Why Covid cases are now rising in China

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China’s health authorities on Monday (December 19) announced two Covid-19 deaths — the country’s first reported fatalities in weeks — amid an expected surge of illnesses after it eased its strict “zero-COVID” approach, the AP reported.

Scary pictures and videos of crowded hospital beds and piled-up bodies have appeared on social media, even though they remain unverified so far.

AP reports from Beijing referred to a “widespread wave of new coronavirus cases”, and quoted unnamed relatives of victims and people in the funeral business as saying deaths linked to Covid-19 were increasing. Before Monday’s two reported deaths — both in Beijing — China had not reported any deaths since December 4, the AP said.

What is the official picture?

The official picture is very different, though. Officially, China’s National Health Commission has put the total number of Covid deaths in the country since the beginning of the epidemic in January 2020 at 5,237, and the number of confirmed cases of the disease at 380,453, according to the AP. These numbers are a small fraction of those in other countries, including the United States and India, and are also questionable.

According to numbers compiled by Our World in Data, cumulative case numbers in China from the beginning of the pandemic are 1.9 million. Cases spiked sharply in late November, and in one 24-hour period crossed 40,000 new infections for the first time, beating a record achieved in April 2022. However, they fell equally sharply soon, and were at 2,819 on December 19, less than the 3,417 on December 18, and 4,656 on December 17. (7-day rolling average from Our World in Data)

China covid cases data Via Our World in Data.

So what’s the problem then?

China is different from the rest of the world — mainly because of the extremely restrictive containment strategy it has adopted, with a fair degree of success. And the new wave of infections has come within days of China dropping — suddenly and without explanations — almost all the restrictions of its zero-Covid policy.

International observers have pointed to a wave of protests against the restrictions and aggressive testing that preceded the dropping of zero-Covid. Some extraordinary protests called for even the resignation of supreme leader Xi Jinping, and some observers said the scenes on the streets and several university campuses were reminiscent of the Tiananmen Square protests.

What exactly is zero-Covid?

While most countries have concentrated on not allowing infections to go out of control while allowing normal activities to continue, China has pursued a zero-Covid strategy from the beginning.

Every known case, even asymptomatic, was mandatorily hospitalised, small outbreaks triggered hard lockdowns, and suspected cases, and all contacts, were kept under long isolation. The financial capital of Shanghai, home to more than 25 million people, was entirely locked down in March.

În effect, the Chinese strategy has been to smash the virus with a blunt instrument, and make it incapable of causing damage by putting people behind an iron curtain of restrictions. Though painful, the strategy was largely successful. It helped that China is an authoritarian country where measures that would be unthinkable in democracies can be implemented with success.

So what is the problem, then?

This very success is now turning out to be a weakness. The vast majority of China’s population has not been infected by the virus and hence has no immunity. Vaccines are not known to prevent infection in very significant ways.

Thus, when a fast-spreading variant like Omicron does manage to break through the strong defences of the zero-Covid strategy, as it sometimes will, it encounters a vast pool of susceptible people. The virus is able to spread very rapidly after that. This is what happened in March-April — and this is what seems to be happening now.

A similar scenario played out in Hong Kong and South Korea in February. Those countries too had kept their populations protected from the virus until then, with Hong Kong adopting a zero-Covid policy and South Korea testing very aggressively to identify cases at an early stage. But when Omicron finally broke through, both countries saw thousands of cases and hundreds of deaths every day.

China faces a similar danger for the second time this year. Omicron causes milder disease compared to Delta or Beta, but it can still lead to deaths among the elderly population.

What about vaccinations?

China has administered almost 3.5 billion doses of vaccines, but the penetration among the 80-plus population has been low. In addition, there have been question marks over the effectiveness of the two Chinese vaccines in use, Sinovac and Sinopharm.

Like most of China’s data, there is uncertainty over the number of booster shots that have been administered. Vaccines become increasingly less effective over time, and in the absence of both a booster as well as natural immunity, the population becomes extremely vulnerable. In India, the Omicron wave of the winter of 2021-22 hit when a very large number of people were already double-jabbed, but the variant got through those immune defences and succeeded in making people sick.

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