What China’s Deadly Covid Surge Means for the World in 2023 – Rolling StoneThank you for reading this post, don't forget to subscribe!
There is a new one form of SARS-CoV-2, the virus that causes it Covid. It’s called XBB.1.5 — and it sucks. XBB.1.5, also known as “Kraken”, is more infectious than previous sub-variants of the Omicron variant of the virus and also has a greater potential to evade our antibodies from vaccines and past infections.
There has been a spike in Kraken-related Covid cases around the world. But that’s not what epidemiologists are most worried about at the start of the fourth year of the coronavirus pandemic. No, China is what scares the experts. A country that, unlike the rest of the world, is just now catching Covid in a big way for the first time.
That’s 1.4 billion people going through what the rest of us went through in early 2020, with just a few twists. And what happens next in China could spill over into the rest of the world in frightening ways.
So far, based on surveillance of Chinese travelers arriving in Italy, China is picking up old forms of Covid. “There are no new variants, just existing circulating strains that spread rapidly in a population with low natural immunity,” said Paul Anantharaja Tambya, president of the Asia-Pacific Society of Clinical Microbiology and Infection in Singapore.
But that could change.
Yes, the Kraken is bad. But it evolved from earlier forms of the virus at a time when most of the world — China, of course, is an exception — has fairly strong immunity. Of course, widespread vaccination was critical early on, but what really protects most people now, two years after the first shots became available, are natural antibodies from past infections. This is because natural antibodies are more effective and longer lasting than antibodies from vaccines and boosters.
Despite all the debate about lockdowns, masks, vaccines and therapies, most of the world has ended up taking a relatively sane approach to Covid. Many countries restricted businesses, schools, crowds and travel until 2020, helping to slow transmission of the virus until vaccines were available later that year.
Then, as more and more people get fully or partially vaccinated – today most of the eight billion people in the world have had at least one Covid shot, and billions have been injected and reinforced — countries are gradually reopening.
People went back to the normal version. Yes, that meant more viral spread, which eventually gave us the Omicron variant and its many sub-variants that are still dominant today. But vaccines blunted the worst effects of these many infections. The case rate went up (and down, and up again, and down again). But overall, hospitalizations and deaths declined, a trend that continues today.
And all these infections fed a virtuous cycle that began with mass vaccination. We caught Covid and for the most part survived — because many millions of us were vaccinated. This rewarded us with natural antibodies that protected us from the worst outcomes the next one when we got Covid, a year or half a year later, when the vaccines started to disappear. And that infection compromised the immunity of the next one six or nine or 12 months.
So on or so on. Epidemiologists expect this cycle to continue unless and until the SARS-CoV-2 virus makes a huge and surprising evolutionary leap that renders all existing antibodies ineffective.
But the longer the pandemic drags on, the less likely that nightmarish outcome seems. With each waning wave of infections, Covid is starting to look more and more like the flu: a disease we should take seriously, but not one that is likely to end the world. “After a few years, Covid-19 will be a major risk along with seasonal flu,” said Lawrence Gostin, a global health expert at Georgetown University.
Which is not to say that Covid, like the flu, isn’t dangerous. Even non-fatal SARS-CoV-2 infections can have serious consequences. Long Covid, for example — a combination of long-term symptoms potentially including fatigue, confusion, loss of senses and even heart problems. But even taking into account the long Covid, the overall risk of the worst outcomes is decreasing in much of the world.
In China, however, things could get a lot worse before they get better. That’s because China locked down the system in early 2020 — and stayed locked down for nearly three years as part of the country’s “Zero Covid” policy. It was not until December 8, after widespread public protests in many major cities, that the ruling Chinese Communist Party finally removing major restrictions in most locations.
“The situation changed completely on December 8,” said Ben Cowling, a professor of epidemiology at the University of Hong Kong. The restrictions had shut down SARS-CoV-2, preventing transmission, and led to what was, until a few weeks ago, one of the lowest levels of Covid cases in any country. But the absence of infections also means the absence of natural antibodies.
Yes, about 90 percent of the Chinese population is at least partially vaccinated. But China’s hundreds of millions of elderly people, who are most vulnerable to Covid, are also the least likely to be vaccinated – a reluctance that experts attribute to misinformation in the Chinese media. And most Chinese who are vaccinated was vaccinated more than a year ago. By now, protection from these early vaccinations has all but disappeared.
So when restrictions were lifted and over a billion Chinese finally started to get out and travel, they did so without the protections that the rest of the world had earned the hard way, through past infection.
It should come as no surprise that China is really getting sick right now. “Almost everyone in the population is susceptible to infection because there were very few infections before December 2022 and very few recent doses of vaccine — which may provide temporary protection against infection,” Cowling explains.
Just how ill is difficult to say for sure, as the country’s authoritarian regime has stopped reporting reliable data. “Fortunately, there are some objective ways to assess what’s going on in China other than relying on China’s vibrant social media scene, which brought the pandemic to the world’s attention in the first place,” says Tambia.
More countries are testing travelers arriving from China. Malaysian health authorities are even testing sewage on passenger planes flying from Chinese airports. Projecting from these samples, experts can begin to track the outbreak in China even without China’s help. “Ideally, this would involve genome sequencing viral samples to see if a new and sinister variant of concern has emerged,” said Peter Hotez, an expert on vaccine development at Baylor College.
China may face a tough 2023 as it catches up to the benign cycle of infection and re-infection that protects most of the rest of the world and makes the pandemic “normal” for many of us. Many Chinese — potentially the majority of the population, according to Cowling — will have to catch the virus and survive it before China achieves its new normal. Most of them will do so with minimal immunity.
Consider that it cost the United States—a country with a billion fewer people than China—more than a million deaths from Covid to build the substantial natural immunity they have today. “It’s a grim and tragic statistic,” said Eric Bortz, a virologist and public health expert at the University of Alaska-Anchorage. “China is looking down that barrel right now.”
The risk to the rest of the world is that the millions and millions of serious Covid infections in China could function as a kind of incubator for new and more dangerous forms of the new coronavirus.
Every infection is an opportunity for the pathogen to mutate. It’s like a slot machine, says Niema Moshiri, a geneticist at the University of California, San Diego. Each individual infection tends to produce two mutations every two weeks, Moshiri explains. In other words, the virus gets two pulls of the lever twice a month, hoping to hit a genetic jackpot that will give it some new advantage. Greater transmissibility. More ability to evade antibodies.
“What if we had 50 million people pulling the levers on the pinwheels at the same time?” asks Moshiri. “We would expect at least one person to hit the jackpot pretty quickly.” Now replace the slot machine with ‘clinically relevant SARS-CoV-2 mutation’ and that’s the situation we’re in.”
It’s fair to say that even with the new Kraken sub-variant rearing its nasty little head, most of the world has Covid more or less under control. But China does not. And some new variant arising from the outbreak in China could spoil 2023 for everyone else.
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