Is the Chinese health system ready for the end of zero-COVID?

Is the Chinese health system ready for the end of zero-COVID?

More Chinese cities have announced easing of restrictions following unprecedented protests against China’s tough “zero-COVID” policies over the weekend.

But easing strict quarantine policies carries other risks, as health experts warn that China must increase vaccination rates, especially among the elderly, and prepare hospitals and medical staff or risk a massive number of deaths.

Ben Cowling, a full professor of epidemiology at the University of Hong Kong’s School of Public Health, said other countries had experiences that Beijing could learn from.

“Until recently they hadn’t thought about a zero-COVID exit. There hasn’t been enough consideration for alternative strategies. This means the country is no longer so well prepared for a zero-COVID exit. .”

He pointed to experiences in Taiwan and Singapore which saw a sharp rise in deaths after abandoning their zero COVID policies of border closures, contact tracing and isolation. But the hospitals were sufficiently prepared for it, which allowed them to avoid being overwhelmed like less prepared countries, such as India.

“One thing we have known for the last three years is that when there is a large increase in cases, even when most cases are very mild, there is a small part that is serious and these cases will exert a lot of pressure on hospitals, whether it’s oxygen supplies and intensive care beds with ventilators or specialist doctors and nurses,” Cowling said.

“I know they can build things very quickly in China, but for ICUs (intensive care units) it’s not always about finding space and having enough beds; the problem is to make sure staff have critical care training, and I don’t think that’s something they can learn quickly.”

Despite recent protests against the policy in several cities across mainland China, as well as economic loss and inconvenience to people, Cowling advises against ending closures immediately.

“I fear a transition now is too sudden as older people haven’t had a chance to get their reminders and hospitals to prepare,” he said. “It may be more rational to continue zero-COVID for a little longer but alert the population and hospitals that there could be a transition in the coming months.”

When hospitals are overwhelmed with patients, death rates rise. China has roughly the same number of hospital beds per 100,000 people as the United States, but it has far fewer intensive care unit beds. According to government statistics, there are 3.6 intensive care (ICU) beds per 100,000 people in China, compared to 11 in Singapore and 29.4 in the United States.

In Hong Kong, the death rate for cases with the same level of severity and similar characteristics was two to three times higher during the height of the outbreak when the medical system was under pressure, Cowling said. Similar observations have been made in other countries.

Chan Chang-chuan, dean of the College of Public Health at National Taiwan University, said China could see around 100,000 deaths if it mirrors what happened in Taiwan, where the death toll has risen d about 16 times after switching to coexistence with the virus.

“Cases and deaths will be much higher than before. They know that, but there’s no other way,” Chan said, noting that the experience in places that previously had strict COVID policies – Iceland, Japan, New Zealand, South Korea and Taiwan — has shown that it is impossible to keep COVID-19 out forever.

A Chinese academic study published in Nature Medicine in May estimated that there could be up to 1.5 million deaths if China ended its wildly unpopular COVID-19 lockdowns without increasing vaccination rates and improving its medical response capabilities.

Avoid overcrowded hospitals

There could also be deaths caused indirectly by COVID, if hospitals can no longer treat patients with long-term illnesses or handle medical emergencies.

“I think in mainland China that will be the case as well and when there’s a really big surge of COVID, there’s a ripple effect for people with other health issues. If anyone has a heart attack in China today the response will be quick and the ambulance will arrive quickly and could save their lives.In two or three months the ambulance line will already be full of people calling and even if you succeed , the ambulance might not come,” Cowling said.

The number of deaths can be reduced if China convinces its people to get vaccinated, especially if they take a dose of the most effective mRNA vaccine, Chan said.

According to the government, 90% of the population have been vaccinated with two doses of Chinese vaccines, including Sinopharm and CoronaVac, but they are made with the traditional method of using inactivated viruses, which is considered by some experts to be less effective than the mRNA method used to manufacture Pfizer-BioNTech and Moderna products.

A much smaller percentage – 56% – of the general population, 68% of people aged 60 or over and only 40% of people aged 80 or over received a booster shot, according to China’s National Health Commission. health.

“If you want to deal with the omicron, you have to have three injections,” Chan said, adding that getting a fourth injection would provide even more protection.

Cowling said there was no need for less vulnerable non-elderly people to receive more vaccines, given that the symptoms of omicron are mild for most people.

“There should be a campaign for people who have never been vaccinated to get three doses, and for older people, if it’s been more than six months since they were last vaccinated, to get a recall now. It’s not necessary for everyone to do this,” he said.

Cowling also said there was no need for China to import the Pfizer-BioNTech or Moderna vaccines, pointing out that a study he and his colleagues conducted and published in the medical journal The Lancet in October found that the Chinese vaccines were as effective as mRNA ones. if three doses are taken.

“I would say for the vaccines that are available in China, they’re very effective against COVID — and we’ve proven that. … I don’t think there’s a need to use the other vaccines,” Cowling said.

Until recently, China considered itself a success in the fight against COVID-19. With a population of 1.4 billion, the most populous country has so far reported around 340,000 cases and 5,200 deaths. But the country’s biggest COVID health challenge may yet be ahead.

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