In light of rising public anxiety over increasing COVID-19 cases in China and other parts of the world, Indian microbiologist and researcher Gagandeep Kang took to Twitter to explain the situation in China and whether Indians should be worried. Beginning the Twitter thread with a brief explanation on why China is seeing a surge in COVID-19 infections, Gagandeep says that China is “opening up fast at a time when their population has low levels of exposure to natural infection.” China had been pursuing the zero-Covid policy for three years, a strategy whereby the country attempted to contain the spread of the coronavirus with restrictive measures like stringent lockdowns, mass quarantines, mandatory hospitalisations, and more. China dismantled its zero-Covid strategy on December 7, which has contributed to a surge in infections.
Gagandeep points out that the highly infectious Omicron variant is doing the rounds in China. She says, “This [being infected by the Omicron variant] means that China will have lots and lots of infections. Remember India's 100s or 1000s of cases in April-May 2021 and January 2022? In the absence of significant mitigations, this will be similar. Lots of infections lead to lots of sick people.”
Although China has vaccinated most of its population (90% as per the official data), Gagandeep says that the sheer number of people being infected by the coronavirus means that even if a small proportion gets severe disease, the absolute number of people requiring hospitalisation will be many, and a proportion of these patients will die.
“The risk factors for severity remain the same. Older age (and news from funeral homes in China indicate that the age related mortality pattern has not changed) and co-morbidities will continue to be drivers of severe disease and deaths,” she tweeted.
The microbiologist also addresses the claim that ‘ineffective’ vaccines were contributing to China’s Covid surge. China made use of two homegrown vaccines — Sinopharm, and Sinovac or Coronavac. Gagandeep says that these ‘inactivated’ vaccines work well to prevent severe disease and death, albeit less effectively than mRNA vaccines like Pfizer and Moderna, or vectored vaccines like AstraZeneca/Covishield. She adds that a booster dose will help. Incidentally, China is rolling out a second booster for people above the age of 60 following a rise in cases.
Gagandeep points out that although vaccines will prevent a proportion of people getting severe disease and dying, the number of people requiring hospitalisation and the number of deaths will be high. She provides two reasons for this. The first is that the surge in Covid cases means that a number of healthcare workers will also fall sick. “Understaffed, overloaded hospitals mean poorer care for patients,” she explains. The second reason is that since it’s winter, there will be more hospitalisations on account of other infections and viruses.
“China may have to experience in weeks what the rest of the world saw over years,” Gagandeep says.
The microbiologist goes on to explain what the rest of the world should be doing. Gagandeep states that there are no new variants as of now and the ones currently circulating in China have existed in other parts of the world for several months now. She adds, “In India as well, we already have XBB and BF.7 (the two variants considered dangerous). They are, like all Omicron sub variants, very good at infecting people because they escape the immune response that prevents infection, but do not cause more severe disease than Delta (another variant).”
Stating that new sub-variants thrive only if it is better at immune escape than the prior ones, Gagandeep notes, “greater infectiousness of new variants is a given and not news.” The microbiologist says that the rest of the world’s concern regarding China is that the spread of Covid means high levels of replication, which could result in new variants emerging.
She further adds, “For this, they [China] and we should maintain variant and clinical surveillance, to ensure that we detect signals of any changes in the behaviour of the virus. This is a public health function where stable surveillance runs in the background and ramps up for emerging threats.”
The microbiologist further explains what stable surveillance should look like. She says that severe acute respiratory infection (SARI) surveillance must be undertaken at all hospitals, as well as detection and investigation of clusters. She further encourages periodic serosurveys and environmental surveillance. She also notes that randomly increasing testing will serve no purpose and what India needs is a strategic approach to increasing testing.
Gagandeep says that India is doing fine at the moment, and that despite the presence of XBB and BF.7, there has been no surge. She also emphasises, “I do not expect a surge.” She points out that most Indians have hybrid immunity, having been vaccinated as well as being exposed to the coronavirus, with 90% estimated to have been infected.
Regarding the need for a booster dose, she says, “We have no data from India that any Indian vaccine reduces in effectiveness over time, but from the rest of the world, the value of a booster in the elderly population is clear.” She further encourages elderly people to take the booster dose if they have not taken it yet.
On the subject of masks, Gagandeep says that those suffering from respiratory infections should stay home and wear a mask if they need to go out. “If you are vulnerable, stay masked in unfamiliar company or if someone around you is obviously ill. If there are a lot of infections and/or cases in the community, staying masked in crowds is good,” she says.
About travelling, the microbiologist says, “Risk perception again, but no need to stop right now. There is very little infection in India. Travel, wear a mask if you are worried. Outside India, some places have more infections, wear a mask, and travel.”
Watch: Why China is seeing a rise in COVID-19 cases