(5) The Unvaxxed Elderly Are A Deadly ‘Accelerant’

• “Accelerant: a factor that makes something go faster, especially something that helps a fire to burn” – adapted from the Oxford English Dictionary

The Cover-Up Comes Apart

China has systematically suppressed information related to the impact of Covid on its population. For over two years – from mid-April 2020 until December 2022 – authorities promoted the fiction that the Mainland had experienced almost no deaths at all from Covid (despite acknowledging more than 100,000 cases of symptomatic Covid infections). Following the abandonment of the strict zero-Covid regime in December, leaked comments from Chinese officials, along with indications from other metrics (such as the number of cremations) have indicated that the pandemic has indeed struck with its full force. Hundreds of millions of people have been infected, hospitals have been overwhelmed, and death tolls are soaring. As The New York Times headlined

• “As Cases Explode, China’s Low Covid Death Toll Convinces No One”

The reality of a severe and continuing Covid impact is a major factor depressing the Chinese economy. The post-Covid recovery that was widely expected has not materialized. GDP grew less than 1% in the 2^nd quarter. Exports and imports have plunged. Manufacturing activity is contracting. The country is flirting with deflation. Chinese stock market performance has reflected all this. Last month The Wall Street Journal declared that “China’s Lost Decade for Investors Has Already Happened.”

• “Domestic [Chinese] share prices are lower than they were in 2007, and earnings per share are the same as in 2013.”

Observers in the West are beginning to realize that “China can’t be counted on to significantly benefit a global economy” – and the country’s ongoing public health emergency is a big part of the reason.

Assessing the true impact of Covid today, and going forward, has taken on urgency. Researchers outside the country have applied various methods to estimate the real mortality figures. The resulting estimates range from 1 million to almost 4 million deaths from Covid for mainland China to date (July 2023) – far above the official toll of about 80,000. (I will detail these estimates in a forthcoming column.)

Two Fatal “Accelerants”

In fact, the situation may be much worse. There are risk factors for mainland China which do not exist in Hong Kong or Korea or other countries than have been viewed as analogous. Three factors in particular will aggravate the impact of the disease, and act as “accelerants” that will intensify the Covid waves sweeping the country.

1. The functional inadequacy of Chinese vaccination programs
2. The large numbers of unvaccinated and under-vaccinated elderly Chinese

These factors are somewhat unique to mainland China. No other country has been so reliant on vaccines based on older inactivated virus technology, known to be less effective. (China has banned the import of superior Western vaccines based on mRNA technology.) And no other country has so neglected the vaccination of its elderly high-risk population.

“Immunologically Unprepared”

China’s vaccination program, while extensive, has relied on vaccine technologies that are now shown to be much less effective against Covid infection and mortality. Controlled studies make this clear.

• “Recent research shows that China’s vaccines offer limited protection … even in protecting people from severe Covid complications and death. This means the vaccines are not providing adequate protective immunity to a citizenry that lacks natural immunity through infection.” – The New York Times (January 25, 2022)
• “A Lancet study… found individuals who received three doses of China’s vaccines, Sinovac and Sinopharm based on older technology that uses the inactivated virus… were nearly twice as likely to develop severe Covid as people who received three mRNA jabs. Those with the Chinese shots were also 50 per cent more likely to be hospitalised.” – The Financial Times (Dec 26, 2022)

Chinese vaccines apparently lose whatever efficacy they have more quickly than Western vaccines.

• “The immunity imparted by Chinese vaccines [is] waning faster than mRNA jabs.” – The Financial Times (Dec 26, 2022)

This highlights the problem of declining immunity levels over time. The virus has evolved in ways to evade the original formula.

• “Most Chinese people have been inoculated with outdated Sinovac an Sinopharm jabs, which were designed to target the original virus strain…. ‘We can’t rely on old vaccines which are being used nationwide…that aren’t of much use,’ said a Beijing-based advisor to the Chinese Center for Disease Control and Prevention.” – The Financial Times (Dec 13, 2022)

This vulnerability is even worse with the Omicron variant, raging in China since the lifting of zero-Covid.

• “Neutralization of Omicron was undetectable in participants that had received a two-dose regimen of CoronaVac vaccine [the Chinese benchmark]…none of the individuals fully vaccinated with CoronaVac had detectable neutralizing antibody against Omicron.” – Nature Medicine (January 20 2022)

In other words, effective immunity against against Omicron is practically nonexistent in China today.

New “immune-evasive” variants of Omicron are emerging, which will drive infection rates up.

• “Cases of Omicron variant XBB are mounting in China, forming a new wave expected to crest around 65 million cases weekly by the end of June [2023].”

That is equivalent to the entire population of France – in new infections, every week.

In short, as Nature magazine described the situation in a lead editorial last December:

• “Most people in China are immunologically unprepared for…any [Covid] variant and, if vaccinated, have received vaccines only against the virus’s original strain.”

“Immunologically unprepared for any variant” – that phrase is a death sentence for hundreds of thousands, perhaps millions, of Chinese citizens. It is also an indictment of Beijing’s obtuse nationalism, in pursuing for political reasons a vaccination policy based on known inferior technology.

The Un-vaxxed Elderly

• “The death rate of COVID-19 increases exponentially with age.” – British Medical Journal (May 2021)
• “In late 2020, data indicated that elderly people had a much greater risk of dying from COVID-19 than did younger people. Those older than 65 were at least 90 times more likely to die or become seriously ill from COVID-19 than were those aged 18–29. People older than 85 were 630 times more likely to die…” – Nature (July 14 2022)
• “The most critical factor that can affect total COVID-19 fatalities in China is the extent to which the elderly can be protected.” – European Journal of Clinical Investigation (Jan 2023)
• “When other countries set about vaccinating their populations against covid-19, they began with those most likely to die from the disease. China did the opposite. Instead of focusing on the elderly and people with medical conditions that made them more vulnerable, it started with healthy working-age groups.” – The Economist (Dec 8, 2022)

Many studies have verified that age is a key determinant of Covid illness, hospitalization and death rates. An early study from Yale examined data from 21 countries (including China), for “six consecutive weeks beginning at the 50th recorded death” for each country. The impact of age on disease outcomes was overwhelming.

In light of this obvious risk factor, the World Health Organization in 2020 recommended giving top priority to vaccinating (1) “health workers” and (2) the elderly. This policy was adopted almost everywhere. Medical resources were initially allocated to the elderly. (In the U.S., Covid tests were at first available only to those over 65.)

But not in China.

China’s failure to vaccinate its older citizens is hard to explain. Authorities often blame the elderly Chinese citizens themselves. They are said to be victims of their own “vaccine hesitancy.” Why are they hesitant? Mistrust of the government is not unexpected in China, especially among those who are old enough to have experienced some of the horrors of recent Chinese history.

But so what? This regime was prepared to lockdown whole cities, close businesses by force, deport those testing positive to “isolation camps,” and even weld people shut in their homes to prevent them from traveling – in short, to pursue a prison-intensity totalitarian approach to public health. It has never seemed plausible that the government would allow anyone to “just say no” to vaccination.

In any case, the scope of the problem in China is massive. Of the nearly 260 million Chinese over the age of 60, 45% were not fully vaccinated (defined as less than three doses) in March 2022 – and 14% were completely unvaccinated.

The numbers of elderly Chinese at high-risk are huge: 113 million older citizens less than fully vaccinated in March 2022, and 36 million completely unvaccinated – including more than 13 million Chinese over the age of 80 with no immunological protection at all.

That was March 2022. Strangely, the vaccination program actually slowed down after that. From June 2021 to December 2021, China administered 650 million doses of vaccine (90 million per month). Then, from January 2022 until the end of zero-Covid on December 8, 2022, Chinese authorities administered just 45 million more doses (4 million per month). The last three months before the abrupt end of the zero-Covid program — when presumably there would have been some foreknowledge of at least the possibility of halting the program – the vaccination effort came to a standstill – less than 1 million doses per month, down 99% from the rate in 2021.

China is now often said to have abandoned zero-Covid “without preparation.” The message of this chart seems more ominous. The virtual elimination of the vaccination program months before the shift away from zero-Covid is very hard to justify as merely a planning failure. It could almost seem intentional – raising another question for future historians, perhaps.

What Is The Impact? The Hong Kong Analogy

How many of these unvaxxed will be infected? How many will die?

As to the infection rate, Chinese officials indicated that in the first two months after the end of zero-Covid restrictions on Dec 8, 2022, over 80% of the entire population had been infected with Covid. It is reasonable to assume that by now, almost 8 months later, the infection rate in China must be nearly 100%.

How many people will become ill? In particular, how many of the exposed elderly segment will die?

The best answer comes from Hong Kong. As of February 2022, vaccination rates and public health policies there were similar to those on the Mainland. Strict zero-Covid was in place. The elderly were largely unvaccinated – 57% of the residents over the age of 80 had not received even one vaccine dose.

When the Omicron variant hit the city in February, zero-Covid was overwhelmed and the healthcare system nearly collapsed. Infections and deaths soared to the highest levels seen anywhere in the world, ever.

• “In just under two months, Hong Kong went from being one of the best places in the world at controlling COVID-19 to one of the worst. Deaths have skyrocketed, the health system is swamped, morgues are overflowing and public confidence in the city government is at an all-time low. Hong Kong has registered the most deaths per million people globally in recent weeks – more than 24 times that of rival Singapore – due to a large proportion of elderly who were unvaccinated as the highly transmissible Omicron variant ripped through care homes since February.” – Reuters (March 17, 2022)

Although the elderly population in Hong Kong is relatively small, the Covid mortality rates (“case fatality rates”) for that age group are extremely high. A detailed study by the U.S. Center for Disease Control’s International Task Force (which involved co-authors from both Hong Kong and Beijing) examined the patterns in Covid mortality in Hong Kong for the period from January 6 to March 21 2022.

The findings are grim.

Age was the most important risk factor.

• Of the total of 5906 deaths, 96% were people over the age of 60, and 87% were over the age of 70
• The very old (over 80 years of age) accounted for 71% of the deaths
• Of those who died despite being fully vaccinated, 92% were over the age of 60
• People over 80 had a mortality rate 867 times higher than those in their 20’s.

Vaccination status was almost as important.

• 88% of those who died were less than fully vaccinated
• 70% of those who died were entirely unvaccinated
• The over-80 who were unvaccinated made up 51% of all the deaths
• The mortality rate for unvaccinated people overall was 33 times higher than the mortality rate for fully vaccinated people.

• Deaths of those 80 and older (regardless of vaccination status) were equal to the deaths of the unvaccinated (regardless of age)
• However the mortality rate (deaths per million) associated with age (80+ years) was 2½ times higher than the mortality rate associated with being unvaccinated

In short, old age was the number one driver of Covid deaths in Hong Kong. That fact alone is an indictment of China’s failure to protect this ultra-vulnerable population. Lack of vaccination in and of itself was also very deadly, however. The combination of old age and unvaccinated status was devastating.

The impact of Omicron on the much larger elderly and unvaccinated population of mainland China will be much greater than in Hong Kong. This highly vulnerable segment is much larger than in any other benchmark country.

Summary

There are other ways to get at this question – the effect of age on the death rate – using ratios derived from countries with higher quality and more complete epidemiological data. It may be still too early to decide which extrapolation is the most accurate – and of course Chinese obfuscations and falsifications are a severe handicap to analysts trying to assess and quantify the damage. We will consider the relative merits of some of the prominent estimates in a future column. But the existence of a large pool of elderly and/or unvaccinated people in China – larger as a percentage and in absolute terms than in for any other country today – means that model estimates may be on the low side of reality.

When the full toll is known, millions will have died who did not need to have died. Xi Jinping’s two great blunders – stubborn reliance on inferior vaccines for political rather than medical reasons, and a bizarre decision to halt the vaccination program a year before lifting zero-Covid, with millions of ultra-vulnerable seniors left fully exposed to the storm of Omicron – will rank alongside Mao’s Great Leap Forward as a self-inflicted humanitarian disaster.

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