Fluid times for COVID-19 in China

China’s COVID-19 situation became the worst in March, mostly in Shanghai, turned the corner in May, largely subsided in June, and is having a small flareup in July.  But this is not the whole picture.  An equally significant development is the overall, clear relaxation of COVID-19 measures in China since May, almost touching every aspect of the COVID-19 responses.  Domestically, the nationwide loosening of testing and travel requirements.  Overseas, allowing more international flights, more visa applications, easing of tests and health code application, and shortening isolation periods from 14+14 or 14+7 to 7+3 days, among others.  The shortage of international flights is the worst problem right now, especially the cancellation, which remains the most contentious issue.  But HK has turned into a good and practical entry point to the mainland China since May 1.  No matter how you describe it, dynamic zero or not, the policies are no longer the same as in April.  One can say measurably better, a good direction at least and long last.

But here is a problem: why is China making the changes?  If a good reason is not given, or accepted by the public, what is preventing the governments from going back to the old way?  This is not nitpicking, because as COVID-19 cases rise to the hundreds again in July, a few places in China are resurrecting the bad, lockdown weapon.  You will never eliminate Omicron, it will always turn up here and there, this time and that time, in China.  What will China do then?  Are the current polices here to stay, getting more relaxed, or tightened?

According to the governments and media, the official reason for the changes is that Omicron can be detected quicker than previous variants, so, e.g., we need 3 days instead of 7 or 14 days to find everybody now.  So, no need for 14+14, 7+3 is good enough, so is a lesser response.  Unofficially, there are too many economic hardship stories, thus economy is definitively another, truly the No 1 reason for the new policies.  But these narratives have a huge, insurmountable problem.

First economy.  It doesn’t make sense to say because Omicron can be detected easier, the economy is suddenly getting the priority.  Everybody knew Omicron spreads faster before 2022: before you find one case, it already infects many others, which by itself makes Omicron no less dangerous.  Also, everybody knew lockdown would hurt the economy, in Wuhan in 2020, and even before Shanghai.  But it was done anyway in Shanghai, and several cities are doing it due to the recent cases, albeit a softer one, right now.  You can’t rule it out as a last resort for a pandemic, but if you don’t set a clear standard, what is preventing governments at all levels from using it arbitrarily?  As an integrated economy, even a local lockdown or restriction can have a widespread impact on the nation.  Unless the government says, in clearer terms, that we need to protect the economy unless under the most extreme condition, these current, sensible changes are on shaky ground.  The central government has already stressed the importance of economy, yet it also included COVID-19 at the same time, which makes it 50:50, thereby diluting the message. 

Then the reason that we can detect Omicron in 3 days instead of 7 days: true, but far from the whole story.  Because in 3 days Omicron can infect as many people as Delta in 7 days, and if Omicron is more pathogenic, it is still the worse.  Here is the thing my previous blogs (3/10/2022, 4/19/2022) had argued that the government and public must accept, which some Chinese scientists and doctors have also written but received much less media attention: Omicron is not as dangerous, especially 2022 is no longer 2020.  Only accepting this truth can the current policy changes have legs and are really followed through in 2022 and beyond.

Mountains of universal evidence, from every country and region on Earth, says that Omicron/COVID-19 in 2022 is less bad than COVID-19 in 2020 and 2021.   This is due to the characteristics of Omicron and the status of public immunity due to vaccination and previous infections.  Take China’s data in 2022.  There have been 700K infections.  <600 deaths.  <0.1% death rate.  Consistent with the data from around the world.  Practically the same as seasonal flu.  Is it the goal of the Chinese government to eliminate seasonal flu, DZ flu, as well?

Compare the 600 deaths to the immense economic and societal losses due to lockdowns in Shanghai and elsewhere, it is clear, actually even before they were implemented, that lockdowns and measures such as mass testing were and are wasteful, stupid and suicidal.  Deaths not due to Omicron infections but as a result of the lockdown, e.g., from lack of medical attention, stress, economic hardship, etc, very likely exceed 600.   

The Lancer paper (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02796-3/fulltext) estimated the excess deaths in China in 2020 and 2021 were 13K.  WHO had its own statistics (https://www.who.int/news/item/05-05-2022-14.9-million-excess-deaths-were-associated-with-the-covid-19-pandemic-in-2020-and-2021), in which China’s excess deaths were actually negative.  Because China has 1.4 billion people and 10 million die every year, 13K or a negative number may just be rounding errors (3/16/22 blog).  But there is no denying that many people died without infection but due to COVID-19 measures or policies, only they were cancelled out by deaths prevented by the measures or policies.  But if we calculate the same for 2022, China’s excess deaths will surely be positive and likely over 10K.

Ultimately, what are the reasons for these changes which are good and long overdue?  First is economy.  Second is the late but eventual realization the Omicron is not that serious.  The government doesn’t want to admit it, because that was known long before Shanghai, so admitting it means the government made a mistake.  So the government uses the 3 day detection ability as an excuse instead.  Third is the public is tired of COVID-19 and lockdowns.  Much less support for the DZ measures than in 2020 and 2021.   But the public still must accept that Omicron is no big deal, living with Omicron is no big deal.  Fourth is in practice China gets better at handling Omicron than earlier 2022.  Jan to April was tough, but the medical and other infrastructures were also setup at the time.  Nowadays testing can be done anywhere and anytime, still a hassle but less so.  More room for isolation and treatment.  Everybody knows what to do now after the confusion a few months ago.  Fifth is COVID-19 vaccination and drugs.  There has been a vaccine push for the elderly.  Although since vaccines apparently offer only months of good protection, and most Chinese got the boosters in Jan-Mar 2022, it is likely time soon for the 4^th shot in light of BA4, BA5, and BA2.75? 

About vaccines, the Western media like to assert that China adopts DZ because the government knows Chinese vaccines are no good.  Need the American mRNA vaccines to save the day.  A complete nonsense.  Look at Shanghai: of the <700K infections, <600 deaths, >95% (?) deaths were unvaccinated.  We don’t know how many infections were vaccinated or not, but just from normal thinking, the Chinese vaccines prevent death by over 95%.  Of course, due to the relatively small death number, the confidence range will be wide.  But Chinese vaccines definitively do the job.  Compare to data in Taiwan, this year >4 million infections, >7K deaths, ~3K deaths receiving two or more shots (local:foreign, mostly mRNA vaccines, ~ 50:50 in the general public).  No case mRNA vaccines are any better at preventing deaths.  The death rate of 0.2% in Taiwan is a bit high, but since the 4 million infections are an undercount, unlike in Shanghai everybody was tested multiple times, the real death rate is likely also 0.1%. 

Thus, even if mRNA vaccines are better at preventing infection and death than other types of vaccines, they are only marginally better, and they come with a bit more serious side effects.  Mainland China has plenty of vaccines already: in addition to the most common inactivated virus vaccines, approved are the protein and Ad virus vaccines, others are still being tested.  So China has enough weapons, and boosters should emphasize protein and Ad virus vaccines to enhance immunity.  Coupled with sensible non-pharmacological COVID-19 prevention and an altered mindset that Omicron is no big deal, China should continue the good trend, throw away the old DZ polices, and live with COVID in its own way.