A week after China dramatically eased its three-year-long zero-COVID policy of lockdowns and near-daily PCR testing, the country is experiencing its biggest wave of COVID-19 infections since the pandemic began in 2020.
But Ray Yip, an American epidemiologist and a former director of the China branch of the U.S. Centers for Disease Control and Prevention, and Professor Jin Dong-Yan, a virologist in the University of Hong Kong's Department of Biochemistry, say the relatively mild nature of omicron, China’s high vaccination rate and people voluntarily staying home, could help China avoid a huge increase in deaths.
Yip, who is also a former head of the China office for UNICEF and the Bill & Melinda Gates Foundation, and Jin, a respected virologist, explained to VOA’s Cindy Sui why the situation in China may not be as bad as feared.
These December 14 and 15 interviews have been edited for length and clarity.
VOA: What is going on in China’s hospitals?
Yip: Most hospitals in big cities right now are overrun, but they are overrun from basically people with symptoms that don't have to go to the hospital, like fever and runny nose. The truth is, COVID is like any flu. Unless you’ve developed respiratory failure and you need to have higher-level care, you get better on your own. You just drink a lot of fluid and stay in bed. But in China, most people, most parents, believe every time your child or your family member has anything not well, you rush them to the hospital emergency room to get [an] IV. Half the people don’t know you can use something like ibuprofen, acetaminophen, and manage the fever yourself.
So right now, is there an omicron outbreak in Beijing, in Shanghai, in every place? The answer is yes. But that doesn’t mean hospitals’ intensive care is overrun and the number of deaths of the elderly is shooting through the roof.
Jin: Most of the cases are mild. Some of them describe it as worse than the flu. That’s actually not very surprising because it's just like the flu.
VOA: Could there be a lot of severe cases that we just don’t know about?
Jin: That’s not possible because the virus is very mild and the vaccination rate in the elderly is not very, very low. (According to government statistics, 86% of the elderly aged 60 or above have had two shots and 68% have had a third booster shot). It’s much higher than in February in Hong Kong (when a major outbreak occurred).
The rate of severe cases or deaths should not be that high … because 99.5% of the people will just have mild or no symptoms for omicron. It’s the same everywhere. As long as they do well in vaccinating the elderly and giving them oral antivirals, the number of severe cases and deaths can be avoided.
VOA: With so many new infections, is there a possibility that the same thing that happened in India will happen in China as omicron spreads, given that there are only 3.6 intensive care beds per 100,000 people in China?
Yip: I don’t think that will happen in China. Omicron doesn’t do that. Omicron causes symptoms of cold. It doesn’t cause pneumonia. It doesn’t make you have trouble breathing. It’s upper respiratory.
Jin: That’s completely different because it's not the same virus and strain. That will not happen in Beijing. For most people, there won’t be need for respirators because it’s the same viral strain as in Inner Mongolia, and as you can see there are not that many deaths and severe cases there. The concept that the virus strain is particularly virulent and will kill a lot of people is wrong.
VOA: According to the government, 90% of the population has been vaccinated with two doses of Chinese vaccines, but a much lower percentage — 56% of the overall population, and just 40% of those 80 or older — have had a booster shot. Would there still be an increase in deaths among the most vulnerable people?
Yip: All those people having COVID now, they are not very old. So, the question is, will this become so pervasive, so rapid, that it will actually overwhelm the elderly population in a very short period of time? If that happens, then there are fears that what happened in Wuhan in the first few weeks in January 2020 will happen again, with bodies lying in the hallways, not enough hospital beds and respirators.
I really doubt these scenes will repeat themselves. My prediction is that even if China gets a very sharp curve, the outcome — in terms of overwhelming the hospitals and deaths — will not be as bad as what happened in Wuhan in 2020 because it’s a different virus. Omicron, even though it’s COVID, is much milder.
There will be 200,000 excess deaths, mostly elderly people. But if you spread that out over a huge country like China, that’s not huge.
Jin: There’s always a danger, but every country has to face that. It’s just that China is facing it all of a sudden. Sooner or later, there would be a tsunami, it’s not a big deal, but they do need to pay more attention to severe cases. In reality, how they can deal with severe cases and identify them is difficult. If they can quickly deliver oral antiviral drugs to those who need it, or those with chronic underlying diseases, it will also save a lot of lives.
VOA: What can China do to avoid a large number of deaths?
Yip: They can minimize deaths by getting the elderly vaccinated and making sure everybody gets three shots. They can also soften the curve, by keeping the rise in cases spread out over a longer period of time. A sharp curve will result in many people getting very sick that might overwhelm the hospitals. But if there’s a gentle curve that goes up over a longer period of time, then the hospitals will be able to handle the caseloads.
With China’s curve, we just have to see. But my prediction is it may not be as bad as one assumes, and the reason for that is that most Chinese in the big cities are totally scared. Beijing right now is in a semi-imposed semi-lockdown. You can go anywhere you want, but people are not going, because everybody right now hears COVID is running amok. So, everybody is staying in their apartment, which is good. By doing that, they will actually make the curve more gentle, not as steep.
Jin: Actually, the most important thing is to educate the general public and explain the rationale of the new policy. They should tell people they don’t need to go to the hospitals, because if everyone infected goes to the hospitals, the hospitals will collapse at some point.
In terms of the curve, they want to have 60% of people infected in the first wave. That’s not possible if everyone stays home, because the virus will not spread anymore. It’s possible it’ll be like Taiwan and Singapore, they will see several waves. They hope to have 80% of the population infected in the second wave.
VOA: Is there a chance China might ride out this storm largely unscathed?
Yip: There’s a reasonable chance China actually might, if what I’m hoping or projecting comes true. As we mentioned earlier, a flatter curve allows the system to absorb the shock. We don’t know. I think you need to wait for another minimum of three weeks to tell. Omicron actually is the best thing that happened to the world. Without omicron, if the virus was still like the delta variant, the alpha, the Wuhan strain, you would be scared every place you go. Omicron immunized everybody. The whole continent of Africa was immunized by omicron.
Jin: We expect the severe cases will be low and they should be able to handle this. If they cannot handle it, they should use other measures to flatten the curve. There are 101 measures to do this. They can close schools, shut down buses, metro systems, they can do everything.
VOA: So, if China also survives this omicron wave, would you agree with Chinese analysts’ assertions that China will have prevented millions of deaths with its zero-COVID policy, even though it has been blamed for hurting the economy and people’s livelihoods, while also restricting freedom?
Jin: I think so because that's the reality, because the most lethal waves are already over. Those are delta, alpha … They have saved millions of lives because they did the lockdown initially and it could have been much worse if they didn’t.
Yip: That is true. I'll tell you why. China did this zero-COVID policy when the bad virus was around — the virus that killed a lot of people, the one you saw in India, in New York, in Italy, in many parts of the world. It killed a million Americans. Those were the older strains. So, China basically said, ‘I protect you during bad virus times, but we got a good virus now. I’m going to let you get infected. You will get sick. You will get a cold. But most of you, if you’re under 50, you have zero chance to die. If you’re over 60 and you’re immunized, you’re in good condition.’
So basically, China averted a major curve of COVID-related deaths. But I tell you, people in the West don’t like to hear that because it makes China look good. You should report it. What I’m telling you is based on epidemiology. It’s based on science. I’m not telling you based on politics.
