Explained: Why is China seeing a spike in Covid-19 cases, and should India worry?

What are the Covid-19 numbers like in Shanghai?

On Wednesday (March 30), local authorities reported nearly 6,000 new infections in a 24-hour period, a new record according to a report in the South China Morning Post. This is significantly higher than the 326 cases discovered just a week ago, on last Wednesday, the paper said. The city reported 2,678 cases on Sunday, 3,500 on Monday, and 4,477 on Tuesday.

But the daily count of new cases in all of China, not just Shanghai, is very low compared to the United States or many countries in Europe, which have been reporting tens of thousands of cases every day for three months now. The US, United Kingdom, Germany, Italy, Spain, India, and more recently South Korea, have, at different times this year, reported several hundred thousand cases in a single day.

China, on the other hand, reported 8,655 cases on Wednesday, according to the South China Morning Post, and this has been its highest single day figure since the beginning of the pandemic.

Cumulative Covid-19 cases in China

If the numbers are low, what is the problem?

The rise in cases is seriously undermining China’s zero-Covid strategy and, worse, it is threatening to go the Hong Kong way. Hong Kong, whose Covid-19 strategy was not very different from that of mainland China’s until December last year, has seen an explosion of cases in the last couple of months, reporting tens of thousands of cases, and hundreds of deaths, every day.

The city’s hospitals have been overwhelmed, and even morgues are reported to be unable to deal with the flow of dead bodies.

The alarm in China has been caused by the fact that for almost two years, the country had been able to keep a lid on Covid-19 cases through very aggressive and restrictive measures. Every known case, even asymptomatic, was mandatorily hospitalised, small outbreaks were met with hard local lockdowns, foreign travellers were put in compulsory quarantine, and suspected cases were kept under long isolation.

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China’s effort has been to completely eliminate the virus from its population, unlike the strategy being adopted in most of the world to try and keep the rate of infections at manageable levels while allowing citizens to have access to pre-Covid normalcy.

A delivery man passes by barriers set up to lock down a community in Shanghai, China, Wednesday, March 30, 2022. (AP Photo/Chen Si)

Has this very aggressive strategy failed, then? 

China’s strategy has not been without success so far. In the two years since March 2020, China reported barely 30,000 cases of coronavirus infection. Even now, the total number of cases discovered in China since the beginning of the pandemic is only about 1.5 lakh, according to Our World in Data. This number is less than what several countries, at different times, have reported in a single day.

In contrast, the United States has reported nearly 80 million confirmed cases, while India has found over 43 million. Even countries with much smaller populations — Brazil, France, the UK, Germany — have reported over 20 million cases each.

Significantly, the rise in cases in China has so far not led to any surge in Covid-19 deaths. Last week, the country reported two deaths — those were the first coronavirus deaths in over a year. The total reported death toll in China is 4,638, according to Our World in Data, and only six of these deaths occurred after the middle of April 2020.

So why is there scepticism about this strategy?

There is a growing scepticism about the sustainability of China’s strategy in the long term. Despite the best efforts of the countries of the world, including the introduction of vaccines in record timelines, the virus has not been eliminated. There is no guarantee that it would not evolve into more dangerous variants in future.

The current line of vaccines have been largely ineffective in preventing infection, even though they have significantly reduced the risk of serious disease and death. Even in China, some of the restrictive measures were being slowly relaxed. According to the BBC, asymptomatic and mild cases were no longer required to be hospitalised and were only being asked to isolate themselves at centralised facilities.

Quarantine period rules have also been reduced, the BBC said. The easing of restrictions could lead to short-term pains, and fears of a Hong Kong-like situation developing on the mainland are not ruled out, especially since some of the reasons being attributed to the recent mayhem in Hong Kong are present in China as well.

What can be a potentially dangerous situation right now?

The large number of deaths in Hong Kong was blamed on low vaccination rates in the elderly population of the city. According to a report in Nature magazine, only about one-third of those above the age of 80 years in Hong Kong were fully vaccinated, and 90 per cent of deaths in the city were of those who were not fully vaccinated.

While the overall vaccination rate in China is more than 85 per cent, only about 20 per cent of the people above 80 years of age have received the primary shot as well as a booster dose, Nature reported. It cited a study to suggest that Sinovac, the primary vaccine being used in China, was able to offer high levels of protection in people over 60 only after a booster dose was received.

If the situation in Shanghai, which accounts for almost three-fourths of all cases in China, goes out of hand, as has happened in many countries in the last one month, the fear is that it could result in a large number of deaths of elderly people as seen in Hong Kong.

The lockdown in Shanghai, even at the risk of a major economic impact, is a desperate attempt by China to prevent that kind of situation.

Residents line up for Covid-19 tests at a residential community under lock down in Shanghai, China, Wednesday, March 30, 2022. (AP Photo)

Does the Chinese situation pose any risk to India?

The pandemic has been in steady decline in India after the third wave. On Wednesday, only 1,233 cases were reported across the country. While nothing can be predicted about this pandemic, the risk of a fresh surge in India seems very low, at least in the near future, in the absence of the emergence of any fresh variant of the virus.

The situation in India has been very different from that in China or Hong Kong, or even South Korea. All these three countries had managed to keep a very tight leash on infections for most part of the pandemic. A very large proportion of the population in these countries was never exposed to the virus, and thus remained extremely susceptible.

Vaccinations have not been very effective in preventing infections. As a result, once a fast-transmitting variant like Omicron managed to breach the defences, the spread was very rapid.

This month, South Korea reported 6 to 8 lakh infections daily. This is more than what the country had detected for the entire pandemic period till the end of last year. The daily case count has dropped a little now, but even on Wednesday, about 4.24 lakh infections were detected.

In India, on the other hand, an overwhelming proportion of the population has already been infected, some multiple times. The Omicron variant itself is estimated to have infected 30-40 per cent of the population.

Repeat infections by the same variant are known to be rare, at least in the near term. In this kind of scenario, a new wave of infections seems unlikely in the immediate future. Still, the situation could change at any time if a new, dangerous variant of the virus emerges.

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