Explained: Should India worry about COVID now? Will booster shots help?

As China fights a fresh onslaught of coronavirus cases, experts have warned that the country will witness at least three waves from January 2023, while the infection will spread to 10 per cent of the world’s population in the next 90 days, leading to at least a million deaths.

While the rest of the world is understandably anxious, experts say the virulence of COVID may be limited to China this time round. The Indian government, while warning states to be vigilant about genome sequencing, has not raised any alarm. 

What is happening in China?

While the Chinese government had put strict curbs as part of its ‘Zero-COVID’ policy for the last three years, enforcing mandatory hospitalisation for known cases (even asymptomatic ones), lockdowns in areas witnessing small outbreaks and isolating suspected cases and their contacts besides imposing a 10-day isolation on foreign travellers, all hell broke loose when the curbs were eased last month following vehement protests by residents.

As the curbs eased, the infection spread at a rapid pace in the first two weeks of December. Media has reported about hospitals overflowing with patients, pharmacies running out of basic cold and fever medicines and crematoriums choked with dead bodies. Shanghai and Beijing are said to be the most affected.

Also read: China’s zero-COVID policy wreaks havoc as cases surge and so do protests

Wu Zunyou, the chief epidemiologist at the Chinese Centre for Disease Control and Prevention, while addressing a press conference in Beijing said that the current outbreak would peak in winter and would be followed by three COVID waves in as many months.

“The first wave would run from now until mid-January. A second wave would likely follow soon after, triggered by the mass travel of hundreds of millions of people across the country from the Lunar New Year starting on 21 January,” he said, adding that the third wave will occur between late February to mid-March when the holiday season is over.

‘Thermonuclear bad’

A series of tweets posted by a Chinese epidemiologist on Monday, who through photos depicted the severity of the situation in China, rang the alarm bells for other countries in Asia including India.

Also read: 4 cases of China’s new Covid variant found in India; airport screening to begin

Dr Eric Feigl-Ding shared footage of an overcrowded health facility where patients wearing oxygen masks were lying next to each other, with some even lying on the floor. Another tweet showed dead bodies lined up on gurneys and beds in rooms and corridors of what looked like a hospital.

“Thermonuclear bad – Hospitals completely overwhelmed in China ever since restricts dropped. Epidemiologists estimate >60% of China & 10% of Earth’s population likely infected over next 90 days. Deaths likely in the millions – plural. This is just the start,” he tweeted.

This is why I warn that “What happens in China doesn’t stay in China”. Medication supply chains included. Please see this mega thread 🧵 on current situation. https://t.co/U94RNXvkTZ

— Eric Feigl-Ding (@DrEricDing) December 20, 2022

 In another tweet, Dr Feigl-Ding said that the virus takes not days but hours to double.

“Doubling time in China may not be days anymore. Doubling time now possibly “hours” says some experts — let that sink in. R is hard to calculate if doubling is <1 day because it’s hard to PCR test that fast. The point is China and the world is in deep trouble (sic),” he tweeted.

While the Xi Jinping government has remained silent on the deaths, Dr Feigl-Ding alleged that the goal of the government is now to “Let whoever needs to be infected, infected, let whoever needs to die, die. Early infections, early deaths, early peak, early resumption of production.”

Cases under-reported?

Dr Feigl-Ding said the cases and deaths in China are grossly under-reported. He said, this is established by a survey of hospitals, funeral houses and related funeral industry chains in Beijing which shows an explosion in funeral services and sharp increase in deaths.

According to Reuters, China reported two deaths on Sunday and five on Monday.

The fresh cases stood at 2,700 on Monday, lower than the 40,000 cases recorded a couple of weeks ago.

Also read: China reports first COVID death in six months; curbs in place

The World Health Organisation, records China’s total COVID cases at 1,00,88,555 and deaths at 31,378 since the outbreak of the pandemic on January 3, 2020. China, however, sticks to the death toll of 5,242 as it only considers respiratory failures as COVID cases.

While deaths where COVID is a contributing factor is counted as a COVID death in most countries, reports say China doesn’t consider such deaths as COVID deaths.

Is BF.7 sub-variant responsible for the surge?

Even though the BF.7 (shorter for BA.5.2.1.7) sub-variant of Omicron variant is the suspected dominant strain that is causing the infections, experts say underlying diseases and the vulnerability of the population, which has been under lockdown for so long, are the main causes that are driving the surge in cases.

The variant has been around for almost a year with cases being reported from the UK, Australia and Belgium.

As compared to sub-variants like BA.1, BA.2 and BA.5, the virus is highly infectious, has a faster transmission rate, shorter incubation period and is capable of evading immunity either from natural infection or through vaccination.

“From what I can understand, the strict lockdowns in China meant that a huge proportion of the population did not get the infection. We have seen that a natural infection provides a wider and longer immunity against COVID-19. In India now we are seeing people out and about, even without masks, but we are not reporting a high number of cases because people have a hybrid immunity from natural infection as well as high levels of vaccination,” Indian Express quoted Dr Ekta Gupta, a virologist, as saying.

What does WHO say?

Taking note of the “potentially devastating wave” in China, the WHO has said that it may be too early to announce the end of the pandemic.

Dutch virologist Marion Koopmans, who is part of a WHO advisory committee on the status of COVID emergency, told Reuters that “pending wave in China is a wild card” when the rest of the world is in a very different phase of the pandemic.

Earlier in September WHO chief Tedros Adhanom Ghebreyesus had said that the end of the pandemic was in sight.

What is India doing?

With India already having reported three cases of the BF.7 sub-variant, Union Health Ministry Mansukh Mandviya during a review meeting on Wednesday (December 21) asked concerned officials to ramp up surveillance in view of the situation in China while assuring that the government is ready to handle any situation.

“In view of the rising cases of COVID-19 in some countries, reviewed the situation with experts and officials today. COVID is not over yet. I have directed all concerned to be alert and strengthen surveillance. We are prepared to manage any situation,” he tweeted.

Also read: COVID cases rising globally, Centre asks states to be on alert

Besides China, cases have also seen an uptick in Japan, US, Korea, and Brazil.

The ministry on Tuesday had directed all states and Union territories to ramp up genome sequencing of infected patients to stay abreast of any new variants. In a letter, the ministry had also requested states and union territories to send samples of all positive cases on a daily basis to designated INSACOG (Indian SARS-CoV-2 Genomics Consortium) Genome Sequencing Laboratories (IGSLs). The exercise will help the government detect new variants faster and take necessary measures.

The ministry said the government with its strategy of test-track-treat-vaccinate and implementation of COVID-appropriate behaviour has been able to curb cases and is recording around 1,200 cases on a weekly basis.

Will booster shots help?

The government has said that COVID-appropriate behaviour like wearing of masks and getting booster shots will go a long way in preventing a fresh outbreak.

VK Paul, member of NITI Aayog said only 27 to 28 per cent of people have taken their precautionary dose, and urged the rest, especially senior citizens, to get jabbed at the earliest.

While expressing concern over the rise in COVID cases in China, Serum Institute of India CEO Adar Poonawalla, however, assured that India is armed with “excellent vaccination coverage” which leaves no space to panic and that people should trust the guidelines set by the government.

The latest state of affairs has also pushed China to get its most-vulnerable section vaccinated at war footing.

Experts have been unanimous in the opinion that while booster shots do not give cent per cent protection against the virus, they significantly lower a person’s risk of getting severely ill or hospitalised if infected.