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Article summary:
1. The features of the massive SARS-CoV-2 Omicron variant wave that spread through China after the abandonment of their zero COVID-19 policy on December 7, 2022, are contested.
2. Indirect inferences suggest that almost everyone in China was infected with SARS-CoV-2 within 2 months after the zero COVID-19 policy ended, but skepticism about the wave's actual course and magnitude is warranted.
3. Transparent, complete, in-depth data are needed on what happened and what is currently happening in China to improve our ability to manage future pandemics.
Article analysis:
The article "What Really Happened During the Massive SARS-CoV-2 Omicron Wave in China?" published in JAMA Internal Medicine attempts to dissect what happened during the Omicron wave in China after the country abandoned its zero COVID-19 policy. The article highlights that there is a divergence between Chinese authorities' announcements and critical Western coverage regarding the features of this wave, including its course, how many people were infected, COVID-19 deaths, and total excess deaths.
The article notes that indirect inferences suggest that almost everyone in China was infected with SARS-CoV-2 within two months after the zero COVID-19 policy ended. However, these estimates seem extreme as massive Omicron waves followed relaxations of zero COVID-19 policies in Hong Kong and South Korea starting in February and January 2022, respectively. Seroprevalence data from Hong Kong and highly urban South Korea suggest that less than one-half of the population was infected within five months. Therefore, skepticism about the wave's actual course and magnitude is warranted.
The article also discusses the number of COVID-19 deaths in China, which official statistics list at 87,475 mostly in patients with comorbidities. However, several modeling simulations have suggested 1 to 1.5 million deaths or more. The actual number of deaths may fall between these estimates. The article notes that China has been criticized for undercounting COVID-19 deaths, but high-income countries have probably overcounted them as well. Additionally, China's statistics do not include COVID-19 deaths at home, and some have claimed that most COVID-19 deaths in China occur at home.
The extent of additional non-COVID-19 excess deaths is also uncertain as death registration data in China were incomplete even before the pandemic. The article suggests that transparent, complete, and in-depth data are needed on what happened and what is currently happening in China.
Overall, the article provides a critical analysis of what happened during the Omicron wave in China and highlights the need for more accurate and unbiased data. However, it is important to note that the article may have biases as it relies on modeling simulations and indirect inferences rather than direct evidence. Additionally, the article does not explore counterarguments or present both sides equally, which may limit its objectivity.