China’s Covid ‘Exit Wave’: (4) Flattening the Curve?

• “In the spring of 2020, as Covid-19 was beginning to take its terrifying toll on the United States, three words offered a glimmer of hope: Flatten the curve.,
• “What we need to do is flatten that down.” , Anthony Fauci
• “For countries trying to reduce the number of rapidly rising coronavirus cases, the race to ‘flatten the curve’ is on.”
• “In some ways, flattening the curve didn’t work as intended.”
• Fauci described the risk of Covid to the US as ‘minuscule’ in late February 2020, and [estimated] ‘Two weeks to flatten the curve’ – Wall Street Journal (August 5, 2021)
• “Flattening the curve became an abstraction without any real meaning.” , Head of the Yale School of Public Health Epidemiology
• “By 2021, the phrase ‘flatten the curve’ had largely been phased out of medical messaging.”

Zero-Covid logic was always there half consistent, A beginning without an end.

Zeroing out the virus involved an aggressive advance program to suppress and control the pandemic through intensive mass testing and contact tracing, massive quarantines, travel restrictions, the closure of businesses and the suspension of public gatherings, which spread throughout the city. Or extends to nationwide lockdown. Increased social and economic costs. But zero-covid leads straight into a corner. SARS-CoV-2 was never going to go away. It is widely broadcast in 175 countries No Following an “elimination” strategy. In fact, the virus continues to mutate – more than 20 significant variants have emerged in the past 3 years – becoming more infectious and more virulent. Risks from both internal and external sources have increased over time.

Time. That’s the key to the argument here. Covid can be kept away, For once… But what is the endgame? What do countries do with the time zero-Covid buys them? How do they prepare for the inevitable but uncertain “Phase 2”?

Public health officials in nearly 20 countries followed virus elimination policies and eventually realized they would need an exit plan. But ending zero-Covid means exposing the population to the full force of the pandemic. A study by researchers at Imperial College in London presented a dire scenario with simulations of outbreaks under several scenarios. (In the chart here, the flat red line is hospital intensive care capacity.)

“Curve” portends danger: “The catastrophic flood of hospitals.”

It was not until effective vaccines became available in late 2020 and early 2021 that it became possible to envision a viable path back to normalcy. If the virus can be contained long enough to reach near
near
-With universal vaccination, and preparing the healthcare system to deal with the projected surge in infections, the most severe countermeasures may seem possible to prevent.

This idea came to be known as “flattening the curve”. It was seen as the best answer to the zero-Covid endgame.

The diagram is practically self-explanatory. If the outbreak can be controlled for some time, the number of hospitalized cases will be spread over a longer period (it is believed), and will not exceed the system’s capacity to handle it. Flattening the curve was widely promoted in the early stages of the pandemic as a better way to manage the pandemic, slowing and spreading the effects of the disease. This gave authorities more time to vaccinate the population and expand the capacity of the healthcare system.

Indeed, “curve-flattening” was a trope of the public health industry before Covid. This predated the emergence of vaccines, though it remained an abstraction – until the Covid outbreak.

• “Flattening the curve was already a well-understood concept in public health circles. But the COVID-19 pandemic provided the first real opportunity to test it.”

In short, the idea struck a chord with politicians and the public. Leveling is a simple (and perhaps simplistic) policy model, easy to communicate visually, free of the statistical arguments typical of most epidemiological models. It seems even more obvious. There is an argument for government policy-makers to view zero-covid, with all its costs, as a temporary program designed to buy time for other measures.

And so, the viral control program… went viral. Someone named Siouxsie Wills (a New Zealander, perhaps surprisingly – see below) coined the hashtag #FlattenTheCurve And pushed the curve-flattening chart out to the world:

• “Our #FlattenTheCurve graphic is now on Wikipedia with proper attribution and a CC-BY-SA license. Please share far and wide and translate this into any languages ​​you can!

The concept offered a comfortable sense of control and policy efficacy. For a time, “experts” expressed unanimous support:

• “Flattening the coronavirus disease (COVID-19) curve has been one of the most important public health goals since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) worldwide.”

And flattening started to drift into the crazy mainstream:

• “Barack Obama with his hundreds of millions of Twitter followers. ‘Flatten the curve’ became a public health meme—there was even a Fauci bobblehead that included it.

flat falls flat

Unfortunately, it didn’t really work.

Some countries carefully planned for a zero-Covid exit. new zealand waited till it happened “crushed the curve” before easing restrictions cautiously. The island nation enjoyed many advantages – low population density, geographic isolation, high vaccination rates, strong public health infrastructure, and a government capable of imposing a full-scale nationwide lockdown even in response to only one new case.

Yet, the carefully planned exit from the very strict zero-Covid regime backfired. NZ saw the death toll rise 63 times over the next 13 months.

Other countries were forced into evacuation mode by unprovoked outbreaks of new forms (omicrons), without any chance to prepare for the subsequent surge of evacuations.

hong kong A zero-Covid program similar to mainland China’s ultra-severe version followed. To no avail – by early 2022, the Omicron version has overwhelmed Hong Kong’s healthcare system and zero-covid is abandoned.

Oddly enough, the relative scale of the Hong Kong surge was roughly the same as that of the New Zealand boom – deaths also increased 63-fold over the next 13 months.

Obviously, it doesn’t matter how much planning goes into it. In all 20 countries with zero-covid exits, there was always an increase in infections and deaths (as described in the previous column – linked at the end of this article). It was only delayed, not reduced.

There is now some concern among researchers that this peak could be worse than it originally would have been without zero-Covid.

• “The flattening of the curve results in a blunting of the midpoint of the curve, which emphasizes the increase in the final number of infections. It is possible that more lives will be lost at the end of this process.”

My personal scan of the numbers so far suggests otherwise. Zero-Covid policies, followed by a controlled exit, may result in lower cumulative death numbers, although infection and mortality rates during the boom are sometimes higher in countries following “mitigation strategies” rather than zero-Covid. Exceeds anything experienced. Yet, as shown above (and in the previous column), the increase was only delayed, not ended. It may be some time before the full data-set is available to properly evaluate this question.

“Flattening the curve” proved to be misleading. After the spring of 2020 — the brief main point for this meme — the concept dropped out of public discourse. Google searches for the term turned up zero. By 2021, as per WikipediaThe phrase was no longer part of “messaging” by public health officials.

What about China?

Now it seems that data from China will never be available.

In early 2020, the Chinese authorities systematically destroyed, destroyed or falsified COVID data. Since the sudden end of zero-covid on December 8, 2022, they have stopped collecting it. Test programs have been closed. The figures published since then are patently false. It may never be possible to chart the course of China’s post-zero-Covid route.

What kind of situation China is facing today, and what kind of population will face in the coming time, should be estimated from comparative studies of other countries following similar policies or from demographic and epidemiological models .

Demography is not in China’s favor, as will be discussed in the next column. There are many elderly and rural Chinese citizens, many with low vaccination rates (especially among the elderly) and inadequate access to healthcare (especially in rural areas). The epidemiological picture can be reasonably inferred from the pattern of zero-Covid exit in countries following policies similar to China.

that’s harsh. If we take the 63 times multiple of Covid deaths in the year following exit, which was experienced by both New Zealand and Hong Kong (planned and unplanned exits), this would mean several million deaths next year. NZ and HK both have better healthcare infrastructures, and NZ (at least) had very high vaccination levels when they kicked off their eradication programs in early 2022.

The main problem China has created for itself is a lack of preparation. He flattened his curve (if we take his word for it) with extreme measures, but he didn’t take advantage of the time he received to prepare for the exit. The intense focus on sustained mass testing under zero-covid diverts resources away from investment in hospital facilities which will now be missed. Major Chinese cities are reported to be in short supply of basic anti-fever drugs such as ibuprofen or acetaminophen. The hospital facilities are said to be overcrowded. The most important shortcoming, and the most inexplicable, however, was Slowdown in vaccination schedule in mid-2022 – To expose at least 100 million vulnerable elderly citizens.

China’s exit from zero-Covid will follow a pattern that all other countries have gone through. This can be taken as a certainty. The increase in infection and death rates would be comparable, and possibly worse. This implies that there will be millions of Covid deaths in China in the coming year(s). How many crores? We’ll examine some of the answers to that question in a future column.

What is less certain, but – to speak coldly of a human tragedy – more important for the rest of the world, will be the extent of the economic impact. If China’s recovery is slow, we will all feel it. That assessment is still unclear. This will be the focus of another future column.

See also:

more than forbesImplications of China’s Zero-Covid Exit: (1) Is China Really Vaccinated?By george calhoun
more than forbesChina’s Covid ‘Exit Wave’: (2) Is It Over?By george calhounmore than forbesChina’s Covid ‘Exit Wave’: (3) What Zero-Covid Exits of Other Countries ShowBy george calhoun