China’s SARS-CoV-2 outbreak spiked after the country ceased imposing sweeping lockdowns

No novel SARS-Cov-2 variant has been reported from Beijing after zero-Covid policy was withdrawn, a latest study published in Lancet has revealed.

“Before December, 2022, Beijing had seen numerous importations and one larger outbreak earlier in 2022, but no ongoing local transmission of SARS-CoV-2,” the researchers point out.

But they agree that the study is subject to several limitations.

“It covers a short period within a few weeks of the lifting of the zero-COVID measures. If new lineages were to emerge in the course of the surge, the study was probably too early to find them,” researchers explain. “Furthermore, the situation in Beijing may not be representative of the whole of China.”

In early December, 2022, China abandoned what until then had been among the most stringent policies against the COVID-19 pandemic globally.

Mass testing, stringent quarantine procedures, and mobility limits, collectively known as the “dynamic zero-COVID policy,” had been designed to contain COVID-19 outbreaks before they could spread.

This approach proved highly effective: from January 22, 2020, until November 1, 2022, China recorded a cumulative 726 COVID-19 cases and 3.9 deaths per million population, compared to 288 384 cases and 3166 deaths in the USA.

Following the abrupt reversal of this policy, there was a massive surge in SARS-CoV-2 infections in parts of China. Revised reporting criteria conceal its true extent, but data suggests a substantial number of cases of infection and severe disease and deaths.

For most of the world, the prevailing strategy of learning to live with COVID-19 is based on widespread immunity. Testing, treatment, and vaccination campaigns, especially with updated (bivalent) vaccines, also have roles to varying degrees.

However, in China, immunity resulting from previous infection was rare due to COVID-19 being effectively suppressed. A substantial proportion of older people were apparently not fully immunised, and the inactivated whole virus COVID-19 vaccines mostly used were not highly effective nor specific for the Omicron variant of concern.

Most concerning for the rest of the world are the potential global consequences of China’s abandonment of its zero-COVID policy.

“Previously, China controlled travel very strictly, with relatively few travellers entering or leaving the country and strict testing and quarantine regimens. The resumption of travel and easing of these restrictions mean that China’s COVID-19 trajectory is no longer largely decoupled from the rest of the world,” the researchers argue.

“Although passengers with SARS-CoV-2 infection arriving from China are unlikely to pose public health challenges per se, the persistent paucity of genomic data from China has raised concerns about the introduction of novel SARS-CoV-2 lineages possibly emerging during a massive epidemic wave.”

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