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  • William Miller, MD

COVID surge following China abruptly abandoning Zero-COVID.

Social media from China suggests a significant surge in COVID cases following the government’s abrupt halt of its Zero-COVID policy. Chinese doctors and nurses, along with desperate families of COVID patients, are posting stories of hospital lobbies filled with overflow beds, ERs with hallways so packed that it is hard to walk through and funeral homes so backed up that they are having to turn away the dead. These stories seem to be corroborated by Western reporters who have toured provinces hit hardest by the COVID surge in the past two weeks according to several articles that have appeared in Reuters, The Washington Post and The New York Times.


Meanwhile, the Chinese government’s official response is that the situation is under control and that the COVID pandemic is close to an end. Officially, China is reporting only seven COVID deaths in the past two weeks, which seems unlikely, and the number of new cases per day at about 2,000 nationally. In the days before halting Zero-COVID, the reported number of new cases per day was over 30,000.


I have reported previously on the harsh aspects of the Zero-COVID policy which has kept this country of 1.5 billion people largely free of COVID since the early outbreak in Wuhan in late 2019. Without a doubt, Zero-COVID did achieve its goal of containing outbreaks by enforcing major lockdowns of cities like Shanghai, sometimes for weeks to months, just because of a handful of cases. However, the consequences had become increasingly unacceptable to the Chinese people. I reported on the growing unrest in China and the government’s response to abruptly change course in the Miller Report of December 5th, which you can read at www.WMillerMD.com. I discussed the concerns of world health leaders that, while agreeing with loosening of the draconian measures of Zero-COVID, there would likely be a major surge in cases if Zero-COVID was rolled back too quickly.


The problem is that China’s healthcare system is considered inadequate for the size of the population. While China is clearly one of the most technologically advanced countries in the world, its healthcare system has not enjoyed the same degree of investment and development that other sectors of China’s society of received. The predictions seem to be playing out now only two weeks following the change in policy. Medications to treat COVID, such as Paxlovid which is widely available in the US and Europe, had not been stockpiled in preparation and as a result national availability of these drugs have dwindled. Even the supply of ventilators and the necessary oxygen to run them appears to be in short supply. ICU beds in regional medical centers are reported to be overflowing and smaller rural hospitals do not have the resources to take care of those that are critically ill.


China also is noted to have a relatively low rate of vaccination amongst the elderly. Only about 20% of this group are fully vaccinated against COVID, compared to about 55% in the US. The two China produced vaccines, Sinovac with a 70% effectiveness in preventing serious illness and death and Sinopharm, which performs slightly better at 79%, were initially targeted to the young, working class. This strategy was based on the need to keep China’s economy strong during the early years of the pandemic. This may mean that the frail and aged in China are at greater risk than in Western countries.


Another unintended consequence of the Zero-COVID lockdowns is that while it did keep COVID cases remarkably low, it also has meant that much of the population has neither been exposed to the virus or to the vaccine and as a result herd immunity is likely to be low. If that is the case, then a rapid relaxation of restrictions could result in a major outbreak spreading across the country. This appears to be what we are starting to see.


As I have said before, it is easy to criticize the decisions of others, especially from a far distance. However, it does appear that it might have been wise to take special steps such as stockpiling anti-viral medications, increasing vaccination efforts of the elderly and ensuring adequate hospital resources before gradually relaxing restrictions. We will continue to follow this unfolding story.

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