Why China's reopening has not yet led to a global Covid spike

Experts say risk remains as millions take opportunity to travel abroad

Cabin crew prepare to leave Pudong International Airport, in Shanghai. EPA

After three years of lockdowns, China has reopened its borders to international travel. EPA

Authorities lifted several major Covid-related entry restrictions as of January 8, including quarantine requirements for international arrivals. EPA

A celebration at Hong Kong's Lok Ma Chau border checkpoint. Reuters

A Hong Kong rail worker reminds passengers to bring their Covid test results as they travel to the mainland border. AFP

Customs officers check documents as people travel from Hong Kong, to mainland China. AFP

As China’s highly publicised loosening of Covid restrictions continues to play out, case numbers are easing off — according to official figures — after an initial spike in positive tests and deaths.

The world’s most populous nation is not the only country in East Asia experiencing a spike in coronavirus infections.

Its neighbour Japan is breaking its monthly record for deaths in January.

But are countries with stricter lockdown measures just catching up with the rest of the world in terms of garnering immunity? Or are these breakouts likely to spread to the rest of the globe?

Around China we have countries like India, Indonesia, Malaysia and Vietnam. They’re all highly populated. We need to not take our eye off the ball

Dr Bharat Pankhania,
University of Exeter

Here, we look at the situation in China and consider what implications, if any, the country’s lifting of lockdown rules after three years may have for the rest of the world.

What is happening in China?

Many observers suggest that China’s official death toll from Covid significantly underestimates the actual figure, but even according to government statistics, the coronavirus has exacted a devastating toll in recent weeks.

Up to December 19, the country’s death toll from Covid was 37,477, but the most recent figure listed by the World Health Organisation puts the total at 111,173, meaning more than 70,000 people have died in just a month.

Reduced vaccination rates among the elderly, a lack of efficacy in the vaccines used and a low level of “natural immunity” because few people have been infected previously make the country vulnerable at this stage of the pandemic.

“They’ve had so many lockdowns, they haven’t had the opportunity to get naturally infected,” said Prof Ian Jones, a professor of virology at the University of Reading in the UK.

About half the people on one flight from China to Italy in December were found to be infected. While just a snapshot, it indicates that infection rates in China are high.

According to official figures, China’s case numbers peaked in mid-December and the death rate peaked at the beginning of January and has since tailed off.

In the first weekly figure for January, China reported 27,728 deaths, falling to 20,031 the following week and 9,999 the week after.

This may in part reflect a reduction in testing, with a British Medical Journal report published in January saying that the country had “effectively stopped counting Covid cases and deaths”.

Why have Covid-19 death rates surged in Japan?

Japan has had a spike in cases that began in October peaked in December, with case numbers now falling away.

As is typical, deaths have followed case numbers with a lag, so they have peaked in January with more than 10,000 fatalities recorded so far, the first time the monthly number has reached five figures.

The death toll was 500 in a single day in January, another first.

Japan’s spike is thought to be the result of the spread of BA. 5, a form of the Omicron variant.

This strain has been described by the University of California, Davis, as “the most easily spread strain to date” and one that is “able to evade immunity from Covid infection and vaccination”.

Scientists have reported large numbers of cases in care homes, many of whose residents have multiple other health conditions that put them at a higher risk if they are infected with Covid.

Another country in the region, South Korea, saw an increase in cases during a similar period to Japan, with numbers building up from October onwards.

While South Korea suffered hundreds of deaths a week from Covid for much of November, December and January, fatality numbers were a fraction of those during previous waves.

Is China’s spike affecting the rest of the world?

Global Covid case numbers saw a spike in December, with the highest weekly figure since the start of the pandemic, 44,941,401, recorded on December 19.

However, this reflects events inside China, with 91.6 per cent of that weekly total coming from the world’s most populous nation.

While some nations have imposed testing requirements on incoming travellers from China, Prof Jones said it was unlikely that China’s spike in cases was having significant consequences for other countries.

“The rest of the world is now more or less all through the epidemic and has a level of immunity,” he said.

“There’s no reason to suppose what’s coming out of China is more dangerous than what’s already circulating in other countries. For that reason, I don’t think it will boost cases.”

Another reason not to expect a huge rise in deaths is that, Prof Jones said, the virus has “lost a bit of its teeth” and tends to cause less severe disease than before.

“Omicron replicates well in the upper respiratory tract, but it doesn’t replicate well in the lower respiratory tract in the lungs, which is where the disease [develops],” he said.

In many countries, the threat from Covid-19 is now similar to that from influenza, he said, with the virus much less able to cause severe disease.

“I think effectively the world is through it and other countries are catching up,” he said.

This month worldwide Covid case numbers have fallen, which again is a reflection of the situation within China.

Dr Bharat Pankhania, a senior clinical lecturer and infectious diseases specialist at the University of Exeter in the UK, said more effective vaccines, especially messenger RNA (mRNA) shots, which have been widely deployed outside China, made much of the rest of the world, particularly western nations, less vulnerable.

Striking a cautionary note, however, he said it was important to monitor what was happening in other parts of Asia in case increases were seen.

“Around China we have countries like India, Indonesia, Malaysia and Vietnam. They’re all highly populated,” he said.

“We need to not take our eye off the ball where they also have similar problems of poor vaccine uptake and poor [rates of administering] boosters.”