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Chinese cities pass Covid-19 peak, but rural surge still to come

The winter Covid-19 wave might have passed in major Chinese cities, but the country will see several more waves, including in rural areas, and a surge again at the end of the year, according to researchers in Shanghai.

Researchers from Ruijin Hospital and Shanghai Jiao Tong University used a mathematical model based on infections from early October 2022 through November 29 to predict Covid-19 trends across the country.

According to their projections, infections in the urban areas of Beijing, Shanghai and Chongqing likely peaked at the end of 2022, while peak infections in Guangzhou had already passed as of late November.

Cases in Beijing and Guangzhou were dominated by BF.7 and BA.5.2 respectively, while Shanghai had a more diverse mix of variants with more cases caused by the BQ.1 and XBB sublineages from inbound travellers.

The research was led by Chen Saijuan, a molecular biologist with Shanghai Jiao Tong University. The team’s findings were published last week in Frontiers of Medicine, a medical journal sponsored by China’s Ministry of Education.

Wu Zunyou, an epidemiologist with the Chinese Centre for Disease Control and Prevention, said last week that Covid-19 cases in Beijing, Tianjin, Hebei province, Chengdu and Chongqing were estimated to have passed their peak.

The Guangzhou Health Commission told Nanfang Daily that the number of patients visiting fever clinics had started to decrease from December 23, going down from 60,000 a day at the height of the wave to 19,000.

Peng Jie, an infectious disease specialist at Nanfang Hospital in Guangzhou, told Nanfang Daily that the number of hospital visits and online consultations had peaked, but he predicted a coming surge in hospitalisations.

“The next peak might be people with underlying diseases and those who need hospitalisation after infection, but an obvious peak has yet to appear,” Peng said.

The researchers looked to the suburbs of Chongqing, home to millions of migrants, as an example for projecting Covid-19 infection delays between urban and rural areas.

They predicted the Covid-19 surge would hit rural areas later, but the Lunar New Year travel rush could speed up its arrival, with infections peaking in mid-January in inner provinces such as Gansu, Qinghai and Shaanxi.

However, the researchers said real-world conditions were far more complicated than their model. They said it was “reasonable” to speculate the Omicron outbreak might appear in multiple waves, with new local surges possible in late 2023 because of dwindling immunity from vaccination or infection.

The scientists noted the importance of conducting regular monitoring of variants in the months and years to come.

“Altogether, these preliminary data highlight the need to allocate resources to early diagnosis and effective treatment of severe cases and the protection of vulnerable populations, especially in the rural areas, to ensure the country’s smooth exit from pandemic and socio-economic recovery,” the researchers wrote.

They said emergency measures should be directed at delivering over-the-counter medicine to low-risk patients and timely treatment of high-risk patients with effective antiviral drugs such as Paxlovid or VV116, an experimental antiviral developed by Junshi Biosciences and Vigonvita Life Science.

Other measures such as wearing N95 masks and social distancing should be taken to relieve the pressure on the healthcare system, and the supply of symptom-relieving medication should be ensured to prepare for Covid-19 waves in rural areas and avoid disease and death related to delayed treatment, they said.

The researchers said it was “critical” to record the number of excess deaths, including those who have died from or with Covid-19.

“The timeliness and accuracy of these data are required for up-to-date evaluation and prediction of the trend of the ongoing pandemic to ensure evidence-based policymaking,” they wrote. South China Morning Post

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