vaccines.
While in China 90% of the population is vaccinated, only about 60% have received a booster shot. Older people are particularly likely not to have received a booster shot. Over 9 million people over 80 have not yet received the third vaccine, according to China’s official Xinhua News Agency.
Vaccination rates have increased more than tenfold since the beginning of the month to over a million doses administered per day. But dr Gagandeep Kang, who studies viruses at India’s Christian Medical College in Vellore, said prioritizing older people is key. Unlike other countries, China has prioritized vaccinating more mobile youth to prevent the spread of the virus, said Ray Yip, the founding director of the US CDC’s office in China. A campaign aimed at the over-60s launched in December, but it’s unclear how successful it was.
They “didn’t pay enough attention to making sure everyone got the full immunization coverage,” Yip said. “How well they perform this particular catch-up effort could determine part of the outcome.”
___
OVERWHELMED HOSPITALS
Around Baoding and Langfang, hospitals have run out of intensive care beds and staff as severe cases rise. Patients lay on the ground while others drove from hospital to hospital Wednesday, looking for beds for loved ones.
The National Health Commission said China had 10 intensive care beds per 100,000 people as of Dec. 9, a total of 138,000 beds, down from 4 per 100,000 people on Nov. 22. That means the reported number of beds has more than doubled in just under three weeks. But that number “might be wrong,” said Yu Changping, a doctor at the Department of Respiratory Medicine at Wuhan University People’s Hospital. “It’s impossible that the number has increased so much in such a short period of time,” Yu said.
Even at face value, the increase in ICU beds does not mean the healthcare system is prepared for a surge in cases, as the pressure point, globally, is often the availability of specialist doctors and nurses who can treat patients who need them in the ICU, said Chen. China has just 80,050 doctors and 220,000 nurses for its critical care facilities, and another 177,700 nurses who the National Health Commission says could potentially work in those units.
“If you look at beds in intensive care units, there is … a huge shortage in China,” he said.
Yu said he has seen a growing number of COVID-19 patients in recent weeks and that almost all doctors in the department are infected. “We are under pressure because we are receiving a large number of patients in a short period of time,” Yu said.
China also hasn’t announced a clear triage plan, a system whereby hospitals prioritize treating the critically ill to ration limited resources. In addition, China’s healthcare system is centered on large hospitals, which usually treat even the mildly ill, Chen said.
Potential shortages would depend on how quickly cases increase, and unless those with mild symptoms stay home to ration resources for the very ill hospitals, they could still be overwhelmed, Chen said.
“That could easily crash the system,” he said.
To try to protect its healthcare system, Beijing has remodeled makeshift hospitals and central quarantine facilities to increase the number of fever clinics from 94 to 1,263. But rural areas could suffer as the vast majority of ICU beds in China are in cities.
The use of digital tools and telemedicine can give hospitals some breathing room: More than a third of hospitals use some form of telemedicine, and around 31% use digital tools in their healthcare delivery, according to a nationwide survey of 120 public and private hospital executives in urban areas conducted by LEK Consulting in Shanghai.
China earlier this year approved Pfizer’s drug Paxlovid for COVID-19 and two domestic therapies: an anti-AIDS antiviral from Genuine Biotech that has been repurposed for COVID-19 and a cocktail of virus-blocking antibodies from BriiBio. However, it is unclear how widespread these drugs are.
___
HOW BAD WILL IT GET?
Scientists aren’t sure, as mortality depends on factors like vaccination rates, people’s behavior and efforts to strengthen hospitals.
The Institute for Health Metrics and Evaluation at the University of Washington in Seattle predicts that the number of deaths could reach one million by the end of 2023 if the virus continues to spread unchecked. But Ali Mokdad, a professor of health metrics at the institute, said the government could likely lower that toll with renewed social distancing measures.
Another Hong Kong University study also predicts nearly a million deaths in a scenario where the virus spreads across the country and authorities are unable to provide vaccine boosters and antiviral treatments. Bill Hanage, co-director of the Center for Communicable Disease Dynamics at Harvard TH Chan School of Public Health, estimated 2 million deaths in a Dec. 14 conversation with reporters.
“China has a very, very tough road ahead of it in the coming months,” Hanage said. “But without vaccination it would be much, much worse.”
Will a surge in China spill over to the rest of the world? Neighboring India has asked its state governments to do so stay alert, and don’t let genome sequencing efforts dwindle. Jeremy Luban of the University of Massachusetts Chan Medical School said large flares of infection increase the potential for a more dangerous mutation to emerge. Luban sees “no particular cause for concern” about alarming variants already brewing in China “other than the fact that many infections are bad.”
Luban added, “The better the transmission rate could be controlled in China, the better.”
___
Ghosal reported from New Delhi and Wu from Taipei, Taiwan. Associated Press journalist Carla K. Johnson in Seattle and video producer Olivia Zhang in Beijing contributed to this report.
___
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Copyright 2022 The Associated Press. All rights reserved. This material may not be published, broadcast, transcribed or redistributed without permission.
