Don't Use China's COVID Surge to Make Predictions for U.S., Experts Say

People with protective masks line up for COVID-19 tests on December 19, 2022 in Shanghai, China

Hugo Hu / Getty Images

Key Takeaways

  • China is experiencing a surge of COVID-19 cases after relaxing its strict infection control policies.
  • Experts forecast high rates of hospitalization and death within China, but the wave likely won’t impact case rates in the U.S.
  • As in the U.S., Omicron subvariants are driving COVID cases in China.

A wave of COVID-19 infections is ripping through China as the country eases up on its “zero-COVID” policy under the pressure of protests against strict lockdowns.

The country long staved off the high rates of COVID-19 infection that have hit other countries due to its firm policies of mass testing, quarantines, lockdowns, and travel restrictions.

Now, as cases are rising, a relative lack of natural immunity throughout the pandemic leaves much of the 1.4 billion population vulnerable to disease. The country also lags in vaccination rates among the elderly, who are at the highest risk of severe disease and death, and many people who received their primary series long ago have yet to be boosted.

The surge is expected to cause high rates of hospitalization and death in China. But it won’t necessarily have a big impact on the health of people in the U.S. About 70% of the U.S. population has completed their primary vaccination series while 40%—and likely far more than that—have recovered from COVID-19, granting them some natural immunity.

The same Omicron subvariants that are responsible for most cases in China are also circulating in the U.S. It’s not yet clear whether the surge will lead to the evolution of a new variant.

Why China is Seeing an Explosion of Cases

About 90% of adults in China have been vaccinated with two doses of vaccine.

But a third dose gives much better protection, especially for older adults, but only two-thirds of people over the age of 60 have gotten a third shot, and only 40% of people over the age of 80, according to the Washington Post. About 11% of people in China are estimated to have been infected as of December 12, said researchers at the Institute for Health Metrics and Evaluation (IHME).

The situation in China could be comparable to that in Hong Kong during its Omicron wave, the IHME researchers said. There were similar rates of vaccination, poor vaccine efficacy, and levels of vaccination among older adults.

If China’s experience mirrors Hong Kong’s, the country could see a million deaths in 2023, according to their statistical model.

If social distancing mandates are imposed when cases reach a high level in each province, the country may see 323,000 COVID-19 deaths by April 1, when the researchers expect the wave to peak. Without these mandates, however, the death toll could surpass half a million by that time.

China said Friday that there had been 5,241 total COVID-19 deaths, but many said that figure is implausible. The World Health Organization called on China to share more data on the outbreak, saying the country may be underreporting the true number of COVID-19 deaths, the Washington Post reported.

The number of people who will actually get sick and die will depend on individual decision-making, such as choosing to wear a mask or stay home when sick. And deaths may hinge in part on the capacity of the health system to care for the surge in sick patients.

The Surge Won’t Necessarily Lead to the Evolution of a New Variant

Omicron subvariants BA.4, BA.5, and BF.7 are responsible for most of the cases in China, according to an international database. Those variants dominated the U.S. in the fall, and BQ.1 and BQ.1.1 are now the primary variants.

“We know that whenever the virus is spreading anywhere widely in an uncontrolled fashion, it has the potential for variants to emerge,” U.S. Department of State spokesperson Ned Price said in a briefing on Tuesday. “We’ve already seen firsthand the cost of variants that have mutated and that have spread around the world.”

However, COVID-19 case surges don’t always cause new variants to pop up. Mark Siedner, MD, MPH, an infectious disease clinician and researcher at Massachusetts General Hospital, said scientists don’t yet totally understand how new variants emerge.

Mark Siedner, MD, MPH

I am no more concerned about new variants developing in China than I am about them developing [in the U.S.].

— Mark Siedner, MD, MPH

A leading theory, he said, is that when people who have weakened immune systems experience long-term infections, the virus can produce new mutations in their bodies and possibly lead to new variants.

“I am no more concerned about new variants developing in China than I am about them developing here,” Siedner told Verywell in an email. “Viruses can mutate wherever they are in circulation. We are currently experiencing a significant surge in cases in the U.S. as well.”

Omicron infections are driving high rates of hospitalization and death in the U.S., even though there’s a perception that the virus is becoming milder. COVID-19 will be among the top five causes of death in the U.S. this year.

“To protect ourselves and our loved ones, I would definitely make sure COVID-19 booster vaccination is on all of our holiday present lists this winter,” Siedner said.

Price said the U.S. is prepared to support China, including by sharing COVID-19 vaccines, “in spite of any political disagreements.”

CoronaVac—the most widely used COVID-19 vaccine in China—is 51% effective against symptomatic COVID-19. It’s unclear whether China will choose to use COVID-19 mitigation measures developed in the West, such as mRNA vaccines and Paxlovid.

What This Means For You

People who are immunocompromised and those who are not up-to-date with their vaccinations are at the highest risk of developing severe disease or dying from COVID-19. To keep yourself and others healthy, make sure you’ve received the updated bivalent booster shot, wear a mask in crowded indoors spaces, and stay home when you feel ill.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. COVID data tracker: variant proportions.

  2. Harari S, Tahor M, Rutsinsky N, et al. Drivers of adaptive evolution during chronic SARS-CoV-2 infections. Nat Med. 2022;28(7):1501-1508. doi:10.1038/s41591-022-01882-4

  3. Centers for Disease Control and Prevention. Monthly provisional counts of deaths by select causes, 2020-2022.

By Claire Bugos
Claire Bugos is a health and science reporter and writer and a 2020 National Association of Science Writers travel fellow.