There’s a new form of SARS-CoV-2, the virus that causes Covid. It’s called XBB.1.5 — and it’s mean. XBB.1.5, otherwise known as “Kraken,” is more contagious than previous subvariants of the Omicron variant of the virus and also has more potential to evade our antibodies from vaccines and past infections.
All over the world there has been an increase in Covid cases linked to Kraken. But that’s not what epidemiologists are most worried about as the fourth year of the coronavirus pandemic begins. No, China this is what scares the experts. A country which, unlike the rest of the world, has only just caught Covid in a big way for the first time.
That’s 1.4 billion people going through what the rest of us went through at the start of 2020, with just a few twists. And what happens next in China could ripple out to the rest of the world in chilling ways.
So far, based on monitoring Chinese travelers arriving in Italy, China is catching old forms of Covid. “There are no new variants, just existing circulating strains that are spreading rapidly in a population with low natural immunity,” says Paul Anantharajah Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection in Singapore.
But that could change.
Yes, Kraken is bad. But it evolved from previous forms of the virus at a time when most of the world – China, of course, is the exception – has fairly robust immunity. Widespread vaccination was essential in the beginning, of course, but what really protects most people now, two years after the first vaccines became available, are natural antibodies from past infection. Indeed, natural antibodies are more effective and last longer than antibodies from vaccines and boosters.
Despite all the debate about shutdowns, masks, vaccines and therapies, most of the world has ended up taking a reasonably smart approach to Covid. Many countries have reduced businesses, schools, crowds and travel through 2020, helping to slow transmission of the virus until vaccines are available later this year.
Then as more and more people were fully or partially vaccinated – today most of the world’s eight billion people have had at least one stroke of Covid, and billions have been bitten and stimulated – countries have gradually reopened.
People went back to a normal version. Yes, that meant greater viral spread which eventually gave us the Omicron variant and its many sub-variants, which are still dominant today. But vaccines have mitigated the worst effects of these many infections. Case rates have gone up (and down and up and down). But overall, hospitalizations and deaths have tended to decline – a trend that continues today.
And all of these infections fueled a beneficial cycle that began with mass vaccination. We caught Covid and for the most part survived – because many millions of us were vaccinated. This rewarded us with natural antibodies that protected us from the worst outcomes of the next time we caught Covid, a year or six months later, as the vaccines began to wear off. And that the infection has sown immunity for the next six or nine or 12 months.
So on or so on. Epidemiologists expect this cycle to continue unless and until the SARS-CoV-2 virus takes a huge and surprising evolutionary leap that renders all existing antibodies ineffective.
But the longer the pandemic lasts, the less likely this nightmarish outcome seems. With each waning wave of infections, Covid begins to look more and more like the flu: a disease we should take seriously, but not one that threatens to end the world. “In a few years, Covid-19 will be a background risk along with seasonal flu,” says Lawrence Gostin, a global health expert at Georgetown University.
Which isn’t to say that Covid, like the flu, isn’t dangerous. Even non-fatal SARS-CoV-2 infections can have major consequences. Long Covid, for its part – a mix of long-term symptoms potentially including fatigue, confusion, loss of senses and even heart problems. But even taking into account the long Covid, the overall risk of the worst outcomes is decreasing in much of the world.
In China, however, things may get worse before they get better. That’s because China locked down at the start of 2020 – and remained locked down for almost three years under the country’s “Zero Covid” policy. It was not until December 8, following widespread public protests in many major cities, that the ruling Chinese Communist Party ultimately lifting major restrictions in most places.
“The situation completely changed on December 8,” says Ben Cowling, professor of epidemiology at the University of Hong Kong. The restrictions had bottled up SARS-CoV-2, preventing transmission and resulting in what was, until a few weeks ago, one of the lowest rates of Covid cases of any country. But the absence of infections also meant a lack of natural antibodies.
Yes, around 90% of the Chinese population is at least partially vaccinated. But the hundreds of millions of China’s elderly, who are most vulnerable to Covid, are also the least likely to be vaccinated – a reluctance experts attribute to misinformation in Chinese media. And most of the Chinese who are vaccinated was vaccinated more than a year ago. By now, the protection from these early vaccinations has largely worn off.
So when restrictions were lifted and more than a billion Chinese people finally started to get out and travel, they did so without the protection the rest of the world had won the hard way, thanks to past infection. .
It’s no surprise that China is getting really sick right now. “Almost everyone in the population is susceptible to infection because there were very few infections before December 2022 and very few recent vaccine doses – which may provide temporary protection against infection,” says Cowling. .
Only How? ‘Or’ What sick is difficult to say with certainty, because the country’s authoritarian regime has stopped reporting reliable data. “There are fortunately objective ways to assess what is happening in China besides depending on the vibrant social media scene in China, which has brought the pandemic to the world’s attention,” Tambyah said.
More and more countries are testing travelers from China. Malaysian health authorities are even testing sewage on passenger planes arriving from Chinese airports. From these samples, experts can start tracking China’s outbreak, even without China’s help. “Ideally, this would include virus samples for genomic sequencing to find out if a worrying new variant has emerged,” says Peter Hotez, an expert in vaccine development at Baylor College.
China could have a tough 2023 as it catches up with the beneficial cycle of infection and reinfection that protects most of the rest of the world and makes the pandemic “normal” for many of us. Many Chinese people — potentially the majority of the population, according to Cowling — will need to catch the virus and survive it before China reaches its own new normal. Most of them will do it with minimal immunity.
Consider that it cost the United States – a country with a billion fewer people than China – over a million Covid deaths to develop the significant natural immunity it has today. “It’s a grim and tragic statistic,” says Eric Bortz, a University of Alaska-Anchorage virologist and public health expert. “China is looking at this barrel right now.”
The risk, for the rest of the world, is that millions and millions of serious Covid infections in China could function as a kind of incubator for new, more dangerous forms of the novel coronavirus.
Each infection is an opportunity for the pathogen to mutate. It’s like a slot machine, says Niema Moshiri, a geneticist at the University of California, San Diego. Each individual infection tends to produce two mutations every two weeks, Moshiri says. In other words, the virus gets two leverage shots twice a month, hoping to hit a genetic jackpot that will give it a new edge. Greater transmissibility. More ability to evade antibodies.
“What if we had 50 million people simultaneously pulling the slot machine levers?” Moshiri asks. “We would expect at least one person to hit the jackpot fairly quickly. Now replace the slot machine with a ‘clinically significant SARS-CoV-2 mutation’, and that’s the situation we find ourselves in. .
It’s fair to say that, even with the new Kraken sub-variant rearing its nasty little head, most of the world has Covid more or less under control. But China does not. And a new variant from the Chinese outbreak could ruin 2023 for everyone.