New Covid wave in China sparks warning for the world, says SBMT president

In 2023 it will still be necessary to guarantee access to antivirals to all countries, especially those in Africa, where access to vaccines and extremely important medications is difficult

A new Covid wave is spreading across China and has caused an overload on funeral and health services. After reports of the explosion in the number of positive cases, China stopped publishing daily updates of cases. A statement from China’s National Health Commission (NHC), quoted by The Guardian newspaper, stressed that relevant information about Covid will be published by the Chinese Center for Disease Control and Prevention for reference and research. The reasons for changing the update model were not detailed. The projection “China’s COVID-19 wave forecast to have two peaks where cases could reach 4.2 million a day” by health data company Airfinity shows that almost 5 thousand people are dying per day in the country.

A study, not yet peer-reviewed, conducted by Hong Kong researchers, entitled “Modelling the adjustment of Covid-19 response and exit from dynamic zero-COVID in China” and a survey on the end of the “Zero-covid” program in China, published in the journal Nature, entitled “China COVID wave could kill one million people, models predict” predict that deaths could reach 9,000 per day in March and the total can be above one million people.

The president of the Brazilian Society of Tropical Medicine (SBMT), Dr. Julio Croda, explains that China went from zero Covid to a new wave of infections because they had a very efficient model of tracking contact cases, using GPS technology mainly through mobile applications, QR Code and instituted specific lockdowns in cities or regions depending on the number of cases. “So they managed, with a very effective strategy, to reduce transmission, but with a very high economic cost, which generated protests and, therefore, in recent weeks the country announced the end of the zero-Covid policy. When there is no search for contacts and measures associated with their decrease, transmission occurs naturally. This is what has happened in China, as it happens everywhere in the world,” he adds. China was the only country that still adopted a stricter policy, mainly to control the transmission of the virus.

Dr. Croda points out that the new wave in China serves as a warning that infection will occur if we do not have vaccines or if they have lost some of the effectiveness for symptomatic disease. “This is what we are looking at this moment, when vaccines do not effectively protect, but still protect against hospitalization and death,” he warns. Also according to him, this was expected, because without non-pharmacological measures, the tendency is for transmission to occur and, consequently, increase the number of cases,” he adds. Chinese experts warn that the worst is yet to come. A second wave is expected to last from late January to mid-February, triggered by mass travel for the Lunar New Year holiday, which will be on January 21. The third wave is expected to occur between late February and mid-March, when people return to work after the week-long holiday.

Despite the circulation of a new variant (BQ.1), the escalation of Covid-19 in China, according to Dr. Croda, is a matter of immunization of the population, either by infection or vaccination. In the case of China, as the virus has not circulated and vaccination coverage, especially of the third dose, essential in the context of omicron and its subvariant, is low, the population has little immunity, especially the elderly over 80 years old, who did not receive the booster dose. This can cause an impact on health services, especially in the demand for hospitalization, for example, infirmary and infirmary beds and Intensive Care Units (ICU). “The impact in China is greater than anywhere else, despite its repercussions in different parts of the world, and it will depend on the vaccination coverage of the population of each region and previous infections,” says the infectious disease specialist.

In Brazil, more people have tested positive for Covid-19 in recent weeks. The new wave of the disease, which came along with two new subvariants of omicron, XBB and BQ.1, already has an impact around the world and begins to grow in Brazil. Dr. Croda draws attention to our moving average, which has exceeded 100 cases/day and, according to him, deaths can be reduced with adequate vaccination coverage and specific antiviral medication for Covid, whose purchase has already been made by the Federal government, despite being a very small batch. But, unfortunately, it is not available for broad population access in the Basic Health Units. The president of the SBMT stresses that Brazil needs to reinforce the importance of completing the vaccination cycle. He recalls that a high coverage, especially of the second booster dose, along with rapid and early access to antiviral (especially for the elderly and immunosuppressed), once the disease is diagnosed, either by PCR or antigen testing, can reduce the lethality of the disease by cutting its impact.

Ministry of Health receives bivalent vaccines

The Ministry of Health received at the end of December the first batch of the bivalent Covid-19 vaccine from Pfizer. It protects against the original strain and against the BA.4/BA.5 omicron subvariants. The board also negotiates the purchase of another 50 million doses. Pfizer’s bivalent immunizers were approved by the National Health Surveillance Agency (Anvisa) on November 22 and are considered second generation. They were designed to offer extra protection against the omicron and its subvariants. The bivalent BA.1, protects against the original strain and also against the subvariant omicron BA.1; and the bivalent BA.4/BA.5, protects against the original strain and also against the subvariant omicron BA.4/BA.5. According to the calculation carried out by the National Council of Health Secretaries (Conass), based on LocalizaSUS, Brazil needs 370 million doses of immunizers, 276 million more than available.

Asked if the vaccines already applied protect against the new variant, Dr. Croda is categorical in stating that yes, especially against hospitalizations and deaths. “It is very important that the population does not wait for a new, updated bivalent vaccine. It is essential that everyone has the vaccination schedule up to date at this time, especially with the increase in transmission”, he stresses. A vaccine given in the last six months guarantees extremely high protection against hospitalization and death.

Florida Court Authorizes Covid Vaccine Investigation

Meanwhile, the Florida Supreme Court, at the request of the state governor, Ron DeSantis, has authorized a jury to investigate any irregularities related to Covid-19 vaccines. The governor stated in the document sent to the Judiciary that the investigation would aim to bring out more information about pharmaceutical companies, vaccines and side effects. According to him, there is an increase in cases of myocarditis and pericarditis in people who received the vaccines from Pfizer and Moderna. In addition, the Florida Department of Health conducted an analysis that would have found an increase in the relative incidence of heart-related deaths in men ages 18 to 39, 28 days after vaccination with immunizers using mRNA technology.

Dr. Croda clarifies that Florida goes against the United States Centers for Disease Control and Prevention (CDC) and most scientific articles. “Again we see the political use of a specific government, as we saw in Brazil, when the government supported the so-called early treatments with Chloroquine and Ivermectin and doubted the effectiveness of the vaccine. We can assure that they are extremely effective, including the mRNA vaccine, to prevent hospitalization and death. Obviously, with the emergence of new variants, there is a loss of efficacy for protection from symptomatic disease, as the virus goes through the process of evolution to escape the immune response so that it can perpetuate among people. Therefore, at this moment we work with updated vaccines so that we can guarantee protection against asymptomatic disease,” he details.

End of Covid-19 emergency

In a hopeful tone, the director-general of the World Health Organization (WHO), Tedros Adhanom, said in mid-December that he hopes to declare an end to the Covid-19 emergency this year. However, he is very concerned about the evolution of the disease in China, with increasing reports of serious illnesses, and said the WHO has helped the country focus its efforts on vaccinating people at higher risk, and that support for clinical care and protection of its health system will be maintained.

Dr. Croda is also hopeful that by 2023 the emergency will be declared over, as it was generated by a lack of preparation to deal with the new disease, with regard to personal protective equipment, hospital beds, vaccine options and therapeutics. “Although Covid still has a huge impact on our society, killing twice as much as the flu virus (Influenza), today we know how to prevent ourselves, we have the ability to treat patients in infirmary and intensive care beds, we have vaccines available that reduce mortality and we have specific antiviral drugs that can be used to further reduce the risk of death. That is, the current reality is quite different,” acknowledges the infectologist. Finally, he reinforces that in 2023 it will still be necessary to guarantee access to vaccines and antivirals to all countries, especially those in Africa, where there is difficulty in accessing vaccines and medications that are extremely important.