China Reports Surge In Hospitalizations...And Reinfections?
Chalk Up Another Departure From World Experience With Omicron
When discussing the current COVID outbreak in China, the baseline understanding has to be simply this: China’s outbreak, as reported by western corporate media, is quite divergent and dissimilar to any COVID outbreak anywhere in the Western world.
Thus it is not entirely surprising to discover a somewhat late surge in COVID hospitalizations in China, even at the time when cases are presumed to be peaking.
China reported a large jump in COVID-19 hospitalisations in the week through to January 15 to the highest since the pandemic began, according to a weekly report published by the World Health Organization on Thursday.
However, the WHO said it awaited "detailed provincial data disaggregated by week of reporting" on nearly 60,000 additional COVID-related hospital deaths reported by China last week and did not include them in the tally.
More precisely, in the WHO’s "Weekly epidemiological update on COVID-19", Edition 126, published 19 January 2023, China reported a 70% spike in hospitalizations during the week since the previous epidemiological update.
Among the 16 countries that reported more than 50 new hospitalizations, three countries showed an increasing trend compared to the previous week: China (63 307 vs 37 215 new hospitalizations; +70%), Ireland (558 vs 510 new hospitalizations; +9%), Greece (1632 vs 1519 new hospitalizations; +7%).
This comes at the same time that China is reporting that ER/ED and fever clinic visits for COVID have peaked.
But a National Health Commission official told a news conference on Thursday that China has passed the peak period of COVID patients in fever clinics, emergency rooms and with critical conditions.
The number of patients with critical conditions in hospital were more than 40% lower on Jan. 17 than a peak seen on Jan. 5, an official said.
Other reports from China put the peak in cases even earlier.
Last week, Guo Yanhong, head of the National Health Commission’s medical emergency department, told reporters that China had passed three peaks – for people seeking treatment at fever clinics and emergency departments, and intensive care unit admissions.
Guo said visits to fever clinics had declined after peaking on December 23, and by January 17 they were down by 94 per cent. She said the number of people with severe Covid-19 infections had peaked on January 5.
It would be an understatement to call the reports contradictory—and yet these are the reports we have: either China has experienced a 70% surge in hospitalizations related to COVID or China has experienced a 40% drop in ER/ED visits for COVID. It is highly unlikely both reports are simultaneously true.
Small wonder that even the normally supine WHO is calling for greater transparency from China regarding its COVID-19 outbreak numbers!
The World Health Organisation again urged China’s health officials to regularly share specific, real-time information on the country’s Covid surge, as the UK joined other countries in bringing in travel restrictions, citing a lack of data as the reason.
In particular, WHO requested more genetic sequencing data, data on hospitalisations, intensive care unit admissions and deaths – and data on vaccinations delivered and vaccination status, especially in vulnerable people and those over 60 years old.
I leave it to the reader to ascertain which is the more reliable in its presentation of the reported facts: the WHO or China.
Yet the WHO-reported hospitalization surge comes on the heels of another unusual—and in many respects far more disturbing report: an anecdotally reported wave of COVID reinfections which appear to be more severe than the initial infection.
Healthcare workers across China are seeing large numbers of people who have been reinfected with the Omicron variant of COVID-19, putting a further strain on the country's beleaguered healthcare system, multiple sources told Radio Free Asia.
A healthcare worker surnamed Li in the northern city of Shijiazhuang said medics are now seeing a wave of secondary infections, due to the damage wreaked by COVID-19 on the immune system.
"We're hearing about a very large number of reinfections in out-of-town areas, due to the damage done to the immune system by the first infection with COVID-19," Li said. "People are presenting with pain that is five to 10 times worse than what they had during their first infection."
Unlike the rest of the world, the Chinese people are finding their bodies being extraordinarily ravaged by the SARS-CoV-2 virus—unless, of course, the severity of most reinfection cases is something other than what we are being told (which is very much a probability).
SARS-CoV-2 reinfection, particularly involving Omicron strains, is itself hardly extraordinary, although according to the literature it should be somewhat uncommon., published on the MedRxiv preprint server January 5, reinfection occurs in as many as 5.5% of cases.
Incidence estimates of reinfections among persons who experienced a SARS-CoV-2 infection are low, ranging from 0.2% to 5.5%. A review of laboratory studies found that the time from primary SARS-CoV-2 infection to reinfection can range from 19 to 293 days. Guidelines generally suggest that a new positive COVID-19 antigen or PCR test should be considered a reinfection if it occurred at least 60 to 90 days after initial infection.
The ~5% range for rate of reinfection is similarly found in a long-term study of healthcare workersexposed repeatedly to COVID infections by patients.
from February of 2022 found that reinfections were extremely rare and generally mild.
From March 10, 2020 until March 10, 2022 there were 37,729 medical consultations due to COVID-19 at the hospital’s Health Workers Services; 25,750 RT-PCR tests were done for suspected COVID-19 of which 23% (n = 5865) were positive. A total of 284 (5%) cases were considered SARS-CoV-2 reinfections. These cases belonged to 281 HW, of which three of them had a second episode of reinfection during the Omicron variant period. Our cohort was predominantly female (n = 202/281, 71%) with a median age of 39 years (30–47), 4% were unvaccinated, 32% had received two doses of a COVID-19 vaccine and 64% a booster dose. In addition, 22% (n = 62/281) had at least one risk factor for progression to severe COVID-19, mainly cardiovascular disease, diabetes, and older age. However, all cases were mild, there were no hospitalizations or deaths
To investigate this, we selected a subset of samples from more than 1,8 million cases of infections in the period from November 22, 2021, until February 11, 2022. Here, individuals with two positive samples, more than 20 and less than 60 days apart, were selected. From a total of 187 reinfection cases, we identified 47 instances of BA.2 reinfections shortly after a BA.1 infection, mostly in young unvaccinated individuals with mild disease not resulting in hospitalization or death.
In conclusion, we provide evidence that Omicron BA.2 reinfections do occur shortly after BA.1 infections but are rare.
Based on these studies, we should expect most reinfection episodes to be milder than the initial infections, a view that is echoed by the CDC.
Studies suggest that reinfection with SARS-CoV-2 with the same virus variant as the initial infection or reinfection with a different variant are both possible; early reinfection within 90 days of the initial infection can occur. Symptoms during reinfection are likely to be less severe than during the initial infection, but some people can experience more severe COVID-19 during reinfection.
It should be noted, however, that a studypublished in Nature Medicine in November, 2022, showed reinfection carried significant risks in all-cause mortality and hospitalization for up to 6 months after the date of reinfection.
In this study of 5,819,264 people, including 443,588 people with a first infection, 40,947 people who had reinfection and 5,334,729 noninfected controls, we showed that compared to people with no reinfection, people who had reinfection exhibited increased risks of all-cause mortality, hospitalization and several prespecified outcomes. The risks were evident in those who were unvaccinated and had one vaccination or two or more vaccinations before reinfection. The risks were most pronounced in the acute phase but persisted in the postacute phase of reinfection, and risks for all sequelae were still evident at 6 months. Compared to noninfected controls, assessment of the cumulative risks of repeat infection showed that the risk and burden of all-cause mortality and the prespecified health outcomes increased in a graded fashion according to the number of infections (that is, risks were lowest in people with one infection, increased in people with two infections and were highest in people with three or more infections). Altogether, the findings show that reinfection further increases risks of all-cause mortality and adverse health outcomes in both the acute and postacute phases of reinfection. The findings highlight the clinical consequences of reinfection and emphasize the importance of preventing reinfection by SARS-CoV-2.
Reinfection may indeed be initially less severe, but it is also reported in the literature to be associated with greater risk of death and hospitalizations over the longer term.
Except in China. The reporting from China suggests a 3% reinfection rate, with most reinfection cases more severe than the initial infections.
"The incidence of reinfections with Omicron has increased significantly," an attending physician surnamed Chen at the No. 2 Affiliated Hospital of the Hunan University of Traditional Chinese Medicine said.
"Some data show that around 100,000 people out of three million cases were reinfections, which is about 3%," Chen said.
Reports of infection rates of around 70% across much of China in recent days would mean an estimated 900 million people in China have been infected at least once with Omicron. If Chen's figure were to be extrapolated nationwide, that would mean the country is also seeing around 10 million reinfections.
Add to this reports of far more severe symptoms upon reinfection and the result is a “first wave” of COVID infection in China that truly amounts to a “coronapocalypse”—if the reports are at all accurate and realistic.
A wave of reinfections presenting with more severe symptoms than the initial infection would offer a plausible explanation for the surge in hospitalizations reported to the WHO. What it does not explain is why this wave of reinfection, while statistically the norm, is so much more severe.
In the US, even the corporate media narrative takes a fairly even tone regarding reinfections—they happen, but they are not a significant issue.
"We don't know know exactly how soon, but people have been recorded to get the infection as soon as four weeks after having a previous infection," said Dr. Sharon Welbel, director of hospital epidemiology and infection control at Cook County Health.
Welbel said that current reinfections could be related to either waning immunity from a previous infection or from vaccinations, depending on if a person has had a booster shot and when. For that reason, Welbel said it's possible some could contract the virus again even earlier than one month post-infection.
Additionally, reinfection in the US, at least as reported by the corporate media, occurs largely among the more vulnerable patient cohorts—the elderly, the immunocompromised, et cetera.
Because the virus is infecting more people now, your chances of being exposed and getting reinfected are also higher, Dr. Abu-Raddad said. And while it’s unclear if some people are simply more susceptible to Covid-19 reinfection, researchers are beginning to find some clues. People who are older or immunocompromised may make very few or very poor quality antibodies, leaving them more vulnerable to reinfection, Dr. Abu-Raddad said. And early research shows that a small group of people have a genetic flaw that cripples a crucial immune molecule called interferon type I, putting them at higher risk of severe Covid symptoms. Further studies could find that such differences play a role in reinfection as well.
The current China narrative, on the other hand, is fearful of a second “tsunami” wave of infection coming on the heels of the anticipated surge in travel that regularly occurs in China right around the Lunar New Year, complete with overloaded hospitals and rampant COVID-caused death.
Amongst the crowds is a Beijing-based office worker in her early thirties surnamed Liu, who is going back home to the northeastern city of Harbin for first time since the pandemic.
China's massive wave of infections after its abandonment of zero-COVID measures appears to be ebbing just as the celebrations and reunions this coming weekend threatens to reignite a new wave.
Yet, absent reinfections, a second wave of infection so soon after the first would be nearly impossible. With 80% of the population already infected, most Chinese should already have SARS-CoV-2 antibodies present to fight off any new encounters with the virus. Even with reinfections, at 3% of cases any such “second wave” would be a fraction of the first wave.
Much like the reporting on the peak of the first wave, contradictions and inconsistencies abound. Either the 80% figure touted for the first wave is greatly exaggerated, or the expectation/fear of a second wave is extremely overdone—or both narratives are at this juncture exaggerated.
Perversely, regardless of which narrative is overstated, the next few weeks and even months for China should be considerably less grim as far as reporting on COVID cases, deaths, and disease burden. There simply are not enough Chinese citizens left who have not experienced COVID to sustain a second “tsunami” of COVID cases.
Without good reliable data—which we do not have—there is no way to determine which China COVID narrative is exaggerated, or if either of them are more or less accurate. Yet because the data we do have seems so exaggerated relative to how the rest of the world has experienced COVID, we can reasonably expect China’s “second wave” of COVID cases to be much milder than the first.
If China’s first wave of COVID cases is receding, then the last place on earth yet to make its peace with the SARS-CoV-2 virus has, in most regards, finally done so. The final act of the Pandemic Panic Narrative has at last come to an end.
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Hadley, E., et al. SARS-CoV-2 Reinfection Is Preceded by Unique Biomarkers and Related to Initial Infection Timing and Severity: An N3C RECOVER EHR-Based Cohort Study. 5 Jan. 2023, https://www.medrxiv.org/content/10.1101/2023.01.03.22284042v1.
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