COVID-19: China’s Breaking Point?

Muraleedharan Nair

This picture shows Covid-19 patients on beds at Tianjin Nankai Hospital in Tianjin |AFP

CAVEAT: Reports coming out of China about the Covid situation there have often been, to put it mildly, confusing. So, only the data gleaned from reliable wire services reporting directly from China, as also reports of established Hongkong- or Singapore-based media houses known for their integrity, are used in this write-up.

It is no news that the Chinese government has all along controlled information related to Covid-19. For it, and for the ruling Communist Party, it was always a matter of pride to prove to the world, and also to its people, that the PRC’s “superior governance model” was successful in controlling the spread of Covid after it broke out in the central city of Wuhan during end 2019. China kept insisting that SARS-Cov-2, the coronavirus that caused Covid-19, did not originate in Wuhan, but only emerge, or was detected there.

China always clamped down on news portals and independent websites that complied nationwide Covid figures in the initial stages of the pandemic and pushed its own ‘made-up’ numbers that suited its narratives. The gap between the numbers put together by these entities and the government figures used to be incredibly huge! That the Chinese side has not cooperated with the WHO team that was instituted to investigate the origin of the virus, its initial spread and related matters is also widely known.

After the rather abrupt retraction of various Zero-Covid restrictions that were in force for about three long years, the virus, claimed to be Omicron B.7 variant mainly, is reported to be infecting millions every day across the country. According to a China National Health Commission report that was available on the net for days, and has not been labelled as fake by the authorities, around 248 million (Rs 24.8 crore) people were infected by the virus between December 1 and 20 this year!

Passengers arriving from China wait in front of a COVID-19 testing area set at the Roissy Charles de Gaulle airport | AP

While country-level official statistics in this regard are not available, there are some provincial-level details that might corroborate the above estimates. A document by the Zhejiang (a prosperous eastern province) authorities available in the open domain reported two million daily cases among its 65 million population. In the huge, centrally administered western municipality of Chongqing, 65 percent of its 16.87 million population were suffering from the disease in the last week of December 2022. Other reports based of mathematical models indicated that major cities of Beijing (total population 21.33 million), Shanghai (total population 28.52 million), Chongqing (total population 16.87 million), Tianjin (total population 14 million) and Chengdu (total population 9.48 million) would have peaked in December 2022 and Guangzhou (total population 13.96 million) a little earlier in November 2022. However, interior provinces with smaller cities, townships and villages are estimated to experience the surge in January or after that.

With an effective reproduction number of the Omicron variants playing havoc in China said to be as high as between 10 and 18.6, according to different mathematical models, between 10-30 and 50-60 percent of the 1.4-plus billion Chinese population would be affected by March 2023. These calculations forecast that between 1 and 1.5 million people could die in China due to Covid related reasons though the Chinese are sure to pare it down to a mere couple of hundreds!

Reports from far away provinces indicated that thousands of doctors, nurses, and other healthcare workers have been drafted to meet the demands in major cities like Beijing where infections were surging. This, despite the situations in such provinces also getting deteriorated. Actually, an official statement a few days ago admitted that China is at a “breaking point” and advised hospitals to form networks and help each other on a need basis. It said that the focus should be to save lives, rather than anything else and urged provinces to prepare more beds, add more critical care facilities and train more personnel. Meanwhile even infected doctors and other healthcare workers with minor symptoms have been asked to look after patients under treatment! Further, China has now downgraded its response to Covid-19 to the same category as that of HIV and viral hepatitis!

Consequent to the explosion of infections, afraid of “losing face” globally, and more so domestically, the authorities took the convenient route of deciding that data pertaining to the number of daily infections or Covid deaths would not be released henceforth. (This, despite demands for the release of real time statistics from the World Health Organisation, though it appeared rather perfunctory on occasions.) On the top of it, it was reiterated that only death cases resulting from Covid-induced pneumonia or respiratory failure during infections would be counted as Covid deaths. In other words, deaths due to pre-existing conditions or any other reasons during or after Covid infections will not be considered as deaths due to Covid. In such a scenario, will the actual statistics regarding China’s Covid infections and deaths ever be known even after the situation returns to normal, or any time after that in the future?

A police robot vehicle patrols near the crowd that has returned to a mall following the easing of pandemic restrictions in Beijing | AP

Am I arguing that China has not been successful at all in controlling Covid infections or related deaths? No! On the contrary, China’s past performance in this area has been far better than those of other countries near or far. But, how China achieved this has come to haunt its leadership today. That is, China controlled spread of Covid by adopting the controversial Zero Covid policy whereby it continuously locked down cities, or parts of cities, whenever even one person was detected with the disease, and implementing other steps like obtaining negative test results for travelling even inside one’s own city, attending office, school and college, strict institutional quarantines, border restrictions, among other measures. So, a vast majority of China’s 14. billion-plus population never got exposed to the virus, even as most other countries opted to live with the virus by opening up gradually. Even as China paid heavy a price both at the economic and societal levels during the Zero Covid restrictions, it is paying a heavier price now with the rather abrupt lifting of restrictions on the face of widespread public protests. The only model the Chinese could rely on while taking the decision to remove the restrictions was the opening up of Hong Kong. The lessons learnt from the Hong Kong model (with a comparatively tiny 7 million population) would not have worked in the Chinese mainland (with a whopping 1.4 billion-plus population) with a totally different demographics.

Thus, unlike in other countries where the populations are believed to have acquired “hybrid immunity” from vaccinations and earlier/past infections, in China only very few people were exposed to the virus in the past three years. Secondly, China did not allow any effective foreign made vaccines into the country even as the major China-made inactivated vaccines have been proven to be not adequately effective, particularly over time. At the same time, while over 90 percent of its population received full course of two vaccinations, only 69 percent of people aged over 60 years and a mere 42 percent of the population above 80 years of age have taken the third/booster dose and are, therefore, vulnerable to infections. Reportedly, more and more Covid deaths are happening these days in these age groups. A clear signal to countries with more or less similar statistics, I guess?

Meanwhile, people wearing masks are allowed to travel inside the country, i.e., without the hitherto mandatory negative RT-PCR reports. International travel is also being allowed to various destinations. Chinese citizens are expected to make a massive 3 billion (Rs 300 crore) trips during the Chinese Lunar New Year (CNY) season that has begun now and would last till the beginning of March. CNY falls on 22 January this year.

According to a study in Singapore, of the between 4900 and 7000 weekly arrivals from China (mostly on business and for meeting relatives), between 40 and 80 were tested positive on arrival there. How many people are going to get infected in China and globally when the 3-billion CNY travel mania comes to an end in March is anybody’s guess.

In such a scenario, taking possible precautions against the disease spreading in other countries is incumbent on various governments as the Chinese are likely to flock to popular destinations after the three-year long “near detainment”. Various countries, including India, are contemplating introduction of different measures like carrying a valid pre-departure RT-PCR negative report, undergoing Covid tests on arrival, quarantine if showing symptoms or being tested positive on arrival etc.

Even as countries across the globe are bracing for the impact of the Chinese surge, one of the questions that crosses the average Indian citizen’s mind is: How severe is the disease spread going to be? The authorities assure that Indians are “adequately” protected as they have “hybrid immunity” from vaccinations and earlier/past infections (unlike in China where only very few people were exposed to the virus in the past three years).

A major issue that hampers such preparations across the globe is that the Chinese authorities have not revealed the exact details of the variants that are currently playing havoc in the country. Such details are important as the same would help other countries prepare themselves for potential attacks particularly from potential new variants from China. For example, unconfirmed reports suggest that some parts of China were impacted by Omicron variant BF.7/BA.5.2 while other areas were infected by BQ.1 / XXB sub-lineages. In the absence of clear information, it might be difficult to say whether fully vaccinated Indians or those who have been exposed to the virus in the past would, in general, require hospitalisation if infected. However, if it is a new variant, particularly if it has mutated from any two different variants, studies may have to be done to see whether the existing vaccines are effective against it, or the immunity acquired from previous infections is good enough to fight it. Though WHO is making demands for such data, how much pressure it can put on the inflexible Chinese authorities is anybody’s guess.

Health workers guide travellers arriving from China in front of a Covid-19 testing centre at Incheon International Airport, west of Seoul | AFP

Meanwhile, the shortage of Covid and fever medicines and other related items like, medical oxygen generators, oximeters etc. have been reported from across China leading to rationing of the same wherever available. Infected people are reported to be flocking to private hospitals assuming that medicines are available with them notwithstanding the prohibitive costs involved. While couriering fever medicines to China directly has been banned in Hong Kong, stocks have become scarce there, as also in Singapore and Macao where people from the mainland have connections. Even as China recently approved the Pfizer-made antiviral like Paxlovid and homegrown Azvudine (an HIV drug, actually), these are not freely available. Those who could afford have been procuring them from the gray market. Interestingly, anti-Covid Indian generic medicines like Primovir, Paxista, Molnunat and Molnatris are in great demand in the country. Said to be between 80 to 50 percent cheaper than the Pfizer brand, these are reportedly illegally imported, though not identified as counterfeit under the Chinese law. Some social media posts asking where the Indian medicines could be bought were noticed, while others thanked India for “sending” the medicines in the hour of the need. It is also reported that enquiries for importing generic flu and fever drugs in bulk have been received by some of the Indian manufacturers.

The Chinese authorities estimate Covid to strike the country in three waves. What is being witnessed now is the first wave consequent to the abrupt lifting of Zero Covid restrictions. The second wave would commence by late January and abate by mid-February when the aforesaid Chinese New Year holiday trips surge. And, the third wave is estimated to happen between late February and mid-March when the workers and tourists return to their workplaces and homes after the holidays. The Chinese policy now appears to be to try and flatten the curve rather than allow it to peak early so that the pressure on hospitals, ICUs and crematoriums could be alleviated. Past experience has, however, shown that manipulating the curve is not in the authorities’ hands. Authorities can claim success if things work as they planned, or deflect flak citing extraneous reasons if things go the other way. The Chinese authorities would know that managing the vagaries of a virulent virus like SARS-Cov-2 for a long period, that too in such a vast, populous country is totally different from managing its people with carrot or stick.

(The author is a Senior Fellow with the Centre for Public Policy Research. Opinions expressed are his own)

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