The situation with COVID-19 in China is of course big news. Modelling by Airfinity predicts total cases in China could reach as high as around 4 million a day with two peaks emerging over the next 4–5 months. Under a hospitalisation rate of 3%, new hospitalisations could exceed 120,000 daily, with cumulative hospitalisations possibly surpassing 6 million by late April.
Further, peak ICU occupancies are projected to be over 300,000 with some regions oversubscribed for a month, and oxygen requirements challenging. Airfinity estimates 3 million cases and 18,900 deaths per day currently, with 33 million cases and almost 200,000 deaths cumulatively so far; there are some news reports citing leaked official case numbers still much higher than this for December 2022.
BBC quotes an official press conference in China’s third largest province Henan, as saying that around 90% of the population have been infected in the current period.
Three years after the pandemic began, we are again seeing many countries applying testing requirements to travellers from China, apparently aimed at reducing the importation of a virus that is already ubiquitous in their own communities. Since my last update many more have announced this, the list now including India, Italy, Japan, Malaysia, South Korea, USA, Spain (non-vaccinated passengers), Ghana, Israel, Qatar, UK, Sweden, Australia and (slightly differently applied) France, also Taiwan for travellers from mainland China. Recently after EU encouraged it, Germany and Portugal joined those requiring testing before travel from China.
A number of scientists have continued to point out the ineffectiveness of these travel measures. Still, so far in China it is reported that 97.5% of samples sequenced are of the BA.5.2 or BF.7 lineages, and no sub-variants have appeared there that are new to the rest of the world.
On the first day of the new restrictions being in place in South Korea, requiring pre-travel COVID-19 testing from China, some 20% of Chinese arrivals tested positive on PCR upon arrival: https://mothership.sg/2023/01/61-covid-positive-china/ underlining the ineffectiveness of the measure. IATA’s own strong statement opposing the testing is here: https://www.iata.org/en/pressroom/2023-releases/2023-01-04-01/ and IATA has engaged with a number of governments as well as with ICAO.
Some experts have called instead for trying to institute wastewater testing from both airports and aircraft, suggesting it could be useful for sequencing potential new variants, and some countries are making moves in that direction, including advice from the EU, although there are there some challenges which need to be met before putting such testing in place.
Europe is encouraging such testing but it has been noted by ECDC that such testing has limited value in detecting new variants that were not previously identified. A UK Government document from a year ago provides a useful analysis of effectiveness of a range of travel-related measures, in context: https://www.gov.uk/government/publications/dft-and-fcdo-international-importation-border-and-travel-measures-21-january-2021/dft-and-fcdo-international-importation-border-and-travel-measures-21-january-2021 Amongst many other findings it notes “By the time a case of a new variant is detected for the second time through sequencing approaches, there will already be a significant number of infections in the community.”
In the other direction, China has lifted many travel-associated measures for arriving travellers. Starting Sunday 8 January, quarantine-free cross-border travel resumed in China after three years. International arrivals will no longer be subject to quarantine, but still need to show a negative COVID-19 test result taken within 48 hours of boarding, according to the Civil Aviation Administration of China and the General Administration of Customs. This retained requirement is also viewed as ineffective and inappropriate.
Elsewhere: Globally, BQ.1 and its sub-lineages account for almost half of new sequences. in the USA, the XBB.1.5 omicron subvariant that’s currently dominating (causing 7 out of 10 infections in Northeast USA) is the most contagious version of Covid-19 yet, although it doesn’t appear to make people sicker, according to the World Health Organization. It has been expected that XBB.1.5 will increase in Europe and this appears to be starting to happen already.
David Powell
IATA Medical Advisor