Category Archives: Pandemic

2023 Nobel Prize in Medicine: Karikó, Weissman awarded prize for mRNA research

Posted on by • Posted in Clinical Research, Clinical Research Funding, Coronavirus, mRNA-based Vaccines, Nobel Prize, Pandemic, Public Health, Public Health Emergency (PHE), Public Health Strategy, Vaccine, Vaccine Development, Vaccine History, Vaccine RNA • Leave a comment
2023 Nobel Prize in Medicine: Karikó, Weissman awarded prize for mRNA research

Two pioneers of mRNA research — the technology that helped the world tame the virus behind the Covid-19 pandemic — won the 2023 Nobel Prize in medicine or physiology on Monday.

Overcoming a lack of broader interest in their work and scientific challenges, Katalin Karikó and Drew Weissman made key discoveries about messenger RNA that enabled scientific teams to start developing the tool into therapies, immunizations, and — as the pandemic spread in 2020 — vaccines targeting the SARS-CoV-2 coronavirus. Moderna and the Pfizer-BioNTech partnership unveiled their mRNA-based Covid-19 shots in record time thanks to the foundational work of Karikó and Weissman, helping save millions of lives.

Karikó, a biochemist, and Weissman, an immunologist, performed their world-changing research on the interaction between mRNA and the immune system at the University of Pennsylvania, where Weissman, 64, remains a professor in vaccine research. Karikó, 68, who later went to work at BioNTech, is now a professor at Szeged University in her native Hungary, and is an adjunct professor at Penn’s Perelman School of Medicine. 

The duo will receive 11 million Swedish kronor, or just over $1 million. Their names are added to a list of medicine or physiology Nobel winners that prior to this year included 213 men and 12 women.

The award was announced by Thomas Perlmann, secretary general of Nobel Assembly, in Stockholm. Perlmann said he had spoken to both laureates, describing them as grateful and surprised even though the pair has won numerous awards seen as precursors and had been tipped as likely Nobel recipients at some point.  

Every year, the committee considers hundreds of nominations from former Nobel laureates, medical school deans, and prominent scientists from fields including microbiology, immunology, and oncology. Members try to identify a discovery that has altered scientists’ understanding of a subject. And according to the criteria laid out in Alfred Nobel’s will, that paradigm-shifting discovery also has to have benefited humankind.

The Nobel committee framed Karikó and Weissman’s work as a prime example of complementary expertise, with Karikó focused on RNA-based therapies and Weissman bringing a deep knowledge about immune responses to vaccines.

But it was not an easy road for the scientists. Karikó encountered rejection after rejection in the 1990s while applying for grants. She was even demoted while working at Penn, as she toiled away on the lower rungs of academia.

But the scientists persisted, and made a monumental discovery published in 2005 based on simply swapping out some of the components of mRNA.

With instructions from DNA, our cells make strands of mRNA that are then “read” to make proteins. The idea underlying an mRNA vaccine then is to take a piece of mRNA from a pathogen and slip it into our bodies. The mRNA will lead to the production of a protein from the virus, which our bodies learn to recognize and fight should we encounter it again in the form of the actual virus.

It’s an idea that goes back to the 1980s, as scientific advances allowed researchers to make mRNA easily in their labs. But there was a problem: The synthetic mRNA not only produced smaller amounts of protein than the natural version in our cells, it also elicited a potentially dangerous inflammatory immune response, and was often destroyed before it could reach target cells.

Karikó and Weissman’s breakthrough focused on how to overcome that problem. mRNA is made up of four nucleosides, or “letters”: A, U, G, and C. But the version our bodies make includes some nucleosides that are chemically modified — something the synthetic version didn’t, at least until Karikó and Weissman came along. They showed that subbing out some of the building blocks for modified versions allowed their strands of mRNA to sneak past the body’s immune defenses.

While the research did not gain wide attention at the time, it did catch the attention of scientists who would go on to found Moderna and BioNTech. And now, nearly 20 years later, billions of doses of mRNA vaccines have been administered.

For now, the only authorized mRNA products are the Covid-19 shots. But academic researchers and companies are exploring the technology as a potential therapeutic platform for an array of diseases and are using it to develop cancer vaccines as well as immunizations against other infectious diseases, from flu to mpox to HIV. An mRNA vaccine is highly adaptable compared to earlier methods, which makes it easier to alter the underlying recipe of the shot to keep up with viral evolution.

As she gained global fame, Karikó has been open about the barriers she encountered in her scientific career, which raised broader issues about the challenges women and immigrants can face in academia. But she’s said she always believed in the potential of her RNA research.

“I thought of going somewhere else, or doing something else,” Karikó told STAT in 2020, recalling the moment she was demoted. “I also thought maybe I’m not good enough, not smart enough. I tried to imagine: Everything is here, and I just have to do better experiments.”

UnitedHealth expects higher medical costs in Q2 as delayed care makes comeback

Posted on by • Posted in Deferred Healthcare, Health Insurance Industry, Inpatient Care, Medical Loss Ratio (MLR), Medicare Advantage, Office Visit, Outpatient Care, Pandemic, Pent-up Demand, Post Pandemic Changes, UnitedHealth Group, UnitedHealthcare, Utilization Trends • Leave a comment
https://www.healthcaredive.com/news/unitedhealth-expects-higher-medical-costs-q2-delayed-care-returns/652930/?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202023-06-14%20Healthcare%20Dive%20%5Bissue:51331%5D&utm_term=Healthcare%20Dive

Dive Brief:

  • Pent-up demand for delayed healthcare during the COVID-19 pandemic is pressuring medical costs for health insurers that had a financial windfall during the pandemic amid low utilization.
  • UnitedHealth, the parent company of the largest private payer in the U.S., expects its medical loss ratio — the share of premiums spent on member’s healthcare costs — to be higher than previously expected in the second quarter of 2023, due to a surge in outpatient care utilization among seniors, CFO John Rex said Tuesday during Goldman Sachs’ investor conference.
  • The news sent UnitedHealth’s stock down 7% in morning trade Wednesday, and affected other Medicare-focused health insurers as well. Humana, CVS and Centene — the three largest MA insurers by enrollee after UnitedHealth — dropped 13%, 6% and 8%, respectively.

Dive Insight:

The early days of COVID saw widespread halts in nonessential services, causing visits to plunge with an estimated one-third of U.S. adults delaying or foregoing medical care in the pandemic’s first year. By 2022, the sizable rebound in deferred care that many predicted had yet to materialize.

Instead, patient volumes increased, but didn’t return to normal levels, threatening the financial health of hospitals, which rely on utilization for revenue. However, the trend helped payers, which reaped some of their highest profits in history during the pandemic on low medical spend.

Now, early signs suggest utilization may again be increasing, with the cost of rebounding care coming around to hit payers. UnitedHealth now expects its MLR for the second quarter to reach or exceed its full-year target of 82.1% to 83.1%.

“As you look at a Q2, you would expect Q2 medical care ratio to be somewhere in the zone of probably the upper bound or moderately above the upper bound of our full-year outlook,” Rex said. “I would expect at this distance that the full year would probably settle in in the upper half of the existing range we set up.”

In comparison, the insurer reported an MLR of 82.2% in the first quarter of 2023. UnitedHealth’s MLR was 82% in 2022.

UnitedHealth said the MLR increase is because medical activity is normalizing after COVID kept seniors away from non-essential care.

“We’re seeing as behaviors kind of normalize across the country in a lot of different ways and mask mandates are dropped, especially in physician offices, we’re seeing that more seniors are just more comfortable accessing services for things that they might have pushed off a bit like knees and hips,” said Tim Noel, UnitedHealth’s chief executive for Medicare and retirement.

The Minnetonka, Minnesota-based insurer has seen strong outpatient demand through April, May and June, particularly in hips and knees with high volumes at its owned ambulatory surgical centers and within its Medicare business, executives said.

Inpatient volumes have remained consistent, and while outpatient utilization has increased, patient acuity has remained the same. Optum Health’s behavioral businesses are also seeing higher utilization in the second quarter, said Patrick Conway, CEO of Care Solutions at Optum, UnitedHealth’s health services division.

UnitedHealth doesn’t expect this higher activity to let up anytime soon. As a result, the payer incorporated higher outpatient utilization into its Medicare Advantage plan bids for 2024, which were placed in early June. The move attests to the longer duration of the trend, SVB Securities analyst Whit Mayo wrote in a note.

“Assuming it is going to end quickly wouldn’t be prudent on our part,” Rex said. “We’ll see how this progresses here.” 

Did All Those Masks Help with Covid or Not?

Posted on by • Posted in Clinical Research, Coronavirus, Infection Control, Infectious Virus, Pandemic, Personal Protective Equipment (PPE) • Leave a comment
Did All Those Masks Help with Covid or Not?

Headlines recently blared about the new review that looked at how effective masks are at preventing the transmission of flu-like disease. Cochrane reviews are well respected, and the media coverage about the recent review has been hard to parse. So is that it, end of story on masks? Not if you skip the media headlines and read the actual review!

Non-hospital physician employment rose sharply during pandemic 

Posted on by • Posted in Market Consolidation, Medicare Advantage, Pandemic, Physician, Physician Employment, Physician Independence, Private Equity • Leave a comment

https://mailchi.mp/28f390732e19/the-weekly-gist-march-10-2023?e=d1e747d2d8

While hospitals, payers, and private equity firms have long been competing to acquire independent physician groups, the COVID pandemic spurred a marked acceleration of the physician employment trend, with non-hospital corporate entities leading the charge.

The graphic above uses data released by consulting firm Avalere Health and the nonprofit Physicians Advocacy Institute to show that nearly three quarters of American physicians were employed by a larger entity as of January 2022, up from 62 percent just three years prior. 

While hospitals employ a majority of those physicians, corporate entities (a group that includes payers, private equity groups, and non-provider umbrella organizations) have been increasing their physician rolls at a much faster rate. 

Corporate entities employed over 40 percent more physicians in 2022 than in 2019, and in the southern part of the country—a hotspot for growth of Medicare Advantage—corporate physician employment grew by over 50 percent.

We expect the move away from private practice, accelerated by the pandemic, will only continue as physicians seek financial returns, secure a path to retirement, and look to access capital for necessary investments to help grow and manage the increasing complexities of running a practice. 

We’ve become even less prepared for the next pandemic

Posted on by • Posted in Health Policy, Pandemic, Pandemic Preparedness, Public Health, Public Health Infrastructure, Public Health Strategy • Leave a comment

https://mailchi.mp/28f390732e19/the-weekly-gist-march-10-2023?e=d1e747d2d8

Published this week in the Washington Post, this sobering article surveys the dismantling of our nation’s patchwork public health infrastructure, driven by a backlash to COVID pandemic restrictions. Positioning themselves as defenders of freedom, a coalition of conservative and libertarian activists, legislators, and judges have neutered many of the nation’s public health authorities. State health officials and governors in over half the country are now unable to issue mask mandates or order school closures without the permission of their state legislatures.

While the implications for a hypothetical “next COVID” are dire, we’re already seeing the consequences today: officials in Columbus, OH can no longer, for example, quarantine a child with measles, or shut down a restaurant experiencing a hepatitis A outbreak. 

The Gist: The anti-public health backlash in the wake of COVID has now been codified, with far reaching consequences for future disease outbreaks. COVID protections for hospital-based healthcare providers are winding down, even in states like California which quickly embraced masking.

But now in over half the country, many reasonable responses to unknown future health threats won’t even be on the table, or will involve debate and legislative action, wasting precious response time. 

So, Is the Pandemic Over Yet?

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Pandemic, Public Health Emergency (PHE), Public Opinion, Public Perception • Leave a comment

In his second State of the Union speech on Feb. 7, President Joe Biden made it clear that the Administration is moving into the next phase of the COVID-19 pandemic—one in which the threats of disease and death are considerably diminished, and therefore no longer require the resources and urgent allocation of funds that the previous two years have.

“While the virus is not gone…we have broken COVID’s grip on us,” Biden said. “And soon we’ll end the public health emergency.”

The President outlined his reasons for not renewing the COVID-19 national and public health emergencies when they expire on May 11, which have been extended every 90 days since they were established in 2020. The decision represents a de-escalation in the way the government is treating the pandemic.

But health experts say now is not the time to let down our collective guard on SARS-CoV-2. “I don’t believe the virus has gotten the memo that the pandemic is winding down,” says Dr. Jeffrey Glenn, director of the Stanford Biosecurity and Pandemic Preparedness Initiative.

“There is a disconnect between the broad perception that the pandemic is behind us, and focusing on getting back to life as it was pre-pandemic,” says Wafaa El-Sadr, founder and director of the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University’s Mailman School of Public Health. “But the reality is that we still continue to have substantial transmission and deaths due to COVID in the U.S., and we are in a situation where the virus will be with us for a long time.”

Even when the emergency states end, therefore, the pandemic will not be over, they and others say.

One reason is that the definition of a “pandemic” is primarily based on the breadth and speed of a virus’ spread, and the amount of the world affected by a pathogen. It’s only partially related to the severity of disease caused by a virus like SARS-CoV-2, or even the amount of immunity a population may have against it.

By that main criterion, COVID-19 is still very much with us, with around 200,000 new cases and 1,000 deaths a day globally. The latest Omicron variants quashed any hope of the pandemic ending any time soon. While they do not cause more serious infections than past variants, they have mastered the challenge of hopping more efficiently from one infected person to another.

Even though the pandemic is far from over, many health experts agree that ending the U.S. national emergencies is justified at this point. When these measures were first implemented in 2020, most people were immunological sitting ducks for the virus. The declarations were designed to devote financial resources and personnel to controlling the impact of infections on the population’s health as much as possible by shoring up the health care system and later by providing free vaccinations. U.S. officials decided to end the national and public health emergencies in May primarily because most people have either been vaccinated or have recovered from an infection (or both), so the population’s immunity stands at a higher level. COVID-19 cases—both overall and the severe kind—have declined considerably since those early days.

But the continuing stream of infections means that the virus is still reproducing and churning out mutations. So far, those variants haven’t caused more serious disease—but that’s purely by chance, which makes public health experts uncomfortable with declaring victory just yet. Even though COVID-19 cases are no longer inundating most hospitals, that means it’s time to rethink the COVID-19 response, not abandon it.

The best way forward at this point is to refine and target COVID-19 services to optimize the chances of controlling the virus where it may be causing the most health problems. “I think we need to move away from universal guidance on vaccines and boosters and mitigation measures where everybody gets the same guidance, to a more differentiated and tailored approach based on the different characteristics—both socioeconomic and clinical—of different groups of people,” says El-Sadr. “We are at a different moment in the pandemic, so the moment is now for a different message.”

That message isn’t to put COVID-19 completely behind us, but to move forward armed with the lessons we’ve learned from our experience—the most important of which is never to underestimate SARS-CoV-2.

Physician burnout reaches record levels 

Posted on by • Posted in Pandemic, Physician, Physician Acquisition, Physician Burnout, Physician Employment, Physician Practice Acquisition, Physician Workforce, Retention, Team-Based Care Models, Work-Life Balance • Leave a comment

https://mailchi.mp/3a7244145206/the-weekly-gist-december-9-2022?e=d1e747d2d8

The long hours, stressful conditions, and labor shortages brought on by the pandemic have done serious harm to the physician workforce. The graphic above tracks physician burnout, a combination of emotional exhaustion, loss of agency, and depersonalization that has become the primary measure of the pandemic’s toll on workers, to reveal that physicians are demoralized like never before. 

Physician burnout levels had been decreasing since 2014, in part due to practice consolidation and the expansion of team-based care models. Burnout reached its lowest levels in 2020—perhaps explained by a pandemic-induced sense of purpose—but 2021 then saw a dramatic spike in every measure of physician dissatisfaction, as the heroic glow of the early pandemic faded, and an overtaxed and understaffed delivery system became the new norm.

In explaining how the pandemic has impacted their career decisions, surveyed physicians list unsustainable burnout and stress as their top concern, and 11 percent say they have exited the profession, either for retirement or a non-clinical job, in the past two years. Four in ten surveyed physicians report changing jobs since 2020, mainly within similar or different practice settings, citing a desire for better work-life balance as their primary motivation. (It should be caveated that these data are from a smaller survey of 534 physicians, 40 percent of whom identified as “early career”.) 

While the solutions here aren’t new, they are challenging: we must continue to implement team-based care models that provide physicians top-of-license practice and improved work-life balance, remove administrative tasks wherever possible, and ensure that we are communicating and engaging physicians—employed and independent alike—in organizational strategy and decision-making. 

A tripledemic hurricane is making landfall. We need masks, not just tent hospitals

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Coronavirus Mutation, Flu Season, Flu Shot, Flu Transmission, Flu-Related Hospitalizations, Health Policy, Infection Control, Infectious Virus, Pandemic, Public Health, Public Health Crisis, Public Health Emergency (PHE), Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution, Vaccine Efficacy • Leave a comment
A tripledemic hurricane is making landfall. We need masks, not just tent hospitals

A viral hurricane is making landfall on health care systems battered by three pandemic years. With the official start of winter still weeks away, pediatric hospitals are facing crushing caseloads of children sick with RSV and other viral illnesses. Schools that promised a “return to normal” now report widespread absences and even closures from RSV and flu in many parts of the country, contributing to parents missing work in record numbers. With this year’s flu season beginning some six weeks early, the CDC has already declared a flu epidemic as hospitalizations for influenza soared to the highest point in more than a decade.

A storm of these proportions should demand not only crisis clinical measures, but also community prevention efforts. Yet instead of deploying public health strategies to weather the storm, the U.S. is abandoning them.

Even before the arrival of the so-called tripledemic, U.S. health systems were on the brink. But as the fall surge of illness threatens to capsize teetering hospitals, the will to deploy public health measures has also collapsed. Pediatricians are declaring “This is our March 2020” and issuing pleas for help while public health efforts to flatten the curve and reduce transmission rates of Covid-19 — or any infectious disease — have effectively evaporated. Unmanageable patient volumes are seen as inevitable, or billed as the predictable outcome of an “immunity debt,” despite considerable uncertainty surrounding the scientific underpinnings and practical utility of this concept.

The Covid-19 pandemic should have left us better prepared for this moment. It helped the public to understand that respiratory viruses primarily spread through shared indoor air. Public health practices to stop the spread of Covid-19 — such as masking, moving activities outdoors, and limiting large gatherings during surges — were incorporated into the daily routines of many Americans. RSV and flu are also much less transmissible than Covid-19, making them easier to control with common-sense public health practices.

Instead of dialing up those first-line practices as pediatric ICUs overflow and classrooms close, though, the U.S. is relying on its precious and fragile last lines of defense to combat the tripledemic: health care professionals and medical facilities.

Warnings and advisories recently issued by U.S. public health leaders, clinical leaders, politicians, and the media have consistently neglected to mention masking as a powerful short-term public health strategy that can blunt the surge of viral illness. Instead, recent guidance has exclusively promoted handwashing and cough etiquette. These recommendations run counter to recent calls to build on improved understanding of the transmission of respiratory viruses.

In the U.S.’s efforts to “move on” from thinking about Covid, it has created a “new normal” that is deeply abnormal — one in which we normalize resorting to crisis measures, such as treating patients in tents, instead of using common-sense public health strategies. Treating Covid like the flu — or the flu like Covid — has effectively meant that we treat neither illness as if it were a serious threat to health systems and to public health. Mobilizing Department of Defense troops and Federal Emergency Management Agency personnel to cover health system shortfalls is apparently more palatable than asking people to wear masks.

The tripledemic has already claimed its first child deaths in the U.S., adding to a large ongoing death toll from Covid. Allowing health systems to reach the brink of collapse will lead to many more preventable deaths among pediatric and other vulnerable patients who can’t access the care they need.

By any accounting, these losses are shocking and tragic. But they should strike us as particularly abhorrent and shameful because the tripledemic is a crisis that leaders, health agencies, and institutions have, in a sense, chosen. Over the past year, the Biden administration and its allies have repeatedly encouraged the public to stand down on public health measures, with the President even stating in September that “the pandemic is over.” By moving real risks out of view and failing to push for more robust measures to mitigate Covid, these messages have put the country on a path to its present circumstances, in which pediatric RSV patients are transferred to hospitals hundreds of miles away because there is no capacity to treat them in their own communities.

Living with viruses should mean embracing simple public health measures rather than learning to live with staggering levels of illness and death. Leaders in public health and medicine should issue timely and appropriate guidance that reflects the latest science instead of second-guessing the prevailing winds in public opinion. Instead of self-censoring their recommendations out of fear of political consequences, they should continue to promote the full range of public health strategies, including masking in crowded indoor public places during surges.

The tripledemic should bring renewed urgency to policies that will reduce the toll of seasonal illness on health, education, and the economy. Improvements in indoor air quality in public spaces, including schools, child care centers, and workplaces, can limit the spread of diseases and have many demonstrated health and economic benefits, yet the U.S. continues to lack standards to guide infrastructure or workplace safety standards. Paid leave enabling workers to stay home when they are ill can reduce the transmission of disease as well as loss of income, yet the U.S. is one of the only high-income countries without universal paid sick leave or family medical leave.

Greater effort must also be made to increase vaccination coverage for flu and Covid and bring an RSV vaccine online as quickly as possible. Only about half of high-risk adults under 65 received a flu shot last year, a gap that can be closed with more energetic vaccination campaigns. Reducing annual flu deaths using a broader range of strategies enabled by the pandemic — rather than pegging Covid deaths to them — should be the goal.

Amid the many sobering stories of the tripledemic, there is some good news. As the experience of Covid-19 has shown, it is possible to limit the toll of respiratory viruses like flu and RSV. However, this work requires resources, appropriate policies, and political will. Americans don’t need to accept winter disease surges and overrun health systems as an inevitable new normal. Instead, the country should see the tripledemic as a call to reinvigorate public health strategies in response to these threats to the health of our communities.

China’s COVID storm

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Health Policy, mRNA-based Vaccines, Pandemic, Pandemic Unwinding, Pandemic Wind Down, Public Health, Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution • Leave a comment

https://www.axios.com/2022/11/26/china-covid-outbreak-lockdown-economy

A new COVID calamity is hammering China, with a surge in infections prompting a return of lockdowns, including in some manufacturing areas that supply the West.

  • China reported a record number of infections this week, amid lockdowns and mass testing that are fueling unrest and darkening the country’s economic outlook. Schools in Beijing returned to online teaching.

Why it matters: In addition to the human misery for the world’s most populous country, the effects will be felt around the globe, Axios China author Bethany Allen-Ebrahimian reports from Taipei.

  • Supply chains are likely to be disrupted, causing prices to rise in an already rocky global economy.

Rare protests broke out today in China’s far western Xinjiang region. Crowds shouted at hazmat-suited guards after a deadly fire triggered anger by prolonged COVID lockdowns, Reuters reports.

  • “End the lockdown!” shouted protesters in the Xinjiang capital Urumqi, where an apartment fire killed 10.

What’s happening: The moment of truth for China’s zero-COVID policy has finally come.

  • Either party leaders will need to plunge much of the country into draconian lockdowns, as we saw at the beginning of the pandemic — or they’ll decide it’s time to learn to live with COVID.

Reality check: China’s doctors have warned Xi Jinping that the healthcare system isn’t prepared for the huge outbreak likely to follow the easing of strict anti-COVID measures, the Financial Times reports.

  • Chinese-made vaccines, which don’t use the mRNA technology employed by many produced by the West, aren’t as effective compared to those made in the U.S. And China has worrisomely low vaccination rates among older people.
  • But the number of cases in China is actually still very low for anywhere but China.

The big picture: “Zero COVID” restrictions have damaged the economy and undermined people’s trust in government.

  • That’s a stark about-face from the height of the pandemic. Then, many Chinese people felt the tight central control had protected them better than any other governance model in the world.
  • But it’s that very model that has plunged China into its current predicament. Xi tied his reputation, and the party’s legitimacy, to the success of “zero COVID.”

Between the lines: Chinese leaders made a huge, politically motivated mistake. They resisted the import of Western-made mRNA vaccines (including Pfizer and Moderna) for its citizens. These vaccines were only recently made available to foreigners.

  • That’s likely because of Beijing’s big vaccine diplomacy push: Chinese officials touted their own vaccines as the best and safest.
  • It was politically unpalatable to admit “defeat,” and allow Chinese people to get more effective — but Western-made — jabs.

China faces dilemma in unwinding zero-COVID

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Health Policy, Intensive Care (ICU), Pandemic, Pandemic Wind Down, Public Health, Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution • Leave a comment

https://www.axios.com/2022/11/28/china-dilemma-unwinding-covid-zero

China is facing an increasingly precarious situation as new COVID cases soar and the population seems to be hitting a breaking point with the government’s stringent zero-tolerance policies.

Why it matters: The world’s most populous nation has massive vulnerabilities heading into this winter, starting with the fact the vast majority of its population has yet to be exposed to the virus and has little ‘natural immunity.’

  • China’s vaccines didn’t work well compared to those distributed in the West, and the government refused to approve foreign vaccines and doesn’t have a version to combat Omicron.
  • Vaccine uptake was particularly low among the elderly.
  • And now, public outrage over new COVID lockdown restrictions has fueled rare protests, Axios’ Herb Scribner writes, with residents demanding the government to lift restrictions quickly and some calling for President Xi Jinping’s resignation.

State of play: Overall, China’s number of reported COVID cases and COVID deaths are far lower than other nations, but there have been recent reported spikes in overall numbers of cases and some new deaths.

  • It came after the Chinese government announced some easing of its zero-COVID policy, such as reducing mass testing and quarantine requirements, earlier this month.

Reality check: China’s doctors have warned that the health care system isn’t prepared for the huge outbreak likely to follow any easing of public health measures, Axios’ Bethany Allen-Ebrahimian writes.

  • That includes worries the nation doesn’t have enough ICU bed capacity to handle such outbreaks, according to the Financial Times.

Between the lines: Another concern is the potential evolution of a new, more dangerous variant if there’s a huge surge of infections, Christian Drosten, Germany’s most prominent virologist, told Bloomberg.

  • “Xi Jinping knows very well that he can’t simply let the virus loose,” Drosten said. “The Chinese population first needs to be as well vaccinated as we are.”

Be smart: China’s officials are scrambling to address the vaccine problem.

  • For instance, they are launching more aggressive vaccine drives and limiting movement among at-risk groups, including the elderly, the Washington Post reports.
  • They’ve also approved the use of the first inhaled COVID-19 vaccine in dozens of cities earlier this month in a bid to boost uptake, WSJ reported. Experts have said the vaccine, which was found to stimulate a mucosal response, may create more durable protection against the virus, although more data is needed.
  • But they have yet to open up the availability of mRNA vaccines from Pfizer-BioNTech and Moderna, opting to focus on their own, per the Post.

The bottom line: China’s zero-COVID policy has kept cases in China relatively low compared to the rest of the world.

  • But even as the societal and economic consequences of shutdowns become apparent, it faces a very difficult path ahead in unwinding strict public health policies.