Hong Kong will scrap some of its COVID-19 restrictions, including PCR tests for inbound travelers and vaccination requirements to enter certain venues, the city’s leader said Wednesday.
But the mainland has relaxed measures in recent weeks, and Hong Kong is preparing for the January reopening of its border with China, which had previously imposed harsh restrictions and snap lockdowns to stamp out the virus.
“Our society as a whole has built an extensive and high-level barrier of immunity (to COVID-19),” said Hong Kong Chief Executive John Lee at a news conference. Over 80% of the city has at least three doses of COVID-19 vaccine.
Close contacts of those who test positive for COVID-19 will also no longer need to isolate in Hong Kong, he said, and there will no longer be a limit on the number of diners per table at restaurants. The relaxed measures will take effect from Thursday.
Masks, however, will still need to be worn in public unless residents are exercising, as doing away with masks may lead to a surge in respiratory diseases like influenza just as Hong Kong faces a seasonal surge of flu cases, said Secretary of Health Lo Chung-mau at the news conference.
Germany’s governing coalition is arguing over whether remaining COVID-19 restrictions should be dropped after one of the country’s top virologists was quoted as saying that the pandemic is over.
Germany has scrapped the bulk of restrictions imposed at the height of the pandemic but, unlike other European countries, still requires mask-wearing on long-distance trains and buses. Masks are also mandatory in doctors’ practices, while masks and negative tests are still required to enter hospitals and nursing homes.
Rules for local transport are a matter for Germany’s 16 state governments, and some have dropped mask mandates. Some also have scrapped rules requiring infected people to isolate at home.
Comments by Christian Drosten, a professor of virology at Berlin’s Charite hospital, to the daily Tagesspiegel’s Tuesday edition prompted a renewed argument over whether the remaining rules are justified.
“We are experiencing the first endemic wave with SARS-COV 2 this winter; my assessment is that, with this, the pandemic is over,” he was quoted as saying. He added that the only reservation about that would be a major new mutation, “but I don’t expect that anymore at the moment either.”
Justice Minister Marco Buschmann said Drosten has been one of the most cautious scientists during the pandemic, and that “as a political consequence, we should end the last corona protection measures.” He said on Twitter that the law allows federal restrictions to be dropped before their scheduled end on April 7 if the situation is better than was expected in the fall — “and this is now the case.”
Buschmann’s Free Democrats, the smallest of three parties in Chancellor Olaf Scholz’s coalition, have long pressed for the fewest restrictions possible.
There was pushback from the other two, center-left governing parties. Health Minister Karl Lauterbach told German news agency dpa that “an immediate end to all measures would be reckless” and Drosten wasn’t calling for it.
Lauterbach said the most vulnerable, for example in nursing homes, still need protection, and pointed to the strain the health system is currently facing from various infections.
“Hospitals are full, the staff overloaded, excess mortality is high and winter isn’t over yet,” he said.
Japanese Prime Minister Fumio Kishida announced Tuesday that Japan will tighten border controls against COVID-19 by requiring tests for all visitors from China starting Friday as a temporary emergency measure against the surging infections there.
The quantitative antigen test that is already conducted on entrants suspected of having COVID-19 will be mandatory for all people arriving from mainland China. Those who test positive will be quarantined for seven days at designated facilities and their samples will be used for genome analysis. The measure begins Friday, just as Japan heads into year-end and New Year’s holidays marked by parties and travel, when infections are expected to rise.
Kishida said China’s lack of information and transparency about the infections made it difficult to assess and figure out safety measures. There are huge discrepancies between information from central and local authorities, and between the government and private organizations, he said.
“There are growing worries in Japan,” Kishida said. “We have decided to take a temporary special measure to respond to the situation.”
Japan’s new measure aims to “prevent rapid increase of the infections in this country” and is not intended to stop global movement of the people, Kishida said. Japan will act flexibly while watching the development in China, he added, including halting the planned increase of flights between Japan and China “just to be safe.” Direct flights between the two countries will be limited to four major Japanese airports for the time being, government officials said.
“The measure is not going to affect Japan’s policy to continue with our ongoing transition toward a ‘with COVID’ lifestyle carefully and steadily while watching the infections at home,” Kishida said.
Japan earlier this year stopped requiring COVID-19 tests for entrants who had at least three COVID-19 shots — part of the country’s careful easing of measures after virtually closing its borders to foreign tourists for about two years.
Could the COVID-19 surge in China unleash a new coronavirus mutant on the world?
Scientists don’t know but worry that might happen. It could be similar to omicron variants circulating there now. It could be a combination of strains. Or something entirely different, they say.
“China has a population that is very large and there’s limited immunity. And that seems to be the setting in which we may see an explosion of a new variant,” said Dr. Stuart Campbell Ray, an infectious disease expert at Johns Hopkins University.
Every new infection offers a chance for the coronavirus to mutate, and the virus is spreading rapidly in China. The country of 1.4 billion has largely abandoned its “zero COVID” policy. Though overall reported vaccination rates are high, booster levels are lower, especially among older people. Domestic vaccines have proven less effective against serious infection than Western-made messenger RNA versions. Many were given more than a year ago, meaning immunity has waned.
The result? Fertile ground for the virus to change.
“When we’ve seen big waves of infection, it’s often followed by new variants being generated,” Ray said.
About three years ago, the original version of the coronavirus spread from China to the rest of the world and was eventually replaced by the delta variant, then omicron and its descendants, which continue plaguing the world today.
Dr. Shan-Lu Liu, who studies viruses at Ohio State University, said many existing omicron variants have been detected in China, including BF.7, which is extremely adept at evading immunity and is believed to be driving the current surge.
Experts said a partially immune population like China’s puts particular pressure on the virus to change. Ray compared the virus to a boxer that “learns to evade the skills that you have and adapt to get around those.”
One big unknown is whether a new variant will cause more severe disease. Experts say there’s no inherent biological reason the virus has to become milder over time.
“Much of the mildness we’ve experienced over the past six to 12 months in many parts of the world has been due to accumulated immunity either through vaccination or infection, not because the virus has changed” in severity, Ray said.
In China, most people have never been exposed to the coronavirus. China’s vaccines rely on an older technology producing fewer antibodies than messenger RNA vaccines.
Given those realities, Dr. Gagandeep Kang, who studies viruses at the Christian Medical College in Vellore, India, said it remains to be seen if the virus will follow the same pattern of evolution in China as it has in the rest of the world after vaccines came out. “Or,” she asked, “will the pattern of evolution be completely different?”
Recently, the World Health Organization expressed concern about reports of severe disease in China. Around the cities of Baoding and Langfang outside Beijing, hospitals have run out of intensive care beds and staff as severe cases surge.
China’s plan to track the virus centers around three city hospitals in each province, where samples will be collected from walk-in patients who are very sick and all those who die every week, Xu Wenbo of the Chinese Center for Disease Control and Prevention said at a briefing Tuesday.
He said 50 of the 130 omicron versions detected in China had resulted in outbreaks. The country is creating a national genetic database “to monitor in real time” how different strains were evolving and the potential implications for public health, he said.
At this point, however, there’s limited information about genetic viral sequencing coming out of China, said Jeremy Luban, a virologist at the University of Massachusetts Medical School.
“We don’t know all of what’s going on,” Luban said. But clearly, “the pandemic is not over.”
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AP video producer Olivia Zhang and reporter Dake Kang in Beijing contributed to this report.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Nearly three years after it was first identified in China, the coronavirus is now spreading through the vast country. Experts predict difficult months ahead for its 1.4 billion people.
China’s unyielding “zero-COVID” approach, which aimed to isolate all infected people, bought it years to prepare for the disease. But an abrupt reopening, which was announced without warning on Dec. 7 in the wake of anti-lockdown protests, has caught the nation under-vaccinated and short on hospital capacity.
Experts have forecast between a million and 2 million deaths next year. Predicting deaths has proven tricky throughout the pandemic, since it is influenced by varied factors and China presents an especially complicated case because of opaque information sharing.
It’s not clear exactly how large the current outbreak is, as China has reduced testing and stopped reporting most mild cases. But in cities and towns around Baoding and Langfang, in Hebei province, an area that was among the first to face an unchecked outbreak, Associated Press reporters saw hospital intensive care units overwhelmed by patients, and ambulances being turned away. Across the country, widespread reports of absences from work, shortages of fever-reducing medicine, and staff working overtime at crematoria suggest the virus is widespread.
China belongs to a small club of countries that managed to stop most domestic transmission of the virus in 2020, but it’s the last to end restrictions. Experiences of ending vary: Singapore and New Zealand achieved high vaccination rates and bolstered medical systems during restrictions, and reopened relatively smoothly. Hong Kong, where omicron overcame defenses while many elderly people were unvaccinated, suffered a disruptive COVID-19 wave in 2022. Nearly 11,000 people died of the illness this year in the city of 7.4 million, with 95% of them older than 60, according to Hong Kong’s department of health. Data from the city showed a 15% fatality rate for those older than 80 and unvaccinated, said Jin Dong-yan, a virology expert at Hong Kong University.
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AN UNDER-VACCINATED POPULATION
China has higher vaccination rates than Hong Kong did at the time of its omicron outbreak, but many people are vulnerable to infection, especially the elderly.
The country has exclusively used domestically made vaccines, which rely on older technology than the mRNA vaccines used elsewhere that have shown the best protection against infection.
A study conducted in Hong Kong, which has administered both an mRNA vaccine and Sinovac’s CoronaVac, suggested that CoronaVac requires a third shot to provide comparable protection, especially for the elderly. An ordinary course of the vaccine is two shots, with an optional booster later.
Most people vaccinated in China have received either CoronaVac or a similar vaccine produced by SinoPharm, but the country has administered at least five other vaccines. Comparable real-world data isn’t available for these vaccines.
While China counts 90% of its population vaccinated, only around 60% have received a booster. Older people are especially likely to have not had a booster vaccine. Over 9 million people older than 80 have not had the third vaccine, according to China’s official Xinhua News Agency.
Vaccination rates have increased over 10-fold, to over a million doses administered a day, since the start of the month. But Dr. Gagandeep Kang, who studies viruses at India’s Christian Medical College in Vellore said prioritizing the elderly would be key. Unlike other countries, China prioritized vaccinating the more mobile young to prevent the virus from spreading, said Ray Yip, the founding director of the U.S. CDC office in China. A campaign targeting those older than 60 started in December, but it is unclear how successful it has been.
They “did not pay enough attention to assure everyone gets full vaccine protection,” Yip said. “How well do they perform this particular catch up effort might determine some of the outcome.”
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OVERWHELMED HOSPITALS
Around Baoding and Langfang, hospitals have run out of intensive care beds and staff as severe cases surge. Patients lay on the floor, while others drove from hospital to hospital searching for beds for relatives Wednesday.
The National Health Commission said China had 10 intensive care beds for every 100,000 people on Dec. 9, a total of 138,000 beds, up from 4 for every 100,000 people on Nov. 22. That means the reported number of beds more than doubled in just under three weeks. But this number “might be wrong,” said Yu Changping, a doctor at the Department of Respiratory Medicine of People’s Hospital of Wuhan University. “It is impossible that the number could have jumped sharply within such a short time,” Yu said.
Even taken at face value, the increase in intensive care beds doesn’t mean the health system is prepared for a surge in cases since the pressure point, as seen globally, is often the availability of specialized doctors and nurses who can treat patients who need intensive care, said Chen. China only has 80,050 doctors and 220,000 nurses for its critical care facilities, and another 177,700 nurses who the National Health Commission says could potentially work in those units.
“If you look at intensive care unit beds, China is… in a great shortage,” he said.
Yu said he’s seen growing numbers of COVID-19 patients in recent weeks, and that almost all the doctors in the department have been infected. “We’re under pressure because we are receiving a large number of patients within a short time,” said Yu.
China has also not announced a clear triage plan, a system where hospitals prioritize giving treatments to the very sick to ration limited resources. Moreover, China’s health system is focused on large hospitals, which typically treat even the mildly ill, said Chen.
Potential shortages would depend on how quickly cases increase, and if those with mild symptoms don’t stay at home to ration resources for the very sick hospitals could still get overwhelmed, said Chen.
“That could easily crash the system,” he said.
To try to protect its health system, Beijing has converted temporary hospitals and centralized quarantine facilities to increase the number of fever clinics from 94 to 1,263. But rural areas may suffer, as the vast majority of China’s ICU beds are in its cities.
The use of digital tools and telemedicine may offer some breathing room to hospitals: Over a third of hospitals use some form of telemedicine, and around 31% used digital tools in their health care, found a nationwide survey of 120 public and private hospital executives in urban areas conducted by LEK Consulting in Shanghai.
China approved Pfizer’s drug Paxlovid for COVID-19 earlier this year, and two domestic therapies: an antiviral used for AIDS made by Genuine Biotech that has been repurposed for COVID-19 and a cocktail of virus-blocking antibodies made by BriiBio. But it is unclear how widely available these drugs are.
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HOW BAD WILL IT GET?
Scientists aren’t sure, since mortality depends on factors like vaccination rates, how people behave and efforts to bolster hospitals.
The Institute for Health Metrics and Evaluation at the University of Washington in Seattle predicts deaths could reach a million by the end of 2023 if the virus spreads unchecked. But Ali Mokdad, a professor of health metrics sciences at the institute, said the government would likely be able to reduce this toll with renewed social distancing measures.
Another study, from Hong Kong University, also predicts nearly a million deaths in a scenario in which the virus spreads throughout the country and authorities can’t provide vaccine boosters and antiviral treatments. Bill Hanage, co-director of the Center for Communicable Disease Dynamics at Harvard T.H. Chan School of Public Health estimated 2 million deaths in a Dec. 14 call with reporters.
“China has got a very, very hard road ahead of it in the coming months,” Hanage said. “But in the absence of vaccination, it would be much, much worse.”
Will a surge in China spill over into the rest of the world? Neighboring India has asked its state governments to remain alert, and not let genomic sequencing efforts wane. Jeremy Luban of University of Massachusetts Chan Medical School said large surges in infections increase the potential for a more dangerous mutation to arise. Luban has seen “no specific reason to be concerned” about any alarming variants already simmering in China, “except for the fact that a lot of infections are bad.”
Luban added: “The more the rate of transmission could be controlled in China the better.”
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Ghosal reported from New Delhi, and Wu reported from Taipei, Taiwan. Associated Press journalist Carla K. Johnson in Seattle and video producer Olivia Zhang in Beijing contributed to this report.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Total Doses Distributed = 937,298,205. Total Doses Administered = 662,148,570. Number of People Receiving 1 or More Doses = 268,143,349. Number of People Fully Vaccinated = 228,989,746.
