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Less than a month ago, I interviewed global health experts about how China can emerge from its nearly three years of “zero covid” lockdowns without creating an overwhelming surge of severe infections and deaths. A cautious approach, carefully synchronized to gradually reopen while increasing vaccinations, could avert catastrophe.

Unfortunately, Chinese officials did not follow this evidence-based road map. Instead, they settled on a “let it rip” plan.

The government went from mandating tests and forcing asymptomatic people into quarantine facilities to shuttering testing sites. It is no longer documenting all infections, so there are no reliable estimates of total covid spread. Many pharmacies are out of over-the-counter fever medicines. In Beijing, the number of patients visiting specially designed fever clinics increased by a factor of 16 in one week. Though officials claim there are only a handful of covid deaths, The Post and CNN have reported waiting lines at funeral homes.

Top doctors affiliated with the Chinese government have been spreading the message that omicron is milder than previous variants and that people should get vaccinated to reduce their likelihood of severe illness. These are accurate statements. Indeed, the vast majority of Chinese people will eventually contract covid, just like most Americans have.

The problem, though, is that all these people could become sick within a short time frame. Even a disease with a low fatality rate becomes problematic if too many patients fall ill at once. As hospitals are overrun with cases, medical care will suffer not only for covid patients but also for trauma patients and people coming in with heart attacks or strokes. As a result, far more people will die than would have if the health-care system were functioning at peak performance.

That is the rationale for “flattening the curve.” If China had instead spread out covid infections over a period of months instead of weeks, this would allow hospitals to handle the sick patients in a manageable way.

It would also have bought time for a greater proportion of the elderly to get vaccinated. In the United States, nearly 9 out of 10 covid deaths are among those 65 and over. That proportion will likely be higher in China, with their less effective vaccines.

But “flattening the curve” didn’t happen. And so we are about to see the consequences of uncontrolled spread.

In the days to come, we should expect to see images of long waiting lines outside clinics and hospitals. Major population centers will experience surges first, but rural areas that have far less health-care infrastructure will be hit the hardest. News reports will emerge of people dying because they couldn’t access care. The mortality rate from covid will climb.

The surges will be tempered by individual behavior, as many will voluntarily hunker down. But the country’s biggest celebration, the Lunar New Year, is just around the corner. Hundreds of millions normally travel during these holidays, and previously unaffected rural areas will become hotspots, too.

All of this will be tragic for China, but the impact isn’t limited there. The United States, and the rest of the world, should brace for the arrival of new variants.

Viruses mutate all the time. The more they replicate, the more they mutate. Most mutations don’t have evolutionary advantage and won’t take hold in the population, but some could. It’s entirely possible that as a result of a massive tsunami of infections in China, one or more new variants will spread beyond its borders.

These new variants could be even more contagious than existing ones. They could be more immune evasive. And there’s always the possibility that they are more virulent and cause more severe disease.

Unfortunately, China is not likely to accept Western assistance to tamp down its current wave. At this point, the abrupt U-turn from “zero covid” has already happened, and “let it rip” is in full swing. There’s not much the United States can do other than hope that we won’t soon have new variants that sets the entire world back in our progress to living with covid.

I am traveling to see friends and family next week. The Checkup resumes on Thursday, Jan. 5. I’ll also be participating in a Washington Post Live event on Jan. 4 and hope you can join us. Wishing everyone a wonderful holiday and happy new year!

“My husband and I are in our early 70s. We are both in good health and active, but my husband takes medication for high cholesterol and high blood pressure. We had the bivalent booster on Sept. 5 and are going to South Africa on Jan. 5. I’m concerned about waning immunity and assume we won’t be eligible for another booster before we leave. Thoughts on how to protect ourselves? (We wear N95 masks indoors and on planes.)” – Rise from Maryland

You and your husband are doing all the right things. The booster should still protect you well against severe illness, though protection against infection will probably be diminished by the time of your trip.

Use other mitigation measures, such as wearing an N95 while indoors. It will be hot in South Africa in January, so you could choose to have meals outdoors. If you are visiting friends, consider asking them to test before seeing you. And have a plan for what happens if you do contract covid. If you are eligible for Paxlovid, know how to access it while traveling.

“My 36-year-old son has been living and working in China for several years. He is finally able to come visit without a stringent request entry problem when he flies back to his job. He has had two Sinovac vaccinations. Can he safely get the omicron bivalent booster here?” – Nancy from California

Yes, your son can receive the updated booster safely. This combination of Sinovac’s CoronaVac vaccine followed by an mRNA shot has been studied. Some research suggests that more than one mRNA booster might be needed for optimal protection against omicron subvariants, but one dose by itself adds protection and is safe.

“I went to Walgreens for the latest omicron variant booster for covid, but they told me that since my other boosters were up to date, I didn’t qualify for it. Was this wrong?” – Molla from North Carolina

It depends. When did you receive your last covid shot? The Centers for Disease Control and Prevention says that you are eligible for the updated omicron booster if it’s been at least two months since your last inoculation. If it’s been at least two months, the pharmacy should give you the new booster.

“How many days before a family holiday gathering should one get tested?” – Sandra from New York

Zero. Ideally, everyone should test right before the gathering, on the same day.

Thanks for your many questions during the live Q&A today! Here’s a transcript. The Post has also compiled Q&As from my previous newsletters. You can read them here.

A fourth dose of the Pfizer vaccine provides temporary protection against covid infection, an Israeli study found. The third dose made the biggest difference in inducing a strong and sustained immunological response. The fourth dose was 52 percent effective against symptomatic infection during the first five weeks following vaccination. By 15 to 26 weeks, it had declined to virtually zero. This study suggests that the mRNA vaccines are at least three-dose vaccines and that additional doses might provide limited additional benefit against symptomatic infection.

New research from the CDC shows that Paxlovid reduced hospitalization in adults by 51 percent. This is an important finding because the study included those with previous infection or vaccination, and a surprising proportion — nearly two-thirds — were individuals under 65. Previous studies showed that Paxlovid had a dramatic effect in reducing severe illness in older individuals and among the unvaccinated. This study underscores the necessity of ensuring those eligible for this safe and effective treatment receive it.

A report from the World Health Organization shows that the coronavirus pandemic hampered efforts to control malaria. In 2020, there were 13 million more infections and 57,000 more deaths than in 2019. This is mainly attributed to the interruptions associated with distributing insecticide-treated bednets, which is the primary method of reducing mosquito bites in most malaria-endemic countries. Eight countries distributed less than 60 percent of their bed nets, for example.

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