This really deserves its own post, but given the circumstances: READ THE WHOLE THING!
People who worked on pandemic preparedness anticipated the Great Toilet Paper Shortage of spring 2020. But many other things about the #Covid-19 pandemic have come as a surprise. I've chronicled some of them. https://t.co/yLtEtNM5cA
— Helen Branswell šŗš¦ (@HelenBranswell) December 27, 2022
As COVID-19 infections surge in China, the U.S. Centers for Disease Control and Prevention is considering sampling wastewater taken from international aircraft to track any emerging new variants, the agency told Reuters. https://t.co/RGFjIFIKO5
— Reuters Health (@Reuters_Health) December 30, 2022
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Chinaās #Covid surge raises the odds of a new coronavirus variant moving around the world. Scientists aren't yet certain, but worry it could happen. It could be similar to #Omicron variants circulating there now, or something totally new & different https://t.co/MSfDRhT8QR
— delthia ricks š¬ (@DelthiaRicks) December 28, 2022
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Beijing is going to look after Beijing first and the rest of us peasants can die in a ditch. No surprise there. They'll get Paxlovid, inhaled vaccines and the rest of us are going to get folk magic.
Hold on while I draw a hex on the side of my house to ward off the COVID… pic.twitter.com/TmqclOnylQ— Naomi Wu ęŗę¢°å¦å§¬ (@RealSexyCyborg) December 30, 2022
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CNY is going to be a blood bath,.
— Naomi Wu ęŗę¢°å¦å§¬ (@RealSexyCyborg) December 30, 2022
The rapid changes have left some citizens bewildered. Some have expressed anger at the swift reversal of zero-Covid, and those who called for changes are facing much of the blame, even as those at the top who ordered the changes have remained shielded.https://t.co/R0EslhwPMC
— Jonathan Cheng (@JChengWSJ) December 29, 2022
Basically shows that the opening up was a shock policy without consulting anyone or any preparation such as informing pharmaceutical industry and hospitals. Absolutely unhinged policy making process. 2/
— å¼ éŗ»åäøåæ ēåē¬ē« š¦š¹(@[email protected]) (@zhangmazijuhuo) December 27, 2022
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Japan announced that visitors from or travelling through mainland China will be required to take a Covid-19 test on arrival. pic.twitter.com/pGMqIwwgSk
— South China Morning Post (@SCMPNews) December 28, 2022
Experts say Indians don't need to panic over China coronavirus surge https://t.co/nkvSWmC58q
— BBC News (World) (@BBCWorld) December 28, 2022
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#LongCovid has played a role in more than 3500 deaths in the United States. That tally is less than 1% of all deaths linked to the #coronavirus, but it shows that it's possible to die from certain dangerously lingering symptoms https://t.co/3fyM3nte29
— delthia ricks š¬ (@DelthiaRicks) December 30, 2022
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Weāve just launched a new research program for immuncompromised individuals in the US with free home molecular testing and rapid access to medications when needed. Please help spread the word š https://t.co/PfZGBYjcQi
— Eric Topol (@EricTopol) December 28, 2022
This is amazing to be able to test for 4 different viruses in a single, low-cost, in-home rapid test. This type of technology should be accelerated for review. The impact on early, appropriate treatment & breaking transmission could be remarkable. https://t.co/4hPV3eIAcD
— Rick Bright (@RickABright) December 28, 2022
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If we believe covid to be so harmless we cannot be bothered to wear masks indoors, what is the point of requiring travelers from China to test negative?
To avoid new variants? To decrease burden of disease?
Doesn't make sense if we don't invest in widespread prevention efforts. pic.twitter.com/asvNmQUdpJ
— Stella Safo, MD MPH (@AmmahStarr) December 28, 2022
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Reader Interactions
64Comments
Comments are closed.
NeenerNeener
Monroe County, NY:
44 new cases on 12/27/22.
83 new cases on 11/28/22.
87 new cases on 12/29/22.
These seem too low relative to the numbers just before Christmas.
rikyrah
How did the folks in China not know what Pax was š¤
New Deal democrat
Biobot updated yesterday, showing a further increase in particles to the highest levels during the entire pandemic except for last winterās Omicron outbreak, equivalent to nearly 400,000 cases a day. The Northeast is by far the highest region, and the South shows a big increase as well. The West remains in good shape for the moment.
Confirmed cases declined to 52,900, in large part because of a hiatus in many Statesā reporting during the holidays. PR, NY, NJ, MA, RI, VA, WV, KY, SC, and OK have the highest cases per capita. Hospitalizations have continued to rise, now just over 40,000. Deaths, at 335, remain in the low range they have been since March.
The CDC will update its variant proportions later this morning. The issue will be the relative dominance of BQ.1&1.1 vs. XBB. But . . . Somebody leaked the data early to Dr. Eric Feigl-Ding; and it shows XBB.1.5 increasing its share to 40% of all cases, while BQ.1&1.1 declined from over 60% to 45%. No info on the remaining 15% of cases yet, or on regional variations.
The bottom line is, we keep seeing ever more easily transmissible variants, with low hospitalizations and even lower deaths. In the last 9 months, deaths have tranistioned from 500,000/year to 133,000/year. The lionās share of deaths skew to the under-vaccinated and the elderly. If people over age 50 were all fully up to date in their vaccinations and always masked in indoor public spaces (yes, this means *no* indoor restaurant dining), deaths would probably be down to about 35,000/year or about 100/day, a true flu-like comparison.
rikyrah
Thanks for this information, AL
Lapassionara
Once again, many thanks for this informative post.
rikyrah
Why does it seem that the Chinese government didn’t think about what would happen after they lifted the restrictions š
BruceFromOhio
Tate and his bro getting busted for sex trafficking was pure, undiluted karma.
Two fresh packages of 10ct N95s to kick off the new year, Gaia help us all.
YY_Sima Qian
Baiduās (Chinese counterpart to Google) COVID-19 transmission index database (based on web searches & big data from other undisclosed sources) shows the vast majority of municipal/prefectural jurisdiction in China have seen peaks in transmission & are now well off peak. There are only a few cities/prefectures that will peak in the coming week, all relatively isolated parts of far flung provinces/regions. As I mentioned before, Baiduās index may be more aggressive than reality, due to its urban bias. IMHO it is more accurate for urban areas than rural, & more accurate for higher tier cities than lower tier ones. It may also underestimate the speed of transmission in southern China were Omicron BA.5.2 is dominant, as it seems to produce lighter symptoms, w/ fewer people suffering fevers and fevers are more fleeting.
Hospitals continue to be stressed in cities that have been at the leading edge of the exit tsunami (such as Beijing & Wuhan), although it seems to be peaking in these places based on anecdotal evidence (both personal contacts & social media reports), waiting times for ambulance service is dropping. Life in the cities at the leading edge of the exit tsunami has substantially returned to normal. There are no more disruptions is delivery services, all of the eateries & entertainment venues have re-opened. Traffic has returned to near normal. The obvious exception, of course, are the hospitals. Severe/critical cases are still on steep uptrend for cities in the behind the leading edge (such as Shanghai & Hangzhou), so the scenes of overflowing morgues & crematoriums running around the clock is starting to be repeated there, too.Ā
Paxlovid has become more readily available in Beijing, still requiring a prescription, but the slow roll out has probably missed the bulk of sever/critical cases there. The rest of the country is still waiting. The drug has been added to the public health insurance coverage, w/ insurance paying 90% of the cost. That is good, because the retail price of Paxlovid in China is 2300 yuans (> US$ 300) for a box of 20 doses. I hear the retail price is even higher in the US?Ā
In the meantime, Chinese pharmaceutical company Junshi Biosciences just published in the New England Journal of Medicine the Phase III head to head trial dataĀ of its VV116 drug (developed in conjunction w/ Wuhan Institute of Virology), against Paxlovid. The results showed ānon-inferiorityā compared to Paxlovid. VV116 is prodrug like Gileadās Remdesivir. Gilead had patented a brethren of Remdesivir called GS-441524, which some Gilead scientists thought would be even more effective than Remdesivir. Junshi managed to sidestep Gileadās patent on GS-441524 by patenting a modification based on a different synthesis process, which Gilead had neglected to cover in its patent. In any case, VV116 does not have Paxlovidās drug-to-drug interaction risk, does not have the Molnupiravirās risk of promoting adverse viral mutations, & unlike Remdesivir can be taken orally. Here is a summary of VV116ās development & potential implications. VV116 is currently underly going Phase III trial against placebo around the world, should have data in H1 2023.
Aside: As I dive into the history of VV116, I am shocked to learn that we do not actually have efficacy data for Paxlovid in a vaccinated population?!! Paxlovid has beens shown to reduce risk of hospitalization by ~ 90% for the immunologically naive, but rather lackluster for those at standard risk (high risk vaccinated & low risk unvaccinated). A short thread by Victoria YanĀ on what the NEJM paper mean for VV116, & indeed Paxlovid. StatNews also has an article that dives into the obstacles for short term adoption of VV116: it will not be relevant for Chinaās current exit tsunami, but could be an important additional therapeutic tool for the worldās fight against COVID-19 into the future, especially if used in conjunction w/ Paxlovid.
Part of the reason for the explosive rise in cases in China is the high R0 of BF.7/BA.5.2 variants, estimated at 10 – 18 (possibly as high as 21). However, generation time plays a role here too. The original Wuhan Variant had a generation time of ~ 7 days. Omicron BA.1/2 had a generation time of ~ 5 days. I have not seen agreed upon estimates for BF.7/BA.5.2 strains, but based on how quickly people have developed symptoms after exposure, generation time in China could be as low as 2 – 3 days. Measles, although having R0 of 18, has a generation time of 15 days. There there is the issue of very high populationĀ density of Chinese cities. Tiers 1 & 2 cities in China have similar densities as Hong Kong or Singapore, Tiers 3 – 4 similar to Taipei. A high percentage of the urban population live in high-rises w/ shared elevators & shared plumbing. The rest live in old run down housing w/ communal kitchens & bathrooms. Only the more recent housing stock have traps in the plumbing to prevent aerosol transmission across apartments. A higher percentage of Chinese live in multigenerational dwellings than elsewhere in the world. All of these factors promote rapid transmission despite near universal masking & high degree of self-distancing.
As of 12/29, 3,476.443M vaccine doses have been injected in Mainland China, an increase of 1.056M doses in the past 24 hrs. As of 12/13, 1,307.222M individuals have taken at least 1 shot (or 92.73% of the total population), 1,274.018M are fully vaccinated (90.37% of the total), & 815.718M boosted (57.86% of the total). Of the > 60 y.o. cohort, 240.217M individuals have taken at least 1 shot (or 91% of the cohort), 228.644M are fully vaccinated (86.6% of the cohort), 184.179M boosted (69.76% of the cohort). Of the > 80 y.o. cohort, 27.73M individuals have taken at least 1 shot (or 77.5% of the cohort), 23.757M are fully vaccinated (66.4% of the cohort), 15.153M boosted (42.35% of the cohort).
On 12/29, Hong Kong reported 27,830 new positive cases, 946 imported & 26,884 domestic, & 72 new deaths. There have been 11,693 total COVID-19 deaths to date.
On 12/29, Macao reported 88 new cases & 1 new death. There have been 33 total COVID-19 deaths to date.
On 12/29, Taiwan added 27,413 new positive cases, 193 imported & 27,220 domestic. There were 34 new deaths (all w/ underlying conditions, 3 fully vaccinated & boosted). There have been 15,179 total COVID-19 deaths to date.
rikyrah
That in home test that can tell you about three diseases
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YY_Sima Qian
On the subject of countries screening arrivals from China, it is understandable. Cries of racism are overwrought, & criticism by the Chinese government (though pretty muted) disingenuous. After all, even after opening up the borders after 1/8, China will continue to require negative PCR tests w/in 48 hrs of departure for all arrivals, though there is no more testing upon entry.Ā
However, such gestures are also pointlessly performative IMO:
Rather than focusing on potential new variants that may emerge from Chinaās exit tsunami (something definitely to keep an eye on), the US is probably better served to closely monitor the XBB.1.5 variant discovered in New York. According to Richard Caoās analysis, the original XBB variant (originating from SE Asia) had strong evasive properties to BA.5 induced antibodies, but poor fit to hACE2 receptors that inhibited its spread. However, since there are no mitigations against transmission anymore, giving the different Omicron variants gazillions of opportunities to replicate & mutate, XBB quickly evolved to XBB.1.5 that retained its immuno-evasive characteristics, but gained much better fit to hACE2 receptors. It is very likely the XBB.1.5 strain is driving the winter surge in the eastern part of the US, that New Deal Dem & May McIrvin have been tracking, soon to spread to the rest of the country.
OTOH, wastewater testing of international flights & sequencing of such samples is definitely a good idea, if applied to all international inbounds.
BTW, Richard Cao is a great person to follow if one is interested in the new variants & the potential threat they pose. He got his PhD at Harvard, returned to China in 2019 to become an associate professor at Peking University, just in time for the pandemic. He has been at the bleeding edge of tracking, analyzing & predicting the evolution of SARS-CoV-2, christened the āCOVID Predictorā by peers around the world, & included by Nature as among the top 10 most impactful scientists of 2022Ā for his work.
OzarkHillbilly
Take that, Tate. Having been happily unaware of his existence, all of sudden I am seeing Tate in the news. Such as, Influencer Andrew Tate held on rape and organised crime charges in Romania. Well, OK, that’s not so bad.
Matt McIrvin
@New Deal democrat: The CDC has shown XBB as the dominant variant in New England for a while now, coming on strong. That’s mostly the “nowcast” projection talking but it stands to reason.
The circa-Christmas numbers for MA so far haven’t been quite as bad as I expected but there is a big outbreak going on out around Springfield. I think the jury is still out as to whether we get a big spike that looks like last winter (maybe with a lower peak) or if it’s a continuation of the sort of extended hump we’ve been in.
YY_Sima Qian
@rikyrah: None of what is happening right now in China is surprising, all if it quite predictable. The time to make a difference was preparations during Q2/3 2022. By the time the decision was made to fully reopen at the end of Nov., what is going to happen is going to happen.
The same applies to much of the criticism of the CCP Regime. The low vaccine uptake among the most vulnerable was well known, as was the lack of recent boosting, the low ICU capacity per capita, the population density, the explosive potential of Omicron variants in a population w/o prior infection. Indeed, at end of Nov. everyone thought China had only 4.5 – 5 general ICU beds / 100K based on 2019 data, so when the China National Health Commission declared in early Dec. that general ICU beds has been increased to 10 / 100K & a surge potential of 12.5 / 100K, it came as a pleasant surprise.
The responsible criticism would have been castigating the Chinese government for its poorly thought out vaccination strategy (particularly the lack of 2nd boosters) & failure to stock up on Paxlovid, & responsible advise would have been to hold on to containment measures for 3 more months (may not have been possible given the state of countrywide outbreaks in Nov.) so these shortcomings can be rectified, & then reopen post-Chinese New Year. There were a few such responsible voices inside & outside of China. Instead, the dominant narrative from Western MSM, governments & China watching circles was that Chinese containment measures were inhumane, unsustainable, damaging domestically & disruptive to global supply chains, & should be abandoned ASAP. Why is anyone surprised at the consequences of reopening? So now much of Western MSM, governments & China watching circles have quickly pivoted to criticizing the CCP Regime for allowing the exit tsunami to happen (as it that was avoidable). Not exactly helpful to anyone in China.
YY_Sima Qian
On a more personal note, my wifeās grandparents remain in the hospital. The grandfather had difficulty breathing during the middle of the week, which made all of us very concerned about the potential for rapid deterioration in his condition. However, in the past couple of days he seems to have improved. Both grandparents have improving appetite, blood oxygen > 95%, & no longer feverish. We continue to hope for the best. My wifeās uncle in Beijing had checked into a hospital early in the week due to persistent low grade fever, a week after he 1st developed symptoms, & was found to have pneumonia. He was prescribed Paxlovid, & tested negative w/in 3 days, & has now been discharged. My uncles & aunts in Beijing & Nanjing have all recovered from their infections (or at least no longer feverish).Ā
One of my team memberās grandmother just passed away, merely 2 days after becoming feverish. She was > 90, but in good health. COVID-19 really is culling the > 90 y.o. cohort in China.
NotMax
Short-term consequence of polar vortex?
Soprano2
The juxtaposition of the tweet from BBC News World and Bloomberg, about the EU saying screening people from China is unjustified, and then finding that almost half of passengers from China had Covid when they were screened in Spain, is breathtaking
I’m sure lots of parents would love to have that home test that does 4 things with one sample. Heck, I’d love to have that. Right now I have around 10 Covid tests between the ones I had that haven’t expired and new ones I’ve gotten in the last month.
YY_Sima Qian
@rikyrah:
Because during “Dynamic Zero COVID” the risk of infection was so low that no one was motivated to research therapeutics. People in China didn’t know any of the Chinese therapeutics approved under EUA, either.
Soprano2
@rikyrah: That’s what I’m wondering; for a dictatorship that can control a lot of things, their reopening was extremely sloppy and not well thought out at all. It’s a mystery to me too.
Dog Mom
My frustration – sibling and spouse living in suburbs of a large southern city, both have chronic issues, Ā primary vaxxed, but not fully boosted, Ā they started with vague symptoms, but tested negative. A day or two later, tested positive. Ā Told me a few weeks ago that they were advised NOT to get bivalent Ā booster by their specialist. . . Ā didn’t sound quite right to me . . . This week’s treatment – was NOT Paxlovid (not sure they could get due to timing) – they got several antibiotic shots, some oral antibiotics, some respiratory treatments, x-rays ordered, some anti-diarrheal (not needed) and Ivermectin! After I said it made every dog I had given it to throw up, I bite my tongue – they said “it helped people they know.” Ā They are getting better at this point. Ā The specialist ( and I don’t know the name), is part of a large practice affiliated with a large hospital – the recommended treatment – I don’t get it.
New Deal democrat
@Soprano2: ātheir reopening was extremely sloppy and not well thought out at all.ā
Xi seemed rattled by the demonstrations several months ago.
A problem with dictatorships for the past 1000s of years is that you never know when there might be an attempt at a palace coup.
One of the well-known advantages to a stable republican government.
Soprano2
@YY_Sima Qian: I guess I’m just surprised the strategy of the Chinese government was so bad regardless of any outside criticism. If they knew all of this, they also had to know what was going to happen when they suddenly lifted all of the restraints. Why do you think their planning for this was so poor?
Matt McIrvin
@Dog Mom: I think there’s more of that going on than is generally reported–wingnut doctors and medical personnel pushing quack remedies and advising patients not to get vaccinated, or not to get boosted.
My own PCP warned me about COVID shots causing shingles flare-ups, which turned out not to be true, but to be fair there were enough anecdotal reports of that floating around to make doctors a bit wary.
YY_Sima Qian
@Soprano2: The CCP regime cannot control the transmissivity of the virus, which dictates what one can realistically do in response to mitigate.
I do think every the government & the people were surprised by the speed of transmission when the soft lockdowns ended. I know I am. I think the expectation was BA.1/2 speed of transmission, & not something that is double that, & possibly w/ a shorter generation time. Exponential growth is unforgiving, & whatever one can do to try to mitigate only scales linearly.
Soprano2
True, but that gives him several months to prepare by stockpiling anti-virals, enlarging hospital capacity (remember how they built a temporary facility in a week at the beginning of Covid?) and encouraging more vaccination boosters to protect the maximum number of people.Ā This whole thing seems to be a decision made in haste without much thought about the consequences for the people of China, and that’s strange for a government that went to such lengths to protect the people for almost 3 years.
p.a.
I guess we’ll never get the info on the thought behind the Chinese gvt’s about-face, but WTF!
Matt McIrvin
@Soprano2: I guess a danger of moving to a more personalized, totalitarian situation like Xi has is that the information you get becomes corrupted and you get high on your own supply. I did think he was personally smarter than that.
Soprano2
@YY_Sima Qian: Yeah, that does make sense. I guess it’s hard for us in the U.S. to understand what the Chinese government does, just like some of what our government did in response to Covid seems crazy to outsiders.
Scout211
That 4-in-1 combo test from Measie looks promising. I checked out theirĀ website.Ā Itās a company in The Netherlands and the product is currently sold out.
I hope something like this test will be available in other countries soon.
Rusty
Thank you for the link to the article on lessons learned, it was exceptionally good.
Dog Mom
@Matt McIrvin: I suspect the doctor feels the need to give them something and maybe the antibiotics do help to avoid pneumonia or other problems. Ā While the had the initial vax, I think the amplification of wackiness from a specific news source has softened them up for acceptance of the treatment that they have heard so much about . . . and who doesn’t want to prove something to big pharma.
Matt McIrvin
…Meanwhile I saw all these news articles fretting about BF.7 coming in from China, but the thing is, BF.7 isn’t a new variant in the US–it has been here for a while and it seems to get pushed out by the BQ.1.x variants and XBB. It might be coming in in quantity but I don’t think it’s going to find us a green field.
YY_Sima Qian
@Soprano2: Even if the Chinese government had addressed all of the legitimate criticisms, at least the ones that it could have realistically addressed, before reopening, a massive exit tsunami would have been inevitable, & neither is hundreds of thousands of deaths. I have written before that correcting these mistakes would have improved things on the margins, but only at the margins.
There is no way China could have expanded ICU capacity to accommodate the exit tsunami, when modeling had suggested 10 – 16X demand of 2019 capacity (or 5 – 8X of 2022 capacity), & that was based on transmission dynamics of BA.1/2, while BF.7/BA.5.2 have up to double the R0 & quite possibly shorter generation time (meaning even higher, but also narrower, peaks for infection/hospitalization/death). There is no way China could have build up enough stocks of anti-fever medicine when everyone is trying to hoard all at once. In any case, anti-fever medicine does not actually improve medical outcomes from COVID019 infection. BTW, that does not excuse the failure to surge production in Nov. when the 20 Rules, loosening measures that would certainly have accelerated transmission.
I have also written before looking at the waves of death the former Zero COVID countries experience 6 – 7 mo. post-opening, & scaling them to China’s population. Singapore has been by far the best performing country, doing as well as Singapore will result in a wave of ~ 300K deaths. China will not be anywhere near Singapore’s performance. Doing as well as Taiwan, South Korea, Australia & New Zealand will result in a wave of ~ 550 – 650K deaths. If China can manage that I would call it a big “win”, since China has a less well thought out vaccination program (comparable to Taiwan, worse than the other 3) & lower health care resources than any of the 4. It would certainly exceed my expectations, but I don’t think China will. By far the worst former Zero COVID region has been Hong Kong. Doing as badly Hong Kong will result in a wave of > 2M deaths. I highly doubt China will perform as badly as that. My own expectation is ~ 1M deaths. A more logical vaccination program & stocking up on Paxlovid might have improved things closer to Taiwan/South Korea/Australia/New Zealand. 400K fewer deaths is massive, but so is 600K deaths.
PST
Rebound COVID is driving me crazy! I had a scratchy throat on December 15, tested positive the next day and started Paxlovid, and was symptom free and negative by December 20. I kept testing daily because I had heard of rebound. I didn’t test on Christmas Eve, but Christmas Day I was again positive with the slightest of scratchy throats, and I have tested positive every day since then up to yesterday. I have never had a fever or any of the other classic symptoms (except an occasional runny nose). I feel energetic and got some cycling in during the warm snap. But I’m still isolating or venturing out masked only. After more than two weeks total, I’d like to assume that the positive tests are an artifact of viral remnants and not a sign of positive contagiousness. There is some CDC opinion that rebound restarts the clock, but after five days of isolation and five days of masking, with no fever and abating symptoms, you’re done. Maybe I should resist the urge to test daily.
New Deal democrat
@Soprano2: With one man rule, occasionally you get a Caesar Augustus or a Frederick the Great, but more often you wind up with an Elon Musk. Even Napoleon eventually turned out to be, well, Napoleon.
In other words, there is no institutional pushback mechanism for poor or rushed decisions.
YY_Sima Qian
@Soprano2: The protests happened on 11/26 – 11/28 (it does feel like a lifetime ago in China), & loosening of restrictions started from 11/30 & accelerated from there.
I think the plan was a more phased opening, evidenced by the 20 Rules implemented in mid-Nov., but the domestic pressure was clearly building, & international criticism becoming relentless in the wake of the protests. Xi & the CCP Regime probably saw the protests as political cover to reopen more aggressively.
In hindsight, given the transmissionĀ dynamics post-opening, I don’t think phased opening was ever possible w/ BF.7 & BA.5.2. Schools have remained online, masking is universal, & the vast majority of most people stayed home when the exit tsunami reached their cities. This level of social distancing would have crushed Alpha or even Delta waves, might have slowed down BA.1/2 waves. Not w/ BF.7/BA.5.2.
NotMax
@New Deal democrat
Or even an Ivar the Boneless.
(A royal nom de throne which once heard can never be forgotten.)
;)
Bard the Grim
@YY_Sima Qian:
Thanks for the info. I’d never thought about the importance of plumbing traps in limiting Covid spread. Yay for mundane sanitation measures that we take for granted! Best wishes for your wife’s grandparents.
YY_Sima Qian
@New Deal democrat: Given the speed of transmission we are witnessing in China, despite the social distancing that have remained in place (by policy or by voluntary action), I am not sure what could have been done to stem the spread. Lockdowns were becoming toxic to a vocal minority (not to mention economically debilitating), some of whom were no longer willing to be consistently compliant. Prevalence in some cities had reached so high that batch testing was becoming counterproductive, & regular mass screenings were only possible w/ batch testing. Certainly after further loosening & the attendant rise in prevalence, batch testing would no longer be viable. OTOH, peak demand for ICUs were going to be many multiple of available capacity, the only means to flatten the curve enough to reduce it to below capacity were the very same soft lockdowns & regular mass screenings. Any other strong mitigation would only prolong the period when the Ā hospitals & ICUs are overwhelmed. It would save more critical COVID-19 patients, but it would also result in a longer period of time were non-COVID-19 patients have difficult accessing medical care. Which side of the balance weighs more?
w/ Wuhan/Alpha/Delta variants, the calculation is clear – flatten the cure to save the hospitals. w/ the latest Omicron variants, I think the calculation is less obvious. I suspect that is also part of the calculation for Xi & the CCP regime as they decided to accelerate opening (or, more likely, tolerate attempts by local authorities to accelerate opening). It is a decidedly amoral & utilitarian approach. Then again, the CCP regime is decidedly utilitarian.
NotMax
@YY_Sima Qian
The spread was inevitable. It was just tactically delayed.
YY_Sima Qian
@Soprano2:
Constructing the buildings are easy. Acquiring the attendant equipment is more difficult (since many have to be imported). Training the requisite ICU doctors & nurses take more than 3 years. To fill out the two temporary ICU hospitals in Wuhan back in Feb. 2020, China had to pool ventilators & ECMOs from hospitals around the country, & pull in staff from around the country (including the military’s medical corps). Throughout the pandemic China has transferred symptomatic patients from rural areas & low tier cities to the best infectious disease hospitals in provincial capitals & high tier cities, for the best treatment. None of that is possible even in a phased reopening.
Jim Bales
Annie Laurie
Thank you for the link to the Branswell piece at StatNews! It is very well written indeed, and the insights of all the experts she interviewed are appreciated
What I find interesting, although not unexpected, it is how – when Ā discussing cultural factors like vaccine hesitancy and quack cures – she carefully avoids noting the role of partisan politics. Without that, Iām afraid her peace is incomplete
what I find interesting, although not unexpected, it is how and discussing cultural factors like vaccine hesitancy and quack cures, she carefully avoids noting the role of partisan politics. Without that, Iām afraid her peace is incomplete
Best,
Jim
Amir Khalid
Malaysiaās Ministry of Health reported 679 new Covid-19 cases yesterday, for a cumulative reported total of 5,025,581 cases. 675 of these new cases were local infections; four new cases were imported. It also reported six deaths, for an adjusted cumulative total of 36,851 deaths ā 0.74% of the cumulative reported total, 0.74% of resolved cases.
23,766 Covid-19 tests were conducted yesterday, with a positivity rate of 4.4%.
There were 12,670 active cases yesterday, 250 fewer than the day before. 645 were in hospital. 34 confirmed cases were in ICU; of these patients, 21 confirmed cases were on ventilators. Meanwhile, 923 more patients recovered, for a cumulative total of 4,976,060 patients recovered ā 99.0% of the cumulative reported total.
The National Covid-19 Immunisation Programme (PICK) administered 3,125 doses of vaccine on 29th December: 125 first doses, 163 second doses, 554 first booster doses, and 2,283 second booster doses. The cumulative total is 72,559,446 doses administered: 28,120,103 first doses, 27,531,459 second doses, 16,278,669 first booster doses, and 629,215 second booster doses. 86.1% of the population have received their first dose, 84.3% their second dose, 49.8% their first booster dose, and 1.9% their second booster dose.
YY_Sima Qian
Helen Branswell’s article in STATNews really is an incredible summation!
However, I think there is a through line was not quite teased out: the importance of NPI & mitigation measures post-mass vaccination. A lot of the surprises noted in the article wrt COVID-19 has to do w/ the speed & nature of evolution, which then affects the effectiveness of vaccines & prior infection. Persistent infection in immunocompromised persons being source of mutation had not been appreciated. Vaccination will offer limited protection to the immunocompromised, by definition. They only way to protect them & prevent them from becoming incubators of surprising new variants are NPI measures.
Stronger mitigation pre- & post-mass vaccination around the world would have better protected the most vulnerable, could have delayed the emergence of Alpha/Beta/Gamma/Delta variants (via saltation), & perhaps prevented the emergence Omicron altogether, by minimizing infection of immunocompromised persons. w/ Omicron, the virus seems to reached a tipping point, where it is so transmissive & immune-evasive that orders magnitude more people are infected w/ SARS-CoV-2 at any given time, affording more opportunities for the virus to evolve rapidly (via drift) w/o needing to rely upon immunocompromised hosts. That might explain why we are now facing a soup of Omicron strains, w/ new ones popping up all over the world. Some of these strains probably should have their own Greek letters. BA.5 partially escapes immunity of BA.1/2 infection (or targeted vaccines), XXB escapes immunity of BA.5 infection (or targeted vaccines). Vaccines design development will continue to lag the speed of mutation, making development of vaccines that actually block transmission all but impossible. We are stuck with variants whose transmissivity we did not think any respiratory transmitted disease could possibly have. & we are stuck until the mutational space is saturated, some time down the line…
I am not sure that lessons has been learned.
Chetan Murthy
I read Naomi Wu’s tweet, and compare it toĀ her happiness and pride and feeling of safety behind the Zero Covid policy only a few weeks ago, and my heart breaks.Ā I thought the PRC’s government had exhibited competence in their response to a raging pandemic.Ā In fact, they’d just broken out the “social controlĀ uber alles” playbook and run it, to great effect.Ā But they didn’t actually know how to deal with a pandemic, so they squandered the three years they bought.
And now people like Ms. Wu and esp. her elders are paying.Ā Jesus wept.Ā It didn’t have to be like this at all.Ā All of this was preventable in a way that even what happened here wasn’t preventable.
A regime that can weld people into their apartments to prevent covid, weld people in so long that some jump to their deaths, is a regime that can force people to take the fucking vaccine.
The incompetence here boggles the mind.
New Deal democrat
The CDC has now updated its variant tracker. XBB.1.5 accounts for 40.5% of all cases, and the original XBB 3.6%, for a total of 44.1%. BQ.1&1.1 account for another 45%. BA.5% is down to 3.7%, and the remaining variants altogether account for the remaining 7%.
Ella in New Mexico
@Dog Mom: Depending on their age, over the past year or so it was being recommended all people get at least 3 total original COVID vaccines, then in spring/summer 2022 a 4th if at high risk or over 60 and since July or so everyone is eligible to get the COVID bivalent booster, but again, particularly high risk or over 60 should get it. I’ve seen lots of people who got the first three and should have gotten the other two but we started letting down on ease of access and pushing folks to do them so lots just didn’t want to take the time to do it.
Also, the window for antivirals is day 1-5, after that no evidence they’re particularly helpful but I’ve prescribed them on day six if someone is at high risk and still having fever, severe symptoms.
Unless your sibling and wife had been sick for 10 days and had signs ofĀ bacterial infection (purulent nasal discharge or sputum, SOB, etc.) antibiotics are not indicated.
And they should sue that provider for malpractice if he/she prescribed Ivermectin.
RaflW
Minneapolis-St Paul metro wasetwater surveilance has been updated (link to graph & more).
The most recent data update includes samples taken December 20 ā December 26, 2022. During this sampling period:
ā¢ The total viral RNA load in wastewater entering the Metro Plant remained high last week, increasing by 2% compared to a week earlier.
ā¢ The contribution of BA.2 sub-lineages to the viral RNA load entering the Metro Plant increased to 15% last week, while that of BA.5 sub-lineages decreased to 83%.
ā¢ BA.2.75 and XBB subvariants are both subsets of the BA.2 lineage. They made up approximately 7% and 8%, respectively, of the viral RNA entering the Metro Plant last week.
ā¢ BQ.1 subvariants are a subset of the BA.5 lineage. They made up approximately 63% of the viral RNA entering the Metro Plant last week, down from 69% a week earlier.
Chetan Murthy
@Chetan Murthy: And the relevant comparison here is between the PRC, and New Zealand, which also enacted a Zero Covid policy.Ā But when the time came and Omicron was breaching the walls, they had a vaccination program in place and put that sucker in overdrive,Ā getting their population vaxxed so that deaths were low.
And like China, they didn’t have any (effective) indigenous vaccines: they had to import them.
Such blistering incompetence.
New Deal democrat
@New Deal democrat: The CDC variant update shows that regionally XBB&1.5 are most prevalent, at 75% in the Northeast, followed by about 25% in the South, less in the Midwest, and least in the West.
In other words, the regional prevalence map corresponds almost exactly to the Biobot data.
Matt McIrvin
I’ve been comparing Massachusetts numbers with this time last year to try to figure out what we’re in for. It’s a somewhat puzzling exercise. I assume, first, that comparisons of case counts are not credible–we are simply missing far more cases than we did a year ago. Wastewater and hospitalizations are more telling.
With wastewater, counts are generally somewhat lower than a year ago but not *enough* lower to make me confident we won’t get another huge spike.
Hospitalizations in the run-up to Christmas were running really only a little behind last year, and there’s been a big spike in Hampden County… but ICU hospitalizations are far below last year. I’m no expert but my best guess is that is the combined result of Paxlovid reducing the number of cases so bad they go on a respirator, but also a greater willingness to actually have sick people come to the hospitals rather than riding it out at home. The vaccination situation isn’t really that different, though on the other hand there are a lot of people with prior Omicron infection now.
Deaths, though, are maybe about half what they were last year, not as big a drop.
So I guess the thing to do is wait for better post-Christmas numbers. These are mostly data from just before Christmas, the holiday rush but not the holiday.
Ella in New Mexico
@Chetan Murthy:Ā occurs to me that the vast majority of deaths in China are/will be in the elderly.
Seeing China refuse Western vaccines and medications boggles the mind. So many people will die for what, national pride?
I remember that here in the US so many antivaxxers and antimaskers on the Right were literally saying that it was ok to lose Gramma and Pop Pops to the disease because they were, well, OLD and they’d already lived out their useful lives…One might suspect the Chinese, having suffered financially under Zero Covid now see a benefit in reducing that population. After all, the elderly don’t work 36 hour days, don’t have babies, consume state resources like pensions and healthcare…
Matt McIrvin
…Ah, they updated the wastewater counts from my town’s sewage plant to cover Christmas.
There’s a definite spike in the RNA counts in the immediate aftermath. It’s running almost exactly 40% of the spike a year ago. The MWRA counts for the inner Boston area are giving a very similar fraction, about 40%.
So maybe that’s the factor to use to predict local impacts. 40% of the big Omicron wave.
P Thomas
Not a Covid comment…but, as “that guy” who whined several times about not having links to the Twitter posts and how broken it all seemedĀ (and then felt bad about my own selfish whining!)…I would like to thank the “back end” people on this site who worked hard to make these long “twittercentric” threads so much more easier to deal with.
Thank you.
Chetan Murthy
@Ella in New Mexico:
They didn’t need to refuse *shit*.Ā All they needed to do was steal that shit and claim it was indigenous.Ā I mean it ain’t like they don’t do that for a ton of other stuff.Ā Ā [And sure, the US did that when it was coming up to, so I’m not drawing a moral judgment here, just stating a *fact*.]Ā So yes, boggles the fucking mind.
I cannot stop myself from coming back to Ms. Wu.Ā Anne Laurie has had tweets from her in these roundups for months, and they’ve always been so confident and proud in the author’s safety.Ā And this one …. *ugh*.Ā I was always a little jealous of her confidence — a confidence I don’t have even today even here in SF, with 5 shots and a P100 mask.Ā And now … (again) *ugh*.
MoreĀ than at any other point, my heart breaks for the people of China.Ā They really deserve better than this.Ā To pay all the *price* of a Zero Covid policy, and to *get* a Let ‘er Rip policy.
*ugh
RaflW
@PST: What you describe is why I made the individual choice to not take Paxlovid.
I was only 10 weeks out from vax shot 4, so even though I was miserable (days 3 & 5 were awful, but not scary – and I had a scrip for Pax if I needed it filled), I was doing better by day 6 and chomping to go to the family cabin by day 10. There was still a faint pink line (vs. deep red on day 2) so I didn’t drive down and join the BF till day 12, but so be it.
I’m not against choosing Pax, but several friends had rebounds, and I weighed that in deciding. Had I felt any shortness of breath, I’da been at the pharmacy stat.
Chetan Murthy
@Ella in New Mexico:
You remember the old saying, yes?Ā “Sufficiently advanced incompetence is indistinguishable from malice” ?Ā I would find it inconceivable (there’s word again, are you sure you know what it means? ;-) that the PRC leadership could have such calculations: it’s inimical to how a functioning society can work.Ā And if they could have done that, it wouldn’t have taken much more, to just force those needles into arms with vaccines.
No, I think this is just incompetence at work.
Chetan Murthy
@RaflW: Can I just say: reading your comment, my *first* thought was: “holey moley, I’d have bought your doses from you, so I could squirrel it away to take on my next plane trip!”
OK, OK, just joking.Ā I’m glad you didn’t need it!
Matt McIrvin
@Ella in New Mexico: My impression is it’s the exact opposite–the elderly are undervaccinated in China out of a misguided desire to protect them. The (disastrously wrong) calculation was that the low infection rates of the “dynamic zero COVID” era would continue forever, such that they were at greater risk from vaccine side effects (which are somewhat worse from the vaccines in use there).
Chetan Murthy
@Matt McIrvin: Shitty vaccines, shitty leaders.Ā They had three years to steal Western designs, and hell, Corbevax was released license-free at least a year ago: more than long enough time to fucking manufacture that shit in quantity: it was *designed* to use old-skool facilities and practices.
Gah.
StringOnAStick
@rikyrah: its almost like the PTB in China looked at the protests and maliciously decided everyone needed to get what they were demanding, good and hard.Ā I have no doubt those are also the people who know exactly what Paxlovid is and have enough on hand for themselves.
Chetan Murthy
@StringOnAStick: I remember in the years before the pandemic, reading about how the wealthy and well-connected had access to better stores for food supplies, better ventilation systems, etc, etc.Ā All while the rest of the country had to contend with melamine-adulterated baby formula and shit like that.
StringOnAStick
@Chetan Murthy: Yeah, memories of things like that are definitely colouring my cynicism on this.
VFX Lurker
Dr Safo is right. That said, I think testing a few unarmed travelers is politically possible and forcing lots of violent Fox News viewers to wear masks is not politically possible.
In the last three years, Americans have threatened public health officials, store greeters, nurses, teachers and other people who asked them to wear a mask.
My friend’s son caught this abuse when enforcing his store’s masking policy in Michigan. This prompted my friend to plead on social media for folks to stop threatening to kill her son.
Even here on Balloon-Juice, a fellow jackal in Oregon had the shock of a complete stranger yanking off the jackal’s mask.
I’ll keep wearing comfy BOTN KF94 masks in public for the foreseeable future, myself.
Bill Arnold
This (Nature paper) is alarming some people. Autopsy study. Paper is a bit hard to read.
SARS-CoV-2 infection and persistence in the human body and brain at autopsy (14 December 2022)
The basic takeaway appears to be that a lot of organs can be infected (properly, the parts with cells that express ACE2 for the SARS-CoV-2 spike protein to bind too. Virologists, whack my wrist if this is wrong.), and that the virus can persist for a long while. Not surprising, really, but good to see an autopsy-based confirmation.