Editorial: The second wave of CoVID-19 starts in China

by Prof. Dr. Wolfgang Georg Arlt FRGS FRAS

Several times it has been stated by your humble editor that he would love to be proven wrong in his predictions about the future of CoViD-19 in China, but it should be stated here again.

The second wave of CoVID-19 has started in China, with Omicron B.A.2 spreading fast throughout almost all provinces in China. As in the rest of the world, vaccination does not stop the B.A. 2 infection in a big way. The vaccines used in the Western world however does prevent in almost all cases the need for hospitalisation or even the final result of death. China has a vaccination rate of 88%, if the vaccines of Sinopharm and Sinovac have the same effect, remains however to be seen. 

The number of daily new CoViD-19 cases jumped from 357 on March 3rd to 2,343 on March 11th, an almost sevenfold increase within eight days and almost doubling the 1,369 cases just one day earlier. Cases were reported in 26 out of 31 provinces. 

Dr. Zhang Wenhong, the “Dr. Fauci” of China wrote a few days ago that the numbers for the mainland were still in the beginning stages of an “exponential rise.” He also confirmed that the current outbreak is being driven by the B.A.2 lineage of the omicron variant. 

The government however still continues the uphill battle against the virus with more lockdowns decreed all over the country including to the almost 20 million inhabitants of Shenzhen. It is enough to have a look across the border to Hong Kong to see that the Zero-case policy is not working anymore. Hong Kong’s Chief Executive Carrie Lam had to announce an “indefinite delay” for the testing and said authorities will prioritize instead efforts to expand vaccinations for elderly people living at care facilities and increase the number of hospital beds to treat patients.

Nirmatrelvir and Lonicera japonica are the two biggest hopes of China now. The government-owned import company China Meheco has agreed with Pfizer Inc. to a partnership to commercialize the CoViD-19 pill Paxlovid in China, which is supposed to help stop infected persons from developing severe symptoms and ultimately from dying because of CoViD-19.

Paxlovid consists of Nirmatrelvir, an orally bioavailable protease inhibitor It has demonstrated antiviral activity against all coronaviruses that are known to infect humans. Nirmatrelvir is packaged with ritonavir (as Paxlovid), a strong boosting agent that has been used to boost HIV protease inhibitors. Coadministration of ritonavir is required to increase nirmatrelvir concentrations to the target therapeutic range. The Food and Drug Administration of the USA issued an Emergency Use Authorization (EUA) for ritonavir-boosted nirmatrelvir for the treatment of patients with mild to moderate COVID-19 symptoms. In January 2022 it was also approved by the EMA of the European Union.

Lonicera japonica is the active ingredient of Lianhua Qingwen, herbal medicine in Traditional Chinese Medicine, which is known for almost 2,000 years in China. It was also used during the first SARS outbreak in 2002. Lianhua Qingwen in the form of capsule or granule is obtained by combining Ma Xing Shigan Decoction with Yinqiao Powder and is widely used in the clinical treatment of respiratory disorders. The China National Medical Products Administration agency has officially approved Lianhua Qingwen for the treatment of mild or ordinary COVID-19 pneumonia. There is only one factory in China, Shijiazhuang Yiling Pharmaceutical Co., Ltd. in Shijiazhuang, the capital of Hebei, producing Lianhua Qingwen.

If the Chinese government stops playing Whack-a-mole and starts concentrating on acquiring and distributing sufficient quantities of Paxlovid and Lianhua Qingwen to the 1.4 billion Chinese in need, a nationwide catastrophe hopefully can be avoided – and one of these days outbound tourism will start again.

Quick update on WW3: As the time of writing did not happen yet.

As always, all best wishes for our readers and for mankind from Prof. Dr. Wolfgang Georg Arlt and the whole COTRI WEEKLY team.