COVID is now regarded as 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 following the 20^th Congress and the subsequent street demonstrations.  Based on hubris and contrary to basic epidemiologic principles, the central government attempted to eliminate COVID 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. The government of China squandered two years during which they 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 half of the population of China will be exposed to COVID within the first quarter of 2023 and that fatalities may exceed 1.5 million inn three months with the elderly most affected.

True to form, the Government is no longer releasing statistics, but it is estimated that during December, as many 250 million of the Chinese population of 1.4 billion were exposed with fatalities running at over 10,000 per day.  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.  Both these viruses have emerged in Japan, although the level of protection afforded by mRNA vaccines and personal protective measures should reduce the impact of these variants. 

Both strains preceded the emergence of XBB.1.5 that has been identified in 29 nations. This Omicron variant was responsible for 41 percent of new cases in the U.S. and 70 percent in the Northeast during the last week in December 2022. This strain is highly efficient at binding human ACE receptor cells and is immune evasive. This virus is contributing to the rise in cases in the U.S. requiring hospitalization, averaging 6,500 per day for the week ending January 4^th 2023. The strain is responsible for most cases in India where it emerged, and has also extended to other Asian nations, including Singapore.

The situation in China has implications for the rest of the world.  The gross mishandling of COVID 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.

It is questioned whether the approach by the communist government of China was a cynical attempt to suppress infection prior to and during the 20^th National Conference that reappointed President Xi to an unprecedented third term and possibly life tenure.  Rapid transition from Draconian restrictions to lassiz faire will cost the nation dearly in lives, expenditure on health support and a loss in productivity.  Obviously, disruption in manufacturing output will depress GNP and may create a new wave of supply chain problems for the U.S and the E.U.

If the world and specifically, the WHO, 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 Rapid Immunoassay tests before boarding international flights is ineffective. A few individuals on a long-haul journey will result in extremely high infection rates on landing as evidenced by a 40 percent positive test result from a planeload of tourists from China landing at Milan Airport, Italy.  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.

Although we were looking forward to an end to COVID 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.