What next for China as Covid-zero ends – and infections soar

It is only now, however, that China is facing its own onslaught from the disease after finally abandoning its increasingly futile Covid-zero policy on December 7 in the wake of mass protests.

There are reports of hospitals and crematoriums becoming overwhelmed - although official statistics say there have been around 20 new Covid deaths. 

Critics argue that the true casualty rate is being undercounted, either intentionally as a result of China’s narrow definition for Covid deaths (pneumonia and evidence of lung damage only, but excluding any patients with pre-existing conditions) or because its reporting systems simply cannot keep track, particularly with mass testing now suspended.

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In a grim reminder that Omicron is anything but “mild”, worst case scenarios predict that the death toll could reach 1.6 million by the end of 2023 out of a population of 1.4 billion unless measures are taken to curb the spread of the virus and its impact on the most vulnerable.

The modelling, by the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, anticipates that mortality could be more than halved, however, through a combination of reimposing some restrictions (social distancing, testing, and mandatory self-isolation) alongside high uptake of third and fourth vaccine doses, widespread use of antivirals, and masking.

To date, China has officially reported around 5,200 Covid deaths compared to more than 213,000 in the UK (Image: Our World in Data)

China’s biggest problem is vaccination.

On the one hand, it has relied on its own home-grown vaccines rather than the more effective Pfizer and Moderna mRNA shots.

The two that are most commonly used by China are CoronaVac and Sinopharm, which were first rolled out in mid-2021.

At the time, clinical trial data indicated that CoronaVac was 51 per cent effective at preventing symptomatic Covid infections based on the original Wuhan strain. Sinopharm was around 79% effective.

This compared to around 90% protection against infection from the Pfizer and Moderna vaccines when they were first rolled out.

The evolution of the virus since then, and especially the emergence of Omicron and its sublineages, has substantially eroded the effectiveness of all Covid vaccines against infection.

However, they continue to provide a robust defence against serious disease, which is why highly-vaccinated countries such as the UK have been able to open up without intensive care units becoming overrun with critically ill Covid patients.

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This is less true of China’s vaccines, which appear to offer reduced protection against serious illness and death.

This was less important as long as the zero-Covid policy remained in place and the probability of being exposed to the virus was low.

However, Omicron has been much harder to contain and the psychological and economic harm of closed borders, repeated and prolonged snap lockdowns, and quarantining had become untenable as restrictions evaporated elsewhere.

Scenes of football fans crammed into packed World Cup venues without so much as a mask seems to have been a boiling point for a frustrated Chinese population.

The difficulty now is that the virus is sweeping through a country with virtually no cumulative immunity from prior infections and, more importantly, very insufficient vaccine protection.

Worse still, the gaps are largest among China’s elderly.

In contrast to the approach adopted across Europe, for example, China prioritised healthy younger adults for vaccination on the basis that they were more likely to be sources of transmission in workplaces and schools.

The rollout of the vaccine to China’s 260 million older adults did not get underway until November 2021, but by that time scepticism had built up about the vaccines’ effectiveness and many elderly Chinese were also reluctant to come forward due to fears over potential side effects.

A major push is now on to maximise protection among the elderly and other high-risk groups with a fourth vaccination (or “second booster”)

However, around 30% of over-60s in China - including 60% of over-80s - have yet to get even a third dose.

In terms of virulence, the Omicron strain is less dangerous than Delta but roughly on a par with the original Wuhan strain.

Waning protection from comparatively weak vaccines means that - if the virus were allowed to “let rip” through China’s - the elderly would not be much better off now than they would have been three years ago.

When Omicron swept through Hong Kong in the Spring of 2022, its Covid death rate soared above 25 per 100,000 - the highest anywhere in the world at the time. Nearly all those who died were over 60 and not fully vaccinated. More than half of over-70s had not even had a single dose.

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Nonetheless, vaccine hesitancy remains.

Suspicion of medical authorities has been exacerbated in China following a string of product quality scandals over the years, including contaminated baby formula and tainted blood thinners.

Once again, what happens in China over the coming months could have major implications for the world, both economically and because an explosion in Covid cases could unleash potentially worrisome variants.

As Dr Anthony Fauci, chief medical adviser to the White House, put it: “Whenever you have a large wave of transmissions of a virus, you give it ample opportunity to mutate. And when you give a virus opportunity to mutate, that allows it to form potentially new variants.

“And once you get a brand new variant that could have an impact on the rest of the world.”

Three years on, the pandemic is far from over.