China’s COVID-19 cases may have reached 900 million. Australia should prepare

Over the weekend, Peking University released a study estimating that 900 million Chinese had been infected with COVID-19 as of January 11, representing 64% of the population.
This compares with 43 per cent of Australians who test positive, although antibody studies indicate the proportion is likely to be much higher.
with is coming, what will this massive wave mean for China and the rest of the world, including Australia?

Numbers aren’t the whole story

The Chinese government says there have been nearly 60,000 deaths of people with COVID-19 in hospitals in the past five weeks. However, based on China’s narrow definition of COVID-19 deaths, the government claims that COVID-19 caused only 5,500 of those deaths because they died of respiratory failure.
Since the beginning of December, he informs the media , funeral homes and crematoria. Yet throughout December, the government reported fewer than 10,000 daily cases and single-digit daily deaths. There have been no official reports since January 12

This lack of transparency led the Director-General of the World Health Organization to ask for more timely information in order to make a comprehensive risk assessment of the situation on the ground.

People sitting on benches inside a hospital.

Patients with COVID-19 treated at Fengyang Village Hospital in Fengyang County, east China’s Anhui Province, in early January. Source: Getty, AFP / Noel Celis

Does this new data help us understand the situation?

Not really. The figure of 900 million cases compares with the official figure of 503,000, a huge gap that can only be resolved through systematic collection of COVID-19 infection data from all provinces.
All reported deaths occurred in hospitals. There is no indication of how many people have died at home or in aged care facilities. Most cities and counties in China have it system and this information should be available to the National Health Commission.
If we accept both Peking University’s case data and the government’s death report (adding the 5,300 previously reported deaths), the cumulative death rate is 0.07 per 1,000 cases. This compares with 1.5 per 1,000 in Australia, which probably has a better hospital system.

Therefore, the Chinese figure is not plausible; either the cases have been overestimated or the deaths have been underestimated. Even if China has not yet reached 900 million cases, lessons from other countries with similarly lax public health measures say it will soon.

Why has this increase happened?

The increase has coincided and the elimination of almost all preventive measures. But the underlying reason is low population immunity due to both a previously low infection rate and a relatively low vaccination rate. While about 90% of the population has received two doses of the vaccine, only 58% have received a third booster dose.
Vaccination rates among older Chinese are much lower. The government recently announced that about 30 percent of people aged 60 and over, about 80 million people, were not vaccinated or boosted. Among those aged 80 and over, it was closer to 60%.

Doubts about vaccination are very common among the elderly in China and Hong Kong. Although two doses of the leading Chinese vaccines, Sinopharm and Sinovac, have been shown to be effective, they are far less effective as boosters than mRNA vaccines, which China refuses to import.

Antiviral shortages may increase death toll

Since the vaccination rate is so low among the elderly, rapid access to antiviral drugs is essential. However, the government did not stock these drugs and they are almost impossible to obtain except on the black market, where a five-day course of Paxlovid costs at least US$2,300 ($3,300).

Negotiations with Pfizer, the maker of Paxlovid, and Merck, which makes Lagevrio, have broken down over China’s insistence on a lower price.

Antiviral medicine COVID-19 in blisters.

The Chinese government did not stock up on anti-viral drugs against COVID-19, such as Paxlovid, and they are almost impossible to obtain except on the black market. Source: AAP, SIPA USA / Richard B. Levine

Implications for the rest of the world, including Australia

With the revival of international travel there from China, it is inevitable that the virus will spread to other countries.
Many countries, including Australia, . Others such as South Korea, Taiwan, Japan and Italy also require proof on arrival. South Korea has reported that 23 percent of travelers from China tested positive for COVID-19. In Taiwan, it was 21 percent.
The world may not see the full impact of the surge in China for another month or so. During the Lunar New Year period, 2 billion trips are expected in China. This will spread the virus to remote rural villages where there is minimal health care and no genomic sequencing facilities. Therefore, the virus could infect an immunocompromised person who can harbor the virus for months. This could result in a mutation emerging as a more transmissible variant.
So Australia’s pre-departure testing policy makes sense, but it should also include routine testing of sewage from aircraft arriving from China. That said, it’s possible that a new variant originating in China won’t arrive directly but via countries, like Indonesia, that don’t require pre-departure testing. It would be useful to do random sewage testing on all arriving international flights.
Most importantly, Australia must be prepared for a change in the dynamics of the pandemic, whether due to a new variant from China or sweeping across the United States. And we’re not coping so well.
We need to improve our vaccination booster rate, make a serious investment in clean indoor air, use high-quality masks in poorly ventilated environments, and facilitate access to COVID-19 testing. Currently, because of our misplaced comfort with widespread transmission, these measures are either dialing in or not. This is at our own risk.

Michael Toole is a Senior Research Associate at the Burnet Institute.

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