China Covid outbreak: Delta variant challenges zero infection strategy — and raises

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The latest outbreak started two weeks ago in the eastern city of Nanjing, where nine airport cleaners were found to be infected during a routine test. Since then, the cluster has spread to at least 26 cities across China, including a tourist hot spot in the southern province of Hunan and the capital Beijing.

Chinese authorities responded swiftly with mass testing, targeted lockdowns, extensive contact tracing and quarantine of close contacts — a tried and tested formula that has helped it quickly tame local flare-ups since March 2020.

In Nanjing, a city of 9.3 million people, residents went through three rounds of coronavirus testing in two weeks. Residential compounds with confirmed cases were locked down, while cinemas, gyms, bars and libraries were shuttered.
In Zhangjiajie, where a theater performance attended by thousands of people has fueled concerns of a super-spreader event linked to the Nanjing cluster, all tourist destinations were shut down and residents are banned from leaving their compounds.

Restrictions have also been ramped up in Beijing, which reported its first local infection in nearly six months last week. Since then, five local cases with travel history to Zhangjiajie have been detected. The city has banned people from medium- or high-risk areas from entering, suspending flights, trains and buses from Covid-hit places.

Huang Yanzhong, senior fellow for Global Health at the Council on Foreign Relations, said Chinese authorities are responding to the threat of the Delta variant with the same playbook used in previous outbreaks, but in an even more stringent manner — several cities have been placed under effective lockdowns.

“It shows the problem of diminishing returns of the existing ‘zero-tolerance’ approach,” he said.

Elsewhere in the world, countries with relatively high vaccination rates are increasingly choosing to tolerate a degree of transmission, as long as it doesn’t translate into a surge in hospitalizations and deaths. In China, however, authorities appear intent on imposing strict restrictions despite having administered more than 1.65 billion homegrown vaccine doses — ranking above the US in terms of doses administered per 100 people.

The rapid spread of the Nanjing cluster to cities across the country has triggered concerns over the level of protection currently offered by Chinese vaccines against the Delta variant.

On July 22, two days after the Nanjing cluster was first detected, a health expert in the city said the “vast majority” of those infected there had been vaccinated, except for one person under 18 years old. Airport staff, along with medical workers and border control personnel, were among the first to be vaccinated in China.

Chinese authorities have not offered a fuller breakdown of how many subsequent cases were also vaccinated.

Several other countries that used Chinese vaccines have also reported infections among vaccinated people. In June, Indonesian officials said more than 350 medical workers in the country had contracted Covid-19 despite being inoculated with vaccines produced by Chinese company Sinovac Biotech.

Breakthrough cases have also been reported among people fully immunized with more effective vaccines, such as those produced by Pfizer/BioNTech and Moderna. In a report released Friday, the US CDC found that about 74% of the 469 Massachusetts residents who were infected in July had been fully vaccinated — with the Delta variant revealed as the main culprit.

Chinese experts have tried to assure the public that Chinese vaccines are still effective against the Delta variant.

On Saturday, Shao Yiming, an expert at the Chinese Center for Disease Control and Prevention, said at a news conference that breakthrough infections are a “normal” phenomenon, while stressing that such cases are only a minority among vaccinated people around the world. Feng Zijian, another Chinese health expert, added that while their immunity level against the Delta variant may be lower, existing vaccines still provide good enough prevention and protection.

But Huang, the expert at the Council on Foreign Relations, said the relatively low efficacy of Chinese vaccines against the Delta variant would only push authorities to double down on their “zero tolerance” containment-based approach as opposed to the mitigation-based method adopted elsewhere.

“That means China is likely still months away from opening its borders to the world,” Huang said.

It remains to be seen if repeated lockdowns and mass testing drives can sustain public support in the long run. Tolerance for such measures could begin to wane if, as expected, the government maintains its hardline approach until after the Beijing Winter Olympics in February next year.

But some prominent Chinese public health experts have raised the prospect that like elsewhere in the world, China will eventually need to learn to coexist with the coronavirus.

Zhang Wenhong, an infectious disease expert at Shanghai’s Huashan Hospital, said it…



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