China, the first country where the covid virus began to circulate three years ago, is paradoxically the last to control it. While the rest of the world has accepted to live with the coronavirus, the Chinese government remains anchored in its zero covid policy. What is missing so that China can also recover normality? And what would happen if the Chinese government decided to let the virus circulate from now on?
The impact of the coronavirus in a country depends on the immunity that its population has acquired against it, either through vaccines or through infections. In populations with immunity as high as the Spanish, the current omicron variants now behave like tame viruses: they are causing many colds, very few serious cases.
In China, 91% of the population has received a first dose of a covid vaccine and 89% the second, according to data from Our World in Data. These figures are higher than those of Spain (87.2% first doses and 85.8% second), and much higher than those of the United States (81% and 69%) and the world average (68% and 63%). It is not, therefore, the total number of vaccines inoculated that explains why the Chinese government maintains the zero covid policy.
None of the eight covid vaccines approved in China uses the messenger RNA technology on which the Pfizer-BioNTech and Moderna vaccines most used in Western countries are based.
According to a study with data from 7.4 million people in Hong Kong, the efficacy of one or two doses of the Pfizer-BioNTech vaccine is superior to that of Sinovac - the most widely used of the Chinese vaccines. In the age groups older than 60 years, two doses of Pfizer-BioNTech are significantly more effective than two doses of Sinovac in reducing the risk of severe covid. In people over 80 years of age, the efficacy is 87% with Pfizer-BioNTech and falls to 58% with Sinovac.
With three doses, these differences disappear. Both vaccines are more than 97% effective in preventing serious covid complications in all age groups, according to results published in The Lancet. But only 40% of China's population over 80 have been vaccinated with three doses.
China has an aging population as a result of the one-child demographic policy, which has meant that the youngest age groups are not the most numerous. Those over 60 years of age represent 18.4% of the population and a total of 266 million people. Of them, 29 million are older than 80.
Unlike what has happened in Western countries, older people in China have been on the whole more reluctant to get vaccinated than younger people. Since relaxing the zero covid policy will inevitably lead to an increase in infections, a part of these infections will affect older people who do not have good immunity against coronavirus and who are at high risk of serious complications from covid.
China has so far had a million and a half confirmed cases of covid: about ten times less than Spain for a population about 30 times larger. The number of deaths from covid recognized by China since the start of the pandemic amounts to 5,232, one of the lowest in the world. In Spain, more than 115,000 deaths from covid have been reported and in the United States more than a million. According to the Chinese government, these figures support the zero covid policy.
But the few cases of covid that have occurred in China have now made the country more vulnerable to the coronavirus. If Spain and other countries have left the acute phase of the pandemic behind, it is thanks to the immunity acquired by the population thanks to vaccines and infections. In China, since the virus has circulated so little, very few have acquired or strengthened their immunity by catching it.
As the coronavirus has spread, and as the world's population has become immunized against it, the virus has evolved and become more contagious. The omicron variants and subvariants BA.2 and BA.5 that are now expanding are among the most contagious viruses that can infect humans.
This implies that the containment measures that China has applied since the start of the pandemic to contain the old variants are no longer sufficient to contain the new variants. The recent increase in infections in China is a first example of this.
Until now, the zero covid policy has been based on isolating people, confining territories, massive early detection tests, and controlling citizens with geolocation technologies. Unless these measures are enforced even more strictly than before, China will not be able to control the circulation of the coronavirus in the coming months.
If the transmission of the virus is not contained, and a large part of the vulnerable population is not well immunized, there will be an increase in cases of severe covid that will require medical attention. But China only has 3.6 ICU beds per 100,000 inhabitants, according to data from the World Population Review. By comparison, Spain has 9.7 and the United States, 34.7.
China also has fewer doctors: 2.0 per thousand inhabitants, while Spain has 4.0 and the European Union average is 4.9, according to World Bank statistics.
Chinese health professionals also complain that the government has concentrated resources on mass testing campaigns to contain the virus and has neglected hospitals, the Financial Times has reported. The result is that the health system is not prepared to attend to a large influx of covid patients.
Containing the transmission of the coronavirus has an enormous economic and social cost, as China is verifying and Spain and other countries have verified before. Allowing the virus to circulate also has an enormous social cost, in this case health and diseases and premature deaths.
Deciding what is the right balance between these two options is not a technical matter. It is a political and even ideological decision.
Bolsonaro in Brazil has been an extreme example of how to let the virus run and ignore the cost to people's health. Xi Jinping in China has been at the opposite extreme. In both cases the decisions appear to have been motivated not by a desire to minimize social harm, but to maximize political benefits. And in both cases there seems to have been a miscalculation. Bolsonaro has lost the elections in Brazil. In China, Xi Jinping sees for the first time how his inflexible zero covid policy is massively questioned.
