What is happening in China?

Scott Gottlieb says we essentially don’t know the extent to which Omicron has spread in China.

What do we know?

We know China has not made great use of its time so far, and seems incapable of the loss of face necessary to get mRNA vaccines, nor does it seem to have stockpiled sufficient amounts of treatment for over a billion people if things get fully out of hand.

We know that China has now locked down tens of millions of people.

We know that they previously shut down schools in Shanghai, with some pretty strange implementation details.

And we know they have quite a few cases. We don’t know how many, but the official counts are certainly not overcounting cases.

“Because of the large number of cases in a short period of time, it is inevitable that there will be some panic all over the country, and Shanghai is no exception,” said Dr. Zhang Wenhong, a prominent infectious disease expert in Shanghai, in a post on his social media account on Monday.

We also know from Hong Kong what it could look like if a population that only had access to Sinovac and has had few previous infections has uncontrolled spread of Omicron. Things get very bad very quickly.

The thing I noticed right away about China’s reaction this time in Shanghai, which came first, was that it wasn’t as complete. The will to succeed seemed not to be there on the same level.

Yes, this was a series of coercive actions the West would be incapable of taking, but what reason was there to think they would work? Closing off all school-based transmission won’t slow down Omicron much. Closing schools is a half-measure. If you have reason to think schools need to be closed, and you are following China’s old playbook, than anything that makes you need to shut down Shanghai’s schools should make you shut down all of Shanghai.

In other cases, China has made this extremely expensive and painful choice, and it has worked. This time, faced with a more dangerous variant, they only closed schools and hoped the problem would go away. That is not going to work (not that it has had time to have an impact yet, but it was never going to work).

Now they’ve ‘restricted movement in many neighborhoods’ of Shanghai, but not in others, and this is still very different from the nature of previous Chinese lockdowns.

And consider what they are doing in Dongguan, which is perhaps too big to shut down in the same way as Shanghai:

City authorities told residents not to leave the city, except for essential reasons. Those leaving must show negative test results within 48 hours of departure.

A few entrances on highways to other cities were closed, while all shuttle buses linking airports in other cities and check-in terminals in Dongguan were halted. Some museums and libraries in the city also closed to visitors.

Its factories are still running, however.

“(Workers) need to do COVID tests, but it’s not a prerequisite for them to be able to enter factories,” said King Lau, who helps manage a metal coating factory.

That is not going to be enough. Some cases will get out, and cases within the city will still rise, unless this was caught so early there really were only a handful to start and then they got super lucky.

They still were willing to shut down Shenzen and a total of about 60 million people so far, while showing signs they are approaching their limits.

So what happens now?

If there are this many cases already, the question is whether the outbreak is somehow contained to the cities and areas that are now locked down, or otherwise the tide can somehow be turned. I do not see how this happens.

China could ramp up its reactions, locking down more cities and areas with harsher conditions, in an attempt to make it stop, but can it afford to do this and if so for how long?

The kinds of extreme measures China has used on locked-down cities have been intense. They require lots of special equipment and manpower and government support. How many such cities can they handle at once? Certainly not all of them, and my guess is not that many.

It sure looks like the thing I kept expecting to happen, that kept not happening, is finally happening. China is no longer one step ahead of its pandemic. Once you fall behind, it’s exponentially harder to catch back up. A single case showing up in a new city won’t always infect that city, but it often will.

It seems like China is likely to have a full containment failure on Omicron, and to have it fairly soon. The kinds of countermeasures they can implement nationwide seem highly unlikely to be sufficient to turn the tide.

It’s too early to count them out entirely, but the Metaculus adjustment of the probability of 50k Chinese Covid deaths from 25% to 35% over the last few days seems way too small.

So:

China keeps daily cases under 50 per million through 2022: 30% → 15%.

This is basically a ‘you can’t fully count out China yet given their track record’ but I definitely know what I expect.

I haven’t been updating the probability explicitly, letting it get neglected, but it surely got up to at least 40% due to passage of time before Hong Kong happened. Then Hong Kong happened. Then Shanghai had its half reaction. Now cases are shooting up and they’re locking down tens of millions of people in different locations. This sure looks like the end.

In terms of getting to 50, this is still only 0.48 cases per million people. So there’s still two orders of magnitude left, or seven doublings, but seems mostly like an all-or-nothing situation. Either containment holds or it doesn’t.

What about the economic impact? That depends on how China reacts. They are potentially facing a similar (but less severe) fate as Hong Kong.

The scale of cases per population here is absurd. At peak that’s 0.6% of the population confirmed as positive per day. The key thing is that the whole thing is still going to be over not that soon after it began in earnest. It has to, because total infections will add to less than 100%, and of course many are missed, so the true daily positive rate was several percent at the peak. That turns things around fast.

If it’s fast enough, the economic disruptions might be minimal, but the human cost will be extreme no matter what path is chosen.

I hope I am wrong, and this can permanently be contained, but if it is going to eventually fail and time is not being well spent, buying more time accomplishes nothing.

We will know more very soon.