China risks 1.6 mn deaths if 'Covid Zero' is abandoned: Shanghai univ study

The research comes as WHO chief Tedros Adhanom Ghebreyesus called on China to rethink its strategy.

China risks a “tsunami” of coronavirus infections resulting in 1.6 million deaths if the government abandons its long-held Covid Zero policy and allows the highly-infectious omicron variant to spread unchecked, according to researchers at Shanghai’s Fudan University.

The peer-reviewed study, published in the journal Nature Medicine, found that the level of immunity induced by China’s March vaccination campaign would be “insufficient” to prevent an omicron wave that would swamp intensive care capacity, given low vaccine rates among the elderly and the virus’s ability to evade immunity from existing shots.   

The findings add heft to the government’s continued insistence on sticking with the zero tolerance approach to Covid that has largely kept the virus at bay for most of the pandemic. Without restrictions such as the country’s mass-testing drives and strict lockdowns, the spread of omicron could lead to 112.2 million symptomatic cases, 5.1 million hospital admissions and 1.6 million deaths, with the major wave occurring between May and July, the study concluded.

Yet concerns are mounting over the social and financial costs of Covid Zero, which has required harsher and harsher restrictions to combat the more transmissible virus. In China’s lockdowns, people have been denied access to medical care and struggled to access fresh food, while manufacturing facilities, supply chains, and other workplaces were hit with disruptions. 

The research -- which mirrors earlier modeling from Peking University -- comes as World Health Organization Director-General Tedros Adhanom Ghebreyesus called on China to rethink its strategy, saying the approach no longer makes sense as the omicron variant spreads and the country’s economy suffers.

“We don’t think that it is sustainable, considering the behavior of the virus now and what we anticipate in the future,” Tedros said in a briefing on Tuesday, adding that a “shift would be very important.”

Tedros’s comments - which were quickly restricted on the United Nations’ social media accounts - mark a rare instance of the WHO chief challenging a member state’s domestic Covid policies. Early in the pandemic, he faced criticism that he was too deferential to China, where the virus first emerged.

Hu Xijin, the former chief editor of the Communist Party-backed newspaper Global Times and an influential commentator in the country, dismissed Tedros’ comments. China needs to make its own decisions on how to handle the outbreak since it will be held to account for any deaths, he said, particularly since Tedros didn’t offer a more effective or sustainable approach.

Infection surge

Relinquishing stringent Covid curbs would lead to a surge in critical Covid-19 patients, creating an intensive care demand as much as nearly 16 times of what the country currently can accommodate, according to the computer model the researchers created to simulate an omicron outbreak. 

The 1.6 million ensuing deaths would be 50% more than what has been reported in the U.S. throughout the pandemic. Three-quarters would occur among those aged 60 or above who aren’t yet vaccinated, the researchers said.

Shanghai would take the brunt of the deaths in China, while two other regions would also post higher mortality rates than seen in the U.S. during its outbreak from December 2021 to April 2022.

Beijing reported 37 cases for Tuesday, down from 74 on Monday. While the declining cases in both cities buoyed investors, officials have vowed to continue their stringent approach until the outbreaks are under control. 

President Xi Jinping has clung to China’s tough Covid strategy, tightening pandemic restrictions in Shanghai and expanding a mass testing sweep in Beijing. Officials are chasing the elusive goal of wiping out Covid-19 cases in the community despite a growing cost to the economy, even as much of the rest of the world opens up.

Experts don’t expect China to start meaningfully shifting away from Covid Zero until Xi secures a record third term as the nation’s top leader at the Communist Party’s national congress expected later this year. Xi and the Party have made much political capital out of the contrast between China’s controlled, low-deaths approach and that of the US, which has the world’s highest fatality tally.

The strategy -- which relies on a playbook of border curbs, mandatory quarantines and repeated mass testing to root out all chains of transmission -- is leaving the country isolated as the rest of the world normalizes and lives alongside Covid. The increasingly tough measures required to eliminate outbreaks of more contagious strains are also hitting the world’s second-largest economy, with analysts saying it is unlikely to meet its annual growth target for this year.

End game

The Fudan study’s modelling also suggests that once effective antivirals are readily available and can be used to treat most Covid patients, the country will see cases and severe infections drop significantly even without imposing curbs.

Therapies such as the antibody cocktail from Chinese biotech Brii Biosciences Ltd. and Pfizer Inc.’s Paxlovid can significantly cut deaths and intensive care admission, provided they are used widely among symptomatic Covid patients, according to the study.

Still, the researchers argue even such a reduction won’t get Covid-related deaths down to the 88,000 level China reports annually for influenza, which Beijing has frequently cited to justify its stringent curbs and lockdowns under the Covid Zero strategy. To do that, the country needs to boost elderly vaccination to 97% and treat at least half of all symptomatic infections, the researchers concluded. 

(With assistance from Linda Lew.)