China?s COVID Wave Is Coming

By?Katherine J. Wu

In China, a dam seems on the verge of breaking. Following a?wave of protests, the government has?begun to?relax some of its most stringent zero-COVID protocols, and regional authorities have?trimmed back?a slew of?requirements?for mass testing, quarantine, and isolation. The rollbacks are?coming as a relief?for the many Chinese residents who have been clamoring for change. But they?re also swiftly tilting the nation toward a future that?s felt inevitable for nearly three years: a flood of infections?accompanied, perhaps, by?an uncharted morass of disease and death. A rise in new cases has already begun to manifest in urban centers such as?Chongqing,?Beijing, and?Guangzhou.?Now experts are waiting to see just how serious China?s outbreak will be, and whether the country can cleanly extricate itself from the epidemic ahead.

A major COVID outbreak in China would also have unpredictable effects on the virus. The world?s most populous country includes a large number of immunocompromised people, who can harbor the virus for months?chronic infections that are thought to have produced variants of concern before. The world may be about to witness ?a billion or more opportunities for the virus to evolve,? Cowling told me. In the coming months, the coronavirus could also exploit the Chinese?s?close interactions with farmed animals, such as?raccoon dogs?and?mink?(both of which can be infected by SARS-CoV-2), and become enmeshed in local fauna. ?We?ve certainly seen animal reservoirs becoming established in other parts of the world,? Worobey told me. ?We should expect the same thing there.?

Then again, the risk of new variants spinning out of a Chinese outbreak may be a bit less than it seems, Abdool Karim and other experts told me. China has stuck with zero COVID so long that its population has, by and large, never encountered Omicron subvariants; people?s immune systems remain trained almost exclusively on the original version of the coronavirus, raising only defenses that currently circulating strains can easily get around. It?s possible that ?there will be less pressure for the virus to evolve to evade immunity further,? says Emma Hodcroft, a molecular epidemiologist at the University of Bern; any new versions of the virus that do emerge might not fare particularly well outside of China. In other words, the virus could end up trapped in the very country that tried to keep it out the longest. Still, with so many people susceptible, Cobey told me, there are zero guarantees.

Either way, viral evolution will plod on?and as it does, the rest of the world may struggle to track it in real time, especially as the?cadence?of?Chinese testing?ebbs. Cowling worries that China will have trouble monitoring the number of cases in the country, much less which subvariants are causing them. ?There?s going to be a challenge in having situational awareness,? he told me. Shioda, too, worries that China will remain tight-lipped about the scale of the outbreak, a pattern that could have serious implications for residents as well.

Even without a spike in severe disease, a wide-ranging outbreak is likely to put immense strain on China?which may weigh heavily on its economy and residents for years to come. After the SARS outbreak that began in 2002, rates of?burnout and post-traumatic stress?among?health-care workers?in affected countries swelled. Chinese citizens have not experienced an epidemic of this scale in recent memory, Chen told me. ?A lot of people think it is over, that they can go back to their normal lives.? But once SARS-CoV-2 embeds itself in the country, it won?t be apt to leave. There will not be any going back to normal, not after this.