COVID-19 upsurge in China poses worldwide threat

Joseph Giambrone, professor emeritus in the Auburn University College of Agriculture’s Department of Poultry Science with a joint appointment in the College of Veterinary Medicine’s Department of Pathobiology, has penned this article about the worldwide threat posed by the latest upsurge of COVID-19 in China.

COVID-19 is now out of control in the People’s Republic of China. Following the precipitous ending of an intended “Zero COVID” policy imposed by the communist government of China, all pretense of suppression was abandoned and the subsequent street demonstrations. Based on hubris and contrary to basic epidemiologic principles, the central government attempted to eliminate COVID-19 infection by a process of mass screening with localized and, in some cases, metropolitan shut-ins and quarantines. This approach, coupled with an obviously ineffective vaccine has resulted in a high proportion of the population being susceptible to COVID-19.

The government of China squandered two years during which it could have deployed an mRNA vaccine, expanded hospital facilities and established an inventory of effective anti-viral drugs. It is estimated from a variety of models that 80% of the population of China has been exposed to COVID-19. This first wave of COVID-19 was swift, but not long-lasting. With the lunar New Year celebration, millions of Chinese are traveling. This could cause a second wave of COVID-19, producing fatalities exceeding 1.5 million, with the elderly most affected.

Social media in China characterizes the escalating incidence rate as a tsunami. The government of China describes the abrupt change in policy from Zero COVID to laissez faire, or allow to do, as “optimization of prevention and control measures.” The government failed to prepare for eventual restoration to pre-COVID-19 social and economic activity by immunizing the population and preparing for an upsurge in hospitalization and ICU admissions.

The inactivated vaccine deployed in China in a two-dose sequence provides only short-term protection against severe clinical signs. The vaccine is based on the 2020 Wuhan strain and is relatively ineffective against the predominant circulating viruses. These include BA.5.2, a subvariant of the BA.5 Omicron sub-variant and strain BF7 also in circulation. The situation in China has implications for the rest of the world.

The gross mishandling of COVID-19 with resulting exponential explosion of new cases creates a situation favoring the emergence of new variants, some of which may be more pathogenic with potentially lower protection provided by current mRNA vaccines. We can but hope that China can control COVID-19, applying effective mRNA vaccines that can be modified in the short term in response to emerging variants.

If they were dealing with a rational government, appropriate control measures could be implemented on a global basis. In the absence of epidemiologic data, disregard of transparency verging on obfuscation, international health authorities are operating in uncharted territory. Responding to the inevitability of dissemination of variant strains, many nations imposed restrictions on air travel from China. The simple expedient of demanding COVID-19 rapid tests before boarding international flights is ineffective. A few individuals with a false negative test on a long-haul journey will result in extremely high infection rates. Post-arrival testing is more effective, but quarantine facilities will be required to accommodate those positive and their contacts. Outright bans on travel are ameliorative, but those who are desperate will find ways to evade regulations. Experience has shown that, by the time travel restrictions are imposed, variant strains have already emerged in nations that establish programs of pre-departure testing.

From a public health perspective, infection of a large, susceptible population with current strains of COVID-19 has the potential to produce new variants that may demonstrate either higher infectivity, pathogenicity or both. This has implications for the entire world population. Attempting to confine variants to China by imposing travel restrictions is essentially shutting the stable door after the horse has bolted.

We can only hope that the World Health Organization has sufficient leverage with more receptive elements within the public health system of China to release reliable statistics, and above all, the molecular characterization of variants. In the interim, genetic sequencing of isolates derived from aircraft wastewater can provide some indication of variants circulating in Asia and other continents. 

Although we were looking forward to an end to COVID-19 with required masking and other restrictions, it would appear that we are not by any measure “out of the woods.” Common sense and basic preventive measures will have to be maintained for the current year. Fortunately, our mRNA vaccines can be modified over the short term to produce more effective and specific protection provided as boosters. These are only effective on the personal and community levels if administered according to public health recommendations.

We must have trust in our public health advisors, extend support to the Centers for Disease Control and Prevention and follow advice from medical specialists based on sound science. Above all, we should reject speculation and politically tainted and anti-science misinformation circulating on the internet if we are going to come to terms with and coexist with this disease.

About Joseph Giambrone:

Joseph Giambrone is a professor emeritus in Auburn University’s Department of Poultry Science with a joint appointment in the Department of Pathobiology in the College of Veterinary Medicine. During his graduate research career at the University of Delaware, he was part of a research group that developed the first vaccine against an antigenic variant of an avian coronavirus. During a sabbatical leave during his tenure at Auburn, he was part of a research group in Australia that sequenced the entire genome of antigenic variant of a coronavirus of chickens. During his 42-year research career as a molecular virologist, immunologist and epidemiologist, he has made critical advancements in understanding the ecology of viral pathogens, led efforts to improve detection and surveillance of viral diseases and developed new and effective vaccines and vaccine strategies to protect commercially reared chickens as well as pathogens, such as avian influenza viruses, which have spilled over into human populations. His research has had a profound impact on practices used today to reduce the incidence and severity of viral diseases of commercially reared poultry as well in human populations.