The COVID-19 pandemic anew

COVID-19 has evolved both predictably and unpredictably for 28 months.  Predictably in that we see many parallels in prior pandemics, unpredictably in that there is also uniqueness in the virus and human responses. Despite the fast changing pace of the pandemic, including from not knowing what it was and did to knowing so much about it in just two months, flying blind to care for patients to the discovery and inventions of treatments and especially vaccines, and the emergence of many variants, my positions have remained consistent since Jan 2020, about lockdowns (Jan 26, 2020 blog), disease origin (May 27, 2021 blog), mass testing (May 12, 2020 blog), data reporting (Jun 3, 2020 blog), and vaccines (Aug 11, 2020 blog).

The first Wuhan lockdown was viewed very critically (Jan 26, 2020 blog).  Even though a major, unprecedented move like that was never easy, there must always have been a better way to handle the situation, or at least a better way to conduct the lockdown (May 2, 2020 blog).  But in Jan 2020 we knew next to nothing about COVID-19, so a lockdown, no matter how well or poorly conducted, might be a necessary evil.  This became salient when later many countries thought to be able to handle COVID-19 better than China failed miserably.  So Wuhan was bad, but it could have been much worse for Wuhan or China.

But by the same token, the current lockdowns in Shanghai and a few other places in China are, no better way to put it, an absolute unnecessary evil, idiotic, and suicidal (March 16, 2022 blog).  For things have changed so much since Wuhan.   Despite what many in China and the West are claiming, 1. Omicron is not a big threat like the virus in 2020, 2. Chinese vaccines work, and 3. China is well prepared for Omicron.  Vaccination rates are >90%, and most seniors (>60%) are vaccinated.  There are now a few drugs to reduce COVID-19 severity and death.  China also still maintains a monitoring, masking, and testing scheme better than any other countries.  All these ensure that COVID-19 will never run wild in China like in the West, and the death rate in China will be low, comparable to other causes.   

Data bear it out.  There have been ~ 400K infections this year in mainland China.  Cases that require especial treatments, like oxygen, are only 1 in 1000.  So far officially two people died in Jilin, but it can be sensibly argued that they died with, not from COVID-19.  It is expected that infections will rise further, and real COVID-19 deaths will follow.  Yet already well over 10 people have died while waiting for treatments not rendered due to COVID-19 restrictions, and these are just the known minority.  Because of the high profile lockdowns, many other cities with few COVID-19 and not under lockdowns also apply strict, bothersome, and self-defeating measures.  Consequently, economy is suffering terribly, the whole country, not just those under lockdowns.  China is wasting too much energy doing things that are hurting itself and yielding little in return.

Then why does China do it?  Inertia is likely the primary reason.  Wuhan lockdown worked, right?  So why don’t we do it again everywhere?  This lazy mentality ignores everything humans learn and gain since Jan 2020.  This is why COVID-19 measures have become even stricter now than two years ago in China, which is laughable and indefensible, as if two years’ worth of knowledge, drug discovery, and vaccines never counted. 

A significant percentage of the Chinese public also have a long-running fear, reinforced by COVID-19, that if you get sick, you must be treated by doctors.  This is why Chinese hospitals are overflowed with people with the slightest symptoms.  Also just a human nature, many Chinese do support lockdowns, particularly if other people are the ones under lockdowns.   It is utterly disappointing that even some scientists and doctors who know better are pandering to the sentiment.  Wu Zhunyou, a prominent national figure, had talked about easing COVID-19 measures before, but turns around to rationalize the current lockdowns by saying that millions would die if loosening.  This is used to justify Shanghai lockdown, and many Chinese agree with it, but it is fearmongering.

A major piece of evidence cited to support the “millions” number is the South Korean data.  The death rate in Korean Omicron is 0.1%, so 1-2 million Chinese could die.  But this ignores the fact that Korea opened up prior to the most recent wave, and China didn’t and won’t in the near future.  Another case often cited is HK, but HK deaths are 90% unvaccinated, and HK also more or less opened up prior to Omicron.  None of those conditions exist in mainland China.  The final piece of evidence in support of lockdown is that China has fewer hospitals, so a rush of Omicron patients will overwhelm the medical system and lead to overall more deaths.  This has happened in places under lockdowns like Xi’An, Jilin, and Shanghai, resulting in savable deaths but, ironically, almost no COVID-19 deaths.  This is because most medical resources are summoned for the senseless, continuous, city-wide COVID-19 screening and gathering all the positives for isolation, leaving fewer to treat other patients at the hospitals.  What is more, many parts of the hospitals are closed for fear of admitting COVID-19 positives.  No wonder all those wildly reported and denounced deaths.  In short, lockdown creates the squeeze, not COVID-19 patients!  This is even the more unacceptable because China has had two years’ experience with lockdowns, Shanghai may have the best medical infrastructure in China, but Shanghai still fails.

The failure in Shanghai is well documented by the media, and it feels worse because it is self-inflicted and completely avoidable.  Of course COVID-19 will lower, but other diseases will kill more people, and a bad economy will kill more people in Shanghai and the rest of China.  In China 10 million people die every year, 200K in Shanghai, 560 per day in Shanghai.  How many have died from COVID-19?  Even those well-known deaths related but not due to COVID-19, 10 so far, times 10 assuming underreporting, that number is still negligible compared to the “normal” daily deaths in Shanghai.  Is it really worthy to shut down the whole city and a huge chunk of China’s economy and anger so many people, without manifestly saving any or many lives?   

What should happen instead?  Like it or not, the whole world, including China, have been and will be living with COVID-19 ever since 2020 (Jan 26, 2020 blog).  China can certainly live with COVID-19 in its own way unlike other countries, with monitoring and other requirements, but no constant city-level lockdowns here and there, this month or next month.  The public must be informed that there is no need to fear or discriminate COVID-19 and to seek care with minor cold like symptoms, and medical professionals must do their usual jobs, not prioritizing COVID-19 above other diseases.  The government needs to improve vaccination of the public and elderly, including the third or fourth shots, perhaps with protein and other types of vaccines coupled with the more widely used inactivated virus vaccines.    

Compared to a month ago (3/16/2022 blog), Shenzhen escaped the worst COVID-19 measures after one week, and Jilin has gone over the wave, leaving Shanghai the only major one still battered, with many other places in China unable to loosen because of an eye on Shanghai.  But just to be fair, Shanghai nowadays may be an emotional hell, but no need to over dramatize, because as calculated above, the actual death toll is nothing standing out comparing to prior records, provided that the lockdown doesn’t drag on much longer.  A ray of light emerges with reports that Shanghai may be preparing for returning to work after over two weeks’ lockdown, a welcoming sign. Another good sign is that a few cities, Shanghai included, will shorten isolation time from 14 days to 10 days for oversea travelers.  There is no doubt that lockdown will reduce COVID-19 infections, but the real improvement will come only after we learn the lessons and act more smartly, not blindly using the old toolkit, the next time around.