China’s COVID disaster is entering a critical phase. The BA.5.2 subvariant of the SARS-CoV-2 virus is spreading essentially unchecked through a population of 1.4 billion people with weak COVID immunity. And as the virus is spreading, it’s mutating—fast.
If the rest of the world’s experience with the same form of COVID is any indication, one of two things will happen in China in the coming weeks and months. The virus could settle down on a genetic level and produce a succession of subvariants closely related to BA.5.2—ones that the Chinese population’s slowly increasing immunity should be able to handle. Or, the unrestrained transmission and runaway mutations will lead to a genetic breakthrough for SARS-CoV-2.
In that case, we might see the first new major variant since Omicron appeared more than a year ago.
That’s the worst-case scenario. “The worry is that new variants, or Omicron subvariants, will be created that are more immune-evasive and will be able to infect those outside of China who currently have some degree of protection from vaccines or previous infection,” John Swartzberg, a professor emeritus of infectious diseases and vaccinology at the University of California-Berkeley's School of Public Health, told The Daily Beast.
For all the debate over shutdowns, masks and vaccines, most countries blundered into a fairly effective approach to COVID. Through 2020 and into 2021, many governments restricted—if not shut down—retail businesses, schools, crowds and travel. That helped slow the virus’ spread until vaccines were available from late 2020.
Over the next two years, most of the world’s eight billion people got at least one shot of some reasonably effective COVID vaccine—and billions got fully vaccinated and boosted, too. That made it safe for countries to gradually lift restrictions. Most of the world reopened.
Yes, that meant more viral spread at first. And in late 2021, that produced the Omicron variant and its many subvariants, which are still dominant today. In most countries, vaccines blunted the worst impacts of back-to-back-to-back Omicron waves. Case rates went up and down but, overall, hospitalizations and deaths trended down.
Most of the world had entered a beneficial cycle that began with mass-vaccination. The protection from vaccines gradually faded, but natural antibodies from past infection more than made up for it. People were getting infected and reinfected, but each infection refreshed the natural antibodies that usually made the next infection milder than the last.
Epidemiologists expect this cycle to continue unless—and until—the SARS-CoV-2 virus makes some huge evolutionary leap that renders all existing antibodies ineffective. “The more infections that occur, as in China, the more times the Omicron evolutionary dice are rolled and the more chances [there are] for new subvariants to arise,” Eric Bortz, a University of Alaska-Anchorage virologist and public-health expert, told The Daily Beast. “It's like adding new spices into the soup.”
If that evolutionary leap happens, it’ll probably happen in China, the one country that locked down in early 2020 and stayed locked down for nearly three years. Only on Dec. 8, following widespread public protests in many major cities, did the ruling Chinese Communist Party finally lift major restrictions.
“The situation completely changed on Dec. 8,” Ben Cowling, a professor of epidemiology at The University of Hong Kong, told The Daily Beast. The restrictions had contained COVID, resulting in what was one of the lowest overall case-rates of any country. But the lack of infections also meant a lack of natural antibodies.
Yes, around 90 percent of the Chinese population was at least partially vaccinated. But most Chinese got jabbed more than a year ago. By December, the protection from those early vaccinations had pretty much worn off.
China might even get its own version of the recombinant XBB.
So when restrictions were lifted and 1.4 billion Chinese finally started going out and traveling, they did so without the natural immunity that the rest of the world had earned the hard way, through past infection. It should come as no surprise that SARS-CoV-2 spread fast in China starting six weeks ago. “It’s inevitable that the end of lockdown would lead to a large number of cases,” Cindy Prins, a University of Florida epidemiologist, told The Daily Beast.
No one outside of the Chinese Communist Party knows for sure exactly how many Chinese have caught COVID in recent weeks. The paranoid, authoritarian CCP stopped sharing good data shortly after lifting restrictions. But testing of air travelers from China is fragmentary evidence of a major crisis.
The same testing, along with hundreds of viral samples that Chinese epidemiologists have uploaded to a global COVID database, tells us which forms of the virus are dominant in China. While most of the world is on the down-slope of a medium-sized winter wave caused by XBB, a “recombinant” blend of several Omicron subvariants, China’s just now catching BA.5.2, a subvariant that was dominant everywhere else around six months ago.
And those millions—or even tens of millions—of Chinese BA.5.2 infections have spawned a trio of BA.5.2 spinoffs. Viral samples from several Chinese cities, uploaded last week, were the first evidence of BA.5.2.48, BA.5.2.49 and BA.5.2.50. That’s right: China is now evolving its own forms of COVID.
It’s a problem for China, of course, which has weeks or months of suffering ahead of it as authorities scramble to organize fresh rounds of vaccinations. The jabs are triage—a desperate effort to prevent overfull hospitals from collapsing as the Chinese population slowly, painfully builds up its natural immunity.
Given China’s sky-high COVID infection rate, accelerating mutation is unavoidable. The most optimistic scenario would be the virus’ evolution hewing close to BA.5.2—albeit at great cost to millions of everyday Chinese. China’s domestically produced vaccines seem to work fine against Omicron and its subvariants. The natural antibodies from BA.5.2 infections should offer strong protection against BA.5.2.48, 49, 50—and even 51, 52, 53 and so on.
Subvariants might mix, like they did in much of the rest of the world. “China might even get its own version of the recombinant XBB,” Edwin Michael, an epidemiologist at the Center for Global Health Infectious Disease Research at the University of South Florida, told The Daily Beast. That subvariant is more transmissible than previous subvariants and it somewhat evades our antibodies. But it’s still a form of Omicron. It’s manageable.
But a major outbreak in a population of 1.4 billion increases the chance that the virus will make a big evolutionary leap. Similar to the leaps that produced the Delta variant back in late 2020 and Omicron a year later. A new variant could be even more transmissible than the Omicron subvariants—and it might totally evade our antibodies.
A new variant could spread from China to the rest of the world, surging across populations that have grown complacent against COVID because they’ve only been dealing with Omicron and its subvariants for more than a year now.
Remember early 2020, when we had neither effective vaccines nor natural antibodies and no way to slow viral transmission except to mask up and stay home? That’s the worst-case scenario, for the whole world, if China’s accelerating BA.5.2 outbreak reaches genetic escape-velocity, so to speak, and evolves a brand-new variant.
A dangerous new variant isn’t likely, Prins stressed. The U.S. got through its worst Omicron wave without producing a new variant. So did Europe and Asia outside of China. “It’s possible that after this first post-Zero-COVID wave subsides and immunity from it wanes that we could see new variants arise,” Prins said, “but I don’t think that is any more likely to happen in China than [it was] in other countries.”
But it’s possible. And it’s a little more possible with each passing day until China’s wave of infections crests. Stay alert. Get boosted. The pandemic isn’t over.