Why the International Response to China’s Covid Wave Must Be Based on Fact, Not Fear

Global Challenges

Why the International Response to China’s Covid Wave Must Be Based on Fact, Not Fear

Commentary
Posted on: 6th January 2023
By Multiple Authors
Ruby Osman
Geopolitical Researcher, Political Team
Daniel Sleat
Director of Research
Brianna Miller
Researcher

As China embarks on a rocky transition to living with the virus, alarm bells are sounding in countries that fear a new variant could unravel their hard-won progress towards business as usual. But as countries rush to impose new controls on the handful of international Chinese travellers, we’re risking a dangerous over-reaction. Surveillance, not restrictions, will be key to a response that takes the threat of new variants seriously without stoking discrimination and risking diplomatic rows.  

Beijing’s Dramatic U-turn Is Pushing China to Its Limits  

China’s staggering case rate – by some estimates, as many as 250 million were infected in the first 20 days of December – comes as Beijing finally turns its back on the zero-Covid policy. For almost three years, China pursued a strict no-tolerance policy, enforced through stringent lockdowns, centralised quarantines and regular mass PCR testing. But in the space of just a few weeks, China has dismantled almost its entire zero-Covid apparatus, leaving the virus to rip through China for the first time.   

It had long been clear the zero-Covid policy was unsustainable, but few expected a change of this speed and scale. Protests across the country – China's most significant outbreak of unrest in decades – were just one part of the picture. Even more important were overburdened local governments, forced to bear the economic brunt of pandemic prevention. Add rattled markets into the mix, and central government was left with little choice but to abandon its flagship policy.   

The problem is, the Chinese system just wasn’t ready. Buoyed by the early successes of zero-Covid, authorities had rested on their laurels for too long. China’s per capita ICU capacity remains just a tenth of the US’s, and vaccination rates, particularly among the elderly, are worryingly low. As of late November, more than a third of the most vulnerable over-80s remained unvaccinated – and now many are fearful of going to vaccination centres in case they catch Covid. 

All of this means China is facing an extremely difficult few months. Authorities have given up releasing case figures, and stringent criteria means death rates are kept artificially low, but the anecdotal evidence of ICUs stretched to breaking point and crematoriums working overtime is overwhelming. And as the virus starts to peak in big cities and reach into under-resourced rural areas, other countries are starting to take note.  

New Variants Are Inevitable, but New Variants of Concern Aren’t  

The scale and speed of China’s reopening is unprecedented and it will, inevitably, do unpredictable things to the virus. As the virus tears through a population of 1.4 billion with limited immunity, new variants are all but inevitable. But the question authorities both in China and abroad need to be asking is whether these are variants of concern. (The WHO classifies “variants of concern” as any variant that poses an increased risk to global public health). 

So far, the news is good. Two sets of data, one presented to the WHO and another to GISAID, a global genome repository that tracks virus mutations, this week found that China’s infections are dominated by strands of Omicron that have already been and gone in the rest of the world and found no current evidence of a significant new variant.  

But even as the virus spreads further across China, especially among immunocompromised people who can potentially harbour the virus for several months, any new variants are unlikely to pose a significant risk to populations outside of China. China is currently grappling with Omicron subvariants that are “less fit” than the more transmissible variants already circulating in Europe and the US, meaning a new variant would struggle to compete beyond China’s borders where immunity levels are far higher.  

But it’s not just a question of science – other countries also need to be monitoring how China’s political response to Covid evolves. Despite scaremongering headlines suggesting a deluge of travellers from China, the real number of arrivals paints a very different picture. International travel may technically have become viable again following the scrapping of quarantine-on-return requirements on 8 January, but experts predict it’ll be years before any return to pre-pandemic normal. For now, international flights to and from China remain at 8 per cent of pre-pandemic levels and most are shorter-haul flights to nearby countries, with just a handful of direct flights to the UK each week. As cases across Europe reach at least a million a week – likely a significant underestimate – potentially infectious travellers from China, where strains of Omicron already circulating in Europe dominate, are just a drop in the ocean of overall infections.  

If these travellers carry a new variant of concern – which is unlikely but not impossible – that does change the equation. The question will be if Beijing’s genomic-surveillance plans are effective – and transparent – enough to flag concerning new mutations to the rest of the world early. A new genomic-monitoring plan, announced last month, requires select hospitals in every province to sequence samples from every death and a sample of severe cases, while some cities are experimenting with innovative waste-testing programmes that can pick up new variants before clinical data. 

But there are fears these samples are too small, especially as authorities encourage those with mild cases not to report positive test results. That means the priority for other countries must be bolstering surveillance efforts, offering practical support to China on its own sequencing plans – an area where the UK has particular expertise – and putting in our own supplementary measures for incoming travellers where needed. More likely than not, any new variants won’t pose a significant threat – but if the past three years have proved anything, it’s that it’s better to be safe than sorry.  

Other Countries Need a Response Based on Fact, Not Fear 

So far, 15 countries have introduced mandatory testing requirements for travellers coming from China, while Morocco has banned Chinese arrivals entirely. In England, Prime Minister Sunak has announced plans to require a pre-flight negative test and a voluntary sampling program on arrival. 

The problem is, it’s not an approach backed up by science. Australia’s chief medical officer has claimed there is no public-health justification for travel restrictions, while the ECDC, Europe’s infectious disease body, has branded screenings and travel measures as “unjustified”.  

Other experts point to the emergence of the new Kraken subvariant in the US as proof that new variants of concern – and ones far better at evading our immunity – can spring up anywhere the virus is in wide circulation.  

What’s required is a strategy that works for any emergent concern from any country, not just knee-jerk responses that pick and choose. New or potential variants from the US and China should be a wake-up call that efforts to roll back surveillance across the globe were premature. Instead, we need continued investment in genomic sequencing and global data-sharing – including platforms like the Global Pathogen Analysis Service, which delivers a global solution to standardise how genomic-sequence data from any sequencing methodology is processed and analysed.  

But what does this all mean in the most immediate sense? Blanket testing travellers from China – let alone completely banning them – is an overly stringent approach that risks unduly upsetting relations with China and, just as importantly, stoking discrimination.  

But that’s not to say we should take our eye off the ball. A big part of this will be monitoring surveillance efforts in China itself, watching how authorities address criticisms over sample sizes or transparency in coming months. China needs to be proactive partner in global knowledge sharing, supplying transparent, timely and comprehensive data. 

And at our own borders, countries should still explore voluntary random sampling schemes, or even more innovative and less intrusive systems like monitoring waste water from planes. Underpinning this all should be plans for how to quickly reactivate testing, PPE and vaccine apparatuses in a worst-case scenario and above all a recognition that, as GISAID’s chief executive puts it, this is a time to “trust science over politics”. 

 

Photo credit: Getty

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