Should India be alarmed by China's Covid surge?

Hello readers. Here’s a short post from COVID hit Beijing. There’s been lots of alarm in India on what this surge means, and I’ve been getting lots of calls too, so I thought I’d briefly share my two cents, on what we know and what we don’t.

I, and everyone I know in this city, has been infected. For me and everyone I know, thankfully, symptoms have been mild (ish) (fever, some really bad body ache for some, chills) and everyone I know has recovered at home after 3-4 days. I was knocked out for 48 hours but on day 4, am feeling much better although a little tired. There are signs of Beijing coming back to life as the first wave of those recovered emerge out into post zero-COVID restriction-free Beijing. A friend recently went to see Avatar 2 and said it was packed on a weekday morning.

But that’s certainly not going to be the outcome for many unvaccinated older folks, and we are seeing a spike in deaths - not accounted for in official numbers. This is going to sadly play out across the country. There have been difficulties for many in getting fever medication. There is going to be a huge stress on medical workers and your heart really goes out to them.

It’s hard to see a silver lining in all of these dark clouds at the moment but one would be the speed of spread may mean a peak arriving faster than anyone predicted and pressure easing on hospitals so those really in need of care can get it.

I’ve seen the Indian media go all out in covering the surge here with typical sensitivity and empathy. Who am I kidding! The fear-mongering that India is likely to follow suit, an implicit message in much of the coverage showing videos of patients collapsing, is totally unnecessary, and is a reason why I wanted to send out a short post.

All I’d say is the two situations in the two countries are completely different given the wave in China is essentially a first wave for a population with no natural immunity. This is essential context that health experts have been pointing out in India but seems that lots of coverage in India seems to be glossing over.

How did we get here? December 7 saw the ending of zero-COVID - and the end came suddenly. This also followed protests on the Nov 26-27 weekend. I think there’s good reason to believe the cases were already out of control by end-November, and the end came simply because control measures couldn’t cope with the highly transmissible BF7 variant. Maybe the protests gave an off ramp and in a counterintuitive way, created political space for it.

Mike Ryan put it succinctly and I largely buy this explanation (we haven’t really had any kind of meaningful explanation from the government why it retired a signature Xi policy overnight as if it never existed, such is the way of things here):

"There's a narrative at the moment that China lifted the restrictions and all of a sudden the disease is out of control," he said.

"The disease was spreading intensively because I believe the control measures in themselves were not stopping the disease. And I believe China decided strategically that was not the best option anymore."

We’ve gone from a zero-COVID policy to zero COVID policy. Its everyone for himself. There has been no preparation for the public and the whiplash is extraordinary. I can only guess the leadership’s thinking is to get this over with as soon as possible.

Some background on the variant in Beijing, which note: has been circulating in India, the U.S., U.K. now for several months without the same impact:

Reports from China indicate BF.7 has the strongest infection ability out of the Omicron subvariants in the country, being quicker to transmit than other variants, having a shorter incubation period, and with greater capacity to infect people who have had a previous COVID infection, or been vaccinated, or both.

To put this into context, BF.7 is believed to have an R0, or basic reproduction number, of 10 to 18.6. This means an infected person will transmit the virus to an average of 10 to 18.6 other people. Research has shown Omicron has an average R0 of 5.08.

The high transmission rate of BF.7, taken with the risk of hidden spread due to the many asymptomatic carriers, is understood to be causing significant difficulty in controlling the epidemic in China.

The symptoms of an infection with BF.7 are similar to those associated with other Omicron subvariants, primarily upper respiratory symptoms. Patients may have a fever, cough, sore throat, runny nose and fatigue, among other symptoms. A minority of people can also experience gastrointestinal symptoms like vomiting and diarrhoea.

BF.7 has been detected in several other countries around the world including India, the U.S., the UK and several European countries such as Belgium, Germany, France and Denmark.

Despite BF.7's immune-evasive characteristics, and worrying signs about its growth in China, the variant seems to be remaining fairly steady elsewhere. For example, in the US it was estimated to account for 5.7% of infections up to Dec. 10, down from 6.6% the week prior.

While the UK Health Security Agency identified BF.7 as one of the most concerning variants in terms of both growth and neutralization data in a technical briefing published in October (it accounted for over 7% of cases at that time), the most recent briefing says BF.7 has been de-escalated due to reduced incidence and low growth rates in the UK.

We don't know exactly why the situation looks different in China. BF.7's high R0 might be due in part to a low level of immunity in the Chinese population from previous infection, and possibly vaccination too. We should, of course, be cautious about the data from China as it's based on reports, not peer-reviewed evidence yet.

Keep this context in mind when we are seeing the fear mongering dialled up to 11. Speaking of which, Opposition politicians are now demanding the government stop flights from China:

ANI @ANI

Covid situation becoming serious in World. We can see what's happening in China, their health system is under strain. I demanded that flights to & from China should be stopped. It's a matter of concern the way Covid cases are rising in other countries: Manish Tewari, Congress

This is puzzling on several levels. Firstly, wonder if someone will tell the good gentleman there are no direct flights from China to India and haven’t been since 2020. Wonder if he also knows where else the variant is circulating so stopping travel from China would be essentially meaningless. There are daily direct flights and more passengers from the US, UK and elsewhere which have the same variant, and a trickle of travel from China mostly through currently limited and expensive third routes, including Hong Kong and Singapore.

Here’s a serious question: If the stated goal is to keep BF7 out of India - some science would be welcome to back up why this is needed - would he advocate closing international borders for India in 2023, as only that would really do it (note that travellers from China can anyway travel elsewhere in the world; this reminds me of early 2020, when India banned China flights very early on but most of the first cases all came from Europe, if my memory serves me right. If you look at the past three years, bans only work if they’re total and borders are closed, as they did for a time for Japan, Taiwan, China, and others, else they serve nothing.) Or is it that folks are aware closing borders is a non-starter for many in 2023, so why not make a “demand” that sounds good for the cameras but is essentially meaningless? Probably the only unfortunate effect this has is adding to a sense of alarm, which many politicians have already done on late night TV by speaking direly on how the surge in China is dangerous and India should be fearful.

Final thoughts:

Randeep Guleria of AIIMS had this to say:

“Nearly three years into the pandemic, we are in a situation where there has been high natural infection—many people have been infected multiple times—and the coverage of vaccines is also high. Our immunity is robust enough to handle the virus and not let it attack us severely. In the past, we had Alpha, Beta and Delta, all different variants, but over the last one year we have consistently seen sub-lineages that have emerged from Omicron. There hasn’t been a new variant that is drastically different. However, we need to be vigilant and have active surveillance because we do not know how the virus will behave.”

Note that China had none of the above - the first wave was mostly limited to Hubei province, and there were no major national waves of the kind the rest of the world has seen.

There’s a lot we don’t know and we may never know on the outbreak here - such as the number of deaths - and the situation is in flux. As I said, let’s all hope China comes out of this as soon and painlessly as possibly.

As many health experts have said there are real concerns for new variants emerging and vigilance and screening - which India is doing - is required but what I will say is the present alarm mongering is unnecessary at the moment — pay attention to what the experts are saying and not to scary WhatsApp videos or politicians looking to play to primetime galleries.

Stay safe.