China’s COVID crisis and mass travel Jan. 7-Feb. 16: Anticipate a new variant of concern

Since earlier this month, a COVID crisis has rapidly begun to spread across China. Beijing appears to have been the first city affected with nearly empty streets and shopping malls, filled hospitals and fever clinics, insufficient medications even for fever and pain, and a spike in funeral home activities and cremations, as reported by CNN and Radio Free Asia.  

Multifactorial in origin, at least three factors are leading contributors to these evolving pan-epidemics in China: (1) the high contagiousness of the Omicron subvariants spreading in the country; (2) weak population immunity due to a lack of prior infections and suboptimal vaccine-induced immunity particularly in the elderly; and (3) the abrupt relaxation this month of the “dynamic zero-COVID policy” that has been in place since the beginning of the SARS-CoV-2/COVID-19 pandemic three years ago.

The Omicron subvariants will spread more during the mass travel 40-day event from Jan. 7-Feb. 16, termed “chunyun,” that traditionally involves hundreds of millions of people traveling inside and outside China, linked with the Chinese New Year, which this year falls on Jan. 22.  

On Dec. 18, the leading Chinese epidemiologist Dr. Wu Zunyou projected three waves of this epidemic across China, as reported by BBC News: (1) now until mid-January; (2) mid-January until late February; and (3) late February to mid-March.

While I respect Dr. Wu’s established expertise in SARS-CoV-2 and HIV epidemiology, and I hope his projection of three waves until mid-March is correct, in my opinion, there will be a fourth wave after March inside China.

In addition, given the hundreds of millions of persons in China who will be infected in the coming months, then the world should anticipate to recognize early not only more Omicron subvariants but also a new variant of concern after Omicron. If such a variant is recognized, then some cases will be found retrospectively, since the Delta VOC was first detected in India as a precedent. This new VOC could be named “Pi” or “Rho” or “Sigma.” It could be more immune-evasive than even Omicron subvariants such as XBB. Unlike Omicron subvariants to date, however, the new variant could be more virulent.  

Such increased virulence could manifest in the elderly with or without vaccine boosters, or for the first time with any VOC, in children. It might evade not only antibody (humoral) immunity as some Omicron subvariants can, but for the first time T-cell immunity or even innate immunity. Diagnostically, this anticipated hypothetical VOC could evade current SARS-CoV-2 tests. Therapeutically, it could be resistant to current first-generation antiviral drugs and emphasize the need for combination antivirals, as was done for combination monoclonal antibodies for earlier variants. New vaccines would be needed urgently.

Early recognition of such a new VOC should facilitate faster actions to counter the above hypothetical issues with diagnosis, treatment and prevention. In addition to the public health problems such a new VOC could create, there could be associated economic, food security, political, media and other problems throughout 2023 and beyond.

Thus, the need to anticipate to recognize early a new VOC in China (like anywhere in the world), then recognize what actions must be taken immediately and sustainably, is why active vigilance now by enhanced genomic surveillance inside China and worldwide is essential.