India is doing fine at the moment but China will see lots and lots of infections, says virologist on current COVD-19 situation

In a tweet thread, the doctor said: " Let's start with China. China is opening up fast at a time when their population has low levels of exposure to natural infection. The current circulating variants are Omicron, which have evolved in vaccinated populations and are therefore very infectious."

"This means that China will have lots & lots of infections. Remember India's 100s or 1000s of cases in April-May 2021 and Jan 2022? In the absence of significant mitigations, this will be similar. Lots of infections lead to lots of sick people," she said.

"Most of China's population has received 2 doses of vaccines. Most infections can be managed at home, but sheer numbers mean that even a small proportion getting severely ill, means that many people will have severe disease and that a proportion of those will die," she said.

Speaking on the Chinese vaccines, she said the Chinese inactivated vaccines work well to prevent severe disease and death, but somewhat less well than the mRNA/vectored vaccines. 

"So the vaccines will prevent a proportion of severe disease/deaths, but numbers of people needing hospitals and dying will be higher than we have become used to in the past several months. BUT this will be higher than with slower opening or at a different time, 2 reasons," she said.

She said at present there has been no information about new variants of COVID-19 emerging.

"As far as we know, there are no new variants. China has the capacity to sequence, & we hope it will share data in real time. The variants now circulating in China have been in the rest of the world for months. The behaviour of the virus is not any different from expected," she said.

Speaking on the scenario in India, she said: "In India as well, we already have XBB and BF.7 (the 2 being hyped as new monsters). They are, like all Omicron subvariants, very good at infecting people because they escape the immune response that prevents infection, but are not causing more severe disease than delta."

"Omicron does result in severe disease in a proportion of infected, but not as severe as delta. It is not mild, but it does infect the upper respiratory tract more than lower. Each new subvariant thrives only if it is better at immune escape than the prior ones," she said.

Cautioning about probable emergence of new variant, she said: "For this, they & we should maintain variant & clinical surveillance to ensure that we detect signal of any changes in the behaviour of the virus. This is a public health function where stable surveillance runs in the background & ramps up for emerging threats."

She said: "Randomly increasing testing has little value. Testing incoming travellers needs a risk based framework, but X% sampling also means that you accept that every incoming case will not be detected. In other words, increasing testing needs a strategic approach."

She said India might not witness another surge in cases amid no presence of a new variant.

"At the moment, India is doing fine. We have few cases, we have had the XBB & BF.7 for a while and they have not driven an upsurge in India. In the absence of an even more highly infectious variant, I do not expect a surge," she said.

She stressed on the need to remain 'watchful' to avoid further escalation of cases.

Meanwhile, the head of the World Health Organization (WHO) expressed concern on Wednesday over the evolving COVID-19 situation in China, saying the UN agency continued to receive increasing reports of severe continuous disease across the country.

To make a comprehensive risk assessment of the situation on the ground, Tedros Adhanom Ghebreyesu told journalists at a regular briefing in Geneva that WHO needs more detailed information on disease severity, hospital admissions and requirements for ICU support.

“WHO is supporting China to focus its efforts on vaccinating people at the highest risk across the country, and we continue to offer our support for clinical care and protecting its health system”, he said.