Given that we are living through THREE global health emergencies (COVID, polio, and monkeypox), new vaccines are being approved, new outbreaks are occurring, and the reality that being healthy is being redefined as a radical selfless act of loving others, “Three Things Thursday” highlights three things I am paying attention to as an epidemiologist each week.
This week all public health eyes are on China. Sure — monkeypox was renamed mpox and a new program to monitor poliovirus in our wastewater was announced. But this week China my focus is on China. Here are three things you need to know about the protests, the policies, and the implications on global health and the economy.
Hoping these posts help to educate and empower you
to be healthy and create healthy communities.
First — the protests in China this week were triggered by a deadly fire (that occurred on November 24) in the far western region of the county, which has been under a COVID lockdown for 100 days. The lockdown measures delayed firefighters getting to the apartment building where the fire occurred. Ten individuals are confirmed dead and nine were injured.
Throughout the pandemic, China has enforced a strict zero-COVID policy — where the goal is zero new infections of COVID. In China, millions of people have been subjected to nearly three years of mass testing, quarantines, and lockdowns. The idea behind the zero-COVID policy is once there are zero cases, normal economic and social activities can be resumed (but not the other way around; living with COVID is not an option under a zero-COVID policy). The policy has slowed transmission of COVID, reduced deaths, reduced illness, reduced long-COVID, and reduced opportunities for the virus to mutate.
BUT…
With highly transmissible variants, like Delta and Omicron, people are still getting COVID in China. And the impact of lockdowns and mass testing on mental health, social-emotional health, education, and the economy have been enormous.
Second — reports from China (published just this morning) are signaling a shift in policies, and it appears that China may be easing some of its COVID restrictions (despite 40,000+ new cases each day). Lockdowns in multiple districts in Shanghai and Guangzhou ended on Thursday. In Beijing, there are reports that individuals with mild COVID symptoms are now allowed to isolate at home, which is a huge change in policy. Earlier this year a single case of COVID would result in an entire building/community being locked down for days/weeks.
During 2021, China successfully vaccinated 90% of its adults against COVID (primary series only); however, a mere 30% of adults 80+ have received a booster shot (the percent booster is lower for younger individuals). As a result, the vast majority of the population has waning immunity. Additionally, China used the Sinopharm and SinoVac vaccines in its vaccination campaigns — both are inactivated vaccines that are not effective against Omicron.
Another (unintended?) consequence of the zero-COVID policy is that only a small proportion of the population in China has natural immunity against COVID. And while avoiding infection is the goal (theoretically), we have seen throughout the past year that hybrid immunity (vaccine + previous infection) creates the strongest immune response against infection, hospitalization, and death.
Third — what does this mean for us? and the rest of the world?
China has not communicated a clear path forward; it is not clear how they propose to live with COVID. The easing of the restriction we are seeing today will likely result in a huge wave of cases. And there is increasing fear that the healthcare system will be overwhelmed.
The result of China’s changing policies, the impacts of multiple years of a zero-COVID policy, and low vaccination/booster shot uptake will be felt around the world. Remember —
Please also remember that a healthy economy is created by healthy people and healthy communities. A wave of COVID cases in China (that could be equivalent to a tidal wave/tsunami) will impact the global supply chain. China manufactures so many products that we rely on on a day-to-day basis. Specifically, many key ingredients for pharmaceutical products are produced in China. A wave of cases 1000s of miles away could (and likely will) directly impact our health.
Additionally, the public health world is watching the virus and its evaluation as China opens up. It is possible that as the virus jumps from person to person to person in China it will evolve further and spur the next variant (this is the likely hypothesis for the evaluation of Delta). On the other hand, it is possible that with so many susceptible people in China (with little to no immunity) there will be little selection pressure on the SARS-CoV-2 virus. So it will spread quickly, but with little change/evolution in the virus.
Only time will tell.
But as we head into the winter months in the Northern Hemisphere. As holiday celebrations occur. As we face epidemics of influenza, RSV, COVID, the common cold, and other infectious diseases. All eyes in the public health and medical communities are on China, as they walk away from a zero-COVID policy and open up to the next normal with low vaccination rates and levels of immunity.
Have questions?