Coping with Omicron
In China, the government has been rushing to revise pandemic control measures in response to the Omicron challenge to allow for a more flexible regime in detecting the virus and treating the infected. This entails making rapid antigen tests (RATs) available to the public, with results recognized as proof of infection. This would be tacit acceptance of the limitations of centralized testing. Widespread use of RATs will mean a more diffuse management of tests.
A second policy change is that asymptomatic cases will be able undergo treatment at government centers instead of hospitals, allowing medical resources to be devoted to life-threatening serious cases. A third adjustment is that patients will be discharged from hospitals even with a positive polymerase chain reaction (PCR) test as long as the reading is above 35, unlike the previous standard when patients had to wait until they tested negative. Given the high sensitivity of the PCR test, patients could test positive even six months after recovery, though they might carry a low viral load and are not infectious.
“These are significant steps towards recognizing the reality of Omicron,” says Professor Jin Dongyan, the Clara and Lawrence Fok Professor in Precision Medicine at The University of Hong Kong (HKU), who has closely followed Covid-19 developments in China. “Tough lockdowns against Omicron have become ineffective in attaining zero-Covid since too many of the infected could be asymptomatic.” Dr Zhang Wenhong, head of disease control in Shanghai and a leading voice advocating a more flexible control regime, heralded the new measures as the “most scientific treatment guidelines.”
The changes have come amid more open debate in China in recent months about the merits of containment versus mitigation. Top Chinese experts are keenly aware of the limitations of the zero-Covid approach and that China needs to develop a strategy to address the onslaught of the Omicron variant and move forward to opening up after two years of stringent application of the coronavirus suppression policy.
The roadmap to open up
Unlike the early days of the pandemic, China and the world now have more tools to combat Covid-19. But each country needs to deploy the tools according to its social and economic situation. In a roundtable with 60 medical experts from around the country, Zhang cited the lessons of Hong Kong, telling the gathering that “we need better vaccines and better vaccination strategies. Vaccination needs to be the priority of our priorities.“
The urgent need for vaccination was something Hong Kong had failed to focus on when the SAR was enjoying the fruits of its zero-Covid approach – low numbers of infections and few deaths. When the fifth wave hit, vaccination rates among older citizens was still relatively low – and most of the elderly who had been inoculated received the Sinovac-CoronaVac vaccine, which some studies have found to be less effective than the Pfizer-BioNTech (Comirnaty) alternative, though other figures have disputed this assertion. In mid-March, the vaccination rate of Hong Kong seniors above 80 years old was still below 40 percent.
In mainland China, vaccination among the elderly is also low, according to information released by the National Health Commission (NHC) March 18. Of the 264 million people aged 60 and above, 52 million have not been fully vaccinated. Among those 80 and above, only half are fully vaccinated and just 19.7 percent have received a booster.
There are other challenges. “We also need to make oral drugs broadly available, provide affordable RAT to the public and develop protocols for home tests and quarantine, preparing medical resources to cope with imported cases and local cases,” Dr Zhang, the Shanghai official, said. “We need drills of triaged treatment facilities. We need to create a comprehensive defense system to guard against the next major scale of imported and localized cases.” As Hong Kong has done, the mainland has imported the first batch of the antiviral drug Paxlovid, which is manufactured by Pfizer. Shipments of the drug are reported to have been rushed to Changchun, the epicenter of the outbreak in Jilin Province.
As for vaccines, China has cited research data from Hong Kong and elsewhere to defend Sinovac’s ability to protect against serious infections and deaths from Omicron, while pushing ahead with the development of its own mRNA vaccines, which have proven to have higher efficacy.