Spread of omicron variant in China sparks fear of major wave

China is currently experiencing its biggest spike in coronavirus cases since the pandemic began in the city of Wuhan in January 2020. While a lot of Chinese cities are recording record numbers of infections, the figures are insignificant when compared to those of other countries. According to data from Johns Hopkins University, there have been 724,248 coronavirus cases and 8,365 deaths since the pandemic began – or 116,902 and 4,636, respectively, according to figures from the National Health Commission of the People’s Republic of China. Spain, with a population that is 30 times smaller, has reported 11.2 million confirmed cases and more than 100,000 Covid-19 deaths. In the current outbreak, which is affecting 27 of China’s 31 provinces, 1,437 new infections have been registered along with 907 asymptomatic cases (that said, the city of Beijing does not include cases in its statistics unless there are symptoms).

The difference between this wave and the previous ones is the rise in the number of asymptomatic cases, which is making tracing difficult. This is an essential part of China’s “zero Covid” approach, under which infected patients and their contacts must remain isolated and under observation, in general in a quarantine center.

The health authorities have associated this huge increase of asymptomatic cases (last week they accounted for a third of infections) to the rise in the incidence of the omicron variant, which is now dominant in the country, as well as the high rate of vaccination.

How many cities have been locked down?

Mass lockdowns have been decreed in Changchun (nine million inhabitants), Dongguan (10.4 million) and Shenzhen (17.5 million). Residents must take three PCR tests, work from home and are not permitted to travel.

As well as these closures, a hundred or so residential complexes throughout the country have been locked down. There are currently 15 zones that have been classified as high risk, while 287 are at medium risk, meaning obligatory tests for residents and in many cases quarantines.

What does “zero Covid” mean in practice?

Most countries in the world have tried to mitigate the consequences of the spread of the virus and minimize infections using certain social restrictions. This is the case of Spain and the rest of the West. Other countries, such as China, Australia and New Zealand, have gone further and have tried to contain the virus: they introduced highly restrictive measures at the outset to try to cut all chains of transmission, thus impeding the propagation of SARS-CoV-2. These measures included generalized lockdowns in large cities when barely a few dozen cases had been detected, and strict control of external borders.

What other measures has China taken?

The country’s authorities are using cellphone applications to track infections, the isolation and observation of positive cases as well as their close contacts, obligatory PCR testing for residents of certain areas, lockdowns and strict quarantine policies at their borders.

Since March 2020, China has barely issued any visas, and anyone who enters the country must quarantine for 21 days in a hotel room (the cost of which must be covered by the traveler themselves). Since the start of the pandemic, China has not relaxed measures such as the obligatory scanning of a QR code before entering establishments, and the use of face coverings when on public transportation.

In recent days online classes and home working have returned to cities such as Shanghai, where mobility is also being restricted and limits placed on capacity. Most provinces are recommending that people not travel, and if they do, they must present a negative PRC test 24 and 48 hours before they depart.

What results has China’s Covid policy produced up until now?

During the first waves of the coronavirus pandemic, the countries that followed this strategy managed to impede the transmission of the virus and drastically reduce mortality compared to other nations. The plan could have worked well if the coronavirus had been eradicated. But with the virus ever-more widespread and the emergence of more-contagious variants, the strategy has proved to be unsustainable in the long term. “The zero Covid strategy has proved to be something of an illusion,” explains Daniel López-Acuña, a former director of emergencies at the World Health Organization (WHO). “And unquestionably it does not work when faced with more contagious variants and with lower protection from vaccines or immunity.”

What’s more, there could be intangible negative consequences, the effects of which may not be seen for several years to come. On the one hand, there is the psychological aspect: while the population of China has shown itself to be extremely disciplined when it comes to complying with restrictions, the constant scrutiny of citizens’ lives is starting to take its toll. On the other hand, thanks to the strict border controls, the Chinese are becoming ever-more isolated from the rest of the world.

Can a zero Covid strategy be implemented during an omicron wave?

The data show that it is nearly impossible to stop the spread of omicron, which is the fastest-spreading virus in the history of mankind. Australia, which had kept the coronavirus under control for nearly two years, suffered an explosion of cases at the start of January. The same happened in February in New Zealand and South Korea. Now it is China that is suffering a new spike, but still with low figures when compared to its neighbors or Western countries.

According to figures from the Our World in Data website, the 14-day cumulative incidence in China is 0.4 cases per 100,000 inhabitants, much lower than that seen in Spain at any time of the pandemic (on Friday, for example, the figure was 430). Mar Faraco, the president of the AMSE foreign doctors association in Spain, believes that it will be very difficult this time for the virus to be contained, although she does admit that China is capable of implementing measures that would be “unthinkable in the West.”

How widespread is vaccination in China?

According to the latest data, 87.4% of the country’s 1.4 billion inhabitants have been fully vaccinated against Covid-19. Unlike in Europe and the United States, the vaccination campaign moved onto seniors after most of the adult population was inoculated. That is why there are concerns that during this latest wave, it is the elderly who are most at risk from infection. Currently, of the 210 million people aged over 60 in China, 79.5% have received two doses.

Is natural immunity having an influence in China on the spread of the virus?

The fact that there have been so few cases of Covid-19 in China could be making this Covid wave more severe, given that natural immunity is practically non-existent, and serious cases in vulnerable people, which elsewhere have been spread across successive waves, could all be concentrated among this group if the spread is very high. What’s more, all Covid-19 vaccines have proved to be less efficient as time passes, and as the virus has mutated.

“We have already seen that omicron infects the vaccinated and that [vaccination] does not stop the spread, and that also applies to the Chinese vaccines,” explains Faraco. What’s more, the rate of seniors with booster shots in China is also low, something that could push the Covid-19 death rate up.

How could these lockdowns affect the global supply chain?

As well as being the biggest technological center in the country, Shenzhen is also one of the main port cities in China. The lockdown there, which is due to last at least a week, is already having an effect on the main manufacturer of Apple’s iPhone and other products, Hon Hai Precision.

When the Chinese authorities interrupted operations in the port of Yantian for four weeks last summer in order to combat an outbreak of Covid cases, there was a delay in shipments that took months to be addressed. Yantian is the fourth-biggest port in the world and processes approximately 90% of electronic products that are shipped from China.

Many of the warehouses around the city have been closed. However, truck drivers who test negative will be allowed to leave Shenzhen, meaning that there should be no notable effect on the functioning of the global supply chain.

How could a major wave in Asia affect the course of the pandemic?

The wave that is currently hitting Asia and Oceania is due to the omicron variant that hit Europe and the United States around Christmas time. Many experts already warned that the strain would inevitably spread throughout the rest of the world, given its more-contagious nature, something that is now happening.

“More than what could happen to us, I’m more concerned about what could happen in China itself, where they have been barely exposed to the virus,” Faraco explains, warning that the more it spreads, the greater risk that there is of new variants.

López Acuña agrees. “We have to think about not throwing caution to the wind in Europe thinking that this is all over.” The former WHO director is also concerned about a plateauing of cases – or even an uptick – in some Western countries and the relaxation of measures in the majority of these. “I don’t think that this is something temporary, but it is still too early to say whether this is the start of a seventh wave.”