Thread by @brownecfm

COVID-19 in China: Current Situation and Downstream effects: 🧵

1/ From the outset, it is very important to recognise that a humanitarian catastrophe is currently unfolding in China. Analysis of this situation is not incompatible with recognising the horror of the situation.

2/ In short, I am well aware that behind this analysis is human suffering on a vast scale.

3/ It is obvious that SARS-CoV-2 is now spreading in an uncontrolled manner across China. The dominant variant within China is most likely BF.7. My feeling is that the virus is now beyond positive control. That is to say, even if the Chinese leadership reversed course...

4/... and re-enacted significant non-pharmaceutical interventions (NPIs), community transmission could now only be slowed down, not stopped. Some reports indicate that BF.7 has an unprecedented R0 of 16 in China right now.

5/ This, of course, means the virus is spreading incredibly quickly in the Chinese population. As we have seen in earlier national outbreaks of SARS-CoV-2, when large amounts of people get sick at the same time, hospital systems fall over.

6/ When hospital systems fall over, severely ill patients cannot get the care they need, which leads to more fatalities. In effect, the absence of a functioning hospital system increases the fatality rate of the disease. I think China will reach that point very soon.

7/ In terms of fatalities, the key question for me is as follows: how well do two doses of Sinopharm or CoronaVac protect against severe disease and death? Especially in the context of vaccine effectiveness waning over time.

8/ Data on this is not particularly reassuring:

nature.com/articles/d4158…

9/ This is the most important variable in determining how many fatalities China will suffer.

10/ Regardless, the sheer number of infections that will occur over the next two to three months will obviously cause four ongoing negative population health effects for China.

(a) There will be millions of cases of Long Covid.

11/ (b) There will be very large numbers of secondary bacterial infections - particularly acute bronchitis and pneumonia - in individuals who have had Covid.

(c) Health system overload will cause excess morbidity and mortality because people with conditions other than Covid...

12/... will not be able to access timely care.

(d) Immune dysregulation caused by SARS-CoV-2 will cause a significant increase in other infections amongst the Chinese population. We may well see other pathogens endemic in China behave atypically or more severely.

13/ Precursor chemicals used in the manufacture of pharmaceuticals are exported primarily from three countries: the US, India, and China. In the context of both inevitable negative supply chain impacts from China, and the recent unprecedented demand for antibiotics...

14/... in other parts of the world, it is likely that the global supply chain for pharmaceuticals will be significantly disrupted. This, of course, will have negative population health impacts globally.

15/ If you are taking regular medication for a chronic condition, now might be a good time to request an extra supply from your healthcare provider.

16/ Uncontrolled viral transmission in China also poses a significant risk for the emergence of a new variant. There are a large number of immunocompromised people in China, and the majority of these individuals are going to get infected over the next few months.

17/ The Alpha variant emerged in the UK in a comparable situation. A relatively immune-naive population, although, unlike China, entirely unvaccinated. Still, my feeling is that there is a good possibility a new variant will emerge from China.

18/ The significance of any such variant cannot be predicted at this time. There are possibilities for increased intrinsic transmission and / or recombination.

It should be remembered, however, that the next new VOC could well appear in some other part of the world /end