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.
The sports betting market has multiplied tenfold in three years and may have reached $7 billion in 2022. More than half of the nation can now legally gamble on sports. Fifty million Americans are expected to bet on the upcoming Super Bowl.
Five years ago, betting on live games was illegal in most of the United States. A Supreme Court ruling in 2018 removed the ban and transformed the industry. Now, 33 states and the District of Columbia allow wagers on games.
Addiction experts fear a coming national epidemic to rival the opioid crisis.
“Gambling is a very different addiction from drugs or alcohol,” said Lia Nower, a professor and director of the Center for Gambling Studies at Rutgers University. “If I’m drunk or high, at some point my family is going to figure it out. With gambling, I can be sitting with my kids, watching cartoons, and gambling away my house, my car, everything I own, on my mobile phone. How would you know?”
The Supreme Court ruling struck down a federal law that had banned most commercial sport wagering outside Las Vegas. The subsequent spread of legal gambling was stunningly swift.
Lobbyists pampered state lawmakers with parties and promises, predicting millions in new tax dollars. Much of the promised revenue hasn’t reached the states, according to a New York Times investigation.
But gambling dollars have reached the betting operators. The industry reaped $4.3 billion in revenue on $57 billion in wagers in 2021. In the first 11 months of 2022, Americans bet $83 billion on sports and delivered $6.6 billion to betting firms. That figure is 15 times what the sports gambling industry reaped in 2018.
“We have a movement toward expanding what was once considered a sin, what was once considered a vice, and embedding it at every level of American culture, down to kindergarten,” said Timothy Fong, a clinical professor of psychiatry at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles.
“Sports gambling market. Ten years ago, those words didn’t exist,” Fong said. “What you have is this massive, exponential expansion of gambling into homes, faster than we can study or monitor it.”
A record 50 million Americans, one adult in five, will bet on Super Bowl LVII, according to an American Gaming Association survey. They will wager $16 billion, twice as much as last year.
Celebrity athletes shill for betting firms on television. Betting firms promote gambling on college campuses. Professional teams court “official mobile sports betting partners.”
“Pete Rose was banned from baseball and blocked from the Hall of Fame because he gambled,” said Nower, of Rutgers. “Now, we’ve got professional ballplayers who are partnering with gambling companies. Now, kids are seeing these things inextricably linked.”
Teams and league owners love sports betting because they “have found that engagement is off the charts among people who are placing bets on games,” said Daniel Barbarisi, author of “Dueling with Kings: High Stakes, Killer Sharks, and the Get-Rich Promise of Daily Fantasy Sports.”
People who bet on games “are not just tuning out if it’s a blowout,” Barbarisi said, because they bet on more than the final score. Fans can place wagers on the margin of victory, the combined point total from both teams and other metrics — such as whether Aaron Judge will hit a home run or Max Scherzer will ring up double-digit strikeouts.
Sports bettors are predominantly male, surveys show. They are mostly under 45. Some are wealthy, but a Rutgers study found that half of sports gamblers earn less than $50,000 a year. Some hail from a distinct subpopulation of Americans who get a thrill from risking money on the Next Big Thing.
“You can kind of draw a through line from the people who were involved in the poker boom in the early 2000s to the daily fantasy thing in the 2010s and then to the crypto thing,” Barbarisi said.
“I don’t know if you can say it’s a small group of guys anymore. It’s a big group of guys.”
Gambling is unquestionably addictive, and arguably immoral: Not for nothing did Las Vegas earn the Sin City sobriquet. Now that betting on sports is broadly legal, however, Americans are warming to the idea.
A poll by The Washington Post and University of Maryland found that 66 percent of Americans approved of legal sports betting in 2022, up from 55 percent in 2017, a year before the Supreme Court decision.
Nower suspects most Americans remain naive about gambling’s ills, much as society once cheerily embraced smoking and drinking. “We are where cigarettes were in the 1940s and alcohol was in the 1950s,” she said.
Most Americans ignored the opioid crisis, a staggering increase in overdose deaths in the 1990s and 2000s, until the government and news media processed the data and tendered a response.
With sports betting, “you have the exact same players you had with opioids,” Fong said. “You have government. You have industry. You have civilians, a lot of whom will benefit from this. And then you have a population who will develop an addiction, let’s say 1, 1.5 percent of the population.”
With legal sports gambling, “It’s a hidden addiction,” Fong said. “You can’t see it, you can’t smell it, you can’t taste it.”
Fong points to one of his patients, a man in his 20s who earns $160,000 a year and owes $40,000 in gambling debts.
“On face value, he can pay his rent, he’s not gonna die,” Fong said. “But he’s miserable. He’s just not happy.”
Over time, researchers say, sports-betting addiction will take a toll in rising rates of bankruptcy, domestic violence, depression, anxiety and suicide.
The federal government takes a keen interest in regulating alcohol, tobacco and drugs. In sports gambling, by contrast, “there is no federal presence at all,” Nower said. “And that is the biggest problem.”
Oversight of the booming sports-betting industry has been mostly left to states.
States that allow legal sports gambling “are not disinterested parties,” the Times wrote in its 2022 investigation. “They collect taxes on gambling, and the more people bet, the more governments get. One result is that states have, in many ways, given gambling companies free rein.”
New Jersey, the state at the heart of the 2018 Supreme Court ruling, offers a rare exception, Nower said.
Gambling regulators in New Jersey studied “the relationship between gambling and problem gambling” before they allowed legal gambling on sports, Nower said. She knows of no other state that took that step.
New Jersey uses gambling data to identify “people who may be exhibiting problem symptoms,” Nower said: Shuffling several payment methods, overdrawing their cards, doubling down on bets, gambling more frequently.
Most other states “are just legalizing this stuff without any idea of the effects,” she said.
The sports betting landscape will remain untamed, researchers say, until governments recognize gambling as a matter of public health.
“I do think there are watershed moments in all public health crises,” Nower said. “Unfortunately, it usually takes some kind of crisis or tragedy to turn the tide.”
A new CDC study has found that the Covid-19 bivalent booster reduces the risk of symptomatic infection from the most common subvariant circulating in the U.S. right now by about half.
Additional new data, set to be published on the CDC website on Wednesday, also shows that individuals who received an updated vaccine reduced their risk of death by nearly 13 fold, when compared to the unvaccinated, and by two fold when compared to those with at least one monovalent vaccine but no updated booster.
CDC officials said during a briefing on Wednesday that the new findings were “reassuring.” But only 15.3 percent of eligible Americans — or about 50 million people — have received the new shot, which was rolled out in September.
Meanwhile, the highly transmissible Omicron subvariant XBB.1.5 — nicknamed “the Kraken” by some — is now the dominant SARS-CoV-2 strain in the U.S., projected by the CDC to make up just over 49 percent of cases in the country as of last week.
Earlier this month, the WHO said XBB.1.5 is the most transmissible variant to date, and is circulating in dozens of countries. Though a catastrophic wave has not emerged in the U.S. yet, there has nevertheless been a spike in deaths this month, with an average of 564 people dying of Covid-19 each day as of Jan. 18, compared with an average of 384 around the same time in December.
The new vaccine efficacy study, which used data from the national pharmacy program for Covid testing, found that the bivalent booster provided 48 percent greater protection against symptomatic infection from the XBB and XBB.1.5 subvariants among people who had the booster in the previous two to three months, compared with people who had only previously received two to four monovalent doses.
It also provided 52 percent greater protection against symptomatic infection from the BA.5 subvariant, though according to CDC estimates, BA.5 only accounted for about 2 percent of U.S. cases last week.
CDC officials cautioned that the findings reflected a population-level rate of protection, and that individual risk of infection varies.
“It’s hard to interpret it as an individual’s risk, because every individual is different,” said Ruth Link-Gelles, the author of the vaccine effectiveness study published in MMWR Wednesday. “Their immune system is different, their past history of prior infection is different. They may have underlying conditions that put them at more or less risk of COVID-19 disease.”
She also said it was unclear, given the limitations of the study, how long the bivalent booster protection will last.
“It’s too early to know how waning will happen with the bivalent vaccine,” she said. “What we’ve seen in the past is that your protection lasts longer for more severe illness. So even though you may have diminished protection over time against symptomatic infection, you’re likely still protected against more severe disease for a longer period of time.”
China is in the middle of what may be the world’s largest covid-19 outbreak after authorities abruptly loosened almost three years of strict pandemic restrictions in December following nationwide protests against the measures.
The sudden dismantling of China’s “zero covid” regime — enforced through mass lockdowns, testing and contact tracing — has left the country’s health system unprepared and overwhelmed. It has alarmed international health experts concerned about Beijing’s transparency and caused diplomatic friction as countries enforce travel restrictions on arrivals from China.
How many people have been infected?
So far, there are no reliable national figures for the number of people among China’s 1.4 billion population who have been infected in the current outbreak. After admitting the difficulty of tracking infections, China’s National Health Commission stopped reporting daily tallies in December.
The data is still maintained by the Chinese Center for Disease Control and Prevention, based on counts from hospitals and local health commissions. But because mandatory mass testing has been dropped, the official figure is believed to massively underestimate the rate of infection. As of Jan. 8, there have been a little more than 500,000 confirmed covid cases since the pandemic began, according to the CDC.
Statements from local governments indicate that the true number of infections is exponentially higher. Officials in Henan province estimated this week that 89 percent of the province’s 99 million residents have been infected. In Zhejiang province, officials said the province was seeing over a million new infections a day in late December. As of Jan. 8, all 31 provinces, municipalities and regions had reported covid infections, according to the CDC.
How serious is the outbreak?
The number of deaths remains unknown, even as evidence is mounting that the true death count is much higher than what has been reported — a little more than 5,200 deaths since the pandemic began and fewer than 40 since zero-covid restrictions were lifted on Dec. 7.
As of Dec. 25, the takeup of intensive care beds in secondary and tertiary hospitals across the country was about 54 percent, but that figure has since increased to 80 percent, Jiao Yahui, director of the Department of Medical Affairs of the National Health Commission, said in an interview with state broadcaster CCTV on Sunday.
Officials reassured the public by noting that the fatality rate of the coronavirus’s omicron variant is 0.1 percent. The current outbreak has mostly consisted of the omicron subvariants BA.5.2 and BF.7, the State Council Information Office said in a news conference Monday.
The lack of testing combined with the narrow definition of what counts as a covid death — positive patients who die of respiratory failure — continue to skew the statistics. Officials have said they will investigate fatalities and release the results in the future.
What is the government saying?
Authorities say the worst of the outbreak is over for Chinese cities where infections spread quickly in December. Now, they are preparing for a new surge in rural areas around the upcoming Lunar New Year holiday that begins Jan. 21.
State media has reported that cases in most major cities have started to decline. Yin Yong, acting mayor of Beijing, told CCTV on Monday that the city had reached its peak and that authorities were turning their focus to monitoring potential new coronavirus variants or subvariants of omicron, and to mitigating the impact of covid on the elderly and other vulnerable groups.
Officials also said the peak had been reached in the province of Jiangsu in late December, while in Zhejiang, authorities said, “the first wave of infections has passed smoothly,” according to Health Times, a publication managed by People’s Daily. The state-run Farmers’ Daily said that visits to 51 villages across 31 provinces showed that most residents had been infected and had recovered.
Data released by Baidu, the main search engine in China, showed that the number of searches related to covid symptoms and medical supplies had dropped since peaking in mid-December.
Yet in Henan, officials said hospitals remain overcrowded because of a rise in critical cases in the past week. Researchers at the Institute of Public Health at Nankai University in Tianjin, using data from fever clinics, project that the nationwide peak will be between Dec. 20 and Jan. 15, with two smaller peaks in the first half of this year.
Officials have predicted a second wave over the Lunar New Year holiday, when the total number of passenger trips by residents is expected to reach 2.1 billion as pent-up demand for travel is unleashed. At this point, more contagion could spread to rural areas, where severe shortages of anti-fever drugs and medical staff have been reported.
How did zero covid affect the outbreak?
China’s pursuit of zero covid, eliminating the spread of the virus through lockdowns, mandatory quarantines, travel restrictions and mass testing, has proved to be a double-edged sword. While the approach kept infections and death rates low throughout most of the pandemic, it left the Chinese population with little natural immunity to the virus.
Many elderly residents — already skeptical of vaccines, which have had a troubled past in China — did not get vaccinated, feeling that they would be protected by the zero-covid strategy. Only 40 percent of residents above the age of 80 have had booster shots.
Under China’s covid policy, the population was immunized with domestically made vaccines that are not as effective against the omicron variant as mRNA vaccines. China has yet to approve foreign mRNA vaccines, and a domestically made one is still under production.
What does this mean for the rest of the world?
Concerns about the possibility of a new variant emerging in China have prompted countries including the United States, Japan and South Korea, and many European countries, to require extra screening for arrivals from China.
Wu Zunyou, the chief epidemiologist at the CDC, told CCTV in a report published Sunday that no new variants have emerged and that new strains are being collected every day to monitor changes.
“All the strains we found so far have already been shared with international sharing platforms,” he said. “They are the ones either reported abroad, or have been introduced to China after spreading overseas. So far, no newly emerged mutated strains have been found in China.”
The World Health Organization has called on China to share more real-time data on the outbreak. Michael Ryan, the health emergencies director, said at a news conference in Geneva on Wednesday that the WHO “still believes that deaths are heavily underreported from China.” He added: “We still do not have adequate information to make a full comprehensive risk assessment.”
Beijing has criticized travel restrictions on people arriving from China imposed by other countries as “ridiculous” and politically motivated. It has threatened countermeasures and this week suspended short-term visas for Japanese and South Korean citizens.
Hospitals across the country are being hit with a spike in respiratory syncytial virus (RSV) and influenza cases, while still dealing with a steady flow of COVID admissions, in what’s been dubbed a “tripledemic”. The graphic above uses hospitalization data from the Centers for Disease Control and Prevention (CDC) to show that each disease has been sending similar shares of the population to hospitals across late fall, with flu hospitalizations having just overtaken COVID admissions after Thanksgiving.
These numbers reflect that we’re experiencing the worst RSV season in at least five years, and we’re set to endure the worst flu season since 2009-10.As RSV is most severe in very young children, its recent surge has revealed another capacity shortage in our nation’s hospitals: pediatric beds. From 2008 to 2018, pediatric inpatient bed counts fell by 19 percent, as hospitals shifted resources to higher revenue services.
This strategy has now come to a head in many parts of the country, as RSV has driven pediatric bed usage rates to a recent high. (The Department of Health and Human Services’ pediatric capacity data only dates back to August 2020.) With three straight weeks of declining RSV hospitalizations, there is reason to hope that pediatric care units will soon feel a reprieve. However, flu season has yet to reach its peak, prompting calls for a return to widespread mask-wearing and a renewed emphasis on flu shots, given that more than half of Americans have not yet gotten vaccinated this season.
Amid a flurry of policy changes initiated by Elon Musk since his takeover of the social media company last month, Twitter has ceased its formal efforts to combat COVID misinformation. To date, Twitter had removed over 100K posts for violating its COVID policy. The company will now rely on its users to combat disinformation through its “Birdwatch” program, which lets users rate the accuracy of tweets and submit corrections. Many of the 11K accounts suspended for spreading COVID misinformation, including those of politicians like Rep. Marjorie Taylor Greene (R-GA), have also been reinstated.
The Gist: We’ve seen the damage caused by inaccurate or deliberately misleading COVID information, which has likely played a role in the US’s lower vaccination rates compared to other high-income countries. Around one in five Americans use Twitter, far fewer than Facebook or YouTube, but the platform is seen as highly influential, both for the reach of its content and also its moderation decisions.
This policy change is worrisome, not only because COVID is still taking the lives of hundreds of Americans daily, but also because COVID misinformation catalyzes broader healthcare misinformation, including antivax sentiments and an overall mistrust of medical experts.
Monkeypox cases in women and non-binary people may be getting misdiagnosed as sexually transmitted infections (STIs), daily Covid-19 hospital admissions are expected to increase for the first time since July, and more in this week’s roundup of monkeypox and Covid-19 news.
Monkeypox:
Monkeypox may be getting misdiagnosed as STIs in women and non-binary people, according to a new study published in The Lancet. For the study, researchers gathered data from 69 cisgender women, 62 transgender women, and five nonbinary people assigned female at birth with confirmed monkeypox cases between May 11 and Oct. 4 across 15 countries. The study found that 73% of monkeypox infections among this group were likely acquired from sexual contact. While nearly all monkeypox infections among trans women were likely acquired through sexual contact, roughly 24% of cis women and nonbinary people were believed to have acquired an infection outside of sexual contact, such as household or occupational exposure, according to the researchers. In addition, the researchers found that around 33% of cisgender women were misdiagnosed before being diagnosed with monkeypox—and almost half received a delayed diagnosis. “It’s very likely that infections have been missed and not picked up at all,” said Chloe Orkin, a physician and researcher at Queen Mary University of London. “The lesson here is that everybody needs to know about this,” Orkin noted. While public health messages have been primarily directed toward men who have sex with men, “it’s important to recognize this is not the only group,” she added. (Mandavilli, New York Times, 11/21; Hart, Forbes, 11/17)
Covid-19:
CDC is forecasting an uptick in Covid-19 hospitalizations for the first time since July, according to national disease modeling. In the coming weeks, CDC’s ensemble forecast from 15 modeling groups is projecting a nationwide increase in daily Covid-19 hospital admissions, with a forecasted 2,000 to 9,000 new daily admissions on Dec. 9. As of Nov. 11, the seven-day average of new hospital admissions for Covid-19 was 3,330—a slight decrease from 3,374 the previous week. In addition, modeling from Mayo Clinic is projecting a 51.5% increase in daily Covid-19 cases over next two weeks, with average daily cases projected to increase from 37,912.7 cases on Nov. 18 to 57,441 on Dec. 2. However, CDC’s ensemble forecast from 13 modeling groups projects that Covid-19 deaths will remain stable or follow an uncertain pattern over the next month. (Bean, Becker’s Hospital Review, 11/21)
Earlier this month, omicron subvariants BQ.1 and BQ.1.1 surpassed BA.5 as the dominant strains of the coronavirus in the United States. Currently, BA.5 accounts for roughly 25% of new Covid-19 cases, and BQ.1 and BQ.1.1 account for an equal proportion of around 48% of cases. As BQ.1 and BQ.1.1 become more dominant, many experts are voicing concern over low vaccine uptake and evidence that suggests the dominant strains are not as susceptible to current treatments. For instance, FDA earlier this month updated its guidance for two monoclonal antibody treatments—bebtelovimab and Evusheld—warning that BQ.1 and BQ.1.1 showed significant declines in susceptibility to the treatments. (Choi, The Hill, 11/18)
A new study published in JAMA Network Open found that almost 15% of 62,525 hospitalized Covid-19 patients had a medical contradindication after taking Paxlovid’s antiviral combination of nirmatrelvir and ritonavir. To evaluate Paxlovid eligibility among hospitalized Covid-19 patients, researchers used a list of individual contraindications created by FDA. The patients were hospitalized in Paris University hospitals between Jan. 24, 2020, and Nov. 30, 2021. In total, over 9,100 patients—or 14.6%—experienced a medical contraindication to Paxlovid, making the treatment inadvisable. Notably, contraindication rates were higher among men (18%) than in women (11.3%). Among older patients, contradiction rates were 26.9%. “The most prevalent contraindications were severe kidney impairment and use of medications dependent on CYP3A for clearance,” researchers said.
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.
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 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.
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.
HENRY KOTULA 