The number of COVID-19 cases in China may reach 900 million. Australia must prepare itself

Over the weekend, Peking University released a study indicating that 900 million Chinese had contracted COVID-19 as of January 11, representing 64 percent of the population.
This compares to the 43 per cent of Australians who have tested positive for the virus, although antibody studies suggest there may be a much higher percentage.
With What will this massive wave mean for China and the rest of the world, including Australia?

The 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, under China’s narrow definition of COVID-19 deaths, the government claims that COVID-19 only caused 5,500 of these deaths because they died of respiratory failure.
Since early December, media reports funeral homes and crematoriums. However, throughout December the government reported fewer than 10,000 daily cases and daily single-digit deaths. There have been no official reports since January 12th

This lack of transparency prompted the WHO Director-General to demand more information in time for a comprehensive risk assessment of the situation on the ground.

COVID-19 patients receiving treatment at Fengyang People’s Hospital in Fengyang County, east China’s Anhui Province, in early January. Source: Getty, AFP / Noel Seles

Does this new data help us understand the situation?

Not right. The figure of 900 million cases compares to the official number of 503,000 cases – a huge gap that can only be resolved by systematically collecting 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 nursing homes. Most cities and provinces in China have it The system and this information should be made available to the National Health Commission.
If we accept the Peking University case data and the government report on deaths (adding the 5,300 previously reported deaths), the cumulative case fatality rate is 0.07 per 1,000 cases. This compares to 1.5 per 1,000 in Australia, which arguably has a better hospital system.

So, the Chinese figure is not reasonable. Either cases have been overestimated or deaths have been underestimated. Even if China has not yet reached 900 million cases, lessons from other countries with similarly abandoned public health measures say it will happen soon.

Why did this increase happen?

The rise coincided with and the abolition of almost all preventive measures. But the underlying cause is the low immunity of the population due to both the low pre-infection rate and the relatively low vaccination rate. While about 90 percent of the population has received two doses of the vaccine, only 58 percent have received a third, booster dose.
Vaccination rates among the Chinese elderly are much lower. The government recently announced that about 30 percent of people over the age of 60 – nearly 80 million people – have not been vaccinated and boosted. Among those age 80 or older, it was closer to 60 percent.

Vaccination hesitancy is very common among the elderly in China and Hong Kong. While two of the main Chinese vaccines — Sinopharm and Sinovac — have proven effective, they are much less effective as boosters than mRNA vaccines, which China refuses to import.

A shortage of antivirals may increase the number of deaths

Since the vaccination rate is very low among the elderly, easy access to antiviral medication is essential. However, the government has not stockpiled these drugs, and it is almost impossible to obtain them except on the black market where a five-day course of baxlovid costs at least $2,300 (US$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.

COVID-19 antiviral medicine in blister packs.

The Chinese government has not stocked antiviral drugs, such as Paxlovid, and they are nearly impossible to obtain except on the black market. Source: AAP, SIPA USA / Richard B. Levin

The implications for the rest of the world, including Australia

With the resumption of international travel to and from China, it is inevitable that the virus will spread to other countries.
Many countries, including Australia, . Other countries such as South Korea, Taiwan, Japan and Italy also require tests upon arrival. South Korea has reported that 23 percent of travelers from China have contracted the COVID virus. 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, two billion trips are expected to be made within China. This will take the virus to remote rural villages where there is only minimal healthcare and no genetic sequencing facilities. Therefore, the virus can infect an immunocompromised person who may harbor the virus for several months. This may result in a mutation that emerges as a more transmissible variant.
So the Australian policy on pre-departure testing makes sense but it should also include routine testing of sewage from aircraft arriving from China. However, the new variant that originated in China may not arrive directly but via countries, such as Indonesia, that do not require pre-departure testing. Random sewage testing on all incoming international flights would be beneficial.
Most importantly, Australia needs to prepare for the shifting dynamics of the epidemic either due to a new variant from China or raging through the United States. We are not doing well as it is.
We need to improve our booster vaccination rate, invest seriously in clean indoor air, use quality masks in poorly ventilated spaces and provide easy access to COVID-19 testing. Right now, because of our misplaced convenience with widespread transmission, these measures are at a standstill or absent. This is our responsibility.

Michael Toole is an Associate Principal Research Fellow at the Burnet Institute.

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