Is China's Covid Surge a New Variant Threat?

Will the hundreds of millions of SARS-CoV-2 cases in one of Asia's most populated countries forge a new variant capable of threatening world health?
06 February 2023


Wuhan, where Covid-19 came from


Someone sent me a Tweet this morning; it opened with the line, “Back in 2020, you said...” Whenever I see those words I always shudder. Is this a good call that I got right, or a bad call back to haunt me? On this occasion, speaking to a TV programme as the Covid-19 pandemic was unfolding in 2020, I’d responded to the challenge that China seemed to be controlling the pandemic very well, with minimal cases and mortalities (they claimed), by pursuing a “zero Covid” policy involving a fierce regime of quarantines and lockdowns. Some were arguing we should emulate them. My reply at the time was, “But they’ll have to open up at some point,” and that’s when, I felt, we’d really get to judge the success or otherwise of their approach.

That point came late last year when President Xi performed his surprising volte face: the strategy of locking down entire cities for months on end, at huge psychological and economic cost to the country and the population, abruptly ended. And, predictably, like a foot lifted from a squashed spring, Covid cases have begun to skyrocket. Cynically, I suspect that President Xi will bat the fallout back onto his people. It cannot be a coincidence that, confronted by a rising tide of civil unrest the like of which had not been since the time of the Tiananmen Square massacre, this apparently ill-thought through knee jerk reopening is happening now. The implicit message, as the healthcare system melts down, funeral parlours cannot cope and industry grinds to a halt through lack of healthy workers, is “see what happens when you don’t do as we tell you!”

China’s Covid-19 crisis has come about because the country has created a perfect storm for itself. Early on, as Chinese diplomats misleadingly blustered to the West on international news networks that their country had saved the world from a pandemic, Beijing was busy reassuring its own population that it had control of the situation and they had nothing to worry about. “We’ve got this,” seemed to be the message going out loud and clear. Regrettably, this reassurance seems to have translated into more of a shot in the foot rather than a shot in the arm against Covid, because subsequent uptake of vaccination among China’s most vulnerable groups has remained woefully low. We’re told that only about half of the at-risk elderly population have been adequately vaccinated, and the “home grown” Chinese-made vaccines they’ve used appear to be less effective than the mRNA vaccines that have become the mainstay of protection in the West.

The result is that China, having effectively kept its huge woodpile of close to 1.5 billion people under cover and tinder-dry for the last 3 years, now confronted by an onslaught of highly transmissible Omicron variants, is effectively allowing a roaring gale to fan a fire that will rip through the population in weeks, translating into millions of cases and potentially millions of mortalities. It’s too late, at this stage, for them to use vaccinations to catch up, because even if you could magically vaccinate - with a perfect vaccine - all those vulnerable people in a matter of days, it takes weekls for immunity to build by which time the fire of infection will have swept past. Moreover, the circulating variants seem to spread with great efficiency in the Chinese population. As one commentator put it recently, “we’re measuring the doubling time [of cases of the infection] in hours, not days...”

What this means for us in the West is hard to judge. There will certainly be knock-on effects: friends and business colleagues who work closely with China tell me that offices in some places are empty, “because they’ve all got it,” and some employers are seeing fewer than one in five of their staff arriving for work. Nor are the affected factories only making iPhones (although production of those has been hit and partly moved to India to compensate): there will be shortages of important drugs including antibiotics, and other feedstock chemicals that our manufacturing industries rely on. This means there will be secondary health impacts globally, both in humans and in animals, for months to come.

But what of the virus itself, does that pose a renewed threat as potentially more than a billion people go down with it in the coming weeks to months, particularly with China recently resuming international air travel? As a safeguard, some countries, including Italy and the US, have re-implemented testing regimes requiring travellers from China to post a negative result before they are allowed in. It’s not the numbers of potential cases they’re worried about though - we’ve already got about a million cases a week here in the UK for instance - the chief concern is, rightly, whether new - more pathogenic - variants of the virus will emerge from the Chinese firestorm.

It’s for this reason that some, including Lord Bethell who was health minister during the pandemic, have been calling for the UK to put in place a testing programme for new arrivals. This seems like a good idea, because one thing that has been stated repeatedly through the pandemic - and echoed by the WHO this week - is that information sharing about the evolution and spread of the virus is critical to controlling it and countering new threats. Unfortunately, this is an area where China have repeatedly failed to cooperate.

Numerous commentaries and reports caution that statistics emerging from China, coupled with the fact that they are using a very specific case definition for a death from Covid, mean even data about caseloads are unreliable. And given that the level of testing being carried out worldwide now is much lower than it was historically, the resolution of our radar screen for keeping tabs on Covid’s evolution is much diminished.

Looking on the bright side though, it seems unlikely that the SARS-CoV-2 virus that causes Covid-19 is going to behave differently in China compared with elsewhere. Given that there are 6.5 billion people outside of China, many of whom have had Covid, and many of whom have also been vaccinated, on statistical grounds there have already been far more infections with Omicron variants among the vaccinated outside China than in China. While you can never say never in medicine, this means that the likelihood of a virulent, vaccine-defeating variant emerging in China, among a largely un- or partially vaccinated population, is low. In other words, if it was going to happen that readily, it probably would already have done so elsewhere in the world. Viruses evolve in response to selective pressure: population immunity places an obstacle in their path forcing the infection to swerve in a new direction to surmount the barrier. China has the opposite problem at the moment: a lack of immunity, so a viral handbrake turn should be less likely to happen.

Nevertheless, that doesn’t mean we shouldn’t keep our eyes open. I also hope I’m right, and that this prediction doesn’t come back to haunt me on Twitter...

This article first appeared in The Daily Telegraph, 29/12/2022, as "We will all feel the consequences of China’s Covid nightmare, but likely not from the virus itself" 


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