China and Covid

 China seems to have got itself into a ‘spot of bother’ with Covid  recently, to put it mildly…

Unlike the USA and most of Europe, where deaths and hospitalisations in most countries are now on the wane, China is currently in the thick of it, and has experienced a major resurgence of SARS-CoV-2 which has spread from an initial ‘hot spot' in Hong Kong to the Chinese mainland. The epidemic appears to be spreading rapidly across China, despite herculean efforts by the authorities there; early control measures included full lockdowns of large areas and even big industrial hubs such as Shenzen. Shanghai itself has been under full lockdown for the last 2 months, and is only now beginning to see a significant fall in case numbers - this is the major industrial hub of south China and its loss of productivity is likely already to have had serious consequences for China's economy.

Why has this happened ? We need to look in detail at the history of SARS-CoV-2 to provide an explanation.

A new viral respiratory syndrome that came to be known as Covid19 was first identified in Autumn 2019 in China, and its initial source was traced to a small area of Wuhan, a city in central China. There is still some question as to its true origin, but the two most credible explanations are either an escape from the Wuhan Virological Institute, or, more probably, animal to human transmission at the Wuhan ‘wet’ market. 

As one might expect in China, the authorities imposed heavy restrictions on press coverage and were slow to publicise the epidemic. Full details of the disease and causative virus were not released to the rest of the world until early January 2020. Wuhan was eventually fully locked down in response to the developing epidemic, but before this happened an unfortunate coincidence of dates with the Chinese New Year holiday exodus resulted in many infected Chinese tourists from the area 'escaping' to Europe. The resulting hotspots of infection generated by their arrival rapidly spread the virus to the rest of the continent and eventually to virtually all other inhabited parts of the globe.

China decided early on in the pandemic to follow a ‘zero Covid’ policy i.e. complete elimination of the disease, and introduced strict quarantine measures and multi-region lockdowns. At the time, this policy seemed reasonable, and it did actually prove quite effective at preventing further spread of the original Wuhan strain within China. It resulted in a much lower 'first wave' death toll in China than that experienced in Europe and the USA, where lockdowns were introduced more slowly and were less aggressive. This made it appear it first sight that elimination was the best strategy to deal with the virus in response to a local outbreak. As it turned out, however, the initial success of this policy, and the complacency it gave rise to, led to a reduced emphasis on vaccine development and immunisation, and perhaps more importantly, lack of 'natural' exposure to the disease, thus storing up trouble for the future.

Most western scientists with a knowledge of Coronavirus behaviour and past epidemiological history realised early on in the pandemic that vaccination would be our only real defence against SARS-CoV-2. Western governments took the hint, if sometimes a little belatedly, and vaccine development proceeded apace in parallel with lockdowns and other social isolation measures during 2020. The first Oxford-Astrazeneca and Pfizer-Biontec vaccines were ready and approved in record time, with the first UK immunisations of MHRA-approved vaccines in December 2020. A ‘race for the jab’ then followed with UK government being one of the first to reach a 70% vaccination rate in its population.

We were, in fact, very lucky that our first attempts at a vaccine strategy worked so well, given that it used novel gene-based technology, and focussed exclusively on the viral spike protein as the expressed antigen. Although none of the approved vaccines are perfect, and none actually manages to ward off infection completely (case numbers continue at high levels to this day as a result), they are highly effective at preventing serious symptoms. As a result of the intensive UK vaccination campaign starting in early 2021, deaths and hospitalisations fell markedly during that year. 

Such more serious outcomes of the disease have, fortunately, so far remained at much lower levels than those seen in the first Covid ’wave’ in Spring 2020, although there are signs that they are rising again in UK. This has vindicated the mass-vaccination approach, which has remained effective at controlling the pandemic in UK despite the advent of many new and more infectious variants of the virus. We have also established beyond doubt the importance of regular booster immunisations, given the decline in immunity within 6 months of vaccination or a natural infection. The vaccine development programme is continuing, although at a less frenetic pace, with the current emphasis on ‘variant upgrades’ to the 1^st generation products.

By contrast, China’s consistent adherence to its initial zero-Covid approach as the only way to deal with the virus has turned out to be problematical for them. There are four reasons for this:

a)  a) Vaccine development has always been seen by the ruling Chinese Communist Party (CCP) as very much a secondary means of control, and has been largely limited to more traditional approaches using inactivated whole virus or isolated viral antigens. Gene-based vaccine technology was only considered very recently and did not figure in early development work. Those 'traditional' vaccines that are approved and available in China have proved to be generally less effective than the approved western vaccines.

b)   b)  The levels of immunity to the virus in the Chinese population are likely to be much lower than those in the remainder of the developed world. Low levels of vaccination uptake and low vaccine efficacy have certainly contributed to this. Perhaps more significantly, the zero-Covid approach itself, based as it is on isolation measures and mass-testing, has effectively prevented the development of large scale natural immunity in the population via exposure to the virus.

c)    c)  Although ‘barrier’ infection control methods and strict lockdowns were undoubtedly highly effective against the original strain of the virus in China, the latest variants to emerge, Omicron variant BA.4 and BA.5, have evolved to be so incredibly infectious that even the current draconian measures that are currently being imposed by the authorities have not managed to prevent the virus spreading rapidly to the mainland from its initial Hong-Kong focus.

       d) There appears to be a significant 'anti-vax' attitude in China, particularly amongst the elderly population. This, and the CCP's previous ambivalence towards vaccination as a mainstay in disease prevention, has prevented widespread uptake of those vaccines that are available in China.

One might be forgiven for thinking that this outcome is to some extent ‘poetic justice’, given that the pandemic started in China and was spread initially by its own citizen-tourists to the rest of the world in early 2020....

However, there is little point in such recriminations after the event. These only serve to emphasise East-West divisions at a particularly sensitive period in our geo-political history, and will also reduce the chances of the global co-operation that is so important in the control of a pandemic. As many pundits have already quoted in reference to Covid “….no-one is safe until we’re all safe…”.

We in the West should certainly offer whatever help to the Chinese population we can – the need to continue the fight against a common foe (Covid, not Putin in this case !) should always override the current political situation.

What practical help could we offer ?

One obvious immediate possibility is provision of any surplus supplies we might have of the AZ and Pfizer/Moderna approved products. Now that our all-out drives to achieve full vaccine coverage in UK are largely over, significant amounts of our existing stocks may in any case go to waste if not used. Technology transfer under licence could also be a way of increasing supplies locally in China, as is already happening in the 3rd world. In contrast to the worsening economic situation in much of the 3rd world, given China’s economic recent rude health, surplus vaccines should be supplied commercially rather than donated. Another equally important commodity we have to offer is knowledge – our vaccine development programmes using gene-based technology are of necessity much further advanced than in China, and practical assistance could be provided to the Chinese vaccine development industry to help them develop and implement the newer technologies only recently adopted there. 

All this, of course, presupposes that the CCP-run government are prepared and willing to accept our help....it is noteworthy that none of the established Western gene-based vaccines have so far been approved for use in China. This should be addressed by their healthcare regulators without delay and a serious catch-up vaccination campaign initiated if the authorities there wish to prevent recurrent future 'waves' and the consequent high death toll***. 

***A very recent announcement indicates that Sinopharm has now started development work on vaccines specifically targeted against Omicron variants. However, their primary candidate is being developed on 'traditional' inactivated virus lines, so might be expected to be inherently less effective than Western vaccines, and is also likely to be less resistant to immune 'escape' by new variants. Further work is being done, however on an mRNA-based vaccine, which suggests a possible change of strategy is being considered by the authorities. It will be interesting to see how quickly this work is progressed, and whether either candidate will be approved in time to make a significant impression on the high death toll expected in the Chinese 'mega cities' due to lack of immunity, particularly in the vaccine-resistant elderly population.

I have generated some ideas myself on where we should go with 2^nd generation Covid vaccines, which might also help with further development worldwide. You can view and /or download these at https://sites.google.com/view/vivweb01/covid19.

Once again, our sympathies and practical assistance to the Chinese people are called for here (in as far as their government will permit), not recriminations or blame.

Let’s rise to the occasion  and at least offer our help….

Update 18.4.22: Since writing this blog, I have been trying to figure out why the CCP is sticking so resolutely to their 'Zero Covid' policy, despite the overwhelming scientific evidence that the Omicron BA. variants are to all intents and purposes unstoppable with current technology and resources. Some recent evidence  suggests that the reason may well be largely political.... 

Our experience in the West over the past 2 years has proved beyond reasonable doubt that unvaccinated and immunologically naive populations are at a particularly high risk of serious consequences from Covid infections, hence our drive in the West for mass vaccination, and more recently mass-exposure. A reluctance to emulate the West in order to preserve life is however is probably not the main issue. Xi Jinping himself has been a strong advocate of the zero Covid policy since the start of the pandemic, and the low death toll reported in China in the first wave in 2020 was taken by the CCP leadership as a vindication of the harsh lockdown measures they introduced at the start of the pandemic. 

Whether the death toll figures were accurate or 'massaged' to look good is a moot point - there still remains some doubt about this, given the difficulty of verification in a media-restricted society. A recent news item  confirms a failure of official CCP death statistics to include a substantial number of confirmed Covid-related deaths at a Shanghai hospital. This could of course be in part due to differences in accounting - our statistics normally include any deaths within 28 days of a positive Covid diagnosis, whereas the Chinese stats include only those deaths where Covid is stated on the death certificate as the primary cause of death. That said, for a virus with an established 'kill rate' of ca 0.5% worldwide, a total of ca 5000 deaths since the start of the pandemic out of a population of 1.5 billion seems somewhat implausible, to say the least...

The fact that the recent outbreak has occurred at all has been a source of considerable personal embarrassment to chairman Xi, given he 'nailed his colours to the mast' of the zero-Covid policy from the start. Like another autocrat currently in the news, Xi needed a quick 'victory' in time to support his petition to waive fixed presidential terms at the next party congress this autumn, and clearly hasn't yet achieved it. (In this case, of course, the victory he seeks is one over a virus rather than over a neighbouring country (thus far, at least !) 

Xi sees his best chance of achieving 'his' victory over SARS-CoV-2 in the short term as being via continued full rolling lockdowns of the sort we have been seeing in Shanghai, and are now being applied throughout China in order to reduce case numbers. He cannot afford the loss of face involved in admitting he was wrong and adopting the west's policy of 'living with the virus' in the short-term.  Given the low level of population immunity, he will also be fearful of the initial high death toll that would result in the cities if the current lockdowns and mandatory testing programmes were suddenly lifted.

The problem Xi faces in maintaining his current strategy is twofold: 

a) Although used to unquestioning compliance with all government edicts, the Chinese population is getting very impatient with the draconian restrictions, which are having profound effects on their everyday lives. There have recently been reports of whole buildings being locked from the outside by the authorities without providing any access to food or water. Frustration is starting to spill over into open dissent in the areas worst affected - something which is very rare in China, and indicates real trouble ahead. Like most other autocratic regimes, control is by 'fear rather than consent' - Xi knows that if and when the political 'powder keg' that is China does eventually blow, the results will not be pretty....particularly for the CCP hierarchy themselves. 

b) The existing lockdowns have already resulted in a major downturn in economic fortunes, with much of China's prosperity linked to the big industrial centres in the South East that are the main focus of the controls. Xi is probably hoping that the hitherto robust health of the economy will provide a financial 'buffer' until the virus is eliminated, and will thus prevent widespread economic collapse. Unlike Putin, he is not yet subject to extensive worldwide sanction regimes, so at least he doesn't have that to worry about - unless of course he decides to try to 'reclaim' Taiwan. He is unlikely to contemplate this until after his confirmation as permanent leader at the Autumn party congress. Recent reports have indicated that he does recognise that the Chinese economy is vulnerable to EU and US sanctions, and he may decide on preemptive measures to try to reduce this dependence.

We in the West do, of course, have an interest in China managing to extricate itself successfully from its current economic and political woes - given the predominance of China in the world economy, even a partial economic 'meltdown' there would be catastrophic  and lead at best to a pronounced worldwide recession.

Only time will tell whether Xi has backed the right political horse......

Viv

Update 14.5.22:...And now North Korea.....

This outbreak looks to be potentially particularly nasty, given that the bulk of N. Koreans:

a) Are malnourished and hence likely to be immuno-compromised

b) Have minimal available healthcare, most of it pretty basic

c) Have, so far as we know, had no access to modern vaccines or effective anti-virals.

This ensures that Omicron BA.2 will spread through the population like wildfire as it has in China, even if strict lockdown measures are enforced (or indeed enforcible.)  

It is to be hoped, for the sake of his population, that Kim Jong Un will have the sense to accept the S. Korean offer of surplus vaccines for immediate delivery, and then mandate rapid general immunisation as far as supplies allow. If he doesn't, there will be carnage....

Initial signs are not encouraging, with no indication of any opening up, and 'Trump-like' remedies being offered by the healthcare system. Even if Kim does relent, it will take time to build up immunity in the population, and there will no doubt be a heavy death toll while this is occurring. Beijing will also be concerned about mass incursions of desperate citizens fleeing across their border. 

The only 'positive' I can see this time round for us in the West is that it's extremely unlikely any N. Koreans will be able to spread the disease outside their boundaries, in the way that  their Chinese neighbours so effectively did in 2020. This is probably just as well, since N. Korea is likely to be a prime 'breeding ground' for new 'escape' variants....

Update 2.6.22: Shanghai opening again ?

After more than 2 months of virtually complete shutdown, Shanghai seems to have been suddenly released from its draconian lockdown. In some ways this is a relief, not least for the world economy, which has become ever more reliant on China to maintain its buoyancy, and has already taken significant knocks from the Pandemic and Ukraine. 

I can't help wondering whether this was a bit too precipitate of the Chinese authorities, though - SARS-CoV-2 certainly won't  have disappeared despite the low case incidence, and will be waiting to 'pounce' on all those nice newly available human hosts when normal human to human contact resumes. We experienced the same thing ourselves in UK between waves in 2020 and early 2021 before the vaccines were widely available. 

I suspect there may be a political motive at work here - if the confinement had lasted much longer, there might well have been civil unrest, which could easily have spread northwards to Beijing - not something Xi would particularly relish in the run up to his bid for political 'immortality' this autumn.

It will be interesting to see how long it will be before the next lockdown hits, as it almost certainly will given the low vaccination uptake and the effect of self isolation in reducing natural viral immunity. We can only speculate as to when Xi will finally take the hint and admit he can't defeat the virus single-handed, and has to live with it.....I suspect that won't be before the November CCP Congress, given the loss of face it would involve...

Update 12.6.22: Two new Omicron sub-variants (BA.5 and BA.5) were identified (yet again in South Africa) in May, and these appear to be even more infectious and also partially antibody-evading, so are particularly likely to hit the non-vaccinated, even if they have already had an infection. They do not appear to  cause any more severe disease. The zero-Covid policy is unlikely to make much impression on these new variants if they do spread to the Chinese mainland as predicted, and they could generate a substantial new 'wave' of infections,  as they appear to be doing already in Europe. Shanghai & Beijing beware....

Update 8.7.22: It looks as though the 'seeds of dissent' are beginning to emerge against Xi's obdurate stance on maintaining his zero Covid strategy 'at all costs'. A recent news report provides some of the detail, confirming my suspicions back in March. If  a new wave of Omicron BA.4/5 infections triggers a large increase in hospitalisations and deaths in China's largely unvaccinated elderly population, Xi may be in for a rough ride at the Party Congress this autumn...

Update 28.10.22: Looks like Xi has got his 3rd term, with Congress simply rubber-stamping his extension of service to what is now effectively 'premiership for life'. At the 'grand old age' of 69, he is still relatively young as presidents go, so could last another 20 or so years. Hope the Chinese enjoy another 20 years of lockdowns....

Version Date: 28.10.22