The COVID-19 pandemic is far from over and continues to threaten the world, yet there remains a concerning lack of agreement between political leaders, public health agencies, economists, and citizens themselves over the best course of action in the face of a global resurgence of coronaviral infections. National responses to SARS CoV-2 continue to vary widely, even as the general public, for various reasons, including some of their own volition, have also diverged, to join the ranks of either the vaccine-deprived, the vaccinated, the vaccine-hesitant, or the anti-vaxxers. Just as citizens in England are enjoying their new-found freedom following the removal of lockdown restrictions under the UK government’s Living with COVID-19 strategy, China has chosen to retain its Zero-Covid strategy and reinstate draconian lockdowns to deal with recent outbreaks within its borders.
The wily Omicron variant BA.1 surfaced in South Africa in November 2021 and soon overtook the prevailing Delta variant, helped by its ability to evade the body’s immune responses, thereby securing world domination. BA. 1 then gave rise to sub-variants BA.1.1 and BA.2. BA.2 was first detected in January 2022 and is now the dominant strain of SARS CoV-2 worldwide. On 22 March 2022, the WHO confirmed the dominance of BA.2, which accounted for almost 86 per cent of all cases subjected to genomic sequencing, or analysis of gene sequence, at the time. In a few instances, BA.2 reinfections have even been reported in people previously infected with BA.1. And waiting in the wings are such largely unknown entities as BA.3 and Deltacron, a hybrid of Delta and Omicron.
Although Omicron infections are frequently less severe than those caused by the Delta variant predecessor, the effects of infection with its new sub-variants must not be underestimated. Existing vaccines may be less effective against BA.2 than against previous variants, and any protection afforded by vaccination may wane over time. Not only is Omicron more highly transmissible, with a postulated reproduction number of 12, but it can also cause severe disease that requires hospitalisation and may prove fatal, especially in the unvaccinated, elderly, and other high-risk groups. Omicron can also be followed by debilitating post-COVID conditions, such as long COVID.
A wider spectrum of symptoms attributable to COVID-19 have been identified since the onset of the pandemic, adding to the original trinity of fever, new continuous cough, and loss of sense of smell or taste. This list of symptoms continues to be updated as our knowledge of the coronavirus increases. Symptom checkers and apps may allow many more people to self-diagnose COVID-19. The problem of self-diagnosis, unsupported by testing, is that many of the listed symptoms are ill-defined and non-specific and may also be caused by other seasonal illnesses, including the common cold and influenza.
A resurgence of COVID-19 was first reported from several provinces in China in early March, spreading to 29 of all 31 provinces by the end of the month, according to the country’s National Health Commission. Over 90 per cent of new cases were reported from hotspots in the north-eastern province of Jilin and in the port city and financial hub of Shanghai, China’s largest city. On 27 March 2022, the Chinese government announced a staggered lockdown in Shanghai, starting with the eastern half of the city before the western half, before changing over to a citywide lockdown from 31 March onwards, involving all 25 million residents.
The recent Chinese lockdowns are the strictest ever in the world, and 38,000 healthcare personnel and 2,000 members of the military have been drafted in to Shanghai to enable enforcement. The Zero Covid strategy includes stay-at-home orders, mass PCR testing, contact tracing, and mandatory quarantine of all people testing positive, in hospital or other designated quarantine facility, and of all incoming travellers, irrespective of test status, for 14 days from arrival in China. Quarantine has on occasion separated children from their parents, with possible exceptions allowable for infected children with “special needs”. This intense focus on COVID may have also led to the neglect of people with non-COVID illnesses. Educational institutions and businesses have closed, factories have stopped working, and public transport has been suspended. People have to order food online and then await home delivery. The overarching aim of these lockdowns is to prevent hospitals from being overwhelmed by large numbers of people testing positive for COVID-19 and to prevent deaths from severe disease.
Closer to home, the Office for National Statistics (ONS) estimated that 4,122,700 people in England, the equivalent of around 1 in 13, had COVID-19 in the week ending 26 March 2022. Similarly, round 19 of the REACT (Real-time Assessment of Community Transmission)-1 study, a collaboration between Imperial College London and Ipsos MORI, ascertained the prevalence of COVID-19 in England between 8 March and 31 March 2022 to be 6.37 per cent, or 1 in 16 people. The UK Health Surveillance Agency reported an overall COVID-related hospital admission rate for England of 20.5 per 100,000 people for the week ending 3 April 2022, compared with a peak of 36 per 100,000 in the first week of January 2021. Increased levels of COVID-related admissions, rising to 2, 274 in England on 3 April, have stretched capacity in some hospitals to the limits, just as staff absences, also from COVID, have compromised the delivery of front-line healthcare. Hospitals in some parts of England, such as Yorkshire, have had to appeal to local residents to avoid their emergency departments whenever possible. While almost three-fifths of the COVID-related admissions are for another condition, the coexisting coronaviral infection only adds to the workload by requiring additional infection control measures.
In England, the Living with COVID-19 strategy is relying on continued mass vaccination, including triple or even quadruple vaccination for some groups of people, to help with “gradual and safe removal of restrictions on everyday life”, while simultaneously “protecting” the NHS and avoiding an alternative predicted “New Normal” scenario. The government hopes that the general public will also play its part and act responsibly in the best interests of the wider community, although recent events have shown that public discipline cannot always be relied upon. Social distancing, mask mandates, and COVID passes have been mostly dispensed with in England, and from 04 00 AM on 18 March 2022 all travel restrictions for incoming international passengers have also been removed. The English COVID trajectory seems to be all about unfreezing restrictions and restoring personal liberties as soon as possible.
Unlike in China, England has de-emphasized testing for the coronavirus, and contact tracing is no longer being undertaken. It is no longer necessary to submit to rapid lateral flow or PCR testing if believe you may have COVID-19 symptoms. The £2-billion-a-month free and universal testing programme for the general public, symptomatic or otherwise, came to a halt in England from 1 April onwards, except for selected groups of people with symptoms. Since then, COVID-19 tests have to be purchased from pharmacies or other retail outlets, either in person or online, which means that figures for positive tests may not represent the actual prevalence of infections in the community as many will lack the inclination and finances to get tested. To the contrary, immense public resources have been mobilised in China to test all 25 million residents of Shanghai, with somewhat different objectives in mind.
The COVID-19 pandemic continues, as the virus contains to reinvent itself and maintain human contact with renewed vigour, leaving us in an uncertain future relationship with the virus. We cannot be confident about the best way to approach to the pandemic as it enters its third year, and it will be interesting to see how China and England fare after their radically different approaches to dealing with the virus. What we do know is that, so far, China has reported 4,638 deaths from COVID-19, if you accept official figures and also recognise that methods for recording deaths differ, compared to around 169,412 deaths within 28 days of testing positive for COVID-19 in the whole of the UK. When it comes to dealing with Omicron, it remains to be seen whether either an overcautious China or a more optimistic England has chosen the right path to navigate the pandemic, carefully balancing the health of the citizens and the interlinked health of the economy for the best possible outcomes under the circumstances.
Ashis Banerjee