On December 7, China relaxed the zero-Covid policy that it had strictly enforced in the past three years. Testing requirements and travel restrictions were reduced; people with Covid-19 who had mild or no symptoms were allowed to isolate at home instead of in centrally managed facilities.
Experts in the country immediately warned of a rise in infections and resultant overload on hospitals. Within a fortnight, the cases shot up. By December 21, there were 5,944 cases (as per Our World in Data). A high number of cases were reported in Japan, South Korea and Thailand, too.
In his last ‘Mann Ki Baat’ radio address of the year, Prime Minister Narendra Modi asked citizens to follow Covid protocols. The Union government soon announced preventive measures: all international passengers arriving from China, Japan, Thailand and South Korea will now be screened; testing has been ramped up; and aggressive campaigning has resumed for administering booster shots and adopting Covid-appropriate behaviour. The government’s mantra has been to prepare but not panic. Health Minister Mansukh Mandaviya said that the government was prepared to handle any situation.
But even as the cases are rising in China because of the “highly infectious and transmissible” BF.7 sub-variant of the Omicron BA.5 strain, experts say it is unlikely to trigger another wave in India. India has so far reported four cases of BF.7.
“In China, the continuation of the zero-Covid policy was not logical,” says public health expert Chandrakant Lahariya, who was formerly associated with the World Health Organization. “The pandemic response has to be based on emerging evidence. Over time, especially post Omicron, it became clear that China should not have continued with its harsh policy. The country is facing this wave so late because the population has not been exposed to the virus.”
Also, the efficacy of the Chinese vaccine, he adds, is lower. “But I believe that even if cases rise, the severity of the infection will be relatively low,” he says. “The country’s hospitals will not be overburdened as [being projected], but the infection transmission rate will be undoubtedly high.”
Owing to the zero-Covid policy, China lacks natural immunity, developed as a result of exposure to the virus, and hybrid immunity, developed as a result of vaccination and previous infection. Experts say that China has now reached a stage where the doubling time is just a few hours.
This has rendered it impossible to calculate the R number―the rate at which an infection spreads. “This is why in that population any sub-variants of Omicron will behave like the parent SARS-CoV-2,” says a scientist from the Indian Council of Medical Research. “All sub-variants of Omicron are highly transmissible and infectious, and December is the time when most variants come to the fore because of the weather.”
Though there has been no scientific data from China on the current outbreak, the ICMR scientist says that the rise in cases is because of BN.1.3, also a sub-variant of Omicron, and not the dominant BF.7. “The China outbreak is owing to a cocktail of viruses,” she says, “which behave differently due to local epidemiology.” In India, she adds, there are two possibilities. “One, the variant is already here and we have all become immune to it,” she says. “Two, because of very low genomic surveillance, we really do not know the variants doing the rounds.” In India, the virus has mutated to a much milder form, and a large number of Indians have acquired hybrid immunity, following exposure and vaccination.
But that does not mean we let our guard down. The government needs to closely monitor serious hospitalisations and deaths from Covid-19, says Dr Rahul Pandit, who serves on the Covid-19 task force in Maharashtra. Merely recording the number of cases and test positivity rates is not enough, he says. “We isolated BF.7 in India some months ago, so we should not panic,” he says. “What is required is good vigilance and some amount of personal responsibility in following Covid protocols. It is highly unlikely that the variant that caused havoc in China will cause severity in India. But a non-Omicron variant, which is completely new, might. But, as of now, we do not know. Genomic surveillance has to be done aggressively to identify any new variant that might be doing the rounds here.”
Virologist Dr T. Jacob John says, “We have never been good at speeding up our genomic surveillance. It is time to [do so] and keep the momentum going.” John is not convinced about reports from China regarding dead bodies piling up in crematoriums and hospitals being overburdened. It could be a deliberate attempt to mislead the world, he says. “This feeling is because Omicron is not a major killer at all,” he says. “Neither does it cause low oxygen levels nor does it cause bilateral pneumonia.”
We do not have to worry about infections from China causing a surge here, says John. “Omicron BF.7 is not a big killer,” he says. “While South Korea managed very well in 2021, their worst scenario happened this year. It is not surprising because once Omicron enters a population, it infects everybody. We, in India, have been having very low numbers since this January, and we are the first country in the world to become endemic, followed by South Africa and Israel.”
India continues to witness a downward trend in Covid-19 cases, with a seven-day average of 172 cases during the week ending on December 25. As per government figures, India has used more than 220 crore vaccination doses. “But the second dose coverage is less than 72 per cent,” says John. “Boosters are even fewer―hardly 10 per cent. That means what happened in India is that the virus did whatever it wanted to do and went away. Now the situation has become endemic.” It may not be endemic in most countries, but as John adds, “Mortality-wise, everywhere the numbers are low, except if it is the elderly who fall in the co-morbid category and contract serious infections.”
The Chinese government is insisting on a second booster shot, preferably of mRNA vaccines, and not the recombinant protein-based vaccines in use. As China plans to reopen its borders on January 8, overseas travel will become easier for Chinese citizens and visitors to China. India has asked for a negative Covid test on arrival for travellers from China, Japan, South Korea, Thailand, Hong Kong and Singapore. The US, which is seeing a spate of infections owing to respiratory syncytial virus, influenza and Covid-19, is also mulling similar measures.
Such safety measures are clearly necessary―in Tamil Nadu, a woman and her daughter, who returned from China via South Korea and Sri Lanka on December 27, have tested positive. The Union health ministry has already directed states to keep oxygen cylinders in stock. “Though Covid cases in the country are low… to face any challenges arising in the future, the operationalisation and maintenance of medical infrastructure is of utmost importance,” said additional secretary (health) Manohar Agnani. India also got its first nasal vaccine for Covid-19 in Bharat Biotech’s iNCOVACC. The Drugs Controller General of India has authorised it for emergency use and it is available on the CoWIN website. It can be used as a booster for adults, too.
But what is perhaps crucial is following Covid protocols. As NITI Aayog member (health) Dr V.K. Paul said, people should take the jab and wear masks in crowded places. It’s back to basics.