Tag Archives: public health

Hong Kong Turns To Boosters To Battle Omicron Threat

As Beijing battles in Xi’an the most severe Covid-19 outbreak since Wuhan two years ago, Hong Kong is starting booster shots for all adults in the city.

Previously, only those in high-risk groups or who had taken the less-effective Sinovac shot were eligible for boosters. Studies in several countries have shown that boosters significantly aid in the fight against the more infectious Omicron variant.

Hong Kong has proved effective in keeping out the Delta variant; it is one of the few places in the world to have avoided a Delta outbreak. There have been no locally transmitted cases of Covid for more than six months.

However, this has led to complacency over vaccination, with less than 70% of the city’s population being inoculated with at least one dose. One-third of those have had the Sinovac vaccine, which provides insufficient protection against Omicron even with three shots.

Hong Kong would be vulnerable if Omicron took hold, and it is increasingly being detected in travellers. As of January 4, 114 cases of Omicron have been detected at the airport, all arriving passengers or directly linked to them. On December 23, the government said an airport cleaner was suspected of having been infected with Omicron, the first time the variant appears to have evaded the city’s strict border controls.

Hence the expansion of boosters. The government has also started making second doses of the Pfizer-BioNTech vaccine available to 12-17-year-olds. Younger people had previously been restricted to one shot due to concerns over the side effect of myocarditis.

Hong Kong’s booster programme will be watched in China and much of the developing world, where millions of doses of Sinovac’s vaccine have been administered. That is especially true for the mainland, where the Lunar New Year (February 1) and Beijing Winter Olympics (February 4-20) pose particular opportunities for Omicron to take hold.

Plans to reintroduce limited quarantine travel between Hong Kong, Macau and the mainland ahead of February may now be scaled back or postponed. Or Hong Kong may have to adopt the tight monitoring of its citizens commonplace on the mainland, which has used all the tools of its surveillance network to tackle the outbreak.

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Xi’an Tests Beijing’s Zero-Tolerance For Covid

Ariel view of Xi'an under lockdown, taken on January 1, 2022. Photo credit: Xinhua/Tao Ming

THE MANAGEMENT OF the lockdown of Xi’an to control the outbreak of Covid-19 has not gone smoothly, highlighting the challenge each new resurgence of the virus poses to China’s zero-tolerance policy towards Covid-19.

The lockdown imposed on December 23 suggests that authorities have no intention to give up on their zero-tolerance approach. However, Vice-Premier Sun Chunlan said late last week that local authorities need to adopt more ‘targeted and forceful’ measures and improve quarantine controls to deal with the outbreak in the city of 13 million people.

For example, multiple reports talk of infections being transmitted by residents mingling while waiting to be tested for Covid.

The Party secretary of Yanta district in the southern part of the city and one of the areas worst-hit by the outbreak has been fired along with another official — far from the first local bureaucrats to take the fall for mishandling Covid flare-ups.

This came as reports emerged of midnight evictions in the district’s Mingde 8 Yingli housing compound on January 1 when residents were instructed to leave their homes and go to quarantine facilities with some waiting for hours outside in the winter cold for the buses taking them there.

To restrict the outbreak regarded as the most severe since the virus was first observed in Wuhan two years ago, residents were already required to remain indoors. Shops are closed. Entry to the city is heavily restricted and driving within it is banned, as the empty roads in the picture of the city above, taken on January 1, testifies.

A few dozen cases in early December increased to more than 150 a day. However, the latest data reported by state media suggest the numbers of new locally transmitted infections have peaked with new infections around the 100 mark on both days of the weekend.

A total of nearly 1,600 cases were confirmed in the city as of January 1. The number is tiny by international comparisons, but the highest in China since March 2020.

The outbreak, which is of the Delta, not the Omicron variant, was traced to a flight from Pakistan but initially evaded detection by contract tracers for some days. As well as instituting a lockdown, authorities say they have conducted six rounds of city-wide testing.

Reports speak of citizens being punished for evading lockdown restrictions by fleeing the city and shortages of food. There have also been complaints about the lack of access to medical services and the availability of heating in the midst of winter in the northwest of the country.

It is thought this was due to recent reported infections in the community. Multiple Chinese outlets reported that locals had mixed while getting tested for Covid.

Authorities say that supplies of groceries and household essentials for residents have improved and that free food deliveries have been made to residents since December 28.

However, the build-up of public frustration in Xi’an directed towards the local government that has ensued — and its expression on social media despite attempts to censor it — points to the increasing difficulty authorities may face in continuing with severe lockdowns to snuff out resurgences of the virus.

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China and US Spar Over Covid Origin While Evidence Fades

THE REACTION TO the report to US President Joe Biden about the US intelligence community’s views of the origins of Covid-19 is as predictable as the report was inconclusive.

  • Zeng Yixin, deputy director of the National Health Commission, repeated Beijing’s long-held line that China opposes turning tracing the origins of the virus into a political issue and its equally long-standing accusation that Washington is engaging in blame-shifting.
  • Vice Foreign Minister Ma Zhaoxu had previously said in the same vein that the report lacked a scientific base and credibility and had been concocted for political purposes.
  • A statement from the embassy in Washington said the report was produced to scapegoat China.

The sanitized unclassified version of the report that was made public is similarly unilluminating. The various arms of the US ‘intelligence community’ are divided on whether the virus took hold among humans due to exposure to infected wild animals or as a result of a lab-related accident. None have high confidence in the positions they take.

However, the report categorically states that the virus was not created as a biological weapon. It also said that Chinese officials had no foreknowledge of the outbreak.

The US intelligence agencies said more information was needed to reach a conclusion with higher confidence and accused China of holding back information and blaming other countries for the outbreak.

Meanwhile, reports of attempts by the World Health Organisation to follow up on its carefully managed research visit to China earlier this year with a second investigative leam have faded from state media.

Last week, eleven members of the WHO’s initial research team said it would soon be biologically impossible to get reliable information about animals and people who might have been exposed to the virus in 2019 when reports of the novel coronavirus first emerged.

In an article in the journal Nature, they write:

Crucially, the window is rapidly closing on the biological feasibility of conducting the critical trace-back of people and animals inside and outside China. SARS-CoV-2 antibodies wane, so collecting further samples and testing people who might have been exposed before December 2019 will yield diminishing returns. Chinese wildlife farms employ millions of people (14 million, according to a 2016 census11) and supplied live mammals to cities across China, including Wuhan3. In response to the SARS-CoV-2 pandemic, many of these farms are now closed and the animals have been culled, making any evidence of early coronavirus spillover increasingly difficult to find.

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WHO Gets Trampled

THERE ARE SEVERAL interpretations of the Trump administration’s latest attacks on the World Health Organisation (WHO): they are a diversionary tactic to deflect scrutiny of the United States’ response to the Covid-19 pandemic; they represent an expansion of this particular front in ‘the new Cold War’ between Washington and Beijing; or they are a central plank of the president’s re-election campaign for November. Whatever view you hold, there is no escaping that they were predictable.

The WHO and the Donald have previous.

In 2016, the WHO urged then-President-elect Donald Trump to expand ‘Obamacare’, the signature health insurance legislation of his predecessor President Barrack Obama, whose enabling legislation, the Affordable Care Act, Trump had promised on the campaign trail to repeal immediately he took office. This did not bode well for the relationship doing the Trump presidency.

His administration from its outset embarked on a decrease of US support for global healthcare assistance in line with the ‘America First’ agenda on which the president was elected and campaign promises to end what the president described as other countries taking advantage of the United States and ‘failing to pay their fair share’. Its first budget, the administration proposed a $4.6 billion cut in humanitarian assistance and global health spending. Some $2.2 billion was accounted for by the latter.

This signalled the United States intent to remove itself from a two-decade-long role as the leading funder for preparing for and responding to global infectious disease outbreaks and basic health care delivery to low-income countries. The cuts included reducing funding for national disease surveillance systems, training and infrastructure.

At the time, there were plenty of warnings that these would put at risk rapid and coordinated responses to infectious disease outbreaks that recognise no borders. Nonetheless, barely a year after taking office, the president made the National Security Council’s global health and biodefence team redundant. This had been established by the Obama administration, with pandemic preparedness part of its remit. In a streamlining of the NSC, in which the directorates for arms control and nonproliferation, weapons of mass destruction and terrorism, and global health and biodefense were combined, the administration cut the pandemic preparedness team. Its role was subsumed within the NSC and given a more national security cast.

Nor has the Trump administration been enamoured with the WHO’s director-general, Tedros Adhanom Ghebreyesus, who has been an enthusiastic endorser of the healthcare component of President Xi Jinping’s Belt and Road Initiative. In a 2017 speech, Dr Tedros described the Health Silk Road as ‘visionary‘. The WHO had just signed a memorandum of understanding on a strategic health partnership with China along the Belt and Road and in Africa, The MOU included additional Chinese funding of the WHO.

China’s contributions to the WHO have been steadily climbing, though they still fall far short of the $400 billion-500 billion a year the United States pays in assessed dues and voluntary donations — or had been; even before Trump suspended payments it was almost 70% in arrears for 2019 and hadn’t handed over a dime of this year. While the US is on the hook for around 27% of the WHO’s member-nation dues, its share of the WHO’s total budget falls below 20% once voluntary contributions are factored in.

China has again offered to up its contributions to the WHO by $2 billion over the next two years to fight the pandemic, including making China the hub of global supply chains for anti-epidemic equipment and products, and to share any vaccine that it develops. The offers are efforts to defuse international criticism of its early response to the outbreak, but put the WHO in a tight spot.

Dr Tedros could call the United States’s bluff, and risk Washington walking away from membership as Trump has threatened. However, this Bystander does not reckon Trump would carry through the threat because of the win it would give Xi in expanding China’s global influence. Beijing would then be in pole position as the WHO’s lead funder and patron. However, it would also give substance to Trump’s allegations that the WHO is in Beijing ‘pocket’. That will concern a significant number of the WHO’s other members, including some who would not see themselves as in the first rank of allies of the United States.

It would also cut the WHO off from the United States’ technical expertise in public health and medical research — not to mention future funding under a different US administration. Setting up a review of its handling of the pandemic (update: now agreed in principle), some cosmetic distancing from Beijing and possibly the premature departure of Dr Tedros before his term of office is due to expire in July 2022, seem more likely.

The WHO may also look at the state of the World Trade Organisation and be reminded that when elephants dance, it is the grass that gets trampled.

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Washington Accuses Beijing Of Hacking US Covid-19 Research

THE US CYBERSECURITY and Infrastructure Security Agency (CISA) is warning US universities and researchers at pharmaceutical and healthcare firms of attempts by what it says are Chinese state-affiliated hackers to steal coronavirus research.

According to an alert the agency put out jointly with the FBI today:

These actors have been observed attempting to identify and illicitly obtain valuable intellectual property (IP) and public health data related to vaccines, treatments, and testing from networks and personnel affiliated with COVID-19-related research. The potential theft of this information jeopardizes the delivery of secure, effective, and efficient treatment options.

That last might be a logical stretch. Yet it underlines what would be a potentially significant escalation of US-China tensions, both from the attempt to steal US research while calling for international cooperation in addressing the pandemic and from how Washington could regard a cyber-attack on public health in terms of its national security and thus what would be proportionate retaliation or preemptive strikes.

The published alert is light on operational details and damage caused, but US intelligence officials have been privately briefing that the attacks started in early January and that Iranian actors were doing much the same. Private-sector cybersecurity firms previously identified Gilead Sciences, maker of the antiviral drug remdesivir, a potential Covid-19 treatment, as the target of Iranian hacks.

US intelligence and academic circles take it as a given that Iranian and Chinese and (and Russian) hackers have been targetting US biomedical research since long before the coronavirus outbreak started. But a race is now on for the bragging rights as the first country to produce a vaccine against Covid-19, giving impetus to more intense cyber attacks.

Conspiracy theories about where the Covid-19 pandemic started may divide Americans. However, they will readily believe the allegations of these latest alleged hacks. That will give US President Donald Trump scope to attack China again over its handling of the pandemic. Beijing’s public response to the allegations will likely to be to play a straight bat and repeat its standard line that it opposes all cyber espionage.

Today’s CISA alert also provides some context for Trump’s outburst earlier this week towards a US reporter who asked him why he regarded how the United States was dealing with the pandemic in terms of global competition. He testily replied, ‘that’s a question you should ask China. Don’t ask me, ask China that question, okay?’ before prematurely ending the press conference.

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China Reimposes Wuhan-like Lockdown In North-East

The main railway station at Jilin, seen in 2011. Photo credit: 阳之下光. Licenced under Creative Commons Attribution-Share Alike 3.0.

JILIN IS REVERSING the lifting of lockdown restrictions amid a flare-up of new Covid-19 cases in the north-eastern province that shares borders with North Korea and Russia.

In Jilin city, the province’s second-largest city with a population of 4.5 million, transport was shut down again Wuhan-like from 6 am on Wednesday. (The photo above is an archive one of Jilin railway station.) City residents may only leave if they can show they have tested negative for Covid-19 within 48-hours of intended travel, and it is not clear that they can get back. Schools have reclosed and several residential compounds have been quarantined. Authorities have also closed places of entertainment and tourist spots and banned group dining.

Nearby Shulan, where there is also a cluster of new cases, was closed off on Sunday. Contact tracing has established connections between the two outbreaks.

Both places are some 150 kilometres north of the nearest border with North Korea. However, the main road from the provincial capital Changchun to the point where the Chinese, North Korean and Russian borders meet runs through Jilin, which also has road connections north through Shulan to Harbin in neighbouring Heilongjiang province, a hub for Chinese-Russian commerce, and which had reported 386 cases of imported infection as of Monday. Travellers arriving in Harbin from along that road now face 28 days of mandatory quarantine.

Inevitably a new cluster of cases has heightened fears of a spillover of infection from either neighbouring country. The epidemic continues to grow in Russia, which now has approaching one-quarter of a million confirmed cases. Heilongjiang is imposing 35 days of quarantine on travellers from Russia.

North Korea has yet to confirm any Covid-19 infections. However, the suspicion is widespread that there are cases, reinforced by the recent exchange of messages about the virus between North Korean leader Kim Jong Un and President Xi Jinping. North Korea’s economy relies on illicit trade back and forth across the Yalu and Tumen rivers that separate it from China, providing a difficult to detect corridor of disease transmission.

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New Coronavirus Cases At Home And In North Korea Worry Beijing

A NEW CLUSTER of Covid-19 cases has been reported in Wuhan. The five cases are the first non-imported ones since April 3. This would appear to be evidence that as lockdown restrictions are lifted, a rise in infections is likely. Worryingly, the latest cases were all previously classified as asymptomatic.

Separately, Shulan city in Jilin province, near the borders with Russia and North Korea, has reported 11 new cases. Neighbouring Heilongjiang has also seen a spike in the number of imported cases, but this is mainly accountable for by Chinese citizens travelling back from Russia. Nonetheless, North Korea’s economy relies on illicit trade back and forth across the Yalu and Tumen rivers that separate it from China. Such back channels of potential infection will concern Beijing, now desperately trying to ensure the primacy of its global narrative about its victory over the pandemic.

Officially, there have been no reported cases from North Korea. However, air quality assessments suggest that there has been a significant increase in cremations, implying the country has not escaped the global pandemic. Supreme leader Kim Jong-un’s three-week disappearance from public view may have been a period of self-isolation. Such a judgement is speculative, given how little is known externally about what is going on inside the hermit kingdom.

China sent a three-person team of senior officials to Pyongyang a couple of weeks back, presumably to assess the situation and Kim’s health. President Xi Jinping has lately expressed concern about the situation in North Korea, offering help in response to a message that he received from Kim congratulating him on China’s handling of the outbreak.

There is a lot of signalling in that message about the primacy of Beijing for Pyongyang. Equally, China does not want the coronavirus to destabilise the Kim dynasty, an outcome that would be worse than the disease.

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Recounting China’s Early Covid-19 Cases

AN INTRIGUING PAPER crosses our desk from the medical journal, The Lancet. Academics from the Li Ka Shing Faculty of Medicine at The University of Hong Kong led by Dr Tim K Tsang have recalculated the early Covid-19 case rate in China by applying a consistent definition of a confirmed case to the official numbers augmented with data from the World Health Organization. They conclude:

If the fifth version of the case definition had been applied throughout the outbreak with sufficient testing capacity, we estimated that by Feb 20, 2020, there would have been 232,000 confirmed cases in China as opposed to the 55,508 confirmed cases reported by that date.

It is worth noting that the official count, at time of writing, is approaching 84,000, barely one-third of what the paper says was the total two months ago. The academics also say that 232,000 may still be an underestimate because many mild cases were neither tested nor confirmed, and some infections were asymptomatic

The official count was gradually broadened to include milder cases and those without epidemiological links to other known cases. Nonetheless, in the early phases of the pandemic, China’s published numbers undercounted the real total.

Whether this counts as a ‘cover-up’ will be in the eye of the beholder. It is not uncommon for the case definition in a viral outbreak to change as the clinical spectrum of infection evolves. However, in public health terms, the cost of not accurately tracking how quickly the virus is spreading is not being able to judge which are the optimal interventions to counter it or how effective they are proving to be.

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Containing Wuhan Coronavirus Gets More Challenging

A nurse from Changchun in Jilin Province seen on January 26, 2020 as she prepares to leave for Hubei province to help coronavirus control efforts there. Photo credit: Xinhua/Zhang Nan.CONFIRMATION THAT PATIENTS with the Wuhan Coronavirus can be infectious before their symptoms show and that the incubation period can be up to two weeks are setbacks for authorities’ attempts to contain the outbreak.

It makes the strategies of isolating patients to minimize the spread of the disease and temperature monitoring of travellers less effective.

Wuhan, the epicentre of the outbreak is on lockdown, many other cities have had travel restrictions imposed and travellers have to undergo temperature screening. Meanwhile, mass New Year events have been cancelled across the country. Towns in and around Wuhan have been described as ghost towns as residents heed official calls to stay inside.

Yet hundreds of thousands of travellers had been on the move before such measures were imposed, potentially making the scale of the outbreak far more extensive than first thought.

Ma Xiaowei, head of the National Health Commission, says the ability of the new respiratory virus to spread appears to be strengthening, without providing any clarification of what he meant. It may be that the virus is mutating in that way, or it could just be that the new information makes the containment more difficult.

Some 2,000 (Update: Nearly 3,000) cases of the new virus, officially named 2019-nCoV, have been confirmed and at least 56 (Update: 80) people have died, mostly elderly with pre-existing conditions but also including one doctor who was treating patients. The new coronavirus is similar to (about 85% identical) but distinct from the SARS virus, according to an academic study by Chinese researchers published in the New England Journal of Medicine.

Army medical teams and doctors and nurses from other provinces have been drafted into Wuhan, where hospitals are under stress and running short of supplies. Reports say that more than 3,000 extra medical personnel have arrived. Two new emergency hospitals are being rapidly constructed. Medical supplies being imported to meet domestic shortages, particularly of masks and protective suits.

Further control measures include a nationwide suspension of sales of wild animals; the outbreak is believed to have started in the Huanan seafood and animal market in Wuhan. Media are also being reminded that they have their part to play in containing the outbreak through responsible reporting. The limits to transparency are being established.

On Saturday, President Xi Jinping chaired a meeting of the Politburo Standing Committee — the top leadership — that set up a leading group headed by Premier Li Keqiang to take control of the response. That is a step up in centralisation and politicisation from the previous national-level response. That was at State Council and National Health Commission level.

One of the leading group’s first actions was to extend the New Year’s holiday for an indeterminate period (Update: by three days to February 2) as part of the control measures on travel and to indicate that there would be further restrictions on individuals’ freedom of movement. The start of the spring semester at educational institutions from universities to kindergartens has been postponed until further notice.

Leading officials have also been told that they ‘must stand at the frontline’. As we said previously, politically, the prize and penalties for how this disease ends up being handled are significant, not just for China internationally but domestically, too.

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Wuhan Coronavirus Will Prove Test For Xi And Party

THERE IS A lot more at risk from the Wuhan coronavirus outbreak than the health of thousands of infected people, critical though that is.

Top-level authorities have now moved swiftly and decisively to contain the outbreak, staking the Party’s reputation for purposeful social management for the public good — one of its justifications for its monopoly on power — on a successful outcome. President Xi Jinping told CCTV earlier this week that ‘people’s lives and health should be given top priority and the spread of the outbreak should be resolutely curbed’. It was, he said, ‘extremely crucial’ that every possible measure was taken to combat the virus.

In that sense, he now ‘owns’ the crisis. Local officials may get blamed, demoted or sacked for being slow to ‘fess up to the outbreak initially, but failure to contain it will now fall squarely on the shoulders of Xi and central government.

The mishandling and initial cover-up of the SARS epidemic in 2002-03, so roundly criticised internationally, will be fresh in the minds of officials high and low. This time the pendulum has swung in the opposite direction, once the initial slowness of Wuhan municipal authorities to recognise and respond to a potential public health emergency had passed.

Doctors followed a standard protocol for detecting new viruses, and, taking advantage of new techniques, quickly mapped its genome and passed the details to international health authorities. The sharing of information internationally has allowed timely monitoring and treatment of arrivals abroad of travellers from Wuhan. As a result, at this point, the outbreak is a Chinese, not a global emergency.

Domestically, central government took control of responding to the outbreak from municipal governments. A coordinating team was set up at the top level. Transport to, from and within Wuhan and nearby Huanggang was shut down, effectively locking down cities of 11 million and 7 million people respectively. In all, eight cities around Wuhan have had restrictions on free travel imposed.

World Health Organization officials called the quarantining of whole cities an unprecedented response to a public health crisis. Few other if any systems of government would have the capacity to implement such abrupt and draconian measures.

Whether such a cordon sanitaire, so to speak, will prove effective, given that an infected person may have passed on the infection to another before showing symptoms themselves of being ill, is yet to be seen. The mass travelling of the Lunar New Year holiday will provide an exacting test.

With public gatherings and events cancelled as well, there will, self-evidently, be significant localised economic impact. Managing that will also be a repetitional challenge for the Party, but one relatively easily met with money.

As with the H7N9 avian flu virus in 2013, widespread internet use domestically and the demands of the international community are likely to force transparency on this issue. The more significant political challenge for Xi will be how an authoritarian system, made more authoritarian by his reforms, copes in a case in which such transparency is essential for an effective response.

The press has now been allowed uncommon freedom to report the outbreak. Where the boundaries of that easing of censorship lie are also yet to be tested and only likely to be so cautiously. The primacy of the official narrative will not be ceded.

The People’s Daily underlines the bigger question at stake: how China handles the outbreak, it said in an editorial, ‘is a test for China’s governance system and capability’. But it will be a test of more than just governmental competence and the health services ability to cope. The outbreak is revealing how surprisingly stretched are the resources of China’s hospitals.

It is still too early to know  how widespread the social and political impact of the Wuhan coronavirus proves to be or how long-lasting, but the penalties for Xi and the Party for not passing this test will be significant both domestically and internationally. But so, too, will be the prizes for success.

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