 The past few days have seen developments on the COVID-19 front. On the one hand, after the rise in cases, Chinese authorities imposed a regime of lockdown and testing in the city of Shanghai. This is in continuation of its zero COVID-19 policy, which has seen a strong focus on identification of every case. We have also seen a rise in cases in European countries, which have of course followed a very different strategy in dealing with COVID-19. A lot of this is attributable to particularly transmissible strains of Omicron. Immunologist Dr. Satyajit Rath analyzes the recent developments and what it means for the battle against the pandemic. Hello and in this week's COVID pandemic roundup, it's quite obvious by now that COVID cases have begun to explode in two different and interesting places in the world. One, everybody is concerned with the news that COVID cases have been growing to the point of three, four, five thousand cases a day in Shanghai, in China. And the Chinese government's public health policy response is interesting to take note of. The second piece of news, of course, is that COVID cases have begun to grow once again. The numbers have begun to grow once again across Europe and this includes France, this includes Germany, this includes the United Kingdom, this includes Italy. So in all of these places in Europe, when cases had gone up to very high numbers a couple of months back and numbers had come down, case numbers have begun to go up again. And it's interesting to look at the implications of these case numbers. So in the first place, the increase in case numbers in China, especially in Shanghai, needs to be seen on the background that China, like New Zealand had adopted a zero COVID policy. New Zealand, of course, has now begun to set that policy aside. The Chinese public health authorities are still very much pursuing a zero COVID policy. What is a zero COVID policy? A zero COVID policy is that all cases are going to be identified, meaning that all infections are going to be identified. Since increasingly, a very large proportion of these infections are asymptomatic, that means that testing does not depend on people going voluntarily because they feel unwell to get tested for the virus with an RTPCR test. Instead, it means that you are doing intensive testing in communities. To the point that the Chinese authorities have now adopted a shutdown of half of Shanghai, the new area, the airport and the financial district have been closed down for a few days. And intensive testing is going to be done, followed by the other half of the city being closed down and intensive testing being done there, so as to keep case numbers extremely low. We should keep in mind that when we say Chinese COVID case numbers are going up, that doesn't mean that those case numbers are matching as infections per million population. Anything like what even India has seen, leave alone what the global North, Europe and North Canada and the US have seen. These are still very small numbers and that's why it needs to be kept in mind that this is on the background of a zero COVID policy. So it's worthwhile asking, why are Shanghai numbers going up? And there are three factors at play here. One, even though China's vaccination numbers are significantly higher, not just significantly higher than Indian numbers, but significantly higher than European numbers. 85 plus percent of the population that has been vaccinated. Despite that, there are always going to be dropouts and therefore there are always going to be a few scattered vulnerable people. That's one. A second is, as we keep noting in many of these conversations, the current strains of the COVID virus that are circulating, strains that belong to the Omicron family, are strains that can infect vaccinated people. And that's the key difference why these new strains of the virus have essentially overcome the Chinese zero COVID policy barrier and have begun to infect people. So it's not simply the non-vaccinated people that are getting infected. Vaccinated people are also getting infected. But in Shanghai, in these numbers, a very large proportion of the people who are getting infected are asymptomatic, meaning that they're being detected only because of intensive testing is being done and very few people are lining up in hospitals. Even though these infected numbers are in the thousands, the numbers of people in hospital are a few score are in 40, 50, 80, 100 kind of numbers. And this is because the vaccines are providing protection against severe illness, hospitalization, leave alone death. But transmission is not stopping. Add to this the last factor, which is that the Omicron strain of the virus, particularly the current strain of the Omicron family, which is called the BA2 strain, is extremely infectious. It's very easily transmissible. In fact, it's very efficiently transmitted. It's the most efficiently transmissible strain that we've seen over the past two and a half years. And all of these factors put together, even China's zero COVID policy is being repeatedly put under strain. And it remains to be seen how China responds, whether this response that they adopted is going to be successful or not. We can, in another episode, debate whether the zero COVID policy, what it costs, what it takes as a public health infrastructure, has a precondition and just how much it saves in terms of lives and how much it saves in terms of lives saved from COVID, as well as lives saved from non-COVID illnesses, treatment of which is also put under stress in the COVID pandemic. And finally, of course, the economic costs of these intensive non-COVID policies. The European situation is a little bit different. Keep in mind that Europe first saw the Omicron family BA1 strain of the virus spreading. And that spread is, again, a consequence of significant non-vaccinated clusters in the community. So this is not statistically random individuals who forgot or who dropped out of vaccination. This is people who have cultural connections to each other, who meet each other and so on and so forth, and who've chosen not to be vaccinated across the global north. There are communities like that. And the virus will spread extremely rapidly in these communities and will cause severe illness hospitalization requirements. So if you look at the numbers in European communities, these are quite rapidly going up in hospitalizations as well, but nowhere near the same rates of increase as infection numbers. Because intensive testing is not being done as a public health policy measure in Europe, the case numbers themselves are not as deeply meaningful as the Chinese numbers are. It does show up clearly, and they are going up and they are going up because now it's the BA2 strain of the virus that's much more easily transmissible, coupled to the fact that physical distancing measures have now been largely withdrawn. People are coming out, people are sitting together to the point that good efficient masking is also less and less in evidence and therefore transmission is happening. Hospitalization is going up, but hospitalization has not exceeded so far the ability of the critical healthcare systems to respond to the needs of COVID related severe illnesses. Again and again, this comes down to how much strength and resilience the critical healthcare system has, how much has been invested, how much has been provided, how much is available, both in terms of personnel and in terms of hospital beds and related instrumentation resources. Clearly the BA2 strain is likely to spread elsewhere, but equally clearly these are all local outbreaks that are going up, coming down then moving somewhere else and they will go up and come down somewhere. So again and again we are seeing the local outbreak nature more and more in evidence of this virus, where it will go next, in all likelihood it will go to North America from Europe, if previous experience is any guide, whether we will see these numbers and India remains to be seen. What's even more concerning is the fact that we don't have any information on this large scale because of a lack of that level of testing in Africa and in Latin America and those numbers are important. It remains to be seen whether those numbers will incorporate, increases in hospitalization numbers and in critical healthcare systems being put under strain and that's going to be the next step this much for this week.