Asia vs Covid (2): the Community Battle

Global media coverage of the recent rise of Covid in China is focused more on the nature of the Shanghai lockdown than on the severity of the current outbreak, and with good reason. During weeks of total lockdown, it has been impossible for affected residents to legally access food and even medicines. Measures have been implemented with military precision; families have been separated from their children as infected people are forcibly quarantined. Factories have had to close and ‘concentration camps’ for quarantined individuals have been created to house those evacuated because of even a single case in a neighbouring block.

Such stringent measures have generated fear amongst populations of other Chinese cities and this in turn has led to panic buying followed by widespread food shortages. The Chinese leadership continues to utilise the language of war as it remains doggedly committed to eliminating Covid entirely; even whilst the number of infections in Shanghai is easing, parts of Beijing are now being locked down because just a few dozen cases of coronavirus have been detected. In one mining community in China’s Inner Mongolia region a lockdown was ordered after just two cases were registered. Although reported new daily infections fell from 25,000 to just 3,000 amongst Shanghai’s 25 million inhabitants over the period mid-April to mid-May the lockdown is getting tighter, not more relaxed – despite what it says in the Chinese press. No other country has responded to this extent to what, by any standards, are relatively small outbreaks of a relatively benign strain of covid.

China’s zero-Covid approach is out of step with the rest of the world. In most places any thought of aiming for total eradication has long been abandoned as the goal has been deemed unachievable by the World Health Organisation (WHO). Throughout the spring of 2022 environmental measures to combat the pandemic have been relaxed in many places, especially where vaccination levels are high and acquired immunity has reached a significant level (conditions which are actually met in China).

High levels of protection have not been achieved overnight; as we explore elsewhere, they are the result of two years of frantic scientific development in vaccines and antiviral medicine. Governments have implemented new levels of controlling population behaviour, largely with the consent of their people. This experimentation in the use of environmental measures to combat the pandemic – based, let’s be frank, on trial and error – is all in the hope of limiting the massive economic disruption that Covid has caused.

In many countries this approach has been termed ‘living with Covid’. One reason zero-Covid can never be achieved in a single country is that if the virus exists, anywhere in the world, it will retain the capacity to spread, creating a threat for the future.

The Chinese would, no doubt, point to a statistic that, for every 100,000 people contracting Covid in their country, only one has died compared to 300 in USA. A draconian approach of total lockdown clearly does work in limiting the spread of the disease, but does it not replace one event which damages society with another? Aside from the human rights element, there is a danger that, in protecting the population from Covid too well, the spread of naturally acquired immunity to the disease through infection (which inevitably happens alongside vaccine rollout) is impeded.

Another factor exposed by the pandemic in Asia is the capacity of health services to cope with major outbreaks. Undoubtedly China has good reason to seek to reduce demand on hospitals to a minimum because, per 10,000 people, China has only 20 doctors compared to an average of 34 across the OECD, and one intensive care bed to every three expected by OECD standards. One in three Chinese people live in rural areas where health services are even more sparse. In that respect, Taiwan and other Asian countries were better prepared.

Restricting the spread of natural immunity is what appears to have happened in Taiwan, which, like most of Asia, has so far avoided a formal, Chinese-style, lockdown. Their rapid adoption of strict border controls, long quarantine periods, rapid test and trace facilities and the compulsory wearing of masks, even outdoors, appears to have served them well (the outdoor masks rule has recently been removed).

Taiwan had enjoyed a relatively benign Covid era hitherto. Apart from a two-month period in summer 2021, when it peaked briefly at 670 in a population of 24 million, the daily number of confirmed new cases has been in single figures throughout; until now. Since mid-March, 2022, Covid has been in exponential growth phase, reaching 2,386 new cases on 20th April and 50,780 on 10th May. This is far higher than was predicted a few weeks earlier, with no sign yet of a plateau. Why is this happening?

Although half of all cases in Taiwan’s current wave are asymptomatic and death rates are still low (4 in every 100,000 patients), shock waves are resonating around the island. That it has been Omicron, perceived elsewhere as the mildest Covid strain yet, that has evaded the defences of both Taiwan and China is a real worry when it comes to the potential to defend against future strains. South Korea, Hong Kong and Vietnam have all experienced similar but very brief peaks in recent months, now passed.

We have discussed vaccination elsewhere, but we need to put Taiwan’s environmental approach into a vaccination context. Despite the apparently successful use of community measures to control the epidemic concern is heightened there because vaccination rates in Taiwan are not as high as they could be. Whilst 80 percent have received two jabs – a very respectable number – only 58 percent have yet had a third, booster, injection. Additionally, unlike in other countries, the vaccination rate amongst the more vulnerable elderly lags behind the rest of their population. What has happened is that success in restricting the spread of the disease by environmental action has combined with that relatively low vaccination booster rate to create one of the lowest levels of ‘natural’ immunity in the world. Only one percent of the people of Taiwan exhibited naturally acquired antibodies before the current surge, compared to 57 percent in South Korea, so ‘herd immunity’ in Taiwan is a long way away. Herd immunity is the ultimate goal, though it cannot be achieved quickly and to try to do so carries many risks. As summer in the northern hemisphere approaches the rest of the world is moving away from peaks observed earlier in the year; Taiwan is confident that its own peak is imminent, and it will be seeking to remove Covid travel restrictions from July.

And yet… probably due to the absence of extreme lockdown measures the Taiwanese economy has proved to be one of the most resilient to Covid in the world. Whereas China claims that its economy is back to functioning at pre-pandemic levels, it is almost as though Taiwan never experienced the pandemic. In 2020 its economy grew at an enviable 3.1 percent which, even if sluggish by historic ‘Asian Tiger’ standards, reflected the global slowdown; but in 2021 growth had doubled, to over 6 percent, its highest since the ‘crash’ of 2008.

Indeed, the economies of all four of the ‘tigers’ – Hong Kong, Singapore, South Korea and Taiwan – have survived Covid relatively unscathed. Their capacity for resilience was proven both following the Asian economic crash of 1997 and the global crash, but they also witnessed the first coronavirus epidemic, SARS-1, in 2002-03, learning the need for rapid response. There were only 8,000 cases in all and fewer than 800 fatalities on that occasion, but three quarters were either in China or the ‘tigers.’

Going forward, the ongoing impact of Covid on national and global economies will be less easy to monitor than hitherto as it will be mixed with the impact of new factors. The 2020s have brought us the global energy crisis (exacerbated by Russia’s war with Ukraine), rapidly rising prices for grain and fertiliser (ditto) leading to food shortages and local problems such as the global shortage of microchips. Add to this economic mix a growing urgency to act on climate change and the long-term economic impact of the current pandemic will be dwarfed, camouflaged by these other factors.

It will not have gone unnoticed that China has Presidential elections in 2023, the first since it removed the limit of two 5-year terms per President. Xi Jinping’s name will be on the ballot paper as he bids – successfully, predictably – to become the longest serving incumbent since Mao Zedong, and he clearly has ambitions that he wants to achieve. A successful winter Olympics notwithstanding, the reputation of Sinovac as a second-class solution and the peaking of covid numbers in some cities must be potentially embarrassing to the country’s leadership. The excessive strength and nature of the local lockdown programme is not only designed to show Covid who’s boss, but it conveys a pre-election message for the Chinese people, too.

Europe and Asia have much to learn from each other in the environmental management of Covid with China and Taiwan providing valuable case studies. Both countries implemented effective environmental controls, in different political climates in respect of consent, though we can now see that both were flawed. Europe took a less extreme approach and appears to have managed peaks of infection better, though the British government was criticised for implementing testing, lockdowns and other measures too late. A British decision to remove thousands of infected (in many cases asymptomatic) older patients from hospitals and into care homes at the start of the pandemic was regarded by many as unethical and has subsequently been ruled illegal.

Planning for future pandemics has taken on a more realistic tone than previously and must build on the sum of global experiences. Zero-Covid is not a realistic aim but herd immunity, as a medium-, not a short-term, goal is achievable.

The world saw around 15 million excess deaths over the period 2021-22, concentrated in the middle-income countries of Asia, Europe and the Americas. Some died of Covid infection and others from the knock-on effects on medical services and their treatments for other conditions.

That cannot be allowed to happen again.

Sources used in this, and its companion Insight, include:

https://www.ft.com/content/729f1dc0-32d1-42c9-bb62-63a41f1e8de2

https://www.ft.com/content/0e6914ed-3ce5-4f7f-ab91-ce7b0ad68f2c

https://www.eastasiaforum.org/2022/01/31/taiwans-economy-outperforms-amid-covid-19-crisis/

https://www.economist.com/briefing/what-taiwan-can-learn-from-russias-invasion-of-ukraine/21808850

https://www.thetimes.co.uk/article/5ce37c20-c3e9-11ec-8a92-caed1bd1c140?shareToken=6c31c13fd2536a0787ede48ffee0f863

https://www.japantimes.co.jp/news/2022/04/24/national/science-health/covid-19-pill/

https://ourworldindata.org/covid-vaccinations?country=OWID_WRL

https://brill.com/view/journals/coso/20/6/article-p695_1.xml

https://www.economist.com/leaders/2022/04/30/chinas-martial-rhetoric-will-not-help-it-defeat-covid

https://bridgebeijing.com/our-publications/our-publications-1/china-covid-19-vaccines-tracker/