China’s surge: should Nepal be worried?

It was exactly three years ago that the novel coronavirus first emerged from Wuhan. SARS-COV-2 has now come full circle as cases soar and hospitals are overwhelmed across China.

Beijing abandoned its zero-Covid policy, and has stopped registering fatalities from Covid-19. Official case load and death figures are said to be underreported. International health experts believe more than 1 million people may die from the disease this winter.

Several countries now require mandatory Covid tests from passengers arriving from China, after Beijing eased travel restrictions in the new year. Countries in the region including Nepal are on high alert.

The Health Ministry last week made masks once again mandatory in public places while appealing to people to resume hand washing and social distancing. On 28 December Nepal reported only 8 cases and zero Covid deaths.

The Ministry has also urged the public to take booster shots, and second boosters for people above 55 and the immunocompromised. The Drug Advisory Committee on 27 December granted emergency use approval for the Pfizer-BioNtech bivalent vaccine of which Nepal is set to receive 1.5 million doses from the COVAX global initiative by mid-January.

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“What is of utmost priority now is to protect our elderly and vulnerable populations. We need to fully vaccinate them if they have not or give them a booster, bivalent would be even more effective as it can fight both the original and Omicron strains,” explains Sher Bahadur Pun at the Teku Hospital.

Pun likens what is happening in China now to the Omicron surge in Hong Kong earlier this year which also saw a significant rise in hospitalisations and deaths. Nepal also suffered a spike in fatalities among the elderly towards the end of the Omicron third surge in 2022. In both cases, the unvaccinated were victims.

“Omicron might be less severe but in vulnerable groups who have not been vaccinated, even this strain can cause complications,” he warns.

More than 80% of Nepal's eligible population (above 5) have been fully vaccinated against Covid-19. But the booster uptake is much lower at only 27%. There is also concern that it has been more than a year since most Nepalis got their last shots, and their immunity might be waning. Officials recommend a booster even though memory cells could provide some residual protection.

The WHO has asked China to reveal its true Covid figures, and the nature of the prevalent strain. Experts attribute its surge to vaccination hesitancy among the elderly, stringent zero-Covid strategy which suppressed natural immunity, and Chinese vaccines like Sinovac being less effective than mRNA jabs.

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“China did great with lockdowns and restrictions but took it to unnecessary levels, which means the population is Covid naïve compared to other countries. When they reopened, the variants already present multiplied rapidly,” explains Buddha Basnyat, physician at Patan Academy of Health Sciences. “It also seems they did not learn from the rest of the world, did not vaccinate their elderly sufficiently and relied only on their own vaccines.”

The efficacy of Chinese-made vaccines has long been debated, but there are no studies to prove their efficacy, or lack thereof. However, experts agree that all the available vaccines recommended by WHO considerably reduce the severity of the disease.

Media amplification of the China surge has caused some panic in the neighbourhood. Japan, Malaysia, Taiwan and India are the latest countries to require Chinese passengers to have Covid tests. India has also introduced nasal vaccine this week, those who had taken Covishield and Covaxin can take it as a heterologous booster dose.

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However, the BF7 Omicron strain has already spread around the world and it is not virulent, and does not seem to adversely affect vaccinated individuals. Experts also caution that although 1 million deaths sounds like a lot, it is a tiny fraction of China’s population. The Chinese government has accused the West of ‘hypocrisy and hyping the threat’.

“The BF7 is not a new variant, it has been around for a while. It has been circulating in Europe, America and parts of Asia. It has been reported in India and chances are high it is in Nepal too, we probably just haven’t detected it yet,” says Sameer Mani Dixit of the Centre for Molecular Dynamics Nepal.

He adds: “Nepalis have developed enough resistance through reinfections and vaccinations, especially as subsequent strains have been more contagious but less virulent.”

The WHO says it is concerned about further mutations and the emergence of new variants, but mutations do not necessarily mean increased severity. Just like Omicron is more contagious but less severe than Delta.

Says Pun: “There are at least 17 sub-variants of Omicron in Nepal. This means we have had enough immunity gained via reinfections. We also have protection from vaccination and the proof of this is how we marked our festivals, and elections without following safety measures and without any resulting surge.”

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Having said that, the pandemic is not yet over. Parts of China including Hong Kong, South Korea, Hong Kong and Japan which have high mobility of Nepalis are also seeing a Covid-19 surge this winter.

The health desk at Kathmandu airport is not strictly checking vaccination or PCR tests anymore, and some experts say it should increase surveillance — especially when flights from Chinese cities resume on 8 January. After being locked down for so long, many Chinese are already booking holiday travel to Asian destinations.

The Rasuwa border post also reopened this week to resume the cargo transport at Kerung and the trade between the two countries. The checkpoint which has been shut due to the pandemic since early 2020.

Says Buddha Basnyat: “There is no harm in continuing to follow safety measures, it is now proven that masks and hand washing saves lives. It also protects us from a host of infections including typhoid and TB and more importantly from air pollution, all non-Covid silent killers.”