Beijing imposes mainland China's first Covid vaccine mandate in face of Omicron subvariant

People stand in line at a coronavirus testing site in Beijing on July 2.

 

Beijing on Wednesday announced a Covid-19 vaccine mandate for residents to enter public venues, becoming the first city in mainland China to do so as it attempts to contain a highly infectious Omicron subvariant.

From July 11, people will need to show proof of vaccination to enter a wide range of public places in the Chinese capital, including cinemas, libraries, museums, gyms, stadiums and training centers, a city health official told a news briefing Wednesday.

People who are "not suitable" for vaccination will be exempted from the requirement, the official added, without clarifying how they can provide proof for exemption.

It also remains unclear how people who received vaccination overseas can satisfy the requirement. China's health code systems -- which are used to show proof of vaccination -- do not currently recognize foreign vaccines, and those who were inoculated abroad have not been able to get their vaccinations registered.

Places that have limited capacity or where reservations are needed are required to prioritize entry to vaccinated customers.

Senior citizens visiting venues offering activities specifically for the elderly, such as recreational centers and game rooms, should be vaccinated as soon as possible, the official said.

The vaccine mandate comes as Beijing reported three cases of the BA.5.2 Omicron subvariant, which is highly transmissible and capable of escaping antibodies. An outbreak of the new subvariant has already shut down the northwestern city of Xi'an, where entertainment, sports and religious venues have been closed -- and restaurants limited to takeaway and delivery services -- until next Wednesday.

A medical worker takes a swab sample at a nucleic acid testing station in Beijing on July 6.

 

Lag in elderly vaccination rate

China remains an outlier for its continued zero-Covid approach, which has seen cities across the country -- including Beijing and Shanghai -- recently placed under full or partial lockdown. The strategy -- which relies on mass testing, quarantine and snap lockdowns to stamp out any resurgence of the virus -- has wrecked economic activity.

Chinese authorities have ramped up efforts to boost vaccination rates, especially among the elderly population, since Omicron caused successive outbreaks this year.

In Beijing, residents are already required to show proof of a negative Covid test taken within 72 hours to enter all public places.

The city has also required people who work in epidemic prevention and control, health care, public transport, delivery and other higher risks sectors to be fully vaccinated.

As of January, 98% of Beijing's over 20 million residents have been fully vaccinated, including 12 million people who have received a booster shot, according to a government statement.

But the vaccination rate among the elderly is lower. As of April, 80% of Beijing residents over 60 had been vaccinated, state news agency Xinhua reported.

Residents line up to get a throat swab at a testing site in Beijing, on July 4.

 

On Chinese social media, users were quick to point out that Beijing's vaccine mandate appeared to contradict national health authorities' guidance that vaccination should be voluntary.

"When did voluntary vaccination become mandatory?" a comment asked on Weibo, China's Twitter-like platform.

Last September, the National Health Commission said it was wrong for local governments to impose restrictions on movement for unvaccinated people in order to speed up the inoculation campaign -- and that such policies should be corrected in a timely manner.

"Covid-19 vaccination should be based on the principles of informed consent, and (be) voluntary," Wu Liangyou, deputy head of the commission, told a news conference.

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Australia was a model in how to handle Covid. Now it's a mess

 

Australia was caught off guard by a steep rise in Omicron cases leading to a shortage of rapid antigen tests.

Summer in Australia is traditionally a time of beaches and barbecues, but this year it's become a hot mess of rising Covid cases and a national shortage of rapid antigen tests.

Last week, worker absences due to Covid isolation and illness became so severe that the national cabinet considered lowering the age limit for forklift licenses so that minors could pitch in to smooth supply chains.

Ministers ultimately decided not to go ahead with the plan. But the idea that Australia, a country once lauded for its Covid-19 response, was considering such a move appeared to show how much the country's leaders were struggling.

After spending much of the pandemic shut off from the world, Australia is now attempting to navigate a new approach of living with Covid. But that shift has coincided with the emergence of Omicron, which has seen case numbers surge.

Most of Australia's 1.5 million Covid infections were acquired in the past three weeks, and on Friday the country reported a record single-day total of 88 deaths.

The surge has exacerbated Australia's existing worker shortage -- earlier this month, the government estimated workforce absenteeism could be as high as 10% at any one time.

On a global scale, Australia's pandemic death toll of about 3,000 fatalities remains relatively low, largely thanks to the government's quick move to shut its borders, impose lengthy lockdowns and promote vaccines.

But while the new course isn't causing a health disaster on the scale seen elsewhere, it is leading to widespread disruption in a country that once prided itself as an exemplar of action on Covid.

NSW is leading the country in cases, but falling hospitalization rates suggest the peak in that state may have passed.

 

The emergence of Omicron

From the government's perspective, Omicron changed everything.

"Omicron has been one of the biggest [surprises] in challenging and pretty much turning on its head the way we'd been managing the pandemic up until that point," Morrison said Thursday.

The government's road map to living with Covid was based on Delta, a less infectious strain that caused chaos in other countries last year. According to Morrison, the old plan was why the government didn't order more rapid antigen tests -- a key pain point in this phase of the pandemic as more people fall ill.

Better known as RATs, the at-home tests provide results in minutes, but they're almost impossible to find in Australia.

Critics say the government should have been able to predict the looming crisis. The United Kingdom has been giving out free tests since last April and the United States suffered a severe shortage of tests well before Australia's case numbers surged.

"I understand that those rapid antigen test shortages have been a great frustration," Morrison said Wednesday. "But a lot of these comments are made with hindsight, not foresight."

Demand for the devices swelled when queues for the traditional PCR tests, performed by pathology labs, grew longer as more people came down with Covid symptoms.

Some people want them to prove they are Covid-free to go to work. Others need them to visit vulnerable relatives in hospitals and care homes. Without them, many people are stuck at home, unsure if they're contagious or not.

The Pharmacy Guild of Australia, a body that represents 5,700 community pharmacies, said members are answering four calls a minute from people desperate for tests. "This is simply not sustainable," the guild's president Chris Freeman said in a statement Thursday.

Pharmacies are receiving four calls every minute from people looking for RATs.

 

RATs are in such short supply that the Australian Federal Police is threatening prison sentences and fines for anyone caught selling them for more than 20% over the retail price. Deals are done on Facebook and some pharmacies post status updates on their RAT stocks every day.

Before the turn of the new year, software developer Matt Hayward noticed the problem and on January 3 launched Find a RAT, a crowdsourcing website where people could report sightings of the elusive tests.

Within a week, the site was getting half a million hits a day. At the peak of the squeeze, tests were available in just 10 locations around Australia, according to Hayward, who co-founded Melbourne software agency Pipelab.

"They were disappearing within about 30 minutes," he said. According to the site, the supply issues have eased since then -- RATs are available in fewer than 200 locations across the country, a number that changes as stock arrives and is sold out.

The government says more stocks are on their way. Free tests are already available from state clinics -- but only for people who are symptomatic or those considered a close contact, which is defined as someone who is living with a positive case or has been with them in close quarters for more than four hours. From Monday, tests will be distributed free through pharmacies to concessional card holders, including pensioners.

However, when asked Sunday how those tests would be distributed in Queensland, Chris Owen, president of the state's branch of the Pharmacy Guild, said: "It's a moot point at the moment. Obviously there is no stock available. They're as rare as hens' teeth."

Tearful reunions as parts of Australia reopen border after 18 months

 

Worker shortages test supply chains

It's not just RATs in short supply -- worker absences due to illness and isolation mean major supermarkets are struggling to keep stores stocked with common products.

This is partly because Covid is spreading rapidly -- but also because close contacts of positive cases are required to isolate for seven days. In a bid to keep the country moving, essential workers are now exempt from that rule -- as long as they return a negative test -- but some industries are still suffering severe shortages.

Processed chicken, in particular, has become a rare commodity as workers call in sick with Covid along all points of the supply chain. A spokeswoman for the Australian Chicken Meat Federation told CNN that as many as 50% of staff are off sick in some processing facilities. Remaining workers are focusing on distributing whole chickens, instead of spending time cutting them up to sell as wings, thighs, and fillets, she told CNN.

"It's really hard to judge who's going to call in sick so planning is pretty impossible at the moment," she said. "There's still people contracting Covid, so just it's really a day-to-day by day thing that doesn't look like it might ease in the next couple of weeks."

There is room for optimism. Health officials say Australia's case numbers should peak sometime in the next two weeks. Falling hospitalization rates in New South Wales suggest the state may be over the worst, though some caution it's too soon to tell.

A new challenge will come in the week ahead when students in the two most-affected states -- NSW and Victoria -- return to school.

NSW Premier Dominic Perrottet said Sunday that all children and teachers will be required to take two RATs when school resumes there Friday. Victoria is taking a similar approach but is only "strongly recommending" twice-weekly tests.

In both states, tests will be provided by the government, taking some pressure off pharmacies. And masks will be mandatory for teachers and most children age 8 and up.

Other anti-Covid measures are being employed, including air purifiers and outdoor lessons where possible in the summer heat.

Last week, the NSW Teachers Federation warned that schools may need to shut if cases surge. But both states say that won't happen.

Either way, Australia's long summer of Covid is not over yet -- and for Western Australia, which reported 24 locally transmitted cases on Sunday despite maintaining closed borders, it may have only just begun.

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Omicron has changed the shape of the pandemic. Will it end it for good?

 

The world feared the worst when a worrying new coronavirus variant emerged in late November and ripped through South Africa at a pace not seen before in the pandemic.

But two months later, with Omicron dominant across much of the globe, the narrative has shifted for some.

"Levels of concern about Omicron tend to be lower than with previous variants," Simon Williams, a researcher in public attitudes and behaviors towards Covid-19 at Swansea University, told CNN. For many, "the 'fear factor of Covid' is lower," he said.

Omicron's reduced severity compared to previous variants, and the perceived likelihood that individuals will eventually be infected, have contributed to that relaxation in people's mindsets, Williams said. This has even caused some people to actively seek out the illness to "get it over with" -- a practice experts have strongly warned against.

But some within the scientific community are cautiously optimistic that Omicron could be the pandemic's last act -- providing huge swathes of the world with "a layer of immunity," and moving us closer to an endemic stage when Covid-19 is comparable to seasonal illnesses like the cold or flu.

"My only view is that it's becoming endemic, and it will continue to stay endemic for some time -- as has happened with other coronaviruses," said David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine.

"All viruses try to become endemic, and to me this one looks like it's succeeding," he said.

 

Covid-19 has evolved with great unpredictability, and the variant that superseded Delta could have been more sinister, experts say; but the world ultimately got a dominant strain that is sweeping through populations with ease, without causing the same degree of hospitalizations, severe illnesses and deaths that previous variants have done.

Experts caution that there may be setbacks along the way -- just as Omicron's make-up was unexpected, the next variant could present a more serious public health risk and delay the end of the pandemic.

And many countries, particularly where vaccination coverage is low, could still face overwhelmed hospitals due to the current Omicron wave.

But a political urgency is appearing in much of the West to return societies to a sense of normality -- with the transmissibility of Omicron forcing leaders to choose between rolling back public health measures or seeing their workforces and economies risk grinding to a standstill.

And for the first time since the spread of Covid-19 stunned the world in early 2020, some epidemiologists and leaders are willing to entertain the prospect that the virus might be making steps toward endemic status.

'The rules of the game have changed'

The question that scientists and wider society will grapple with throughout 2022 is when Covid-19 will leave its current stage and enter endemicity.

A disease that is endemic has a constant presence in a population but does not affect an alarmingly large number of people or disrupt society, as typically seen in a pandemic.

Experts don't expect Covid to fully disappear in any of our lifetimes. Instead, it will eventually reach a period similar to several other illnesses, where "most people will be infected as children, possibly multiple times, and as those infections accumulate, they build up an immunity," according to Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh and the author of a book about the early stages of the pandemic.

"That's the situation we're heading towards," he said. "Omicron is another dose of virus. We will all be on average less susceptible to disease having had that dose, or having had the vaccine."

That's why Omicron's reduced severity is so key -- it adds an extra layer of immunity, but doesn't come with the same risk of hospitalization that Covid-19 held for most of last year. Omicron is associated with a two-thirds reduction in the risk of hospitalization compared to Delta, according to a Scottish study. A separate paper from South Africa put the same figure at 80%.

"Well over half the world has now got some exposure to the virus or the vaccine. The rules of the game have changed from the virus's point of view," Woolhouse said.

 

And underlining experts' confidence is history -- though comparing the current scenario to previous pandemics is not an exact science, there is evidence from the past that viruses can be expected to evolve into less severe versions and eventually disappear into the arsenal of annual colds and influenzas.

"There are four other coronaviruses that have become endemic," Heymann said. "The natural history of infections" indicates that Covid-19 will be the fifth, he added.

"People have reinterpreted 'Russian flu' in the late 19th century as the emergence of a common cold-type coronavirus," added Woolhouse, referring to the 1889-90 outbreak that is estimated to have killed around a million people, but which ultimately became a common cold.

"The 'Spanish Flu' basically gave the whole world a very nasty dose of an H1N1 influenza virus" in 1918, he said. Now, "we get a wave of that virus pretty much every year."

Experts generally agree that Omicron moves us closer to that stage with Covid-19. But there is a big caveat that determines how fast we'll get there -- and it depends not on the current strain, but the one that comes next.

"It is an open question as to whether or not Omicron is going to be the live virus vaccination that everyone is hoping for, because you have such a great deal of variability with new variants emerging," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Monday.

"I would hope that that's the case," Fauci told the Davos Agenda, a virtual event this week held by the World Economic Forum, mirroring the cautious optimism that many epidemiologists are expressing. He added that the world was "fortunate" that Omicron didn't share more of Delta's characteristics.

But for all the positive indications, it "doesn't mean a new variant won't come up and force us backwards," Woolhouse said.

"I would not like to call which way the next (variant) would go, he added. "The next variant has to outcompete Omicron, and the main thing it will have to be able to do is evade natural immunity, and to evade vaccine-induced immunity," he said. "What we can't say in advance is how bad (it) will be."

An arms race towards endemicity

Epidemiologically speaking, Omicron has delivered some cause for optimism -- but much depends on how the virus evolves from here.

Pandemics do not move merely with the whims of a virus, however; they are also directed by human behavior and political acts. And as the pandemic's two-year anniversary in March edges closer, signs are emerging of an arms race towards endemicity.

Spain's Prime Minister Pedro Sanchez, who presided over one of the West's most effective vaccination rollouts, told radio station Cadena Ser earlier this month that it's time "to evaluate the evolution of Covid from pandemic to an endemic illness." His health minister said she has put that viewpoint to fellow European Union leaders.

Britain's education secretary Nadhim Zahawi, who previously oversaw the UK's vaccine rollout, added to Sky News that he wanted the UK to "demonstrate to the world how you transition from pandemic to endemic."

And that move is already well underway in countries such as Denmark, where Covid rules were ditched and then re-introduced last year. Tyra Grove Krause, an official at the Statens Serum Institut (SSI) that deals with infectious diseases in the country, told local network TV2 this month that Omicron could "lift us" out of the pandemic and return Danes to normalcy within two months.

"Those governments that have achieved a high degree of population immunity through the privilege of vaccination or the burden of infection now have a wider range of choices than they did at the start of 2021," said Thomas Hale, associate professor at Oxford University's Blavatnik School of Government, and the academic lead of its Covid-19 Government Response Tracker.

Many countries are starting to act as if Covid is already endemic. England resisted new restrictions despite record-breaking infection figures in recent weeks, and though hospitalizations and deaths have risen, its health care sector appears to have survived the peak of the Omicron wave without recording the high admissions seen during previous variants.

 

Early real-world examples like this could give other nations the confidence to strip back restrictions and, as British Prime Minister Boris Johnson proposed this month, "ride out" the Omicron wave. "Many countries have looked to the UK, because they see that the UK has some degree of permissibility" in restrictions, Heymann said.

That approach is quickly becoming more commonplace. Covid-related financial aid is soon set to end in France as restrictions are eased; "We are announcing [to people in France] that the pandemic will perhaps be behind us by mid-February," French Prime Minister Jean Castex announced Thursday.

Driving this push is the ravaging impact that Omicron is having on essential workforces -- a development that has changed the calculus of governments. Faced with dilemma of tackling transmission or keeping their countries running, leaders have swiftly moved to slash isolation periods.

"Clearly taking people out of the workforce -- particularly schools and healthcare -- is one costly impact," of Omicron, Hale said. "Of course it is preferable to prevent widespread transmission in the first place, though for many countries now facing Omicron this point is now moot."

That means that an increasing number of countries are looking to "transfer the risk assessment to their populations," Heymann said -- relaxing rules and encouraging self-testing, personal decisions on mask-wearing, and even individual assessments among infected people of how long they need to isolate.

Many experts still encourage restrictions to reduce transmission, at least while the Omicron wave is with us. But Williams noted that populations are increasingly moving away from that view.

"The way Omicron has been represented in some media reports, and even indirectly by some politicians -- who were a bit too quick to emphasize the 'we need to learn to live with it' message -- have contributed to this now quite widespread view that Omicron is less worrisome," he said.

The problem with that approach, many warn, is that some parts of the world are less able to take on a relaxed approach.

"By definition a pandemic is not over until it's over, for everyone, everywhere," Williams said. "Our attention now should increasingly focus on getting enough vaccines to those in low- and middle-income countries."

Vaccination coverage is lower in many poorer regions of the world -- particularly in eastern Europe, central Asia and large parts of Africa -- leaving those places especially susceptible to worrying new variants or more severe waves of hospitalizations.

"A pandemic has various components to it in various countries," Heymann said. "I think countries will become endemic at different rates."

And that adds an extra layer of uncertainty to the question of whether Omicron will hasten the end of the pandemic.

"Health systems around the world will have to be cognizant" of the risks of Covid even if it soon starts to act and feel more like a seasonal cold, Woolhouse said.

"The world has changed -- there's a new human pathogen there, and it's going to continue to cause disease for the foreseeable future," he concluded. "We were always going to be living with Covid. it was never going to go away -- we knew this from February 2020."

"What we didn't know, and still don't fully, is exactly what that looks like."